Healthy Woman Research Articles

Amine variations in faecal content in the first weeks of life of newborns in relation to breast-feeding or infant formulas.

Breast-feeding is the ideal nutrition for a newborn's integral necessities. It seems crucial therefore to know its composition in order to provide suitable infant formula when required. Of these, polyamines (with lactation and the microbiota being its intestinal source) are involved in the development of gut epithelium and immunity. Safety concerns limit human intervention studies. Therefore, we studied the amounts of polyamines supplied by breast milk (varying among mothers) or infant formula feeding, up to day 30 postpartum, in the faeces of newborns. Independent samples (68) of breast milk from fifty-nine healthy Caucasian woman (day 0, 1, 3, 5, 7, 15 and 30 postpartum) who had natural deliveries after week 38, same-day faeces of newborns when available (eighty-one from breast milk and fifty-five from infant formula fed) and six infant formulas were collected and the polyamine content was determined by HPLC. In breast milk, polyamines and isoamylamine (a primary amine), with inter-individual variations, increased over time (with a higher content of spermidine; no other amines were present). Overall, they were much higher than in infant formula. By the 2nd week after birth, polyamines, cadaverine and tyramine, but not isoamylamine, were higher in the faeces of those fed infant formula compared with those fed breast milk. Cadaverine and tyramine could be used to predict the feeding type used for newborns. The differences in the content may be related to distinct colonisation of amine-producing bacteria, which can be established by polyamines. Further studies are required to determine the clinical utility of these findings.

Pain Lower Abdomen due to Spontaneous Hematometra: A Case Report

Hematometra is a rare condition that is most commonly associated with congenital anomalies and prior surgical procedures. This is an unusual case of spontaneous hematometra occuring in 32 years old healthy woman with no prior medical or surgical history. Only five cases of spontaneous hematometra without any risk factors have been reported.
 Keywords: abdominal pain; Depot medroxyprogesterone acetate; hematometra.

Importance of early elevated maternal HbA1c levels in identifying adverse fetal and neonatal events

AimsThe aims of this study were to explore factors that associated with gestational diabetes mellitus (GDM), and to determine the relationship between early maternal HbA1c levels and adverse fetal or neonatal events, and to determine an optimal maternal glucose testing method in order to decrease the potential health risk for their offspring. MethodsFrom December 2015 to May 2016, a total of 6744 pregnant women were enrolled from Shanghai First Maternal and Infant Hospital affiliated to Tongji University prospectively in the nested case-control study. Each GDM case was matched with a healthy pregnant woman and followed up. Outcome analyses were conducted between GDM case and control groups, as well as elevated and normal maternal HbA1c levels, respectively. ResultsA total of 1836 women were included in the adverse fetal and neonatal events examination. For pregnant women with early HbA1c ≥ 5.2%, the adjusted risk ratios (RR) of respiratory distress syndrome (RDS), pneumonia and jaundice were 4.37 (95%CI 1.54–12.35), 2.03 (95%CI 1.24–3.33) and 1.49 (95%CI 1.01–2.20), respectively. After treatments, the frequency for the majority of events in GDM group was similar to that of healthy pregnant women. Moreover, the area under the curve (AUC) of early maternal HbA1c in predicting potential RDS is 0.734. HbA1c ≤ 4.9% excluded for RDS. ConclusionsCompared with women with normal HbA1c, those with an early elevated HbA1c level were more likely to develop adverse events, including RDS, pneumonia and jaundice. Early HbA1c testing can be used as an auxiliary method identifying potential RDS.

Elevated plasma RANTES in fibrodysplasia ossificans progressiva – A novel therapeutic target?

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary disease caused by a mutation in the intracellular domain of the activin A receptor type I and is characterized by episodes (flare-ups) of progressive heterotopic endochondral ossification (HO) in the soft tissues. The mutation alone is not sufficient for the occurrence of HO since flare-ups are triggered by inflammation and activation of the innate immune system. A number of cellular and humoral mediators have been implicated in animal and in vitro models. Observations in humans support the inflammatory nature of the condition, but data on the involved mediators are variable. We hypothesize that for induction of flare-ups in patients with FOP increase in at least one of the pro-inflammatory cytokines is both essential and sufficient to trigger the entire process of the inflammatory cells influx resulting in the novel ectopic bone formation and we suggest that C–C motif ligand 5 (CCL5), a pro-inflammatory chemokine also known as Regulated on activation, normal T-cell expressed and secreted (RANTES), might be the key candidate. CCL5 is a chemoattractant for all cellular types implicated in HO and is produced by the cells of the tissue microenvironment at the sites of HO as well as by the pro-inflammatory cellular mediators. CCL5 induces ossification in cultured human pluripotent mesenchymal cells (hMSCs) and in the primary culture of monocytes from FOP patients (but not from their healthy relatives), stimulation with lipopolysaccharide induces CCL5 expression. Finally, in a pilot study we used a panel of 23 cytokines and chemokines to screen the plasma samples of three subjects: a female patient with FOP during a flare-up; a female patient with hyperostosis corticalis generalisata (van Buchem disease), another rare disease characterized by excessive bone formation at the sites where it regularly occurs that does not include inflammatory events; and a healthy woman without bone disorders. There appeared a rather clear-cut signal of a 2-fold higher level of CCL5 in the FOP patient vs. the healthy subject and the van Buchem patient. Evaluation of the hypothesis would require an international prospective study, with main motivation being the lack of a conclusive treatment as the major unmet need in FOP. A treatment targeting CCL5 receptor already exists and is used in HIV-infected patients.

No. 385-Indications for Pelvic Examination.

No. 385-Indications for Pelvic Examination.

Euthanasia requests in a Canadian psychiatric outpatient clinic: A case series part 2 of the McGill University euthanasia in psychiatry case series

The Canadian province of Quebec enacted in 2014 a legislation that permitted medical assistance in dying (MAID) under specific conditions and the rest of Canada followed suit in June 2016. In this article, which is the second in a set of case series of requests for MAID in Canadian psychiatry, we present the cases of two patients who made a request for MAID to their treating psychiatrist in an outpatient clinic. While one is advanced in age and suffering from intense physical and psychic pain with little if any psychiatric comorbidity, the other is a young and medically healthy woman who nonetheless suffers from extensive psychiatric comorbidity. This article discusses both cases in light of recent scientific literature and case law that is slowly emerging in Canada, focusing on the concepts of the end of life and its legal definition as well as psychic suffering and its management in those wishing to receive physician-assisted dying. In our conclusion, we stress the need to clarify the definition of treatment resistance, the necessity to determine each physician's role when many are involved, as well as the importance of treating psychic pain holistically, which can sometimes require going beyond standard psychiatric care.

Varibaculum timonense sp. nov., a new bacterial species isolated from human stool sample.

Varibaculum timonense sp. nov. strain Marseille-P3369T (= CSURP3369) is a new species from the order Actinomycetales that has been isolated from a fresh stool sample of a healthy French woman.

DNA Methylation Status of SHOX-Flanking CpG Islands in Healthy Individuals and Short Stature Patients with Pseudoautosomal Copy Number Variations

SHOX resides in the short arm pseudoautosomal region (PAR1) of the sex chromosomes and escapes X inactivation. SHOX haploinsufficiency underlies idiopathic short stature (ISS) and Leri-Weill dyschondrosteosis (LWD). A substantial percentage of cases with SHOX haploinsufficiency arise from pseudoautosomal copy number variations (CNVs) involving putative enhancer regions of SHOX. Our previous study using peripheral blood samples showed that some CpG dinucleotides adjacent to SHOX exon 1 were hypomethylated in a healthy woman and methylated in a woman with gross X chromosomal rearrangements. However, it remains unknown whether submicroscopic pseudoautosomal CNVs cause aberrant DNA methylation of SHOX-flanking CpG islands. In this study, we examined the DNA methylation status of SHOX-flanking CpG islands in 50 healthy individuals and 10 ISS/LWD patients with pseudoautosomal CNVs. In silico analysis detected 3 CpG islands within the 20-kb region from the translation start site of SHOX. Pyrosequencing and bisulfite sequencing of genomic DNA samples revealed that these CpG islands were barely methylated in peripheral blood cells and cultured chondrocytes of healthy individuals, as well as in peripheral blood cells of ISS/LWD patients with pseudoautosomal CNVs. These results, in conjunction with our previous findings, indicate that the DNA methylation status of SHOX-flanking CpG islands can be affected by gross X-chromosomal abnormalities, but not by submicroscopic CNVs in PAR1. Such CNVs likely disturb SHOX expression through DNA methylation-independent mechanisms, which need to be determined in future studies.

Correlation Between V̇O2max and Anaerobic Power in Law Enforcement SWAT Team Members

PURPOSE: The purpose of this investigation was to examine the relationship between maximal oxygen uptake (V̇O2max) and anaerobic power in Special Weapons and Tactics (SWAT) team members of law enforcement. METHODS: Fourteen healthy men and one healthy woman (age: 33 ± 6 y, height: 179.6 ± 6.7 cm, body mass: 89.6 ± 10.4 kg) performed a graded exercise test to measure V̇O2max and a Wingate Anaerobic Test to measure anaerobic power on two separate occasions. V̇O2max was determined with a graded exercise test on a motorized treadmill using the Costill-Fox protocol. Anaerobic power was determined using the Wingate Anaerobic Test where participants cycled against a resistance of 9% of body mass (8 ± 1 kg) on a Wingate cycle ergometer. Pearson’s r correlations were conducted to analyze the relationship between absolute V̇O2max and absolute power as well as relative V̇O2max and relative power. RESULTS: Absolute V̇O2max was significantly positively correlated to absolute peak power (r = 0.60; p = 0.02) and absolute average power (r = 0.75; p < 0.01). Moreover, relative V̇O2max was significantly positively correlated to relative peak power (r = 0.56; p = 0.03) and relative average power (r = 0.64; p = 0.01). CONCLUSIONS: There are moderate-to-strong positive correlations between V̇O2max and anaerobic power. It is possible that adaptations that occur with high intensity anaerobic exertions might be related to changes in aerobic metabolism. Future research might consider examining the effectiveness of anaerobic power training on aerobic fitness among the tactical athlete populations.

Ketogenic Diet-induced Severe Ketoacidosis in a Lactating Woman: A Case Report and Review of the Literature (FS17-01-19)

ObjectivesKetogenic diet is a high-fat, adequate-protein, and low-carbohydrate diet that leads to nutritional ketosis and weight loss. Although ketogenic diet is safe in non-pregnant individuals, its safety in lactating mothers is unknown. Methods24-year-old 18 weeks’ post-partum healthy non-diabetic woman complained of severe nausea, vomiting and diarrhea with associated abdominal pain, low back cramps & malaise. She reported intentional 25-pound weight loss by adhering to strict ketogenic diet as a health-conscious life style modification since recent childbirth. She exclusively breastfed her son. She had unremarkable pre, natal and postnatal care. Typical diet consisted of egg, bacon, cheese, meat, peppers, spinach, broccoli, carrot soups, chicken, salmon, peanut butter. Daily caloric intake was approximately 2200 Kcals/day.She was hemodynamically stable. Physical examination revealed dry mucous membranes, comfortable resting tachypnea, mild epigastric/right upper quadrant tenderness.Laboratory studies demonstrated compensated anion gap metabolic acidosis acidaemia, elevated beta-hydroxybutyric acid level (Figure 1) and ketonuria. She was managed conservatively with intravenous fluids, electrolyte repletion, and restarting carbohydrate diet. ResultsLactation ketoacidosis is well described in post-partum lactating cattle. Few case reports in human exist. Most cases were precipitated by starvation, infection or nil per mouth status (table 1). It occurs by depletion of glycogen stores forcing the body into using gluconeogenesis as energy substrate for breast milk production. This is the first case report of life-threatening lactation ketoacidosis in setting of ketogenic diet with adequate number of calories, above 2000 kcal/day.Ketogenic diet is an alternative weight loss tool against obesity due to proven results of greater weight loss compared to other balanced diets. Studies that evaluated acid-base safety of patients on ketogenic diet demonstrated no significant metabolic derangement. Patients who ate plant-derived protein have lower mortality compared to those who ate animal-derived protein and fat. Postpartum mothers have increased pressure to lose weight gained during pregnancy and may easily resort to this method of rapid weight loss. ConclusionsThe index case may provide caution in lactating mothers on/or considering ketogenic diet. Healthcare professionals need to educate lactating mothers interested in weight loss. Funding SourcesThere are no funding sources. Supporting Tables, Images and/or Graphs▪▪

PB1774 ACUTE PROMYELOCYTIC LEUKEMIA PRESENTING AS VERTEBROBASILAR ISCHEMIC STROKE IN A YOUNG WOMAN

Background:Acute Promyelocytic Leukemia (APL) carries a high risk of early death due to coagulopathy triggered by the leukemic cells, which initiate a cascade of disseminated intravascular coagulation and hyperfibrinolysis. Patients are at risk for hemorrhagic and thrombotic events, but bleeding dominates the clinical picture and is responsible for most of the early deaths.Arterial thrombosis is rare in APL, and its mortality is extremely high. The best management strategy when occurring in APL is unknown, since anticoagulants or fibrinolytics may aggravate the CID but without them the thrombosis may be fatal.Aims:We present a rare case of APL presenting as a vertebrobasilar ischemic stroke, which evolved favorably with treatment of the subjacent leukemia alone, without use of anticoagulation or antiaggregation.Methods:Case report.Results:A 36‐year old previously healthy woman presented with sudden onset aphasia and right‐sided hemiparesis with central facial paralysis, vertical gaze palsy and loss of horizontal gaze to the left.Blood work showed anemia (Hb 6.6 g/dL), a white blood cell (WBC) count of 7900x109/L of which 62% were atypical promyelocytes, and 19,000 x109/L platelets (Figure 1‐A). A concomitant disseminated intravascular coagulation was diagnosed based on thrombocytopenia, hypofibrinogenemia (100 mg/dL), prolonged prothrombin time (&gt; seconds) and elevated D‐dimers (10,98 μg/mL). These findings raised the suspicion of Acute Promyelocytic Leukemia, an entity usually associated with bleeding but also rarely with thrombosis.Emergent head CT and angio‐CT scan showed no lesions. Based on the neurological findings, a presumptive diagnosis of vertebrobasilar ischemic stroke was established, and thrombolysis with alteplase was indicated. However, the risks of aggravating the bleeding predisposition of the patient and precipitating hemorrhagic transformation of the stroke outweighed the benefits, and both alteplase and anticoagulants were withheld.Instead, management focused on treating the leukemia. Oral all‐trans retinoic acid was immediately initiated, and idarrubicin was added after confirming major infiltration of the bone marrow with atypical promyelocytes. Surprisingly, the hallmark translocation t(15;17) was not detected by fluorescence in‐situ hybridization (FISH), but the fusion transcript PML‐RARα was identified by reverse transcription with polymerase chain reaction (RT‐PCR), thus confirming a diagnosis of cryptic APL.A magnetic resonance of the head performed 24 hours later showed hyperintense lesions in the left thalamus, caudate and midbrain, and right parietal operculum (Figure 1).The patient achieved hematologic complete remission after induction therapy and recovered to a mild right hemiplegia after intensive physical rehabilitation. She is currently in molecular complete remission and is undergoing maintenance treatment in the outpatient setting, medicated with dipyridamole as secondary stroke prevention.Summary/Conclusion:The management of thrombotic events in APL is a challenge, since the increased bleeding risk associated with anticoagulation must be weighed against the potential lethality of the thrombosis if it is left untreated. Central nervous system arterial thrombosis has a particularly poor prognosis.imageWe present a case that illustrates the importance of early APL treatment with ATRA and supportive measures in reverting the coagulopathy of the disease.

IgA-Targeted Lactobacillus jensenii Modulated Gut Barrier and Microbiota in High-Fat Diet-Fed Mice.

IgA-coated Lactobacillus live in the mucous layer of the human or mammalian intestine in close proximity to epithelial cells. They act as potential probiotics for functional food development, but their physiological regulation has not yet been studied. We isolated IgA-targeted (Lactobacillus jensenii IgA21) and lumen lactic acid bacterial strains (Pediococcus acidilactici FS1) from the fecal microbiota of a healthy woman. C57BL/6 mice were fed a normal (CON) or high fat diet (HFD) for 6 weeks and then treated with IgA21 or FS1 for 4 weeks. HFD caused dyslipidemia, mucosal barrier damage, and intestinal microbiota abnormalities. Only IgA21 significantly inhibited dyslipidemia and gut barrier damage. This was related to significant up-regulation of mucin-2, PIgR mRNA expression, and colonic butyrate production (P < 0.05 vs. HFD). Unlike IgA21, FS1 caused a more pronounced gut dybiosis than did HFD, and, in particular, it induced a significant decrease in the Bacteroidales S24-7 group and an increase in Desulfovibrionaceae (P < 0.05 vs. CON). In conclusion, IgA-coated and non-coated lactic acid bacteria of gut have been demonstrated to differentially affect the intestinal barrier and serum lipids. This indicates that IgA-bound bacteria possess the potential to more easily interact with the host gut to regulate homeostasis.

Direct insertion of papillary muscle into mitral valve leaflets in a healthy patient without hypertrophic cardiomyopathy

We present the case of a healthy young woman that was evaluated before participation in amateur sports. A systolic and diastolic murmur was heard during the physical examination. Two-dimensional echocardiography was performed, and a direct insertion of the posteromedial papillary muscle into the mitral valve leaflets was found. Mild mitral stenosis and moderate regurgitation were also found. Because she was asymptomatic, a follow-up in 6months was planned to control the evaluation of her valve disease.

A partial supernumerary umbilical vein: a case report

BackgroundAbnormalities in the number of vessels can be found for both the umbilical artery and vein. We sometimes encounter cases of a decreased number of umbilical cord vessels, such as a single umbilical artery. In contrast, there may be an increase from three to four vessels within the umbilical cord. A supernumerary umbilical vein is particularly very rare, and it is generally found in combination with congenital anomalies. We report a case of a partial supernumerary umbilical vein.Case presentationThe previous pregnancy of a 37-year-old healthy Japanese woman (gravida 2, para 1) had been uncomplicated, and the resulting child was alive and well. Prenatal examination at 36 weeks of gestation revealed the coexistence of a four-vessel part and a normal three-vessel part of the umbilical cord. A healthy female neonate weighing 2726 g was born at 38 weeks of gestation. The umbilical cord measured 40 cm in length; the four-vessel part continued to a distance of 18 cm from the surface of the infant’s body, and the remaining umbilical cord comprised three vessels. On histological examination, the fetal side of the umbilical cord had two arteries and two veins, and the placental side had two arteries and one vein. Isolated supernumerary umbilical veins tend to be overlooked. We consider that it is important to evaluate the number of umbilical cord vessels in the second trimester using ultrasound combined with color Doppler in at least three sites: the insertion sites on both the fetal abdomen and placenta, and the free loop of the umbilical cord.ConclusionsPrenatal diagnosis of isolated supernumerary umbilical cord vessels tends to be overlooked. However, supernumerary vessels of the umbilical can be associated with fetal congenital anomalies. The number of vessels within the umbilical cord must be examined because the detection of such abnormalities may lead to the prenatal diagnosis of other congenital anomalies.

Endometriosis of the Appendix

A 51-year-old healthy asymptomatic woman had an index colonoscopy for colorectal cancer screening, which was normal except for a prominent bulging mass at the appendiceal orifice (Figure A). Endoscopic evaluation of the overlying mucosa of the mass appeared normal using high-definition white light imaging, and mucosal biopsies were normal. Contrast-enhanced computed tomography imagines of the pelvis revealed a soft tissue density at the base of the appendix. Laparoscopy was unremarkable, aside from dense periappendiceal adhesions, and adhesiolysis with appendectomy and partial cecectomy was performed.

Necrotizing fasciitis following primary peritonitis caused by Streptococcus pyogenes with covS mutation in a healthy woman: a case report

BackgroundPrimary peritonitis due to Streptococcus pyogenes (S. pyogenes) is uncommon in patients without comorbid conditions such as immunosuppression, nephritic disease, or liver cirrhosis. Furthermore, it does not cause another infection at the same time in a healthy person. However, several S. pyogenes mutants have been reported, and some of them exhibit strong virulence. Mutation of the control of virulence (cov) S gene of Streptococcus enhances bacterium survival by repressing negative regulators of virulence, which causes bacterial invasion of aseptic tissues, such as the parenteral space. We report a case of primary peritonitis and subsequent necrotizing fasciitis by the same S. pyogenes species with mutated covS in a previously healthy woman.Case presentationWe present the case of a 55-year-old woman admitted to the hospital due to abdominal pain and nausea. She was treated for peritonitis. A few days later, she became hypotensive and tachycardic and was transferred to the intensive care unit (ICU) for the treatment of septic shock with primary peritonitis. On the second day of her ICU stay, both of her forearms developed swelling and redness around the peripheral injection site. The patient had developed necrotizing fasciitis. Since her skin symptoms spread rapidly, urgent debridement was performed. Her condition improved with antibiotic treatment and multiple episodes of debridement. S. pyogenes was detected in cultures of the patient’s blood, ascites, and skin. The identified strain was emm89 genotype and had a genetic mutation of covS.ConclusionsS. pyogenes with covS mutation may spread from a portal, such as the upper respiratory tract or digestive system, to all organs immediately, causing septic shock. Infection with S. pyogenes with mutated genes should be considered in the differential diagnosis of gastrointestinal symptoms, even in a previously healthy patient.

Rebusan Buah Asam dan Jahe Sebagai Upaya Mengurangi Dismenore

SSetiap wanita sehat akan mengalami siklus menstruasi pada setiap bulannya. Lebih dari 50% wanita di setiap negara mengalami nyeri menstruasi atau dismenore. Cara mengatasi dismenore yang aman adalah dengan rebusan herbal. Tujuan penelitian ini untuk mengetahui perbedaan efektivitas asam dan jahe dalam mengurangi dismenore. Desain penelitian ini menggunakan quasi eksperimen pre dan post test dengan sampel 30 mahasiswa yang dibagi dua kelompok. Masing-masing kelompok diberikan rebusan asam dan rebusan jahe pada pagi dan sore hari selama menstruasi hari pertama sampai hari ketiga. Responden dilakukan pengkajian nyeri sebelum dan sesudah diberikan intervensi. Analisis dengan menggunakan independent T-Test. Hasil didapatkan responden yang diberikan rebusan buah asam sebelum intervensi 60% mengalami nyeri sedang dan setelah intervensi 87% mengalami nyeri ringan, sedangkan responden yang diberikan rebusan jahe sebelum intervensi 67% mengalami nyeri sedang dan setelah intervensi 73% mengalami nyeri ringan sehingga disimpulkan rebusan jahe lebih efektif dibandingkan rebusan asam. Diharapkan peneliti selanjutnya melakukan penelitian mengurangi dismenore dengan rebusan herbal selain buah asam dan jahe.

Complete Genome Sequence of Lactobacillus crispatus AB70, Isolated from a Vaginal Swab from a Healthy Pregnant Korean Woman.

The vaginal bacterial strain AB70, belonging to the species Lactobacillus crispatus, was isolated from a vaginal swab from a healthy pregnant Korean woman. Here, we report the 2.37-Mb complete genome sequence of this strain.

Fulminant myocarditis associated with severe fever with thrombocytopenia syndrome: a case report

BackgroundSevere fever with thrombocytopenia syndrome (SFTS) is an emerging viral infectious disease with high mortality. It causes multiple organ dysfunction; however, myocarditis has never been reported as a complication with SFTS.Case presentationA 62-year-old previously healthy woman developed fever, fatigue, diarrhea, and a mild consciousness disorder. She visited a local clinic, and laboratory data showed leukocytopenia, thrombocytopenia, and elevation of the aspartate aminotransferase level. She was transferred to Kagoshima University Hospital and diagnosed as having SFTS by real-time reverse transcription polymerase chain reaction. Subsequently, her blood pressure gradually decreased despite fluid resuscitation and vasopressor administration. Based on elevated toroponin I levels in serum, a transient diffuse left ventricular hypokinesis and wall thickening in echocardiography, diffuse ST elevation in electrocardiography, and exclusion of other heart diseases, she was diagnosed as having fulminant myocarditis. After hemodynamic support with inotropic agents, she recovered near normal cardiac function. She was discharged to home on day 28.ConclusionsWe report the first case of fulminant myocarditis associated with SFTS.

Understanding the Breadth and Depth of the Subspecialty: TBI and Neuropsychiatry

Understanding the Breadth and Depth of the Subspecialty: TBI and Neuropsychiatry