Trasmissione post-natale del citomegalovirus attraverso il latte materno al neonato VLBW

Introduction Postnatal human cytomegalovirus (CMV) infection is usually asymptomatic in term babies, while preterm infants are more susceptible to symptomatic CMV infection. Breastfeeding plays a dominant role in the epidemiology of transmission of postnatal CMV infection, but the risk factors of symptomatic CMV infection in preterm infants are unknown. Patients and Methods Between December 2003 and August 2006, eighty Very Low Birth Weight (VLBW) preterm infants (gestational age ≤ 32 weeks and birth weight < 1500 g), admitted to the Neonatal Intensive Care Unit of St Orsola-Malpighi General Hospital, Bologna were recruited. All of them were breastfed for at least one month. During the first week of life, serological test for CMV was performed on maternal blood. Furthermore, urinary CMV culture was performed in all the infants in order to exclude a congenital CMV infection. Urine samples from each infant were collected and processed for CMV culture once a week. Once every 15 days a blood sample was taken from each infant to evaluate the complete blood count, the hepatic function and the C reactive protein. In addition, samples of fresh breast milk were processed weekly for CMV culture. A genetic analysis of virus variant was performed in the urine of the infected infants and in their mother’s milk to confirm the origin of infection. Results We evaluated 80 VLBW infants and their 68 mothers. Fifty-three mothers (78%) were positive for CMV IgG antibodies, and 15 (22%) were seronegative. In the seronegative group, CMV was never isolated in breast milk, and none of the 18 infants developed viruria; in the seropositive group, CMV was isolated in 21 out of 53 (40%) mother’s milk. CMV was detected in the urine samples of 9 out of 26 (35%) preterm infants, who were born from 21 virolactia positive mothers. Six of these infants had clinically asymptomatic CMV infection, while 3 showed a sepsis-like illness with bradycardia, tachypnea and repeated desaturations. Eight out of nine infants showed abnormal hematologic values. The detection of neutropenia was strictly related to CMV infection (8/9 infected infants vs 17/53 non infected infants, P<.005), such as the detection of an increase in conjugated bilirubin (3/9 infected infants vs 2/53 non infected infants, P<.05). The degree of neutropenia was not different between the two groups (infected/non infected). The use of hemoderivatives (plasma and/or IgM–enriched immunoglobulin) in order to treat a suspected/certain infection in newborn with GE< 28 ws was seen as protective against CMV infection (1/4 infected infants vs 18/20 non infected infants [GE<28 ws]; P<.05). Furthermore, bronchopulmonary dysplasia (defined both as oxygen-dependency at 30 days of life and 36 ws of postmenstrual age) correlated with symptomatic infection (3/3 symptomatic vs 0/6 asymptomatic: P<.05). Conclusion Our data suggest that CMV infection transmitted to preterm newborn through human milk is always asymptomatic when newborns are clinically stable. Otherwise, the infection can worsen a preexisting disease such as bronchopulmonary dysplasia. Human milk offers many nutritional and psychological advantages to preterm newborns: according to our data, there’s no reason to contraindicate it neither to pasteurize the milk of all the mothers of preterm infants who are CMV seropositive.

Il teatro comunitario in Argentina: paradigmi e pratiche tra identità e memoria. Con un focus sul caso italiano

La tesi indaga l’esperienza del teatro comunitario, una delle espressioni artistiche più originali e pressoché sconosciute nel panorama teatrale novecentesco, che ha avuto in Argentina un punto di riferimento fondamentale. Questo fenomeno, che oggi conta cinquanta compagnie dal nord al sud del paese latinoamericano, e qualcuna in Europa, affonda le sue radici nella Buenos Aires della post-dittatura, in una società che continua a risentire degli esiti del terrore di Stato. Il teatro comunitario nasce dalla necessità di un gruppo di persone di un determinato quartiere di riunirsi in comunità e comunicare attraverso il teatro, con l'obiettivo di costruire un significato sociale e politico. La prima questione messa a fuoco riguarda la definizione della categoria di studio: quali sono i criteri che consentono di identificare, all’interno della molteplicità di pratiche teatrali collettive, qualcosa di sicuramente riconducibile a questo fenomeno. Nel corso dell’indagine si è rivelata fondamentale la comprensione dei conflitti dell’esperienza reale e l’individuazione dei caratteri comuni, al fine di procedere a un esercizio di generalizzazione. La ricerca ha imposto la necessità di comprendere i meccanismi mnemonici e identitari che hanno determinato e, a loro volta, sono stati riattivati dalla nascita di questa esperienza. L’analisi, supportata da studi filosofici e antropologici, è volta a comprendere come sia cambiata la percezione della corporeità in un contesto di sparizione dei corpi, dove il lavoro sulla memoria riguarda in particolare i corpi assenti (desaparecidos). L’originalità del tema ha imposto la riflessione su un approccio metodologico in grado di esercitare una adeguata funzione euristica, e di fungere da modello per studi futuri. Sono stati pertanto scavalcati i confini degli studi teatrologici, con particolare attenzione alle svolte culturali e storiche che hanno preceduto e affiancato l’evoluzione del fenomeno.