Detection of Candida spp. in the vagina of a cohort of nulliparous pregnant women by culture and molecular methods: is there an association between maternal vaginal and infant oral colonisation?

BACKGROUND: Most studies describing vaginal Candida spp. in pregnancy focus on symptomatic vaginitis, rather than asymptomatic colonisation, and solely utilise microbiological culture. The extent to which asymptomatic vaginal carriage may represent a reservoir for infant oral colonisation has been highly debated. MATERIALS AND METHODS: This study formed part of the Candida and Staphylococcus Transmission Longitudinal Evaluation (CASTLE) study, in Melbourne, Australia, from 2009 to 2011 and used culture and molecular methods to examine vaginal swabs collected late in the third trimester of pregnancy for Candida spp. Oral swabs from infants were also examined using culture methods. RESULTS: Overall, 80 of 356 (22%) women were positive for Candida spp; the majority being Candida albicans (83%). Candida glabrata and other Candida spp. were also identified, but in much lower numbers. Molecular analysis identified numerous positive samples not detected by culture, including 13 cases of C. albicans. In addition, some positive samples only recorded to genus level by culture were accurately identified as either C. albicans or C. glabrata following molecular analyses. Eighteen infants recorded positive Candida spp. cultures, predominantly C. albicans. However, there were only four (25%) mother/infant dyads where C. albicans was detected. CONCLUSIONS: This study provides valuable data on asymptomatic colonisation rates of Candida spp. within an asymptomatic population of women late in pregnancy. The utilisation of molecular methods improved the rate of detection and provided a more accurate means for identification of non-albicans Candida spp. The low mother/infant colonisation rate suggests that non-maternal sources are likely involved in determining infant oral colonisation status.

Feminist poetics : symbolism in an emblematic journey reflecting self and vision

My thesis tilled Feminist Poetics: Symbolism in an Emblematic Journey Reflecting Self and Vision, consists of thirty oil paintings on canvas, several preparatory sketches and drawings in different media on paper, and is supported and elucidated by an exegesis. The paintings on unframed canvases reveal mise en scčnes and emblems that present to the viewer a drama about links between identities, differences, relationships and vision. Images of my daughter, friends and myself fill single canvases, suites of paintings, diptyches and triptychs. The impetus behind my research derives from my recognition of the cultural means by which women's experience is excluded from a representational norm or ideal. I use time-honoured devices, such as, illusionist imagery, aspects of portraiture, complex fractured atmospheric space, paintings and drawings within paintings, mirrors and reflective surfaces, shadows and architectural devices. They structure my compositions in a way that envelops the viewer in my internal world of ideas. Some of these features function symbolically, as emblems. A small part of the imagery relies on verisimilitude, such as my hands and their shadow and my single observing eye enclosed by my glasses. What remains is a fantasy world, ‘seen’ by the image of my other eye, or ‘faction’, based on memories and texts explaining the significance of ancient Minoan symbols. In my paintings, I base the subjects of this fantasy on my memories of the Knossos Labyrinth and matristic symbols, such as the pillar, snake, blood, eye and horn. They suggest the presence of a ritual where initiates descended into the adyton (holy of holies) or sunken areas in the labyrinth. The paintings attempt a ‘rewriting’ of sacrality and gender by adopting the symbolism of death, transformation and resurrection in the adyton. The significance of my emblematic imagery is that it constructs a foundation narrative about vision and insight. I sought symbolic attributes shared by European oil painting and Minoan antiquity. Both traditions share symbolic attributes with male dying gods in Greek myths and Medusa plays a central part in this linkage. I argue that her attributes seem identical to both those of the dying gods and Minoan goddesses. In the Minoan context these symbols suggest metaphors for the female body and the mother and daughter blood line. When the symbols align with the beheaded Medusa in a patriarchal context, both her image and her attributes represent cautionary tales about female sexuality that have repercussions for aspects of vision. In Renaissance and Baroque oil painting Medusa's image served as a vehicle for an allegory that personified the triumph of reason over the senses. In the twentieth century, the vagina dentata suggests her image, a personified image of irrational emotion that some male Surrealists celebrated as a muse. She is implicated in the male gaze as a site of castration and her representation suggests a symbolic form pertaining to perspective. Medusa's image, its negative sexual and violent connotations, seemed like a keystone linking iconographic codes in European oil painting to Minoan antiquity. I fused aspects of matristic Minoan antiquity with elements of European oil paintings in the form of disguised attribute gestures, objects and architectural environments. I selected three paintings, Dürer's Setf-Portrait, 1500, Gentileschi's Self-Portrait as the Allegory of Painting, 1630 and Velazquez's Las Meniruis, 1656 as models because 1 detected echoes of Minoan symbolism in the attributes of their subjects and backgrounds. My revision of Medusa's image by connecting it to Minoan antiquity established a feminist means of representation in the largely male-dominated tradition of oil painting. These paintings also suggested painting techniques that were useful to me. Through my representations of my emblematic journey I questioned the narrow focus placed on phallic symbols when I explored how their meanings may have been formed within a matricentric culture. I retained the key symbols of the patriarchal foundation narratives about vision but removed images of violence and their link to desire and replaced it with a ritual form of symbolic death. I challenged the binary oppositional defined Self as opposed to Other by constructing a complex, fluid Self that interacts with others. A multi-directional gaze between subjects, viewers and artist replaces the male gaze. Different qualities of paint, coagulation and random flow form a blood symbolism. Many layers of paint retaining some aspects of the Gaze and Glance, fuse and separate intermittently to construct and define form. The sense of motion and fluidity constructs a form of multi-faceted selves. The supporting document, the exegesis is in two parts. In the first part, I discuss the Minoan sources of my iconography and the symbolic gender specific meanings suggested by particular symbols and their changed meanings in European oil painting, I explain how I integrate Minoan symbols into European oil paintings as a form of disguised symbolism. In the second part I explain how my alternative use of symbolism and paint alludes to a feminist poetic.

Baseline comorbidities in a population-bases cohort of rheumatoid arthritis patients receiving biological therapy: data from the Australian Rheumatology Association database

Aims: To describe the baseline characteristics of an Australian population-based cohort of rheumatoid arthritis (RA) patients commencing biological therapy.

Methods: Descriptive analysis from the Australian Rheumatology Association Database (ARAD).

Results: Up to October 2006, there were 681 RA patients taking biologics enrolled in ARAD. Baseline data were available for 624 (72% female, mean (SD) age 57.0 (12.5) years). Of these, 59.5% reported at least one comorbid condition, most commonly hypertension (35.7%) and osteoporosis (30.4%); 61 (9.8%) had a history of malignancy (35 nonmelanoma skin, 5 breast, 4 bowel, 5 cervix, 3 melanoma, 3 prostate and 1 each of lip, lung, myeloma, testis, uterus, vagina). Self-reported infections within the previous 6 months were common (71.5%).

Conclusions: History of comorbidities, including recent infections, is common among Australian RA patients commencing biologics, and 10% have a history of malignancy. This may impact future evaluations of health outcomes among this population, including attribution of adverse events of biologic therapy.

Does Candida and/or Staphylococcus play a role in nipple and breast pain in lactation? A cohort study in Melbourne, Australia

Objective: To investigate Candida species and Staphylococcus aureus and the development of 'nipple and breast thrush' among breastfeeding women. Design: Prospective longitudinal cohort study. Setting: Two hospitals in Melbourne, Australia (one public, one private) with follow-up in the community. Participants: 360 nulliparous women recruited at 36 weeks' gestation from November 2009 to June 2011. Participants were followed up six times: in hospital, at home weekly until 4 weeks postpartum and by telephone at 8 weeks. Main outcome measures: Case definition 'nipple and breast thrush': burning nipple pain and breast pain (not related to mastitis); detection of Candida spp (using culture and PCR) in the mother's vagina, nipple or breast milk or in the baby's mouth; detection of S aureus in the mother' nipple or breast milk. Results: Women with the case definition of nipple/ breast thrush were more likely to have Candida spp in nipple/breast milk/baby oral samples (54%) compared to other women (36%, p=0.014). S aureus was common in nipple/breast milk/baby samples of women with these symptoms as well as women without these symptoms (82% vs 79%) (p=0.597). Time-to-event analysis examined predictors of nipple/breast thrush up to and including the time of data collection. Candida in nipple/breast milk/baby predicted incidence of the case definition (rate ratio (RR) 1.87 (95% CI 1.10 to 3.16, p=0.018). We do not have evidence that S aureus colonisation was a predictor of these symptoms (RR 1.53, 95% CI 0.88 to 2.64, p=0.13). Nipple damage was also a predictor of these symptoms, RR 2.30 (95% CI 1.19 to 4.43, p=0.012). In the multivariate model, with all three predictors, the RRs were very similar to the univariate RRs. This indicates that Candida and nipple damage are independent predictors of our case definition.