Hypocalcemia (milk fever) is a severe metabolic disease in dairy cattle, affecting up to 50% of multiparous cows postpartum and leading to significant economic losses and increased risk of secondary disorders. Rapid, low cost, and on-site detection of low blood calcium levels (< 1.1 mM) is needed for timely intervention, yet current diagnostic methods are costly, complex, or require centralized laboratory analysis, delaying treatment. This study addresses the need for a simple, rapid, and cost-effective diagnostic tool by developing a gold nanoparticle-functionalized test strip for the quantification of ionized calcium (Ca[2+]) in bovine plasma and milk. The assay uses the Ca[2+]-sensitive fluorescent dye Fluo-5 N, with gold nanoparticles (AuNPs) integrated into nitrocellulose membrane to amplify the fluorescent signal based on the metal-enhanced fluorescence (MEF) effect. This test is designed for rapid, dip-and-read operation. Optimal assay performance was achieved through a simple, scalable fabrication process costing an estimated $0.14 CAD per strip and yielding a rapid 30-second readout after sample application. MEF optimization demonstrated a threefold increase in fluorescence intensity compared to controls without AuNPs. The test strip established strong linear correlations across clinically relevant dilutions in bovine plasma (R[2] = 0.981) and skim milk (R[2] = 0.941), with 95.0% to 108.6% recovery across different milk dilutions and an average recovery of 96.7% in skim milk, confirming its robustness against matrix effects in the target biological fluids. The functional detection range, spanning from a limit of detection of 431µM to 1.1 mM, and with a limit of quantification of 616 μM, effectively covering the critical diagnostic window for subclinical hypocalcemia (< 1.1 mM). Additionally, the test strips demonstrated long-term stability, maintaining performance for at least 120 days when stored at 4 °C. Lastly, the simple dipping-based sample application was validated as statistically equivalent to pipetting, showing potential for adaptation to farm use. This simple, portable technology could significantly improve herd health management with the potential to enable rapid, on-site screening for subclinical hypocalcemia, facilitating early treatment, and reducing the economic burden due to milk fever.

We present the case of a 39-year-old Indian female patient diagnosed with tuberculous mastitis and lymph node tuberculosis. The patient had a history of tuberculosis infection treatment as a newborn. She initially presented with symptoms including fever, weight loss, and coughing. Clinical examination revealed a newly developed mass in the right breast. Diagnostic workup included an 18F-FDG PET-CT scan, followed by repeated biopsies. Microbiological culture, molecular testing, and histopathological analysis confirmed the presence of Mycobacterium tuberculosis. Tuberculous mastitis is a rare form of extrapulmonary tuberculosis. Its diagnosis is often complicated due to frequent false-negative results in microbiological and histological tests. It predominantly affects women of childbearing age, especially in the postpartum period.

Maternal satisfaction with labor epidural analgesia is a clinically relevant patient-centered outcome influenced by analgesic efficacy, the care process, and perinatal complications. This retrospective cohort study analyzed de-identified clinical records and routinely collected postpartum satisfaction assessments from 2221 parturients who received labor epidural analgesia at Fujian Maternity and Child Health Hospital between July 2023 and March 2024. The cohort was randomly divided into training (n = 1555) and internal validation (n = 666) sets. Least absolute shrinkage and selection operator regression, followed by univariate and multivariable logistic regression, was used to construct a nomogram predicting maternal dissatisfaction. Fever, nausea and vomiting, puncture pain, lumbar soreness, and lower limb motor impairment were independent predictors of dissatisfaction. The model showed good discrimination in the training set (AUC 0.789, 95% CI 0.764-0.814) and validation set (AUC 0.764, 95% CI 0.720-0.809), with satisfactory calibration (Hosmer-Lemeshow χ[2] = 4.58, P = 0.205). This complication-based nomogram demonstrated acceptable internal performance for predicting maternal dissatisfaction with labor epidural analgesia; external validation is needed before wider implementation.

Emphysematous endometritis is a rarely described clinical entity. The present report describes the case of a 44 -year-old woman who presented 2 weeks postpartum with abdominal pain, malodorous vaginal discharge, fever, and paresthesia in the setting of uterine embolization. Imaging showed emphysematous changes in the wall of the uterus. Histology of the hysterectomy sample showed acute suppurative myometritis, subserosal neutrophilic infiltrates, and emphysematous air pockets; these were accompanied by embolic material, bacterial clumps, and granulation tissue. Her recovery from the hysterectomy was without further complications.

Acupuncture at traditional Chinese medicine (TCM) sites used to treat low milk supply has been claimed to cause release of prolactin and oxytocin, although published studies have found mixed results on serum prolactin. In one study, acupuncture did not affect prolactin hyperresponsiveness after stimulation with metoclopramide in women with amenorrhea-galactorrhea syndrome. Galactorrhea has been reported following acupuncture for pain treatment. No adverse effects on milk production were seen among lactating women who received acupuncture for postpartum sciatica.[1] Acupuncture has been well described in TCM for treating insufficient milk supply,[2,3] and is also recommended in some Western countries.[4] Numerous studies found acupuncture at CV 17 (also referred to as Ren 17, Danzhong or Shanzong; located at the center of the sternum), SI 1 (Shaoze; on the little finger), ST 18 (Rugen; lower breast margins), Zusanli (ST 36), and Taichong (LR 3) to benefit women with a low postpartum milk supply.[5] These studies generally do not meet current evidence-based guidelines, partly because of the extreme difficulty in double-blinding and placebo-controlling acupuncture studies. However, 2 studies did find a better response to electroacupuncture applied at a traditional site for lactation stimulation (SI 1) than electroacupuncture applied at a site unrelated to milk production (LI 1). Electroacupuncture increased serum prolactin, infant weight and maternal perception of milk production more than domperidone alone.[6] None of the studies reported to date have made an attempt to optimize maternal nursing technique before acupuncture. Although less studied, acupressure at milk acupuncture sites has had similar effects. A systematic review concluded that acupuncture and acupressure are effective in increasing breastmilk volume.[7] Acupuncture therapy has been used to treat breastfeeding for milk stasis (engorgement). Randomized, nonblinded studies in an outpatient Swedish lactation clinic compared routine care (including oxytocin spray) to routine care plus acupuncture at 2 or 3 points for treating milk stasis.[8,9] A meta-analysis concluded that women who received acupuncture were less likely to develop an abscess, had less severe symptoms on day five, and had a lower rate of fever than women in the usual care group However, there is insufficient evidence from published trials to justify widespread implementation.[10] A survey of 50 Swedish maternity units in 2007 found that 60% of hospitals used acupuncture to treat milk stasis, 18% used acupuncture to treat mastitis, and 2.2% each used it for painful breastfeeding or to improve milk supply. The authors felt that this extensive use was not justified based on the limited evidence for most of these uses.[11] Acupuncture and acupressure have also been used successfully as a treatment for breast engorgement.[7,12] Auricular therapy uses stimulation of acupoints on the ear corresponding to various anatomical sites and functions of the body for the diagnosis, treatment, and prevention of disease. All studies applied Vaccaria seeds to press on ear acupoints. Two systematic reviews on auricular therapy to increase milk supply have come to differing conclusions. One review found a positive effect on milk production, onset of lactation, serum prolactin, breast fullness, neonate states, and frequency of newborn urination and defecation.[13] A more recent review found varying efficacy between studies and poor methodology that did not allow for a definitive conclusion on efficacy as a galactogogue.[14] No adverse effects were reported in any studies.

The pubic symphysis is a rare site for septic arthritis. We report a case of infectious pubic symphysitis occurring in the postpartum period. A 33-year-old woman, gravida 2, para 2, with one living child and one stillbirth at 6 months of gestation was admitted 10 days postpartum with pubalgia and bilateral subacute inflammatory hip pain associated with fever. Initial examination revealed systemic inflammatory response syndrome. Rheumatological assessment showed bilateral clinostasis, tenderness on pubic palpation, and painful hip mobilization with a positive FABER test. Laboratory findings showed elevated inflammatory markers with a C-reactive protein (CRP) level of 338.15 mg/L. Blood cultures identified Escherichia coli sensitive to amoxicillin-clavulanic acid. Urinary cytobacteriological examination was sterile. Magnetic resonance imaging (MRI) revealed edema of the pubic symphysis and significant pelvic muscle infiltration with an intersymphyseal fluid collection extending to the hip joints. Joint fluid aspiration could not be performed due to the low volume. The diagnosis of infectious pubic symphysitis and septic hip arthritis was established. Targeted antibiotic therapy with amoxicillin-clavulanic acid (4 g/day) was initiated, leading to clinical improvement and a significant decrease in inflammatory markers. Although septic pubic arthritis is rare, it should be considered in cases of pubalgia with fever, particularly in postpartum settings where microbial seeding of the pubic symphysis may occur.

Infective endocarditis (IE) is a life-threatening condition that can lead to valvular destruction, systemic embolization, and multiorgan failure. While IE typically presents with fever and murmur, acute myocardial infarction (MI) is a rare initial manifestation, particularly in postpartum women. We report the case of a 34-year-old postpartum female who presented with chest pain and hypotension. Electrocardiography showed ST-segment changes suggestive of anterolateral MI. Laboratory tests revealed elevated troponin, leukocytosis, and methicillin-resistant Staphylococcus aureus bacteremia. Coronary angiography identified thrombotic occlusions, and echocardiography showed a mobile vegetation on the aortic valve with severe regurgitation. She underwent angioplasty, targeted antibiotics, and emergency valve replacement. Intraoperative findings confirmed extensive valve destruction. Postoperative recovery was uneventful. This case underscores the importance of considering IE in young patients with MI-like symptoms and systemic infection. Early echocardiography, blood cultures, and timely surgical intervention are critical for survival in such complex presentations.

Methylmalonic acidemia with homocystinuria (MMA-HC) is a rare inherited metabolic disorder characterized by diverse and nonspecific clinical manifestations. Here, we report the first case of MMA-HC presenting in the postpartum period, aiming to enhance clinicians' awareness and diagnostic capabilities regarding this condition. This will help prevent misdiagnosis and missed diagnosis, thereby enabling timely and effective treatment for patients. A 17-year-old woman who underwent cesarean section presented with encephalitis-like symptoms shortly after childbirth, including fever, headache, psychiatric disturbances, and limb weakness, accompanied by a progressive macrocytic anemia that worsened significantly from the late prenatal to the early postpartum period, along with markedly elevated red cell distribution width (RDW) and leukopenia and severe hyperhomocysteinemia. Genetic testing confirmed cblC-type MMA-HC. A metabolic crisis was triggered after administering valproate for seizures. The patient was effectively treated with a multidisciplinary approach, highlighting the importance of careful clinical monitoring and systematic metabolic screening in peripartum women presenting with progressive hematological abnormalities and encephalopathic symptoms. It further validates the critical role of early diagnosis and multidisciplinary comprehensive treatment in managing complex inherited metabolic disorders, thereby contributing to enhanced overall diagnostic and therapeutic standards.