Novel Lactation Induction Protocol for a Transgender Woman Wishing to Breastfeed: A Case Report.

Background: Lactation induction in transgender women is a clinical and research priority in the field of breastfeeding medicine. To date, there are four case reports detailing successful induced lactation in transgender patients who wished to breastfeed. The Academy of Breast Feeding Medicine does not formally recommend a specific medication regimen for transgender patients due to lack of high-quality research. Case Presentation: A 50-year-old transgender woman with a hypercoagulable disorder who was able to lactate and breastfeed with novel hormone regimen management at a gender care clinic. Her baseline hormone treatment was an estradiol 0.3 mg transdermal patch every 72 hours and micronized progesterone 200 mg daily. Results: Within four weeks of initiating a modified hormone regimen (estradiol 0.4 mg patch every 72 hours, progesterone 300 mg daily, metoclopramide 10 mg three times daily), the patient was lactating spontaneously. On multiple occasions, she breastfed and expressed up to 30 mL of milk through pumping. Conclusion: This report offers a new effective hormone regimen for transgender patients who wish to lactate and cannot access domperidone-the galactagogue used in previous case reports. It also provides a review of previously published case reports on this subject. Future research in this field should prioritize cohort studies of transgender patients who desire lactation to further assess patient attitudes, experiences, and outcomes.

Examining the Role of Narrative in Palliative Care for Parkinson Disease: Changing the Story.

Recent years have seen growing interest in neuropalliative care as a subspecialty. Simultaneously, the rise of narrative medicine in patient support groups and clinician training programs offers a way to listen deeply to the stories of those living with chronic illness and may inform corresponding health interventions. This commentary examines the ways in which an understanding of illness narrative schemata, particularly the so-called "chaos narrative," can contribute to patient and care partner distress, which in turn can be alleviated by a palliative care approach. Through examples of stories of people with Parkinson disease and their care partners, the article emphasizes the intersections between narrative medicine, neurology, and palliative care. Specific opportunities for bringing narrative medicine into the clinic are discussed.

TikTok, #IUD, and User Experience With Intrauterine Devices Reported on Social Media.

TikTok, a video-sharing application, offers a growing platform for contraception-related content. The top 100 videos tagged "#IUD" were compiled using a web-scraping application. User demographics and video content were analyzed by two independent reviewers, with a third to arbitrate differences. More videos had a negative tone (37.8%) about intrauterine devices (IUDs) than positive (19.4%), and 27.6% mentioned distrust of health care professionals. Of videos conveying patient experiences, all had a negative or ambiguous tone and 96.8% highlighted pain and other side effects related to IUDs. Videos scored low on information health quality (1.2/5 on DISCERN) and averaged 73.8% in understandability and 17.7% in actionability on PEMAT (Patient Education Materials Assessment Tool). #IUD videos on TikTok often portray negative experiences related to pain and informed consent.

Pathogen Evasion of Chemokine Response Through Suppression of CXCL10.

Clearance of intracellular pathogens, such as Leishmania (L.) major, depends on an immune response with well-regulated cytokine signaling. Here we describe a pathogen-mediated mechanism of evading CXCL10, a chemokine with diverse antimicrobial functions, including T cell recruitment. Infection with L. major in a human monocyte cell line induced robust CXCL10 transcription without increasing extracellular CXCL10 protein concentrations. We found that this transcriptionally independent suppression of CXCL10 is mediated by the virulence factor and protease, glycoprotein-63 (gp63). Specifically, GP63 cleaves CXCL10 after amino acid A81 at the base of a C-terminal alpha-helix. Cytokine cleavage by GP63 demonstrated specificity, as GP63 cleaved CXCL10 and its homologs, which all bind the CXCR3 receptor, but not distantly related chemokines, such as CXCL8 and CCL22. Further characterization demonstrated that CXCL10 cleavage activity by GP63 was produced by both extracellular promastigotes and intracellular amastigotes. Crucially, CXCL10 cleavage impaired T cell chemotaxis in vitro, indicating that cleaved CXCL10 cannot signal through CXCR3. Ultimately, we propose CXCL10 suppression is a convergent mechanism of immune evasion, as Salmonella enterica and Chlamydia trachomatis also suppress CXCL10. This commonality suggests that counteracting CXCL10 suppression may provide a generalizable therapeutic strategy against intracellular pathogens. Importance: Leishmaniasis, an infectious disease that annually affects over one million people, is caused by intracellular parasites that have evolved to evade the host's attempts to eliminate the parasite. Cutaneous leishmaniasis results in disfiguring skin lesions if the host immune system does not appropriately respond to infection. A family of molecules called chemokines coordinate recruitment of the immune cells required to eliminate infection. Here, we demonstrate a novel mechanism that Leishmania (L.) spp. employ to suppress host chemokines: a Leishmania-encoded protease cleaves chemokines known to recruit T cells that fight off infection. We observe that other common human intracellular pathogens, including Chlamydia trachomatis and Salmonella enterica, reduce levels of the same chemokines, suggesting a strong selective pressure to avoid this component of the immune response. Our study provides new insights into how intracellular pathogens interact with the host immune response to enhance pathogen survival.