Breastfeeding Practices in Patients with Heart Disease Stratified by Area Deprivation Index

Objective: We sought to evaluate breastfeeding (BF) practices in patients with maternal cardiac disease (MCD) stratified by area deprivation index (ADI) to identity communities at risk. Study Design: Retrospective cohort of patients managed by the University of Alabama at Birmingham (UAB) Cardio-Obstetrics Program. Patients were included if they had ≥1 prenatal visit with the Cardio-Obstetrics team, delivered at UAB, and had a street address on file. The primary outcome was BF rate at hospital discharge. Secondary outcomes included BF intent on admission and BF at the postpartum (PP) visit. ADI reports socioeconomic disadvantage at the census tract level; 1 = least deprived and 100 = most deprived. Baseline characteristics and BF rates were compared by ADI categories: Low (ADI 1-33), medium (ADI 34-66), and high (ADI 67-100). Results: One hundred and forty-eight patients were included: 14 (10%) low, 42 (28%) medium, and 92 (62%) high ADI. Patients in the high ADI category were younger relative to those in the medium or low ADI (26 versus 28 versus 32 years; p < 0.01) and less likely to be married or living with a partner (30.4% versus 58.5% versus 71.4%; p < 0.01), There was no difference in BF intent between the lowest, medium, and highest ADI categories (85.7% versus 85.4% versus 81.6%; p = 0.38) or BF rates at hospital discharge (100% versus 92.7% versus 85.6%, p = 0.23). However, there was a significant difference in BF rates at the PP visit (90% versus 63.0% versus 38.6%; p < 0.01) even after controlling for differences in baseline characteristics (odds ratio = 0.11 (95% confidence interval [0.01-0.93]), p = 0.043). Conclusions: There was an association between living in a resource-poor community and early cessation of BF in our population of patients with MCD. Community-based interventions targeting mothers with heart disease living in high ADI communities may help these individuals achieve higher BF rates.

New Paradigms in the Treatment of Cervical Cancer

Despite effective screening strategies and the development and implementation of prophylactic high-risk human papillomavirus vaccination, cervical cancer remains a significant public health burden. This burden is most pronounced in under-resourced countries without fully developed screening and vaccination programs, although the disease remains present worldwide, including in industrialized countries. To that end, the World Health Organization (WHO) has an active focus on the elimination of cervical cancer, with objective metrics to be achieved by countries by the year 2030. Although increased vaccination and screening will be needed to approach potential eradication of cervical cancer, as recognized by the WHO initiative, treatment will need to continue to not only be effective in the near term, but to improve outcomes as well. Accordingly, assessments to improve primary treatment options, including surgery for women with early-stage disease, modification of chemoradiation for those with locally advanced cervical cancer, and systemic therapy for those with recurrent or metastatic presentations, are ongoing. Accordingly, we highlight important areas of both recent and ongoing focus as they relate to improving cervical cancer outcomes.

Breastfeeding practices among patients managed by a comprehensive cardio-obstetrics program

Objective: To evaluate breastfeeding intent, rates at discharge, and continued breastfeeding at follow-up in patients managed in a comprehensive cardio-obstetrics program stratified by severity of maternal cardiac disease.Study Design: Retrospective cohort of patients managed by a comprehensive cardio-obstetrics program at the University of Alabama at Birmingham (UAB). Patients were included if they had ≥1 prenatal visit with the Cardio-Obstetrics team and delivered at UAB. The primary outcome was the breastfeeding rate on discharge from the delivery-associated hospitalization. Secondary outcomes included intent to breastfeed on admission and breastfeeding at the postpartum visit. Baseline characteristics and rates were compared between patients with less severe (mWHO I - II/III) vs. more severe (mWHO III - IV) maternal cardiac disease.Results: 147 patients were included: 85 (57.8%) mWHO class I - II and 62 (42.2%) mWHO class III-IV. Patients with more severe maternal cardiac disease had higher rates of chronic hypertension (22.6% vs. 9.4%; p = 0.027), lower gestational age at delivery (36.4 vs 37.7 weeks; p = 0.008), and higher rates of NICU admission (31.2% vs. 14.1%; p = 0.013). There were no significant differences between mWHO class I-II vs. mWHO class III-IV in intent to breastfeed upon admission to the delivery-associated hospitalization (84.7% vs. 82.3%; p = 0.67), breastfeeding rates upon discharge from the delivery-associated hospitalization (90.6% vs. 87.1%; p = 0.50), or breastfeeding rates at the postpartum visit (54.1% vs. 48.5%; p = 0.60).Conclusions: Despite potential barriers in this high-risk population, over 85% of patients breastfed upon discharge from the delivery-associated hospitalization. However, breastfeeding rates dropped by 40% at the postpartum visit. Strategies to support breastfeeding in the post-partum period in patients with maternal cardiac disease are imperative.

Sustaining peer support groups: Insights from women living with HIV in rural Kenya

OBJECTIVE

As HIV transitions to a chronic disease, measures that foster continued health are critical. Peer support groups can help in reducing stigma and ensuring wellbeing for those living with HIV. The purpose of our study was to gain an understanding of the ways in which women living with HIV in rural areas sustain peer support groups.

DESIGN AND SAMPLE

For this descriptive qualitative study, 20 women living with HIV participated in the study. Women were randomly divided into two peer support groups of ten women each; the groups met over a 12-month period. monthly for the first two months and then every three months for the remainder of the year.

RESULTS

Discussion themes indicated women found ways to sustain the groups by using them as a platform for engaging in income generation; starting and participating in table banking; addressing food security; and finding financial and moral support. Problem-solving challenges of sustaining peer support groups was also a major theme.

CONCLUSION

As people live longer with HIV, long-term peer support will be needed to maintain wellbeing. Community-based peer support groups can be sustained by engaging women in common income-generation activities.

[Pulmonary surgery for pulmonary lesion with pulmonary tuberculosis or of tuberculosis]

Nine patients with pulmonary tuberculosis underwent open chest surgery for pulmonary lesions of tuberculosis or other than tubercolosis. They were 1 case of lung cancer, 4 cases of pneumothorax, 1 case of multi drug resistant pulmonary tuberculosis and 3 cases of tuberculoma. Postoperative complications developed in 3 cases including 2 of pneumothorax and 1 of lung collapse.

[A case of panpleuropneumonectomy for diffuse pleural mesothelioma]

A 73-year-old male was admitted with dyspnea and cough. The chest X-ray showed left massive pleural effusion and diffuse pleural tumor in the left thorax. It was diagnosed as epithelial-cell type mesothelioma by pleural needle biopsy. After conforming the regression of the tumor from conducting two courses of combined treatment with cisplatin and doxorubicin, panpleuropneumonectomy was performed. He died from sepsis on the thirty second day after operation due to complication of postoperative diaphragmatic hernia and gastric perforation. When conducting a panpleuropneumonectomy to diffuse pleural mesothelioma, the most appropriate approach must be taken to the combined with resection and reconstruction of the diaphragma.

[A case report of pulmonary actinomycosis presenting as a mass shadow on chest X-ray]

A 58-year-old man admitted to hospital because of hemoptysis. Chest X-ray showed a large mass in the right middle lobe. A tumor marker CYFRA was slightly elevated. Despite a detailed examination after admission, no definite diagnosis was made. Lung cancer was suspected and a middle lobectomy was performed. Histopathological specimen of resected lung showed typical "sulfur granule" of actinomycosis. Pulmonary actinomycosis should be included in the differential diagnosis of a pulmonary mass lesion.

Single administration of captopril and combined use with beta-blocker and/or thiazide diuretic in the treatment of essential hypertension

Thirty-four patients with essential hypertension at WHO stage I or II were divided into three groups. Group I consisted of 22 cases who displayed normal renin activity (NR) or low renin activity (LR) and who received a single administration of captopril. Group II consisted of 6 cases given beta-blockers after administration of captopril. Group III consisted of 6 cases in whom beta-blocker was replaced with thiazide diuretics after administration of captopril alone. Blood pressure decreased significantly by captopril treatment alone in group I of the NR and LR subgroups (except for the diastolic blood pressure [DBP] of the NR subgroup) and fell below the target blood pressure (SBP of 165 mmHg and DBP of 95 mmHg) in 86% of the NR subgroup and 73% of the LR subgroup. Combined treatment with captopril and beta-blocker in Group II did not decrease blood pressure any lower than with captopril alone treatment and achieved the target blood pressure in only 50% of the patients. In group III, combined treatment with captopril and thiazide achieved the target blood pressure in 100% of the patients. Plasma renin activity (PRA) was increased by captopril but reduced by captopril in combination with beta-blocker. However, when beta-blocker was replaced with thiazide, PRA increased. The serum sodium concentration was significantly reduced in the LR subgroup after a single administration of captopril, but there was no other variation.

Effect of nifedipine on oxygen delivery in patients with angina pectoris: relation between blood viscosity and hematocrit

The effect of nifedipine on blood viscosity and hematocrit was investigated. Blood was sampled from eight patients with angina pectoris (mean age: 59 +/- 8 yr) treated with nifedipine (20-30 mg/day) for 5 months. Using a cone-plate type viscometer, blood viscosity was determined at the shear rates of 37.5 and 375 sec-1 at 37 degrees C. Hematocrit was also measured at the same time. Since the ratio of hematocrit to blood viscosity at a shear rate of 375 sec-1 can be considered to reflect oxygen delivery, this ratio (oxygen delivery index) was also calculated. Blood viscosity at a shear rate of 37.5 sec-1 was significantly (P less than .05) decreased by nifedipine treatment, but hematocrit and the blood viscosity at a shear rate of 375 sec-1 were not changed. The oxygen delivery index, however, was significantly (P less than .01) increased after the administration of nifedipine. These results suggest that oxygen delivery increased by the treatment with nifedipine and inhibited erythrocyte aggregation by decreasing blood viscosity at low shear rate.

Reduction in blood viscosity by treatment with coenzyme Q10 in patients with ischemic heart disease

The effects of coenzyme Q10 (CoQ10) on blood viscosity were studied in twelve patients (mean age 49 +/- 16 years) with ischemic heart disease. Twenty mg of CoQ10 was orally administered three times daily for two months (total dose 60 mg per day). Blood viscosity was measured with a cone-plate type viscometer at the shear rates of 37.5, 75, 150, and 375 s-1. Yield shear stress was calculated from Casson's plot. Blood viscosity decreased at each shear rate after the administration of CoQ10. Yield shear stress decreased significantly by the treatment with CoQ10. Hematocrit and fibrinogen were also measured, but showed no significant change. These results suggest that CoQ10 decreases the blood viscosity, i.e., improves the rheological properties of blood in ischemic heart disease.

[The effect of prostaglandins on steroidogenesis in isolated human and bovine adrenal cells: a study of the effect of the ACTH action mechanism (author's transl)]

It has been reported that prostaglandins (PGs) stimulate steroidogenesis in the adrenal glands of various mammarian species. However, the exact role of PGs in steroidogenesis remains unclear. Therefore, attempts were made to clarify the action mechanism of PGs on steroidogenesis. The production of 11-OHCS in adrenal cells was stimulated by ACTH, PGE2 and PGF2 alpha. PGE2 increased the c-AMP level, but PGF2 alpha had no effect on it. No effect was observed by indomethacin or theophylline on the production of 11-OHCS by ACTH. Cycloheximide inhibited the elevation in 11-OHCS by PGE2 and PGF2 alpha. Different results were observed: PGs-combined effects of varying concentrations of ACTH were additive, PGs-combine effects of varying concentrations of dbc-AMP were synergic, and simultaneous incubation of maximal concentrations of ACTH and PGs failed to elicit a supramaximal response. These results suggest that PGs act like ACTH on steroidogenesis in human and bovine adrenals and are in keeping with the hypothesis that the action of ACTH and PGs in steroidogenesis is Ca++ influx in the adrenal cells.

[Adrenal venography; improvement of the shape of catheter and its clinical application (author's transl)]

The preoperative identification of adrenal tumor is essential to correct diagnosis and appropriate treatment. Adrenal venography is one of the most useful adjuncts for this purpose, but catheters of various types introduced in the past are not necessarily well configured to catheterize adrenal veins. The catheter newly designed by us made catheterization of the left adrenal vein much easier even for unskilled hands. Our new catheter has been used in 20 of 55 venographical studies which have been carried out in our service. Determination of cortisol concentrations in adrenal venous blood which was performed in 6 cases failed to give any clue to determine the laterality of the existing adrenal tumor.

[Effect of calcium on steroidogenesis in isolated human adrenal cells (author's transl)]

Isolated adrenal cells were obtained surgically from patients with primary aldosteronism, breast cancer, or Cushing's syndrome. They were prepared by the modification of Sayers method, and incubated at 37 degrees C for 2 hours under 95% O-2-5% CO-2, in the medium of calcium-free Krebs-Ringer bicarbonate buffer containing 0.2% glucose and 0.5% bovine serum albumin, to which various doses of calcium, ACTH, dibutyryl cyclic AMP or cycloheximide were added. Steroid production was measured by the method of Silber et al. In isolated normal adrenocortical cells, 11-OHCS was produced by calcium alone in the absence of ACTH or dibutyryl cyclic AMP, while it was not produced by ACTH alone without calcium. 11-OHCS production by ACTH was decreased in the high concentration of calcium (10.16 mM, 12.70 mM). Cycloheximide partially blocked an increase in 11-OHCS synthesis induced by calcium. These data suggest that adenyl cyclase of human adrenocortical cells may be stimulated by calcium alone, supporting the notion that calcium is a second messenger. The ratio of 11-OHCS production by calcium alone to that by dibutyryl cyclic AMP was higher in adenoma cells than in normal cells. This may account for the character of autonomic steroid production in adrenocortical adenoma cells.