Heterogeneity of Outcomes Reporting in Trials Evaluating Traditional Chinese Medicine Breast Massage for Stasis Acute Mastitis: A Methodological Review.

Objective To systematically analyze the current status of outcomes reporting in clinical trials on treating stasis acute mastitis with Traditional Chinese Medicine breast massage.Methods We searched CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, Embase, Cochrane library, JBI, CINAHL, PsycINFO, Clinical Trials Registry Platform portal, Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Center Watch Registry from inception to May 15, 2022 to find randomized controlled trials, non-randomized controlled trials, case series and cohort studies which reported the outcomes of stasis acute mastitis managed with Traditional Chinese Medicine breast massage, with search terms of mastitis, acute mastitis, lactation mastitis, puerperal mastitis, breast problem, breast engorgement, milk stasis, blocked ducked, breast pain, breast massage, and acupoint massage. Outcomes and the measurement schemes (measurement methods, timing of assessing outcome, frequency of assessing outcome, measurers) were extracted from the included studies. We used the Management of Otitis Media with Effusion in Children with Cleft Palate (MOMENT) to assess the quality of each study, then categorized outcomes derived from the included studies into different domains according to the Outcome Measures in Rheumatology Arthritis Clinic Trials (OMERACT) Filter 2.1 framework.Results We identified 85 clinical trials, in which 54 different outcomes were reported. A total of 81.2% (69/85) of studies were assessed as medium quality with a mean score of 2.6, and 18.8% (16/85) as low quality with a mean score of 0.9. These outcomes were organized in three core areas. Lump size (89.4%, 76/85) was the most frequently reported outcome, followed by breast pain (69.4%, 59/85) and milk excretion (68.2%, 58/85). Five methods were used to assess lump size and four methods to assess breast pain.Conclusions The outcomes reported in clinical trials regarding stasis acute mastitis treated by Traditional Chinese Medicine breast massage are heterogeneous. Developing a core outcome set to achieve consistent standards for reporting outcomes and modalities for validation of the outcomes is clearly warranted.

Heterogeneity of Outcomes Reporting in Trials Evaluating Traditional Chinese Medicine Breast Massage for Stasis Acute Mastitis: A Methodological Review / 中国医学科学杂志(英文版)

Objective To systematically analyze the current status of outcomes reporting in clinical trials on treating stasis acute mastitis with Traditional Chinese Medicine breast massage.Methods We searched CNKI, Wanfang, VIP, SinoMed, PubMed, Web of Science, Embase, Cochrane library, JBI, CINAHL, PsycINFO, Clinical Trials Registry Platform portal, Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, Center Watch Registry from inception to May 15, 2022 to find randomized controlled trials, non-randomized controlled trials, case series and cohort studies which reported the outcomes of stasis acute mastitis managed with Traditional Chinese Medicine breast massage, with search terms of mastitis, acute mastitis, lactation mastitis, puerperal mastitis, breast problem, breast engorgement, milk stasis, blocked ducked, breast pain, breast massage, and acupoint massage. Outcomes and the measurement schemes (measurement methods, timing of assessing outcome, frequency of assessing outcome, measurers) were extracted from the included studies. We used the Management of Otitis Media with Effusion in Children with Cleft Palate (MOMENT) to assess the quality of each study, then categorized outcomes derived from the included studies into different domains according to the Outcome Measures in Rheumatology Arthritis Clinic Trials (OMERACT) Filter 2.1 framework.Results We identified 85 clinical trials, in which 54 different outcomes were reported. A total of 81.2% (69/85) of studies were assessed as medium quality with a mean score of 2.6, and 18.8% (16/85) as low quality with a mean score of 0.9. These outcomes were organized in three core areas. Lump size (89.4%, 76/85) was the most frequently reported outcome, followed by breast pain (69.4%, 59/85) and milk excretion (68.2%, 58/85). Five methods were used to assess lump size and four methods to assess breast pain.Conclusions The outcomes reported in clinical trials regarding stasis acute mastitis treated by Traditional Chinese Medicine breast massage are heterogeneous. Developing a core outcome set to achieve consistent standards for reporting outcomes and modalities for validation of the outcomes is clearly warranted.

The efficacy and safety of Chinese massage in the treatment of acute mastitis: A protocol for systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: The incidence of acute mastitis (AM) in lactating women has been increasing year by year. If there is no timely and appropriate treatment, AM may develop into mammary abscess and septicemia. This special situation has aroused social attention. Chinese massage has been widely used in the treatment of AM in recent years, but there is no systematic review of the effect of Chinese massage on AM. We plan to explore the efficacy and safety of Chinese massage in the treatment of AM. METHODS: We will use a computer to search the following 8 electronic databases (PubMed, Web of Science, Cochrane, Embase, Sinomed, China National Knowledge Infrastructure, Chongqing VIP Information, WanFang Data) on November 30, 2021. Randomized controlled trials (RCT) of Chinese massage therapy for AM were screened. Primary outcome measure: overall clinical response rate, breast pain score. Secondary outcome measures: milk secretion, temperature, mass size and time to resolution, White blood cell count, C-reactive protein, and the incidence of adverse reactions. According to the inclusion criteria and exclusion criteria, the included literature will be independently evaluated by two researchers using the RCT bias risk assessment tool in the Cochrane evaluation manual Handbook5.4, and meta-analysis will be performed by RevMan5.4 software. Funnel plots were used to analyze whether the study had publication bias. RESULTS: We will evaluate the clinical effect of Chinese massage therapy on AM based on RCTs. CONCLUSION: This study will provide evidence-based evidence for the effectiveness and safety of Chinese massage in the treatment of AM. PROTOCOL REGISTRATION NUMBER: INPLASY2021120019.

An overview on mastitis-associated Escherichia coli: Pathogenicity, host immunity and the use of alternative therapies.

Escherichia coli is one of the leading causes of bovine mastitis; it can cause sub-clinical, and clinical mastitis characterized by systemic changes, abnormal appearance of milk, and udder inflammation. E. coli pathogenicity in the bovine udder is due to the interaction between its virulence factors and the host factors; it was also linked to the presence of a new pathotype termed mammary pathogenic E. coli (MPEC). However, the presence of this pathotype is commonly debated. Its main virulence factor is the lipopolysaccharide (LPS) that is responsible for causing an endotoxic shock, and inducing a strong immune response by binding to the toll-like receptor 4 (TLR4), and stimulating the expression of chemokines (such as IL-8, and RANTES) and pro-inflammatory cytokines (such as IL-6, and IL-1ß). This strong immune response could be used to develop alternative and safe approaches to control E. coli causing bovine mastitis by targeting pro-inflammatory cytokines that can damage the host tissue. The need for alternative treatments against E. coli is due to its ability to resist many conventional antibiotics, which is a huge challenge for curing ill animals. Therefore, the aim of this review was to highlight the pathogenicity of E. coli in the mammary gland, discuss the presence of the new putative pathotype, the mammary pathogenic E. coli (MPEC) pathotype, study the host's immune response, and the alternative treatments that are used against mastitis-associated E. coli.

A Five-step Systematic Therapy for Treating Plugged Ducts and Mastitis in Breastfeeding Women: A Case-Control Study.

PURPOSE: This study aimed to describe the clinical response to five-step systematic therapy (FSST) in the management of plugged ducts and mastitis. FSST was a comprehensive milk stasis dredging treatment, which contained five steps to make the milk out of the plugged duct. METHODS: This retrospective study included 922 breastfeeding women, 714 with plugged ducts, and 208 with mastitis who received FSST from June to September 2017. The breast pain score, swelling degree, and range of breast induration were recorded pre-FSST and post-FSST. RESULTS: After a single FSST, pain score and swelling degree were significantly improved (both p < .001) in all cases. After FSST, the mean breast pain relief score was 1.69 ± 0.70, whereas the mean swelling fade away degree was 1.61 ± 0.62. In the subgroup analysis, pain score and swelling degree were significantly improved (both p < .001) in the plugged ducts group and the mastitis group. The score of pain relief in the plugged ducts group was less than that in the mastitis group (1.63 ± 0.68 vs. 1.91 ± 0.70, t = 5.30; p < .001), whereas improvement of swelling fade away was greater in the plugged ducts group than the mastitis group (1.65 ± 0.64 vs. 1.48 ± 0.56, t = 3.49; p = .001). The composition ratio of changes in induration range between the two groups was statistically different (Pearson χ2 = 137.87, p < .001), of which more obvious improvement in the plugged ducts group than the mastitis group (χ2 = 25.65, p < .001). CONCLUSION: FSST can relieve pain, reduce breast swelling and range of induration, and for plugged ducts or mastitis varied degree differently.

The Use of Osteopathic Manipulative Medicine in the Management of Recurrent Mastitis.

Mastitis affects breastfeeding mothers everywhere and management obstacles often lead to cessation of breastfeeding. Breastfeeding mastitis is commonly managed with antibiotics despite lack of clear infectious etiology. With the emerging problem of antibiotic resistance, novel managements are required. We present the case of a 34-year-old woman with 6 pregnancies and 3 children (gravida 6, parity 3) who had 5 cases of mastitis within 6 months treated with multiple courses of antibiotics. The patient underwent with osteopathic manipulative treatment (OMT) to the affected breast over 2 sessions and was taught how to perform self-myofascial release. Techniques are shown in an accompanying Supplemental Video. As of this report, the patient had been symptom free for 1 year. Future research, including a clinical trial of OMT, is required to determine whether osteopathic physicians can effectively manage recurrent lactational mastitis.

Chinese medicine treatment of mastitis in COVID-19 patients: A protocol for systematic review.

BACKGROUND: Assessing the effectiveness and safety of Chinese medicine for the mastitis in COVID-19 patients is the main purpose of this systematic review protocol. METHODS: The following electronic databases will be searched from inception to April 2020: MEDLINE, Ovid, EMBASE, the Cochrane Library, the Allied and Complementary Medicine Database (AMED), Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), VIP Database and Wanfang Database. In addition, Clinical trial registries, like the Chinese Clinical Trial Registry (ChiCTR), the Netherlands National Trial Register (NTR) and ClinicalTrials.gov, will be searched for ongoing trials with unpublished data. No language restrictions will be applied. The primary outcome will be the time of disappearance of main symptoms (including fever, asthenia, cough disappearance rate, and temperature recovery time), and serum cytokine levels. The secondary outcome will be the accompanying symptoms (such as myalgia, expectoration, stuffiness, runny nose, pharyngalgia, anhelation, chest distress, dyspnea, crackles, headache, nausea, vomiting, anorexia, diarrhea) disappear rate, negative COVID-19 results rate on 2 consecutive occasions (not on the same day), CT image improvement, average hospitalization time, occurrence rate of common type to severe form, clinical cure rate, and mortality. Two independent reviewers will conduct the study selection, data extraction and assessment. RevMan V.5.3 will be used for the assessment of risk of bias and data synthesis. RESULTS: The results will provide a high-quality synthesis of current evidence for researchers in this subject area. CONCLUSION: The conclusion of the study will provide an evidence to judge whether Chinese medicine is effective and safe for mastitis in COVID-19 patients. PROSPERO REGISTRATION NUMBER: CRD42020189924.

Antimicrobial activity of propolis extract fractions against Staphylococcus spp. isolated from goat mastitis / Atividade antimicrobiana de frações do extrato de própolis frente à Staphylococcus spp. isolados de mastite caprina

The indiscriminate use of antibiotics in the treatment of caprine mastitis causes the appearance of resistant microorganisms, besides leaving residues in milk, putting at risk to human health. In this way, propolis is an alternative in the treatment of diseases because it has antimicrobial activity, mainly because of the presence of flavonoids in its composition. The aim of this study was to evaluate the antimicrobial potential of propolis to Staphylococcus spp. Isolated from cases of goat mastitis and qualify the crude ethanoic extract by high performance liquid chromatography (HPLC). In this study, the minimum bactericidal concentration values of propolis extracts in ethanol, ethyl acetate and hexane showed that the best concentrations capable of promoting the highest mortality of the isolates of Staphylococcus spp. from mastitis in goats, were 6250, 3125 and 1562.5µg/mL, respectively. By the microplate adherence test, it was found that 20.78% isolates were not able to form biofilm, 14.70% were classified as moderate and 64.70% were weak and none as a strong biofilm producer. Propolis in its different diluents was able to affect the formation of biofilm and showed a pronounced marked antimicrobial activity against Staphylococcus spp. strains and may be indicated for use in in vivo studies.(AU)

O uso indiscriminado de antibióticos no tratamento de mastite caprina leva ao desenvolvimento de micro-organismos resistentes que poderão estar presentes em alimentos, colocando em risco a saúde humana. Dessa forma, a própolis surge como uma alternativa para o tratamento de doenças por possuir uma ação antimicrobiana, principalmente pela presença de flavonoides em sua composição. O objetivo desse estudo foi avaliar o potencial antimicrobiano da própolis frente à Staphylococcus spp. isolados de casos de mastite caprina e qualificar o extrato etanoico bruto por cromatografia líquida de alta eficiência (CLAE-DAD). Neste estudo, os valores de concentração bactericida mínima (CBM) dos extratos de própolis em álcool etílico, acetato de etila e hexano nos isolados foram de 6250, 3125 e 1562,5µg/mL, respectivamente. Pelo teste de aderência à microplacas, observou-se que 20,78% dos microorganismos, não foram capazes de formar biofilme, 14,70% foram classificados como moderados, 64,70% em fracos e nenhum como forte produtor de biofilme. A própolis em seus diferentes diluentes foi capaz de afetar a formação de biofilme e apresentou significativa atividade antimicrobiana frente a cepas de Staphylococcus spp., podendo ser indicada para utilização em estudos "in vivo".(AU)

Effectiveness of breast massage for the treatment of women with breastfeeding problems: a systematic review.

OBJECTIVES: The aim of this systematic review was to identify the effectiveness of breast massage as a treatment for women with breastfeeding problems. More specifically, the objective was to identify if breast massage as an intervention led to less pain or increased milk supply, or assisted in a reduction or resolution of blocked ducts, breast engorgement and mastitis. INTRODUCTION: Breastfeeding protects babies against many illnesses, and the health benefits for women have been well documented. However, breastfeeding rates steadily drop to approximately 15% by six months, which is the World Health Organization's recommended length of time for exclusive breastfeeding. Breastfeeding problems such as blocked ducts, breast engorgement and mastitis are major complications attributing to the decline in breastfeeding rates. Breast massage may relieve pain and resolve symptoms associated with conditions that contribute to discontinued breastfeeding. INCLUSION CRITERIA: This review considered both experimental and epidemiological study designs and included breastfeeding women of any age, parity or geographical location. The types of interventions considered for inclusion were any type of breast massage that was offered to women for breastfeeding problems. Comparators included the usual care provided to women with breastfeeding problems. Primary outcomes of interest were an increase in breast milk supply, reduction of breast pain, and symptom resolution of blocked ducts, engorgement and mastitis. Secondary outcomes included duration of breastfeeding. METHODS: Studies published from 1980 to 2017 in English and Japanese were considered for inclusion in this review. The databases searched with the majority of results included CINAHL, Cochrane Library, Embase, PubMed, Science Direct, Scopus and Web of Science. Search for unpublished studies included Google Scholar, ClinicalTrials.gov and ProQuest Dissertations and Theses. RESULTS: There were six studies included in this review: three randomized controlled trials and three quasi-experimental studies. There was considerable heterogeneity of study outcome measures, and the use of unvalidated tools in many of the studies led to the inability to pool the results. Furthermore, the heterogeneity of the interventions themselves coupled with small sample sizes for each study greatly decreased generalizability of the outcomes and reduced the overall effectiveness of the interventions. However, all included studies reported a reduction in pain regardless of the breast massage technique used. Overall, varying types of breast massage were helpful in reducing immediate pain and resolving symptoms. CONCLUSIONS: Overall, different types of breast massage were reported as effective in reducing immediate pain for the participants. However, the lack of detailed explanation of the breast massage technique and the extensive training needed to undertake the breast massage decrease the ability to replicate the results. These outcomes may be useful for healthcare professionals caring for women with breastfeeding problems. Future research needs include validating a universal measurement tool for breastfeeding problems and the need for more robust randomized controlled trials, particularly in vulnerable groups such as mothers of preterm infants. Longer follow-up periods are also suggested to establish if breast massage impacts breastfeeding duration.

Ductal Lavage for Patients With Nonlactational Mastitis: A Single-Arm, Proof-of-Concept Trial.

BACKGROUND: Surgery, steroids, and/or observations alone have been proposed for patients with nonlactational mastitis (NLM), but most of these studies were retrospective. The optimal treatment for these patients remains unclear. This prospective, single-arm, proof-of-concept trial aimed to evaluate the feasibility and safety of ductal lavage as a novel treatment for patients with NLM. METHODS: Eligible patients with NLM received an intraductal infusion of corticosteroids and antimicrobial agents and returned the next day for a breast massage. This cycle was repeated for 2 wk, and we followed up these patients for 1 y. Patients did not receive surgery or steroids after ductal lavage. The primary endpoint was the time to complete response (CR). RESULTS: This trial included 32 patients with a median (range) age of 32 (20-53). Skin erythema and tenderness were the major symptoms. The median (range) visual analog score was 5 (0-9). There were 21 (65.6%), 4 (12.5%), and 7 (21.9%) patients diagnosed as idiopathic granulomatous mastitis, periductal mastitis, and unspecific NLM, respectively. During the ductal lavage, the median (range) number of cannulated ducts at first attempt was 5 (3-8). Ductal lavage significantly reduced the visual analog score and mastitis score (M-score) (P < 0.01). Within a median follow-up of 15.6 mo, 93.8% (30/32) of patients achieved CR. The median (range) time to CR was 6 (0.5-21) mo. Three patients (10.0%) relapsed. No adverse events associated with ductal lavage were observed. CONCLUSIONS: Ductal lavage for patients with NLM is feasible and safe, and a definitive randomized controlled trial for further investigation is warranted. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02794688.

The microbiology and treatment of human mastitis.

Mastitis, which is generally described as an inflammation of breast tissue, is a common and debilitating disease which frequently results in the cessation of exclusive breastfeeding and affects up to 33% of lactating women. The condition is a primary cause of decreased milk production and results in organoleptic and nutritional alterations in milk quality. Recent studies employing culture-independent techniques, including metagenomic sequencing, have revealed a loss of bacterial diversity in the microbiome of mastitic milk samples compared to healthy milk samples. In those infected, the pathogens Staphylococcus aureus, Staphylococcus epidermidis and members of corynebacteria have been identified as the predominant etiological agents in acute, subacute and granulomatous mastitis, respectively. The increased incidence of antibiotic resistance in the causative species is also a key cause of concern for treatment of the disease, thus leading to the need to develop novel therapies. In this respect, probiotics and bacteriocins have revealed potential as alternative treatments.

Important knowledge gaps among pastoralists on causes and treatment of udder health problems in livestock in southern Ethiopia: results of qualitative investigation.

BACKGROUND: Ethiopia has high prevalences of udder health problems including clinical and subclinical mastitis across production systems in different livestock species. Previous studies on udder health problems have largely focused on identification of mastitis causing microbial pathogens and associated risk factors. However, relatively little is known about the knowledge and beliefs of livestock keepers regarding udder health problems. An understanding of the beliefs on the other hand would facilitate effective communication between livestock keepers and animal health professionals. Therefore, this study aimed at exploring the knowledge and belief surrounding the causes, clinical signs and treatments for udder health problems in (agro-) pastoral communities in southern Ethiopia using qualitative investigation. RESULTS: The result showed that udder health problem, locally known as 'dhukkuba muchaa', which translates to 'disease of teats', was classified into three main types: (1) tick infestation (dirandisa), (2) swelling of udder often with pus discharge (nyaqarsa) and (3) acute mastitis caused by evil eye (buda) with 'bloody milk'. Tick infestation was perceived to directly cause mechanical damage to udder tissue or to resulting in swelling leading to nyaqarsa. Our analysis also revealed the strong misperception that acute and severe swelling of udder was caused by evil eye. According to the pastoralists, cows with large udders in the late pregnancy are prone to evil eye infliction upon giving birth. The pastoralists often treat udder health problems by combining both modern and traditional methods. Removal of ticks by hand and acarcide application were the preferred methods for limiting tick infestation while swelling and evil eye cases were treated with antibiotics (e.g. oxytetracycline). The study also revealed that specific herbs, only known by the herbalists, were used for traditional treatment of udder health. Although this information could not be divulged at the time, it should form the subject of further investigation. Traditional treatment for evil eye was often administered through nostrils, raising questions about its effectiveness. CONCLUSION: The narration given by the pastoralists in associating tick infestation with udder health problems was compatible with existing scientific evidences. In this respect, such local knowledge can be better utilized for the educational messages targeting control and management of tick infestation in livestock. However, the misperception of causes for acute udder swelling as evil eye can be problematic as far as the application of appropriate treatment and management of the problem is concerned. The misperception can significantly impact the welfare of animals and highlights the need for capacity building of the pastoralists on the causes and treatment of udder health problems.

Therapeutic Breast Massage in Lactation for the Management of Engorgement, Plugged Ducts, and Mastitis.

BACKGROUND: Many women in developed countries do not meet their breastfeeding goals and wean early because of breast pain. OBJECTIVE: This study aimed to describe clinical response to therapeutic breast massage in lactation (TBML) in the management of engorgement, plugged ducts, and mastitis. METHODS: Breastfeeding women presenting with engorgement, plugged ducts, or mastitis who received TBML as part of their treatment were enrolled (n = 42). Data collected at the initial visit included demographic, history, and exam data pre-TBML and post-TBML. Email surveys sent 2 days, 2 weeks, and 12 weeks following the initial visit assessed pain and breastfeeding complications. A nested case control of engorged mothers (n = 73) was separately enrolled to compare engorgement severity. RESULTS: Reasons for the visit included engorgement (36%), plugged ducts (67%), and mastitis (29%). Cases, compared to controls, were significantly more likely to have severe engorgement (47% vs 7%, P < .001). Initial mean breast pain level among those receiving TBML was 6.4 out of 10. Following TBML, there was significant improvement in both breast (6.4 vs 2.8, P < .001) and nipple pain (4.6 vs 2.8, P = .013). All women reported immediate improvement in their pain level. At the 12-week survey, 65% found the massage treatment very helpful. The majority of the women with a new episode of mastitis or plugged duct during the study follow-up found the techniques learned during the office visit very helpful for home management of these episodes. CONCLUSION: In office, TBML is helpful for the reduction of acute breast pain associated with milk stasis. Mothers find TBML helpful both immediately in-office and for home management of future episodes.

Challenges in the treatment of lactational mastitis for general practitioners.

OBJECTIVES: To determine how GPs manage breastfeeding women with mastitis and how confident they are in treating women with breast conditions that occur during lactation. DESIGN, PARTICIPANTS AND SETTING: A cross-sectional survey conducted among all Croatian GPs. KEY FINDINGS: Sixty-four per cent of the total number of respondents (171/268) had seen a patient with lactational mastitis (LM) in the previous 12 months. Among respondents who recommended medication for the treatment of LM, 93% prescribed an antibiotic (122/131). Fifteen per cent of respondents who gave advice on infant feeding advised alternative feeding methods. Approximately half (47%) felt completely confident when treating LM while more than half (57%) felt partially confident when treating other breast conditions that can occur during lactation. CONCLUSION: The management of LM among Croatian GPs is not in full compliance with current recommendations. FUTURE IMPLICATIONS: There is a need for further training of Croatian GPs in the management of mastitis.

Low-level laser therapy attenuates LPS-induced rats mastitis by inhibiting polymorphonuclear neutrophil adhesion.

The aim of this study was to investigate the effects of low-level laser therapy (LLLT) on a rat model of lipopolysaccharide (LPS)-induced mastitis and its underlying molecular mechanisms. The rat model of mastitis was induced by inoculation of LPS through the canals of the mammary gland. The results showed that LPS-induced secretion of IL-1ß and IL-8 significantly decreased after LLLT (650 nm, 2.5 mW, 30 mW/cm(2)). LLLT also inhibited intercellular adhesion molecule-1 (ICAM-1) expression and attenuated the LPS-induced decrease of the expression of CD62L and increase of the expression of CD11b. Moreover, LLLT also suppressed LPS-induced polymorphonuclear neutrophils (PMNs) entering the alveoli of the mammary gland. The number of PMNs in the mammary alveolus and the myeloperoxidase (MPO) activity were decreased after LLLT. These results suggested that LLLT therapy is beneficial in decreasing the somatic cell count and improving milk nutritional quality in cows with an intramammary infection.

Evaluación del efecto antimicrobiano de Aloe barbadensis Miller asociado a ceftiofur sobre cepas de Escherichia coli / Evaluation of the antimicrobial effect of Aloe barbadensis Miller associated with ceftiofur on strains of Escherichia coli

El uso indiscriminado de antimicrobianos en animales de producción es la principal causa del aumento de la resistencia bacteriana, por lo que organizaciones intergubernamentales solicitan disminuir el uso excesivo de estos fármacos. La mastitis es causada principalmente por Escherichia coli en la zona central de Chile y, debido a que su tratamiento se concentra en el uso de antimicrobianos, se ha estudiado Aloe barbadensis Miller (Aloe vera) como una alternativa terapéutica por su efecto antimicrobiano. El objetivo de este trabajo fue evaluar el efecto inhibitorio "in vitro" de A. vera asociado a Ceftiofur en concentraciones menores a su Concentración Mínima Inhibitoria (CMI), frente a E. coli ATCC 25922 y en cepas aisladas de vacas con mastitis clínica. Se utilizó el Método de Macrodilución en Caldo. La CMI fue determinada mediante turbidez y confirmada por recuento de UFC/mL y por espectrofotometría UV-visible. Las cepas de campo fueron sometidas a un estudio de sensibilidad (Kirby Bauer) frente a un panel de antimicrobianos antes de analizar el efecto inhibitorio de A. vera. La CMI de A. vera se determinó en 60 mg/mL. La asociación de A. vera/Ceftiofur no inhibió el crecimiento de E. coli ATCC 25922. Todas las cepas de campo presentaron sensibilidad intermedia o resistencia a al menos un antimicrobiano, pero fueron inhibidas por A. vera. Esto sugiere que A. vera es más efectiva en la inhibición del crecimiento de E. coli en comparación a la asociación y podría presentarse como una alternativa terapéutica frente a mastitis clínicas causadas por E. coli.

Antibiotics for mastitis in breastfeeding women.

BACKGROUND: Mastitis can be caused by ineffective positioning of the baby at the breast or restricted feeding. Infective mastitis is commonly caused by Staphylococcus aureus. The prevalence of mastitis in breastfeeding women may reach 33%. Effective milk removal, pain medication and antibiotic therapy have been the mainstays of treatment. OBJECTIVES: This review aims to examine the effectiveness of antibiotic therapies in relieving symptoms for breastfeeding women with mastitis with or without laboratory investigation. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 September 2012), contacted investigators and other content experts known to us for unpublished trials and scanned the reference lists of retrieved articles. SELECTION CRITERIA: We selected randomised controlled trials (RCTs) and quasi-RCTs comparing the effectiveness of various types of antibiotic therapies or antibiotic therapy versus alternative therapies for the treatment of mastitis. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted data. When in dispute, we consulted a third author. MAIN RESULTS: Two trials met the inclusion criteria. One small trial (n = 25) compared amoxicillin with cephradine and found no significant difference between the two antibiotics in terms of symptom relief and abscess formation. Another, older study compared breast emptying alone as 'supportive therapy' versus antibiotic therapy plus supportive therapy, and no therapy. The findings of the latter study suggested faster clearance of symptoms for women using antibiotics, although the study design was problematic. AUTHORS' CONCLUSIONS: There is insufficient evidence to confirm or refute the effectiveness of antibiotic therapy for the treatment of lactational mastitis. There is an urgent need to conduct high-quality, double-blinded RCTs to determine whether antibiotics should be used in this common postpartum condition.

Recapturing the art of therapeutic breast massage during breastfeeding.

Milk expression is a normal part of breastfeeding, but in developed countries in particular, the focus tends to center on mechanical expression. In Russia, there is a long tradition of hands-on techniques that continues in the present day and includes mothers turning to providers trained in hand expression and breast massage techniques to resolve breastfeeding complications including engorgement, plugged ducts, and mastitis. As observed over the course of several trips to Russia, Russian clinicians routinely combine hand expression with breast massage for the treatment of milk stasis, engorgement, and plugged ducts. A better understanding of these hands-on techniques to assist in resolution of complications may provide additional treatment options for the lactation community.