Compreendendo a vivência do pai frente à amamentação

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Análise químico-farmacêutica de preparações injetáveis contendo ceftazidima

Pós-graduação em Ciências Farmacêuticas - FCFAR

Estudo metalômico do mercúrio em leite materno coletado da população ribeirinha da área de influência do Ahe Jirau-bacia do rio Madeira

Pós-graduação em Biologia Geral e Aplicada - IBB

Vitamina E no plasma de recém-nascidos de pré-termo de muito baixo peso no primeiro mês de vida. Relação com a vitamina E recebida

Pós-graduação em Pediatria - FMB

Cariogenicidade do leite materno: mito ou evidência científica

Introduction: Breast-feeding has stood out as health care measure and is part of the Government’s National Health Policy, involving dental professionals. However, it has been suggested that breast milk could be a risk factor for the development of early childhood caries. Objective: The purpose of this report was to search for scientific evidence that would support or refute the statement that breastfeeding is associated with the development of early childhood caries. Method: Medline and SciELO databases were consulted to retrieve studies, ranging from laboratory investigations to epidemiological surveys, which relate breastfeeding to dental caries. The key words ‘breast-feeding’ and ‘dental caries’ were used on the reference search. There was no scientific evidence that could demonstrate a clear relationship between breast milk and cariogenicity. This is attributed to fact that dental caries is a multifactorial disease that is susceptible to multiple confusing factors, among which the early introduction of sucrose to the infant’s diet and late introduction of oral hygiene habits. The dentist should encourage exclusive breast-feeding because, in addition to the undeniable benefits to the child’s physical and psychological health, it contributes to a harmonic facial growth and prevents the development of atypical deglutition and malocclusions, in combination with early introduction of oral hygiene habits and noncariogenic diet. Conclusion: There is no scientific evidence to demonstrate an association between breast-feeding and early childhood caries.

Conhecimento de mães sobre promoção de saúde bucal em bebês

The aim of this study was to assess the knowledge level on oral health promotion for babies of all mothers (n=60), aged 18-42 years, assisted in the Preventive Dentistry Clinic of the Faculty of Araraquara, at Universidade Estadual Paulista (UNESP), during the period 2005-2008. Methods - An interview was performed using a questionnaire with 18 open and five closed questions about knowledge and practices related to caries prevention as well as demographic information. Methods - The majority believed that breast milk does not cause caries (73,3%), that caries is not a transmissible disease (51,6%) and that anatibiotics cause caries (63,3%). Almost all mothers (93,3%) responded that brushing teeth could prevent the disease, action that should be initiated since first tooth erupts (75%). For 73,3% of the respondents, the use of dental floss should be initiated onle after all deciduous teeth erupt. Results - The majority (83,3%) knew what was fluoride, but a third of them (33,3%) did not know the best time to start using it. The dentist counseling related to oral health of babies was considered imoprtant by 96,7% of mothers. Conslusion - The mothers presented good knowledge about baby's oral hygiene, however, they did not know about other important variables for oral health promotin of babies.

Capacidade de adesão, invasão e produção de enterotoxinas de Staphylococcus aureus isolados de leite de vacas com mastite subclínica e leite humano de um banco de leite

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Capacidade de adesão, invasão e produção de enterotoxinas de Staphylococcus aureus isolados de leite de vacas com mastite subclínica e leite humano de um banco de leite

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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.

Perfluoroalkylated substances in food matrices: development of mass spectrometry based analytical methods and preliminary monitoring

Perfluoroalkylated substances are a group of chemicals that have been largely employed during the last 60 years in several applications, widely spreading and accumulating in the environment due to their extreme resistance to degradation. As a consequence, they have been found also in various types of food as well as in drinking water, proving that they can easily reach humans through the diet. The available information concerning their adverse effects on health has recently increased the interest towards these contaminants and highlighted the importance of investigating all the potential sources of human exposure, among which diet was proved to be the most relevant. This need has been underlined by the European Union through Recommendation 2010/161/EU: in this document, Member States were called to monitor their presence of in food, producing accurate estimations of human exposure. The purpose of the research presented in this thesis, which is the result of a partnership between an Italian and a French laboratory, was to develop reliable tools for the analysis of these pollutants in food, to be used for generating data on potentially contaminated matrices. An efficient method based on liquid chromatography-mass spectrometry for the detection of 16 different perfluorinated compounds in milk has been validated in accordance with current European regulation guidelines (2002/657/EC) and is currently under evaluation for ISO 17025 accreditation. The proposed technique was applied to cow, powder and human breast milk samples from Italy and France to produce a preliminary monitoring on the presence of these contaminants. In accordance with the above mentioned European Recommendation, this project led also to the development of a promising technique for the quantification of some precursors of these substances in fish. This method showed extremely satisfying performances in terms of linearity and limits of detection, and will be useful for future surveys.

Valutazione della presenza di contaminanti perfluoroalchilici in alimenti destinati al consumo umano

Le sostanze perfluoralchiliche (PFAS), composti fluorurati ampiamente utilizzati negli ultimi anni in diverse applicazioni industriali e commerciali, sono ritrovati diffusamente nell’ambiente e in diverse specie animali. Recentemente i PFAS hanno destato preoccupazione anche per la salute umana. Il rischio di esposizione è principalmente legato alla dieta (i prodotti ittici sembrano essere gli alimenti più contaminati). Lo scopo di questo lavoro è stato quello di valutare la presenza del perfluorottanosulfonato (PFOS) e dell’acido perfluorottanoico (PFOA), in diverse matrici alimentari: latte vaccino commercialmente disponibile in Italia, latte materno italiano, diverse specie di pesce commercialmente disponibili in Italia e 140 branzini di diverse aree (principalmente Mediterraneo). I campioni di latte sono stati trattati con estrazione liquido-liquido seguita da due fasi di purificazione mediante cartucce SPE prima dell’iniezione nell’UPLC-MS/MS. L’analisi del latte vaccino ha evidenziato una contaminazione diffusa di PFOS, ma a basse concentrazioni (fino a 97 ng/L), mentre il PFOA è stato ritrovato raramente. In questo studio, in grado di individuare anche i livelli delle ultra-tracce, sono state osservate nel latte materno concentrazioni di 15-288 ng/L per il PFOS e di 24-241 ng/LPFOA. Le concentrazioni e le frequenze più alte, per entrambi i PFAS, sono stati ritrovate in campioni di latte forniti da donne primipare, suggerendo un rischio di esposizione per i primogeniti. Il metodo utilizzato per i campioni di pesce era basato su un’estrazione con solvente organico seguita da due fasi di purificazione: una con i sali e una con fase solida dispersiva. L’estratto, analizzato in UPLC-MS/MS, ha confermato la contaminazione di questa matrice a livelli significativi, ma anche l’alta variabilità delle concentrazioni misurate. Il monitoraggio monospecie ha mostrato una contaminazione rilevante (PFOS 11,1- > 10000 ng/L; PFOA < 9-487 ng/L), soprattutto nei branzini pescati, rispetto a quelli allevati.

Update on safety during pregnancy of biological agents and some immunosuppressive anti-rheumatic drugs

A consensus paper concerning the interaction of anti-rheumatic drugs and reproduction was published in 2006, representing data collected during the year 2004 and 2005. Because of an increasing use of biological agents in women of fertile age, the information was updated for the years 2006 and 2007. Experts disagree whether TNF-inhibitors should be stopped as soon as pregnancy is recognized or may be continued throughout pregnancy. Pregnancy experience with abatacept and rituximab is still too limited to prove their safety for the developing fetus. They must be withdrawn before a planned pregnancy. LEF has not been proven to be a human teratogen. Registries of transplant recipients have shown that cyclosporin (CsA) and tacrolimus do not increase the rate of congenital anomalies, whereas mycophenolate mofetil (MMF) clearly carries a risk for congenital anomalies. Prophylactic withdrawal of drugs before pregnancy is mandatory for abatacept, rituximab, LEF and MMF. Data remain insufficient for gonadal toxicity of immunosuppressive drugs in men and for excretion of these drugs in human breast milk.

Cholesterol transporters in lactating and nonlactating human mammary tissue

In mammals milk is the principal nutrient for neonates at birth. The basic milk composition is similar between different mammals, but the content of individual constituents such as lipids may differ significantly from one species to another. The milk fat fraction is mainly composed of triglycerides which account for more than 95% of the lipids found in human and bovine milk. Though sterols and in particular cholesterol, the predominant milk sterol, represent less than 0.5% of the total milk lipid fraction, they are of ultimate importance for biological processes such as the formation of biological membranes or as precursors for steroid hormone synthesis. Cholesterol found in milk originates either from blood uptake or from local synthesis. This chapter provides an overview of cholesterol exchanges between the blood, the mammary tissue and the milk. The current knowledge on the expression, localization and function of candidate cholesterol transporters in mammary tissues of human, murine and bovine origin is summarized. Different mechanisms of how cholesterol can be transferred via the mammary tissue into milk, and which active cholesterol transporters are likely to play a role in this process will be discussed.

Transient Neonatal Zinc Deficiency Caused by a Heterozygous G87R Mutation in the Zinc Transporter ZnT-2 (SLC30A2) Gene in the Mother Highlighting the Importance of Zn (2+) for Normal Growth and Development

Suboptimal dietary zinc (Zn(2+)) intake is increasingly appreciated as an important public health issue. Zn(2+) is an essential mineral, and infants are particularly vulnerable to Zn(2+) deficiency, as they require large amounts of Zn(2+) for their normal growth and development. Although term infants are born with an important hepatic Zn(2+) storage, adequate Zn(2+) nutrition of infants mostly depends on breast milk or formula feeding, which contains an adequate amount of Zn(2+) to meet the infants' requirements. An exclusively breast-fed 6 months old infant suffering from Zn(2+) deficiency caused by an autosomal dominant negative G87R mutation in the Slc30a2 gene (encoding for the zinc transporter 2 (ZnT-2)) in the mother is reported. More than 20 zinc transporters characterized up to date, classified into two families (Slc30a/ZnT and Slc39a/Zip), reflect the complexity and importance of maintaining cellular Zn(2+) homeostasis and dynamics. The role of ZnTs is to reduce intracellular Zn(2+) by transporting it from the cytoplasm into various intracellular organelles and by moving Zn(2+) into extracellular space. Zips increase intracellular Zn(2+) by transporting it in the opposite direction. Thus the coordinated action of both is essential for the maintenance of Zn(2+) homeostasis in the cytoplasm, and accumulating evidence suggests that this is also true for the secretory pathway of growth hormone.

Certolizumab treatment during late pregnancy in patients with rheumatic diseases: Low drug levels in cord blood but possible risk for maternal infections. A case series of 13 patients

OBJECTIVE Due to reduction of immune-suppressive drugs, patients with rheumatic diseases can experience an increase in disease activity during pregnancy. In such cases, TNF-inhibitors may be prescribed. However, monoclonal antibodies with the Fc moiety are actively transported across the placenta, resulting in therapeutic drug levels in the newborn. As certolizumab (CZP) lacks the Fc moiety, it may bear a lower risk for the child. METHOD We report a case series of thirteen patients (5 with rheumatoid arthritis and 8 with spondyloarthritis) treated with CZP during late pregnancy to control disease activity. RESULT CZP measured in cord blood of eleven infants ranged between undetectable levels and 1μg/mL whereas the median CZP level of maternal plasma was 32.97μg/mL. Three women developed an infection during the third trimester, of whom one had a severe infection and one had an infection that resulted in a pre-term delivery. During the postpartum period, 6 patients remained on CZP while breastfeeding. CZP levels in the breast milk of two breastfeeding patients were undetectable. CONCLUSION The lack of the active transplacental transfer of CZP gives the possibility to treat inflammatory arthritis during late gestation without potential harm to the newborn. However, in pregnant women treated with TNF-inhibitors and prednisone, attention should be given to the increased susceptibility to infections, which might cause prematurity. CZP treatment can be continued while breastfeeding.