338 Management of Periprosthetic Breast Infection: A Systematic Review and Meta-Analysis

Aim This systematic review and meta-analysis aims to synthesize the current evidence and establish the efficacy of the various managements of infected breast implants. Method A comprehensive search in the MEDLINE, EMBASE and CENTRAL databases was conducted for primary clinical studies reporting on the management of infected breast implants from 1946 to September 2019. The primary outcome measure was the proportion of patients with successful treatment. Results Nineteen articles involving 1044 patients were included. Mild infections seen in 29.00%(95%CI=11.51% to 50.58%) of the patients were treated exclusively with antibiotics, of which, 81.41%(95%CI=57.82% to 96.63%) were successfully treated without the need for surgical intervention. Overall, 39.01%(95%CI=21.41% to 58.23%) of the patients underwent surgical salvage of the infected breast implants, of which 84.56% (95%CI= 74.92% to 92.20%) successfully retained the salvaged implants without infection recurrence. Meanwhile, 35.01%(95%CI=27.01% to 43.57%) of the patients underwent explantation of the infected breast implant, of which, only 39.02%(95%CI=23.93% to 55.28%) had re-insertion of a new implant on a later date, and 4.99% (95%CI=1.66% to 9.99%) of these patients had recurrence of infection requiring removal of the infected implant. The commonest complication was capsular contracture, which was reported in 10.78%(95%CI=4.41% to 19.49%) of the patients. Changes in the quality of life and cost implications were not reported. Conclusions This study consolidates current available evidence on the management of infected breast implants, which could assist decision making and improve patient education, however current data is limited by the lack of level-1 evidence.

Patterns and Barriers of Breast Feeding among Lactating Females in Kafr Esam Rural Health Unit

Background: Breastfeeding is considered as one of the major public health strategies for improving infant and child morbidity and mortality, as well as decreasing maternal morbidity because of the wide range of benefits of exclusive breastfeeding to the mother and infant. The aim of the work was to identify the frequency of exclusive breastfeeding, patterns and barriers of breastfeeding. Methodology: A cross- sectional study was carried out on 400 lactating women from July 2019 up to Sep. 2020 at Kafr Esam Rural Health Unit in Gharbia Governorate, Egypt. Data were collected by a self-administrated questionnaire. Results: The frequency of exclusively breastfeeding women was 44.75%, while 30.25% were mixed breastfeeding and formula and 25% were using formula only. The barriers of exclusive breastfeeding were: had low breast milk supply (20.25%), mothers work related (9.5%), infant illness (9.25%), mother illness (8%), sore and cracked nipples (7%), easier bottle feeding (6.5%), more than one problem (6.25%), mother on medication (4.75%), 4.5% had baby crying too much, 2.25% had breast infection, 2.25% didn’t like breastfeeding, 1.25% had pressure from family, 0.75% were fasting in Ramadan and no patient said that husband didn’t support breastfeeding. Conclusions: The prevalence of exclusive breastfeeding for the first 6 months of infant’s life was accepted (44.75%) but needs more improvement and multiple barriers were present. Management of breastfeeding barriers and their problems. Encourage pregnant women for vaginal delivery. Initiate and support breastfeeding campaigns by mass media annually define a national day for breastfeeding. Further studies are needed.

Necrotizing Soft Tissue Infection of the Breast during COVID-19 Pandemic

Necrotizing soft tissue infection has been historically recognized as a severe, rapidly spreading soft tissue infection associated with a very high risk of mortality. Cases of primary necrotizing fasciitis of the breast are rarely described but often fatal. We present a case of necrotizing soft tissue infection of the right breast extending to the anterior abdominal wall in a 39-year-old obese female, with a history of tobacco use. The patient presented 10 days after symptom onset due to concerns and anxiety related to COVID-19 exposure. This delay allowed for further extension and smoldering of the breast infection. The treatment of this aggressive disease process begins with early diagnosis, where a high index of suspicion is vital. Once diagnosed, the treatment regimen should be composed of emergent surgical debridement, which can include breast salvage debridement or total mastectomy, in addition to antibiotic therapy.

Recurrent bilateral breast abscess due to Mycobacterium abscessus in an immune-competent woman

Mycobacterium abscessus is a rapidly growing, non-tubercular mycobacteria, often associated with skin and soft tissue infections. We report a case of 57-year-old immune-competent woman who suffered recurrent bilateral breast infection for 6 years. She did not benefit from repeated surgical interventions and multiple courses of antibiotics, and one course of empirical antitubercular therapy. Chronicity of the presentation and non-response to varied treatment interventions prompted further microbiological investigations. The patient was diagnosed with M. abscessus and treated with rifabutin, clarithromycin daily for 6 months and injection amikacin for 1 month. Amikacin was replaced with oral levofloxacin due to bilateral sensory-neural hearing loss for higher frequencies after 6 months. Suspicion and identification of NTM are important as the treatment involves long-term combination antibacterial therapy along with surgical debridement for extensive infection or when implants are involved.

Complications and Diseases in the Postpartum and Their Treatment

The general purpose of the study is to know and understand the basic concepts of presentation and position at birth and dystocia during labor. The infection that happened causes complicatons and disease for example Mother’s milk dam, breast infection, Tromboplebitis, and Psychological disorders during Postpartum. Postpartum period which starts from the time the baby is born and the placenta is born until the womb returns to what it was before pregnancy. The paper will discusse about the symtoms, system and treatment of the disease in the Postpartum.