BACKGROUND

Granulomatous mastitis (GM) of the breast has long posed a clinical dilemma in terms of diagnosis and management. GM can range from acute to chronic inflammations, which will have treatment implications. Inflammation of the breast may clinically mimic breast carcinomas and pyogenic abscesses. Thus, in the absence of known etiology, such as trauma or breastfeeding, GM may be difficult to diagnose. Currently, the incidence of GM is 2.4 per 100,000 women and 0.37% of the total population in the US. The rarity of GM contributes to it being a poorly understood disease. It has no definite clinical features and is often confused with a neoplasm or infection clinically and radiologically.

The study aimed to describe the clinical characteristics of GM seen in the Breast Care Clinic in the Philippine General Hospital (PGH) from January 2015 to June 2019. This study would initially provide institutional data on GM that is relevant in the Philippines.

This is a retrospective observational study of patients with GM seen in the Philippine General Hospital, a national tertiary referral hospital, from January 2015 to June 2019.

A total of 43 patients with pathological findings of GM from January 1, 2015 to June 15, 2019 were recorded. Among these 43 patients, 98% were female. The median age was 38.9 ± 11.3 years old. In 60.5% (26 out of 43) of patients, the initial impression was breast malignancy. The most common clinical presentation in 69.8% (30 out of 43) of the subjects was a breast mass. In more than 50% of the patients, breast ultrasonography was the initial imaging performed. The histopathologic profile of the patients showed inflammation, of which, the greatest were that of chronic granulomatous inflammation (46.5%, n-20). Treatment options performed were tended more medical (53.5%, n-23) than surgical (16.3%, n-7).Among those who received medical treatment, the therapeutics given were antitubercular medications (34.9%, n-15) and antibiotics (16.3%, n-7), while the others had a combination of antitubercular and antibiotic regimen medications (2.3%, n-1); unknown treatment (25.6%, n-11) and none (11.6%, n-5). For patient outcomes, no mortalities were recorded during the study period. However, most patients had inconsistent followups. Approximately 7%-23% of the patients who had followed up within the six months showed improvement or resolution of symptoms.

This study assessed the clinical profiles of patients with GM in a national tertiary referral hospital. Internationally, there is still no consensus on the algorithm and management of GM patients. However, the authors recommend a close follow-up every two weeks to re-evaluate patient response to the medical regimen being administered. The authors recommend a prospective study with a longer follow-up period to gain a deeper understanding of GM in Filipinos.

OBJECTIVES: To explore the role of C1q, the promoter of the classical pathway of the complement system, in regulating postpartum depressive-like behaviors in mice and the therapeutic mechanism of C1q-neutralizing antibodies. METHODS: Female C57BL/6 mouse models of postpartum depression established by hormone-simulated pregnancy (HSP) were evaluated for depression-like behaviors, and peripheral blood levels and hippocampal expressions of C1q were detected using ELISA and Western blotting. Immunofluorescence staining was used for detecting co-labeling of C1q and microglia, and the differentially expressed mRNAs in the hippocampus of HSP mice were analyzed using RNA sequencing. The Edinburgh Postnatal Depression Scale was used to screen patients with postpartum depression, from whom peripheral blood mononuclear cells were extracted for detecting C1q expression levels with Western blotting. The HSP mice were subjected to stereotactic injection of C1q-neutralizing antibody or a control IgG in the hippocampus, and the changes in depressive-like behaviors and hippocampal expression of C3 were examined. RESULTS: The HSP mice exhibited obvious depressive behaviors, demonstrated by significantly decreased preference for sugar water and increased forced swimming and tail suspension time. The mouse models showed significantly increased peripheral blood C1q level and hippocampal expression level of C1q, accompanied by an increase in Iba1 and C1q co-labeling in the hippocampus. The expression level of C1q in peripheral monocytes was also significantly increased in patients with postpartum depression. In HSP mice, stereotactic injection of C1q-neutralizing antibody, but not the control IgG, obviously alleviated depressive-like behaviors, shown by significantly increased preference for sugar water and decreased forced swimming and tail suspension time, resulting also in decreased expression of C3 in the hippocampus and lowered serum levels of IL-6 and TNF-α. CONCLUSIONS C1q-neutralizing antibodies improve postpartum depressive-like behaviors in mice possibly by regulating the C1q/C3 signaling pathway.
Animals ; Female ; Depression, Postpartum ; Complement C1q/metabolism* ; Antibodies, Neutralizing/pharmacology* ; Mice, Inbred C57BL ; Mice ; Hippocampus/metabolism* ; Pregnancy ; Disease Models, Animal

Non-lactational mastitis is a group of benign, non-specific inflammatory diseases with unknown causes that occur in non-lactating women. The main treatment methods are medication and surgery, but both of these methods have certain limitations and cannot meet the individualized needs of patients. In recent years, thermal ablation technology has been widely used in clinical practice, with significant progress in the treatment and research of breast diseases, especially in the exploratory treatment of non-lactating mastitis, where it has achieved certain therapeutic effects. However, the use of thermal ablation technology in the treatment of non-lactational mastitis is still in its infancy and development stage. In order to standardize development and clinical practice protocols, Interventional Ultrasound Committee of Chinese College of Interventionalists,Tumor Ablation Committee of Chinese College of Interventionalists,The Society of Tumor Ablation Therapy of the Chinese Anti-Cancer Association,and The Ablation Expert Committee of the Chinese Society of Clinical Oncology(CSCO) organized a group of some domestic experts in the field of breast disease ablation treatment. Subsequently, based on the latest research progress and considering the actual clinical situation in China, these experts formulated the "Multidisciplinary expert consensus on ultrasound-guided thermal ablation for non-lactating mastitis (2025 edition)" which primarily covers (1) epidemiological and clinical characteristics; (2) diagnosis and staging; (3) operating procedures, indications, contraindications, and related complications of thermal ablation technology; and (4) efficacy evaluation and postoperative follow-up.
Humans ; Mastitis/therapy* ; Female ; Consensus ; Ultrasonography, Interventional ; Lactation

Chronic Myeloid Leukemia, a chronic hematopoietic stem cell disorder, is uncommon among younger age group such as pregnant patients. Due to the rarity of this condition in pregnancy, there are no randomized controlled trials to address the optimal management of this condition. We are presented with a 26 year old patient, who had an unplanned pregnancy in the advanced phase of the disease. Due to the risk to the mother in delaying treatment, she was continued on Imatinib, a tyrosine kinase inhibitor, which is a known fetal teratogen. Her pregnancy was carried to term. The patient delivered via spontaneous vaginal delivery to a live, neonate, with findings of hydrocele and syndactyly on the 4" and 5™ digit of the right foot. Due to the maternal disease progression, she presented with postpartum hemorrhage, in contrast to an augmented procoagulant state among normal pregnancies. Obstetric adjunctive measures, such as intrauterine balloon tamponade and uterine artery ligation, were done. The patient was discharged stable.
Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; Imatinib Mesylate ; Postpartum Hemorrhage ; Pregnancy

Introduction: Obstetrical hemorrhage remains to be one of the most common causes of maternal morbidity and mortality. Postpartum hemorrhage occurs after delivery and is usually secondary to uterine atony, genital tract lacerations, and retained placental fragments. Case: A case of a 21-year old, primipara, presented with profuse vaginal bleeding and hemoptysis at 3 weeks' postpartum. A clinical diagnosis of gestational trophoblastic neoplasia was established after an elevated serum beta human chorionic gonadotropin was obtained and an intrauterine mass was seen on ultrasonography, including metastasis to the lungs and liver seen through imaging studies. Discussion Chemotherapy with etoposide, methotrexate, actinomycin D, cyclophosphamide and oncovin (EMACO) is the mainstay treatment for Stage IV disease. However, complications such as hemorrhage and tumor rupture are best managed surgically. Although rare, a diagnosis of choriocarcinoma should be considered in patients with persistent bleeding after a normal pregnancy to institute proper management and avoid associated complications of tumor progression.
Choriocarcinoma ; Gestational Trophoblastic Disease ; Postpartum Hemorrhage

Objective: To investigate the clinical characteristics of induced labor in twin pregnancy and the related factors of induced labor failure. Methods: The clinical data of twin pregnant women who underwent induced labor in Peking University Third Hospital from January 2016 to December 2022 were retrospectively analyzed. According to whether they had labor or not after induction, pregnant women were divided into the success group (pregnant women who had labor after induction, 72 cases) and the failure group (pregnant women who did not have labor after induction, 30 cases). Logistic regression was used to analyze the related factors of induction failure in twin pregnant women. Results: The parity and cervical Bishop score in the failure group were significantly lower than those in the success group, while the proportion of dichorionic diamniotic twins, assisted reproductive technology pregnancy and cervical Bishop score <6, postpartum hospital stay and total hospital stay in the failure group were significantly higher than those in the success group (all P<0.05). The proportion of induced labor by artificial rupture of membranes ± oxytocin intravenous infusion in the success group was 72.2% (52/72), which was significantly higher than that in the failure group (46.7%, 14/30; P=0.030). There were no significant differences between the two groups in the gestational age at delivery, the incidence of severe postpartum hemorrhage and blood transfusion, the amount of postpartum hemorrhage, the neonatal weight of two fetuses, the incidence of neonatal asphyxia, and the proportion of neonates admitted to the neonatal intensive care unit (all P>0.05). There were no severe perineal laceration and hysterectomy in all pregnant women. Multivariate logistic regression analysis showed that primipara (OR=3.064, 95%CI: 1.112-8.443; P=0.030) and cervical Bishop score <6 (OR=5.208, 95%CI: 2.008-13.508; P=0.001) were the independent risk factors for induction failure in twin pregnancy. Conclusions: Elective induction of labor in twin pregnancy is safe and feasible. It is helpful to improve the success rate of induction of labor by strictly grasping the timing and indications of termination of pregnancy, choosing the appropriate method of induction according to the condition of the cervix, and actively promoting cervical ripening .
Infant, Newborn ; Pregnancy ; Female ; Humans ; Pregnancy Trimester, Third ; Pregnancy, Twin ; Postpartum Hemorrhage/etiology* ; Retrospective Studies ; Labor, Induced/methods* ; Cervical Ripening

BACKGROUND

Postpartum depression (PPD) is the most common perinatal psychiatric disorder and women are at greatest risk of developing this during their first postpartum year. Extraneous factors and events indirectly related to maternity like the quarantine measures imposed during the COVID-19 pandemic can add to the already burdensome mental effects of pregnancy.

The aim of the study is to determine the prevalence of and possible risk factors for PPD during the COVID-19 pandemic using the Edinburgh Postnatal Depression Scale in Filipino (EPDS-F) in a tertiary government hospital.

This is a cross-sectional study involving patients 18 years of age and above who delivered vaginally or through cesarean section to a live or dead fetus more than 20 weeks age of gestation and more than 500 g, preterm or term during the pandemic. Patients included were those who tested positive for COVID 19 infection who delivered 48 h up to 8 week postpartum. All the patients who consented and fulfilled the inclusion criteria answered the EPDS-F questionnaire to determine the prevalence rate of PPD. A score of 13 or greater suggests the presence of major depressive symptoms.

There was a total of 61 postpartum patients who were delivered in a tertiary hospital from September 2022 to October 2022. Out of 61 patients, 20 scored 13 points and above in the EPDS-F questionnaire showing a PPD prevalence of 32.8%. Patient’s age showed a statistically significant association with the likelihood of having PPD (P = 0.0148), the highest prevalence observed at an average age of 25 and a lower prevalence at 29 years old.

Although age seems to have a significant association with PPD, direct causality is difficult to establish as the likelihood of having PPD depends on the mother’s personal qualities and traits, the societal background, and her coping mechanisms during an extraordinary circumstance such as this global COVID-19 pandemic.

Postpartum depression is a condition that is commonly experienced by postpartum women after childbirth. Determination and detection of factors influencing postpartum depression will help mothers explore evidence-based strategies for early prevention and treatment. A quantitative descriptive survey design was utilized in the study. Data was collected through stratified random sampling. The childbearing mothers in four selected communities of Bontoc, Mountain Province: upland, riverside, AlBaGo, and central Bontoc were the respondents of the study. Data gathered utilized a self-made questionnaire based on journals and research studies about postpartum depression. Results of the study showed that the respondents considered the impact on the extent of factors causing postpartum depression among child bearing mothers. There is a significant difference on the extent of factors influencing postpartum depression among child bearing mothers when grouped according to civil status but no significant difference when grouped according to age, educational attainment and employment status. The respondents ranked the suggested measures to prevent postpartum depression as: 1) psychological, 2) physical and;3) social. Promoting the mental health and well-being of mothers and families through implementation of an evidence-based strategy in the Municipal and Provincial health units can prevent or reduced Postpartum depression. Early interventions on postpartum depression promoted maternal recovery and strong foundations for postpartum mothers. This includes educating mothers, planning health education programs, focusing on early detection, and distributing behavioral change communications through flyers, brochures, and training materials.

Based on the theory of "milk-blood homology", the evidence of Shaoze (SI 1) in treatment of postpartum hypogalactia was explored and the clinical application introduced. In traditional Chinese medicine, small intestine meridian and the functions of small intestine are extensively involved in the procedure of milk formation, i.e. transformation, transportation and connection. Shaoze (SI 1) communicates the meridians of hand-taiyang and hand-shaoyin. It enhances the connection of the small intestine with the heart, spleen and stomach. It is the jing-well point for unblocking and moistening to promote the transformation and transportation of qi and blood and improve lactation. This acupoint is specifically characterized as promoting lactation in the small intestine meridian and is valuable considerably in clinical practice of hypogalactia of deficiency pattern/syndrome.
Female ; Humans ; Pregnancy ; Acupuncture Points ; Acupuncture Therapy ; Lactation ; Lactation Disorders/therapy* ; Meridians ; Postpartum Period

Postpartum hemorrhage (PPH) remains to be the leading cause of maternal deaths worldwide. The first-line treatment in its prevention is the administration of uterotonics before the delivery of the placenta. Recently, a newer synthetic analog has been developed – carbetocin. With its introduction, new questions arise as to which is more effective in preventing PPH. Four major electronic databases were searched for randomized controlled trials comparing carbetocin and oxytocin in terms of additional uterotonic use, incidence of PPH, and need for blood transfusion. Only randomized controlled studies involving pregnant women undergoing cesarean section under regional anesthesia were included. Outcomes included are the need for additional uterotonic use, the incidence of PPH, and the need for blood transfusion. Of the three outcomes, carbetocin was found to show statistically significant protection against the need for additional uterotonic administration and the need for blood transfusion. Results showed that carbetocin provided a statistically significant risk reduction for the need for additional uterotonics (risk ratio [RR] = 0.53, 95% confidence interval [CI] 0.46–0.81,P< 0.00001) and need for blood transfusion (RR = 0.34, 95% CI 0.19–0.62,P= 0.0004). Need for additional uterotonics and for blood transfusion was found to be almost twice (1/0.53 = 1.88) and almost thrice (1/0.34 = 2.94) as likely, respectively, to occur in the oxytocin group versus the carbetocin group. Reduction of PPH pointed toward carbetocin providing greater protection against it, but it was found not to be statistically significant (RR = 0.85, 95% CI 0.56–1.28,P= 0.43).