Lactating Women Research Articles

Food Consumption Pattern and Dietary Diversity Among Pregnant and Lactating Women, Children, and Adolescent Girls in Devbhumi Dwarka District, Gujarat: A Cross-Sectional Study.

BackgroundFood consumption patterns and dietary diversity are vital sources for the nutrition status of pregnant women (PW) and lactating women (LW), children, and adolescent girls. Undernutrition, food consumption pattern, and poor dietary diversity are interlinked; however, not much is known in the context of rural Gujarat. This study aims to assess the regional pattern of food consumption and dietary diversity among pregnant and lactating women, children, and adolescent girls from Devbhumi Dwarka District in the state of Gujarat.MethodsA cross-sectional study was conducted in four blocks of Devbhumi Dwarka District of Gujarat. A cluster sampling method was used for a better representation. A total of 632 pregnant women, 562 lactating mothers, 855 children aged 7-24 months, and 1,252 adolescent girls were assessed for food consumption patterns.ResultsConsumption of cereals (98%) was found to be highest among pregnant women, whereas consumption of pulses and fruits, which are rich in proteins and vitamins, was inadequate. Overall, the consumption of fruits was inadequate among adolescent girls (56.5%). Moreover, inadequate consumption of green leafy vegetables (36.4%) was noted among children. The dietary diversity score (DDS) for the study population ranges between 4.5 and 4.8, indicating medium diversity in food.ConclusionCereal consumption is higher, which indicates a major part of the energy consumed by vulnerable groups. In contrast, low consumption of pulses, fruits, milk, and green leafy vegetables suggests the possibility of one or more micronutrient deficiencies. There is a need for innovative intervention to change food habits and promote locally available nutrient-rich food and awareness of the importance of various food groups to improve food patterns and the health of vulnerable groups.

Monoclonal antibody treatment during pregnancy and lactation in women with multiple sclerosis or neuromyelitis optica spectrum disorder

AbstractMultiple sclerosis (MS) and neuromyelitis optica (NMOSD) are more prevalent in women and mainly affecting young women, the majority of whom are of childbearing age. In addition, recent treatment algorithms suggest that patients who have poor prognostic factors are treated with highly effective disease‐modifying drugs from the beginning. Monoclonal antibodies for MS or NMOSD are basically highly effective disease‐modifying drugs. Therefore, young women with MS or NMOSD will have more opportunities to receive monoclonal antibody treatment than ever before. Currently, five monoclonal antibodies for MS or NMOSD are available in Japan: natalizumab and ofatumumab for MS, and eculizumab, satralizumab and inebilizumab for NMOSD. The pregnancy and breastfeeding of each monoclonal antibody drug is reviewed, and the evidence surrounding the safety of monoclonal antibody drugs during both pregnancy and breastfeeding in women with MS or NMOSD is discussed.

Use of Compartmental Modeling and Datasets for Theoretical Lactating Women to Determine Conditions under Which Vitamin A–Specific Activity in Breast Milk Provides Accurate Estimates of Vitamin A Total Body Stores by Retinol Isotope Dilution

Vitamin A concentrations in breast milk are related to maternal vitamin A intake and status. Our objective was to identify conditions under which vitamin A specific activity in breast milk (SAm) could be used instead of retinol specific activity in plasma (SAp) to predict vitamin A total body stores (TBS) by retinol isotope dilution (RID). We used 12 previously-studied theoretical lactating women with assigned values for TBS (219-1348μmol) and retinol kinetic parameters; we assumed subjects ingested a dose of stable isotope-labeled vitamin A. We expanded a 9-compartment steady state tracer model to include a parallel model for tracee (unlabeled retinol) and then adapted that model so vitamin A intake entered the system in 3 meals each day. Using compartmental analysis, we first simulated SAm and SAp after an overnight fast (as in actual RID experiments) and then with vitamin A intake also restricted in sequential meals on the day before sampling for RID. After an overnight fast, SAm at day 21 postdosing was lower than SAp. However, if vitamin A intake was also restricted in 1, 2, or 3 meals before sampling, SAm/SAp (mean±SD) was 0.92±0.042, 0.96±0.016, or 0.99±0.004, respectively; results for days 14 and 28 were similar. When either SAp or SAm was used to predict TBS by RID on day 21 after 1-d restriction, predictions for all subjects were within 25% of assigned TBS. Results indicate that, for theoretical lactating women with a wide range of vitamin A status, SAm will accurately predict TBS by RID at 2-4 wk postdosing if vitamin A intake is restricted for 1 d before sampling. If confirmed in community settings, results suggest that vitamin A status in lactating women can be determined without collecting blood.

Development of a Compartmental Model for Studying Vitamin A Kinetics and Status in Theoretical Lactating Women

Low vitamin A status and suboptimal milk vitamin A concentrations are problems in many populations worldwide. However, limited research has been done on whole-body vitamin A kinetics in women of reproductive age, especially during lactation. Goals were to develop compartmental models describing retinol kinetics in theoretical nonlactating (NL) and lactating (L) women and to determine whether the retinol isotope dilution (RID) method accurately predicted vitamin A total body stores (TBS) in the groups and individuals. We adapted 12 previously-used theoretical females with assigned values for retinol kinetic parameters and TBS (225-1348μmol); subjects were NL or L (nursing one 3- to 6-mo-old infant) during 49-d kinetic studies after isotope dosing. We used an established compartmental model, adding a compartment for chylomicrons and, for L, another for mammary gland milk with inputs from holo-retinol-binding protein and chylomicron retinyl esters and output to milk. Using compartmental analysis, we simulated tracer responses in compartments of interest and calculated TBS using the RID equation TBS= FaS/SAp [Fa, fraction of dose in stores; S, retinol specific activity in plasma/specific activity in stores; SAp, specific activity of retinol in plasma]. Models for both groups were well identified. Simulated plasma tracer responses were similar for NL and L, with L always below NL; milk tracer paralleled plasma from 10 d postdosing. Geometric mean FaS ratios (L/NL) were ∼0.75 during days 2-30. Using appropriate group FaS, RID provided accurate TBS predictions for >80% of NL and L subjects after day 18 when CV% for FaS was ∼10%. These new physiologically-based models for vitamin A kinetics may be useful for future research in women of reproductive age. Results indicate that, in groups like these, RID to assess an individual's vitamin A status should be done at 21-28 d after isotope dosing.

COVID 19 Vaccination Related Misconceptions and Myths

Background: Mass vaccination is the most effective way to fight against COVID 19 but a significant number of people are unwilling to be vaccinated, mainly due to misinformation and false beliefs, associated with this drive. The objective of this study was to identify these misconceptions and myths and associate them with sociodemographic factors.
 Methodology: This cross sectional survey was conducted on 562 residents of Rawalpindi and Islamabad from July 2021 to November 2021. Data was collected through structured questionnaire both in English and Urdu, analysed by SPSS version 23. χ2-test was used to check the association of categorical data with sociodemographic factors.
 Results: Out of all the participants, 328 (58.4%) had received COVID19 vaccination. Among these vaccinated individuals, 81.8% were graduates or above and 74.2% had family income more than Rs.50,000. Out of total, 40.7% respondents believed that, vaccine is harmful for diabetics, hypertensive and heart patients, 40.6% agreed that it is not safe for pregnant or lactating women and 40.4% assumed that they have acquired immunity through natural infection. A strong association of misconceptions and myths was found with residence (p value 0.0001), educational level (p value 0.0010) and monthly income (p value 0.0001).
 Conclusion: Several misconceptions and myths are related with COVID 19 vaccination, strongly influenced by various socio demographic. Hence, there is a need to launch various campaigns regarding the safety and effectiveness of vaccination.
 Key words: COVID-19, Misinformation, Vaccine

Factors Influencing Muslim Women’s Decisions about Induced Lactation: A Qualitative Study

The induction of lactation occurs when breast milk is produced in a woman, without going through the process of pregnancy and delivery. Induced lactation is a method of strengthening the bond between the adopted child and the adoptive mother. This study aimed to explore the factors influencing Muslim women’s decisions about induced lactation in Malaysia. This qualitative study used in-depth interviews with women who had induced lactation in five states based on five regions in Malaysia (Central Region (Selangor), Northern Region (Penang), Southern Region (Johor), East Coast Region (Kelantan), and Malaysia Borneo (Sabah)). All interviews were consented, audio-recorded, and transcribed verbatim, followed by identification of emerging themes. After interviewing 23 induced lactation women, data saturation was achieved. Data synthesized using thematic analysis revealed three themes describing the main factors in determining women’s decisions on induced lactation: (1) mahram relationship, (2) experiencing motherhood, and (3) the perceived superiority of breastfeeding. It is hoped that by identifying the various factors that influence the decision to induce lactation, health care professionals and the community will be empowered to support breastfeeding in terms of facilitating motherhood, providing breastfeeding aid equipment, and assisting with daily necessities. By expanding efforts and programs, the government and other stakeholders can assist adoptive mothers in breastfeeding their children and feeling more accomplished as women and mothers.

Prevalence of vitamin A deficiency in women of childbearing age in Brazil: a systematic review and meta-analysis.

Vitamin A is an essential micronutrient, especially during pregnancy. We aimed to assess the prevalence of vitamin A deficiency in Brazilian women of childbearing age. We conducted a systematic review with meta-analysis of studies that assessed vitamin A deficiency in women of childbearing age following the registered protocol (CRD42020171856). Independent peer researchers selected the studies retrieved from MEDLINE, Embase, Scopus and other sources. Data from the eligible studies were extracted in pairs and assessed for methodological quality. The prevalence of vitamin A deficiency (< 0·70 µmol/l or <0·20 µg/dl) and 95 % CI was combined by meta-analysis, and heterogeneity was estimated by I2. Out of 3610 screened records, thirty-two studies were included, which assessed 12 577 women from 1965 to 2017, mostly in maternity hospitals. Main limitations of the studies were in sample frame (30/32) and sampling method (29/32). Deficiency occurred in 13 % (95 % CI 9·4, 17·2 %; I² = 97 %) of all women and was higher in pregnant women (16·1 %; 95 % CI 5·6, 30·6 %; I² = 98 %) than non-pregnant women (12·3 %; 95 % CI 8·4, 16·8 %; I² = 96 %). The prevalence increased according to the decade, from 9·5 % (95 % CI 1·9–21·6 %; I² = 98 %) up to 1990, 10·8 % (95 % CI 7·9, 14·2 %; I² = 86 %) in the 2000s and 17·8 % (95 % CI 8·7, 29·0 %; I² = 98 %) in the 2010s. Over 10 % of Brazilian women in childbearing age were deficient in vitamin A. Higher prevalence was observed in pregnant women, and deficiency seemed to be increasing over the decades. Low representativeness of the studies, mainly based on convenience sampling that included pregnant, postpartum, lactating and non-pregnant women, as well as high heterogeneity, limits the findings.

Iodine Status of Mother-Infant Dyads from Montréal, Canada: Secondary Analyses of a Vitamin D Supplementation Trial in Breastfed Infants

BackgroundMost pregnant or lactating women in Canada will not meet iodine requirements without iodine supplementation. ObjectivesTo assess the iodine status of 132 mother-infant pairs based on secondary analyses of a vitamin D supplementation trial in breastfed infants from Montréal, Canada. MethodsMaternal iodine status was assessed using the breastmilk iodine concentration (BMIC). Singleton, term-born infants were studied from 1–36 months of age. Usual (adjusted for within-person variation) iodine intakes were estimated from urinary iodine and creatinine concentrations. Iodine status was assessed using median urinary iodine concentrations (UICs) and by estimating inadequate intakes by the cut-point method using a proposed Estimated Average Requirement for infants 0–6 months of age (72 μg/d). ResultsAt 1, 3, and 6 months of age, 70%, 63%, and 3% of infants, respectively, were exclusively breastfed. From 1–36 months of age (n = 82–129), the median UICs were ≥100 μg/L (range, 246–403 μg/L), which is the cutoff for adequate intakes set by the WHO for children <2 years. Almost all (98%–99%) infants at 1 and 2 months, 2 and 3 months, and 3 and 6 months of age had usual creatinine-adjusted iodine intakes ≥ 72 μg/d. The median BMIC was higher (P < 0.001) at 1 month compared to 6 months of lactation [1 month, 198 μg/kg (IQR, 124–274; n = 105) and 6 months, 109 μg/kg (IQR, 67–168; n = 78)]. At 1 and 6 months, 96% and 79% of mothers, respectively, had a BMIC ≥ 60 μg/kg, the lower limit of a normal reference range. The percentages of mothers that used a multivitamin-mineral (MVM) supplement containing iodine were 90% in pregnancy and 79% and 59% at 1 and 6 months of lactation, respectively. ConclusionsThe iodine status of infants was adequate throughout infancy. These results support a recommendation that all women who could become pregnant, who are pregnant, or who are breastfeeding take a daily MVM supplement containing iodine.

Prevalence and predictors of anaemia among adolescents in Bihar and Uttar Pradesh, India

In adolescents, anaemia has been linked to affecting physical disorders, growth, and mental retardation and also increases reproductive morbidities among adolescent girls during their womanhood. It is believed that with increasing age, females are more prone to anaemia than their male counterparts. Unfortunately, the anaemia intervention program, such as the National Nutrition Anaemia Prophylaxis Programme, primarily targets infants, young children, pregnant and lactation women, and not adolescents. Therefore, this study tries to fill this gap and study the prevalence of anaemia and the associated factors among adolescent boys and girls residing in Uttar Pradesh and Bihar, India. Secondary data analysis was performed on cross-sectional survey data from the Understanding the Lives of Adolescents and Young Adults survey. The sample size was 20,594 adolescents aged 10–19 years in Uttar Pradesh and Bihar, India. The outcome variable was anaemia, and the explanatory variables were age, education, working status, media exposure, marital status, received IFA and deworming tablets, BMI status, stunting status, wealth index, caste, religion, residence, and States. Descriptive statistics and bivariate analysis were used to find the preliminary results. Multinomial regression analysis was carried out to provide the adjusted estimates. Overall, anaemia was more prevalent among adolescent girls than adolescent boys (20% vs. 8.7%). Moderate/severe anaemia was 0.24 and 0.49 times less likely among adolescent boys and girls, respectively, who had 10 and above years of schooling than adolescents with no schooling (p < 0.01). Rural adolescent boys were 1.49 times (p < 0.05) more likely to suffer from moderate/severe anaemia than urban counterparts. The odds for moderate/severe anaemia among adolescent boys were relatively higher among late adolescents, with no mass-media exposure, stunted, and rural adolescents. Similarly, odds for moderate/severe anaemia among adolescent girls were higher among late adolescents and adolescents without schooling and mass-media exposure. Prevalence of anaemia was higher among adolescent girls than in boys. Lower education status, rural residence, late adolescence, no exposure to mass media, and stunting were the predictors of moderate/severe anaemia among adolescents. Anaemia among adolescents must be addressed through effective public health policy targeting adolescents residing in rural areas. There is a need to disseminate information about anaemia-related programs, such as National Iron Plus Initiative (NIPI), through mass media, and subsequently, the public health system may be prepared to tailor the needs of adolescent boys and girls.

Multi-site observational maternal and infant COVID-19 vaccine study (MOMI-vax): a study protocol

BackgroundPregnant women were excluded from investigational trials of COVID-19 vaccines. Limited data are available to inform pregnant and postpartum women on their decisions to receive a COVID-19 vaccine.MethodsThe goal of this observational, prospective cohort study is to evaluate the immunogenicity and safety of various Emergency Use Authorization (EUA) or licensed COVID-19 vaccines administered to pregnant or lactating women and describe the transplacental antibody transfer and kinetics of antibodies in mothers and infants. The study is adaptive, allowing additional groups to be added as new vaccines or vaccine regimens are authorized. Up to 20 clinical research institutions in the United States (U.S.) will be included. Approximately 200 pregnant women and 65 postpartum women will be enrolled per EUA or licensed COVID-19 vaccine formulation in the U.S. This study will include pregnant and postpartum women of all ages with and without chronic medical conditions. Their infants will be enrolled and followed beginning at birth in the pregnant cohort and beginning at the earliest possible time point in the postpartum cohort. Blood samples will be collected for immunogenicity outcomes and pregnancy and birth outcomes assessed among women and infants. Primary analyses will be descriptive and done by vaccine type and/or platform. DiscussionGiven the long-standing and legitimate challenges of enrolling pregnant individuals into clinical trials early in the vaccine development pipeline, this study protocol describes our current study and provides a template to inform the collection of data for pregnant individuals receiving COVID-19 or other vaccines.Trial registrationNCT05031468.

COVID-19 disease and vaccination in pregnant and lactating women.

BackgroundMore than 325,000 cases of coronavirus disease 2019 (COVID‐19) have been reported among pregnant women in the Americas.AimsThis review examines the impact of COVID‐19 in pregnant women and describes available evidence on the safety, effectiveness, and immune response(s) to vaccination among pregnant and lactating women.ContentMultiple studies indicate that pregnant women are more susceptible to adverse COVID‐19 outcomes, including hospitalization, intensive care unit admission, and invasive ventilation than non‐pregnant women with COVID‐19. Furthermore, COVID‐19 in pregnancy is associated with adverse maternal and neonatal outcomes. Adverse COVID‐19 outcomes appear to disproportionately affect pregnant women from low‐ and middle‐income countries, likely reflecting inequities in access to quality healthcare. Despite the absence of safety and efficacy data from randomized clinical trials in this subpopulation, observational studies and data from pregnancy registries thus far have demonstrated that vaccination of pregnant or lactating women against COVID‐19 is safe, effective, and results in robust immune responses including transfer of antibodies to the newborn via the placenta and breast milk, respectively.ImplicationsThese data support vaccination recommendations intending to help protect these vulnerable individuals against COVID‐19 and its sequelae. Randomized clinical studies will further evaluate the safety and immunogenicity of COVID‐19 vaccines in these populations. This review examines the impact of COVID‐19 in pregnant women and describes available evidence on the safety, effectiveness, and immune response(s) to vaccination among pregnant and lactating women.

Effect of Expressed Milk, Peppermint Water Versus Routine Care on Cracked Nipple among Lactating Women

Effect of Expressed Milk, Peppermint Water Versus Routine Care on Cracked Nipple among Lactating Women

Quality of life of patients with locally advanced rectal cancer after neoadjuvant therapy and sphincter-preserving surgery

Objective: To investigate quality of life (QoL) of patients with locally advanced rectal cancer (LARC) who underwent low anterior resection with protective stoma under neoadjuvant therapy mode, and to explore the changes of QoL of patients from before neoadjuvant therapy to 12 months after stoma reversal. Methods: A descriptive case series study was carried out. A retrospective study was performed on patients with mid and low LARC who received complete neoadjuvant long course radiotherapy and chemotherapy, followed by radical low anterior resection (LAR) combined with protective stoma at Peking Union Medical College Hospital from December 2017 to January 2020. Inclusion criteria: (1) patients with rectal MRI assessment of mT3-4b or mN1-2 without distant metastasis (M0) before neoadjuvant therapy; (2) distance from tumor lower margin to the anal verge <12 cm; (3) rectal adenocarcinoma confirmed by biopsy before neoadjuvant therapy; (4) complete cycle of neoadjuvant therapy; (5) patients undergoing radical LAR with sphincter preservation and protective ostomy; (6) patients receiving follow-up for more than 12 months after stoma reversal. Exclusion criteria: (1) patients as grade Ⅳ to Ⅴclassified by the American Society of Anesthesiologists (ASA); (2) patients with multiple primary colorectal cancer; (3) patients with history of other malignant tumors in the past 5 years; (4) patients of emergency surgery; (5) pregnant or lactating women; (6) patients with history of severe mental illness; (7) patients with contraindication of MRI, radiotherapy, chemotherapy, or surgical treatment. A total of 83 patients were enrolled, including 51 males and 28 females with median age of 59 years and mean BMI of (24.4±3.1) kg/m(2). EORTC QLQ-CR29, international erectile function index (IIEF), Wexner constipation score and low anterior resection syndrome (LARS) score were applied to investigate the QoL of the patients before neoadjuvant therapy, 3 and 12 months after ostomy reversal, including rectal anal function and sexual function. M (P25, P75) was used for the scores of the scale. Results: (1) EORTC QLQ-CR29 score showed that before neoadjuvant therapy, before surgery, 3 months and 12 months after ostomy reversal, anxiety [64.4 (52, 0, 82.5), 75.3 (66.0, 89.5), 82.6 (78.5, 90.0), 83.6 (78.0, 91.0)] and concern about body image [76.8 (66.0, 92.0), 81.1 (76.5, 91.5), 85.5 (82.5, 94.0), 86.1 (82.0, 92.0)] were improved (all P<0.01); pelvic pain [5.4 (2.0, 8.0), 5, 0 (2.0, 7.8), 3.9 (1.0, 5.0), 3.0 (1.0, 5.0)], urinary incontinence [15.7 (7.0, 22.0), 11.1 (0, 17.5), 10.0 (0, 17.0), 9.9 (0, 16.0)], impotence [14.3 (4.2, 19.0), 12.2 (0, 16.8), 5.6 (0, 10.0), 5.2 (0.2, 8.0)], urinate [26.4 (13.0, 38.5), 13.9 (0, 20.0), 13.4 (2.5, 21.5), 13.2 (2.0, 20.0)] and mucous bloody stool [4.7 (3.0, 6.0), 2.6 (0, 5.0), 2.2 (0, 5.0), 1.9 (0, 4.0)] were improved as well (all P<0.01). The scores fluctuated in the improvement of male sexual function, abdominal pain, dry mouth, worry about body mass change, skin pain and dyspareunia, but the symptoms were significantly improved after ostomy reversal compared with before neoadjuvant therapy (all P<0.05). There were no significant changes in female sexual function, dysuria, dysgeusia and fecal incontinence after ostomy reversal compared with before neoadjuvant therapy (all P>0.05). (2) IIEF scale showed that all scores were similar before and after neoadjuvant therapy (all P>0.05). (3) Rectal and anal function scale revealed that before neoadjuvant therapy, before operation, 3 months and 12 months after stoma reversal, gas incontinence [3.1 (0, 4.0), 2.3 (0, 4.0), 1.8 (0, 4.0), 1.2 (0, 3.0)] and urgent defecation [7.2 (0, 11.0), 5.2 (0, 11.0), 2.9 (0, 9.0), 1.7 (0, 0)] were improved (all P<0.001). In terms of improving incomplete emptying sensation, the symptoms fluctuated, but the symptoms improved significantly after ostomy reversal compared with before neoadjuvant therapy (all P<0.05). While the symptoms of assistance with defecation [0 (0, 0), 0.7 (0, 1.0), 0.6 (0, 1.0), 0.7 (0, 1.0)] and defecation failure [0.2 (0, 0), 1.0 (0, 2.0), 0.8 (0, 1.5), 0.8 (0, 1.0)] showed a worsening trend (all P<0.001). Stratified analysis was performed on patients with different efficacy of neoadjuvant therapy to compare the changes in QoL before and after neoadjuvant therapy. Patients with less sensitive and more sensitive neoadjuvant therapy showed similar changes in function and symptoms. Patients with less sensitive therapy showed significant improvement in dysuria, urinary incontinence, skin pain and dyspareunia (all P<0.05), and the symptom of defecation frequency in more sensitive patients was significantly improved (P<0.05). Conclusions: For patients with LARC, neoadjuvant radiochemotherapy combined with radical LAR and protective stoma can improve QoL in many aspects. It is noted that patients show a worsening trend in the need for assistance with defecation and in defecation failure.

Health Benefitting Postpartum Care Ethnic/Traditional Super Foods of Karnataka

Nutrition plays a major role in lactating women to strengthen the foundation for long-term health for both mother and infant. From aegis, it is a known fact that, all cultures in India and across the world follow certain beliefs and practices including ethnic special/super foods and food taboos during confinement. Our rich traditional knowledge is losing its significance. As an eye opener, a comprehensive view on the traditions with special prominence of selected health benefitting ethnic/traditional super foods given to lactating women across Karnataka, obtained through Focus Group Discussions and Key informants is emphasized. Understanding our ethnic or traditional super foods aids to do further research on traditional superfoods and in turn can contribute in formulating a balanced diet for the modern-day Lactating women without losing our rich traditions. Key Words: Traditional Knowledge, Lactation, Traditional/Ethnic Super Foods, Postpartum, Confinement

Biocompatibility of Amalgam vs Composite - A Review.

The Minamata Convention resulted in restrictions in the use of amalgam in daily dental practice. This opens up new discussions about the biocompatibility of amalgam, but also of composites as alternative materials. In the following review article, these issues will be discussed in more detail to provide dentists with a knowledge base for themselves and for communication with their patients. In addition to mercury in amalgam or monomers in composites, bisphenol A and nanoparticles generated during the grinding, polishing or removal of restorations must also be included in the biocompatibility evaluation. In laboratory tests, these substances cause toxic reactions, and bisphenol A also exhibits estrogen-like effects. However, it must be taken into account that the concentrations used in laboratory tests are much higher than in clinical practice. Thus, both amalgam and composite can be used in the general population. Nevertheless, for scientifically, politically and legally defined risk groups (e.g. dental personnel, allergic persons, pregnant or lactating women, children under 15 years of age, people with certain systemic diseases), indication restrictions and precautionary measures must be observed. The well-known amalgam discussion has taught us the importance of thorough and open risk communication with the patient.

Vaccine strategy against COVID-19 with a focus on the Omicron and stealth Omicron variants: Life Cycle Committee Recommendations

The Severe Acute Respiratory Syndrome Coronavirus type 2 (SARS-CoV-2), the cause of the pandemic of coronavirus disease 2019 (COVID-19), was first discovered in December 2019 in Wuhan, China, and was consequently transmitted across the world. Further, within a year of its initial discovery, vaccines against SARS-CoV-2 were developed using diverse techniques comprising mRNA-, adenoviral vector-, and recombinant DNA-technology. Researchers have assessed these vaccines in large, placebo-controlled trials and determined them to be both safe and efficient. However, there are several distinct vaccines for SARS-CoV-2 and its variants comprising Alpha, Delta Omicron, and stealth Omicron. Omicron vaccines are available to the public with reasonable safety and scientifically acceptable levels of protective effectiveness for COVID-19. Of clinical significance, it is demanding in clinical practice to precisely interpret the efficiency and the persistence of the distinct vaccines ascribed to the notion that there are no gold methods to assess neutralization levels. In this guideline, our aim is to review vaccine strategies against COVID-19 and its variants for adults, children and adolescents, and pregnant or lactating women.

Nutritional status and associated factors among lactating women in Dire Dawa, Ethiopia.

Lactating women's nutritional status is critical since it influences the health of their infants. However, there was a scarcity of data on maternal nutrition in low-income countries such as Ethiopia, particularly in the study area. Institutional-based cross-sectional study was conducted among 401 lactating women in Dire Dawa town health facilities from February 10, 2019 to March 30, 2019. The sum of the number of food categories consumed by each respondent over the 24-h recall period is the women's diet diversity score. To identify factors linked to undernutrition, all variables with a p-value of less than 0.25 were included into multivariate logistic regression. Prevalence of undernutrition was 22%. Women who age 15-25 years were four times more likely undernourished than older (adjusted odd ratio [AOR]=4.04; confidence interval [CI]: [1.74, 9.40]). Unable to read and write women were almost five times more likely to be undernourished than formal education (AOR=4.76; CI: [2.31, 9.81]). Women who have family size >7 were six times more likely to be undernourished than family size <3 (AOR=5.53; CI: [1.15, 26.53]). Women not take additional food during lactating were 4.5 times more likely undernourished than take additional food (AOR=4.56; CI [1.50, 13.9]). DD score <5 were four times more likely to be undernourished than (≥5) DD (AOR=4; CI: [2.02, 7.90]). Prevalence of undernutrition in the study area was high. Factors associated with undernutrion were: age of lactating women, education status, family size, additional food during lactation and DD score. Thus, multisectoral collaboration targeted at improving women's educational status and increasing food during lactation need to be emphasized.

Abstract OT1-08-01: Concurrent versus sequential chemo-endocrine therapy in er positive and her2 negative non-metastatic breast cancer- an open-label, phase III, randomized controlled trial

Abstract Background-Traditionally, endocrine therapy follows chemotherapy for hormone receptor (HR) positive breast cancer (BC) in the adjuvant setting. Concurrent chemo-hormonal therapy fell into disrepute due to previous studies showing a probable, small detriment in survival. (Albain et al, Lancet, 2009; Bedognetti et al, JNCI, 2009; Pico et al, Ann Oncol, 2004) However, the early studies are fraught with biases. The biological rationale was that endocrine therapy is cytostatic, pushing cancer cells into G0 phase which was feared to reduce the efficacy of chemotherapy which is known to act best on rapidly dividing cells. Thus, the two mechanisms of actions were thought to be antagonistic. However, this fear may be irrational and evidence at molecular level is contradictory. The current sequential strategy delays the start of an equally effective treatment modality in HR+ BC patients. Recent studies have shown that concurrent chemo-endocrine therapy is safe in metastatic HR+ setting. (Sledge et al, J Clin Oncol, 2000) One also needs to rethink neoadjuvant strategies in these patients to improve the current dismal pathological complete response (pCR) rates in this subset. (Cortazar et al, Lancet, 2014) Concurrent treatment seems to have improved pCR rate. (Sagiu K et al, Acta Med Okayama, 2015) Here, we describe a phase III, randomized study aimed to evaluate the efficacy of concurrent chemo-endocrine therapy in the adjuvant and neoadjuvant setting. (CTRI/2018/09/015643) Aims and Objectives- The primary objective is to assess the improvement in disease-free survival by administering concurrent versus sequential, (neo) adjuvant chemo-endocrine therapy in HR+, HER2 negative, non-metastatic BC. The secondary objectives are to assess improvement in overall survival, pCR rates, breast conservation rates. Biomarkers of response to treatment and tumour dormancy in HR+ BC will be studied in a subset of patients.Patients and methods-This is a prospective, open label study where non-metastatic, biopsy proven, HR+, HER2- BC patients who warrant chemotherapy in the adjuvant or neoadjuvant setting are considered. The study started accrual in December 2018 and 285 patients are randomized till date. Pregnant or lactating women and those with inflammatory breast carcinoma are excluded. After obtaining informed consent, patients are randomized to receive concurrent versus sequential chemo-endocrine treatment. Patients will receive all chemo and endocrine therapy as per the institutional standard protocols otherwise. Stratification criteria are neoadjuvant vs adjuvant therapy, pre vs postmenopausal status, node positive vs node negative status, 1st gen (anthracyclines alone) versus 2nd gen (including taxanes) chemotherapy. A two-sided log-rank test with an overall sample size of 2316 (2432 with a 5% dropout rate) (1158 in control and 1158 in treatment group) achieves 80% power at a 0.05 significance level to detect a hazard ratio of 0.80 when the proportion surviving in the control group is 0.70. An interim with respect to safety is planned in the protocol. Expected results and conclusion-Ours is a large, prospective trial evaluating the efficacy of concurrent chemo-endocrine therapy in HR+ BC patients. This has the potential to improve pCR rates in the neoadjuvant setting and change the standard of care in the management of HR+ BC patients. The biomarker analysis will help us further understand the biology of HR+ BC and shed light upon tumour dormancy signatures. Citation Format: Shalaka Joshi, Sridevi Murali-Nanavati, Vaibhav Vanmali, Rohini Hawaldar, Mujahid Gafur Shaikh, Mohammad Sadique Ansari, Sushmita Rath, Jaya Ghosh, Seema Gulia, Jyoti Bajpayi, Nita Nair, Vani Parmar, Purvi Thakkar, Garvit Chitkara, Tanuja Shet, Sangeeta Desai, Ayushi Sahay, Sudeep Gupta, Rajendra Badwe. Concurrent versus sequential chemo-endocrine therapy in er positive and her2 negative non-metastatic breast cancer- an open-label, phase III, randomized controlled trial [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT1-08-01.

Reduced n-3 and n-6 PUFA (DHA and AA) Concentrations in Breast Milk and Erythrocytes Phospholipids during Pregnancy and Lactation in Women with Obesity.

Obesity during pregnancy is a worrying public health problem worldwide. Maternal diet is critical for fatty acid (FA) placental transport and FA content in breast milk (BM). We evaluated FA composition in erythrocytes phospholipids (EP) and BM in pregnant women with (OBE, n = 30) and without (non-OBE, n = 31) obesity. Sixty-one healthy women were evaluated at their 20–24th gestational week and followed until 6th month of lactation. Diet was evaluated through a food frequency questionnaire. FA composition of EP and BM was assessed by gas-liquid chromatography. The OBE group showed lower diet quality, but total n-6 and n-3 polyunsaturated FA (PUFA), ALA, EPA, and DHA dietary intake was similar between groups. N-3 PUFA, ALA, DHA, and the n-6/n-3 PUFA ratio in EP were lower at the 6th lactation month in the OBE group. In BM, the arachidonic acid (AA) concentration was lower at the end of the lactation, and DHA content showed an earlier and constant decline in the OBE group compared to the non-OBE group. In conclusion, n-3 PUFA and AA and DHA levels were reduced in EP and BM in pregnant women with obesity. Strategies to increase n-3 PUFA are urgently needed during pregnancy and lactation, particularly in women with obesity.

Diurnal Preference Contributes to Maximal UVB Sensitivity by the Hour of the Day in Human Skin In Vivo

Diurnal Preference Contributes to Maximal UVB Sensitivity by the Hour of the Day in Human Skin In Vivo