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Agostini SBN, Machado VLDS, Virtuoso LS, Nogueira DA, Pereira GR, Carvalho FC. Influence of the ionic strength on the physicochemical properties of methotrexate-loaded chitosan polyelectrolyte complexes. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
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Agostini SBN, Malta IHS, Rodrigues RF, Freitas JTJ, Lino MEDS, Dos Santos RS, Elisei LS, Moraes TR, Giusto LADR, de Oliveira MK, Bassi da Silva J, Bruschi ML, Santos AMD, Nogueira DA, Novaes RD, Pereira GR, Galdino G, Carvalho FC. Preclinical evaluation of methotrexate-loaded polyelectrolyte complexes and thermosensitive hydrogels as treatment for rheumatoid arthritis. Eur J Pharm Sci 2021; 163:105856. [PMID: 33882329 DOI: 10.1016/j.ejps.2021.105856] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 12/29/2022]
Abstract
This work proposes new methotrexate (MTX) loaded drug delivery systems (DDS) to treat rheumatoid arthritis via the intra-articular route: a poloxamer based thermosensitive hydrogel (MTX-HG), oligochitosan and hypromellose phthalate-based polyelectrolyte complexes (MTX-PEC) and their association (MTX-PEC-HG). MTX-PEC showed 470 ± 166 nm particle size, 0.298 ± 0.108 polydispersity index, +26 ± 2 mV and 74.3 ± 5.8% MTX efficiency entrapment and particle formation was confirmed by infrared spectroscopy and thermal analysis. MTX-HG and MTX-PEC-HG gelled at 36.7°C. MTX drug release profile was prolonged for MTX-HG and MTX-PEC-HG, and faster for MTX-PEC and free MTX. The in vivo effect of the MTX-DDSs systems was evaluated in induced arthritis rats as single intra-articular dose. The assessed parameters were the mechanical nociceptive threshold, the plasmatic IL-1β level and histological analysis of the tibiofemoral joint. MTX-HG and MTX-PEC-HG performance were similar to free MTX and worse than oral MTX, used as positive control. All DDSs showed some irritative effect, for which further studies are required. MTX-PEC was the best treatment on recovering cartilage damage and decreasing allodynia. Thus, MTX-PEC demonstrated potential to treat rheumatoid arthritis, with the possibility of decreasing the systemic exposure to the drug.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Merelym Ketterym de Oliveira
- Instituto de Ciências Biomédicas, Departamento de Ciências Fisiológicas, Universidade Federal de Alfenas, Brazil
| | - Jéssica Bassi da Silva
- Laboratório de Pesquisa e Desenvolvimento de Sistemas de Liberação de Fármacos, Departamento de Farmácia, Universidade Estadual de Maringá, Brazil
| | - Marcos Luciano Bruschi
- Laboratório de Pesquisa e Desenvolvimento de Sistemas de Liberação de Fármacos, Departamento de Farmácia, Universidade Estadual de Maringá, Brazil
| | - Aline Martins Dos Santos
- Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista "Julio de Mesquita Filho". UNESP, Araraquara, Brazil
| | | | - Rômulo Dias Novaes
- Instituto de Ciências Biomédicas, Departamento de Biologia Estrutural, Universidade Federal de Alfenas, Brazil
| | - Gislaine Ribeiro Pereira
- Escola de Farmácia, Departamento de Fármacos e Alimentos, Universidade Federal de Alfenas, Brazil
| | - Giovane Galdino
- Instituto de Ciência da Motricidade, Universidade Federal de Alfenas, Brazil
| | - Flávia Chiva Carvalho
- Escola de Farmácia, Departamento de Fármacos e Alimentos, Universidade Federal de Alfenas, Brazil
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Bernardes MTCP, Agostini SBN, Pereira GR, da Silva LP, da Silva JB, Bruschi ML, Novaes RD, Carvalho FC. Preclinical study of methotrexate-based hydrogels versus surfactant based liquid crystal systems on psoriasis treatment. Eur J Pharm Sci 2021; 165:105956. [PMID: 34314841 DOI: 10.1016/j.ejps.2021.105956] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/29/2021] [Accepted: 07/21/2021] [Indexed: 12/11/2022]
Abstract
Psoriasis is an autoimmune, inflammatory and chronic skin disease in which cell growth and proliferation are increased, causing erythema, lesions and skin's peeling. Oral methotrexate (MTX) is the first-choice drug when phototherapy or retinoid treatment are not effective. Topical administration can be advantageous to better orientate the drug's delivery; however, the stratum corneum performs as a barrier for hydrofilic drugs penetration. This study sought to evaluate two different types of vehicles for MTX on the psoriasis treatment - hydrogel and liquid crystal systems (LCs). Lamellar and hexagonal liquid crystalline phases were selected from a ternary phase diagram based on polysorbate 80, isopropyl miristate and water. The hydrogel was based on alkylated carbomer (ACH). Rheological analysis showed ACH was more elastic than lamellar and hexagonal phases. ACH interacted better with pig skin than LCs in bioadhesion assay. Preclinical study revealed the ACH decreased inflammation in mice with induced psoriasis, being as effective as dexamethasone to regulate epidermis thickness, COX-2 and myeloperoxidase activity and TNF-α level, while LCs demonstrated inflammatory effect. Therefore, MTX-loaded hydrogel based platforms are indicated for local treatment of psoriasis and present great potential for further studies.
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Affiliation(s)
| | | | - Gislaine Ribeiro Pereira
- Faculdade de Farmácia, Departamento de Fármacos e Alimentos, Universidade Federal de Alfenas, Brazil
| | - Laíla Pereira da Silva
- Instituto de Ciências Biomédicas, Departamento de Biologia Estrutural, Universidade Federal de Alfenas, Brazil
| | - Jéssica Bassi da Silva
- Laboratório de Pesquisa e Desenvolvimento de Sistemas de Liberação de Fármacos, Departamento de Farmácia, Universidade Estadual de Maringá, Brazil
| | - Marcos Luciano Bruschi
- Laboratório de Pesquisa e Desenvolvimento de Sistemas de Liberação de Fármacos, Departamento de Farmácia, Universidade Estadual de Maringá, Brazil
| | - Rômulo Dias Novaes
- Instituto de Ciências Biomédicas, Departamento de Biologia Estrutural, Universidade Federal de Alfenas, Brazil
| | - Flávia Chiva Carvalho
- Faculdade de Farmácia, Departamento de Fármacos e Alimentos, Universidade Federal de Alfenas, Brazil.
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de Souza IFF, Dos Santos TQ, Placido RV, Mangerona BA, Carvalho FC, Boralli VB, Ruela ALM, Pereira GR. The liquid crystalline phase behaviour of a nasal formulation modifies the brain disposition of donepezil in rats in the treatment of Alzheimer's disease. Colloids Surf B Biointerfaces 2021; 203:111721. [PMID: 33798905 DOI: 10.1016/j.colsurfb.2021.111721] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/26/2021] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Abstract
Although nanoparticles, polymeric micelles, liposomes, nanoemulsions, and microemulsions were extensively evaluated as formulations for nasal administration of drugs, lyotropic liquid crystal (LLC) mesophases have been few studied. The phase transition from a low-viscosity microemulsion to a more viscous LLC may improve the mucoadhesion of the formulation. Donepezil is a drug administered orally in the treatment of Alzheimer's disease, and with gastrointestinal side effects that are typical of acetylcholinesterase inhibitors. Based on this, donepezil administration by nasal pathway using a mucoadhesive LLC may be a feasible alternative. A colloidal formulation was selected from a ternary diagram, combining CETETH-10, oleic acid, and water (40:45:15, w/w). Donepezil was incorporated into the formulation, and the characterisation included in vitro studies, such as mucoadhesion and drug release. Pharmacokinetics in Wistar rats included evaluations by the nasal pathway with donepezil incorporated into microemulsion. A phase transition from an isotropic to an anisotropic system was observed after the swelling of the microemulsion with artificial nasal fluid (12-20 %). The release of donepezil in vitro occurred in a sustained manner. Significant levels of donepezil were achieved in the brain after nasal administration of the microemulsion, as a promising strategy for the treatment of Alzheimer's disease.
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Affiliation(s)
| | | | | | | | - Flávia Chiva Carvalho
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, MG, Brazil.
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Casco N, Jorge AL, Palmero D, Alffenaar JW, Fox G, Ezz W, Cho JG, Skrahina A, Solodovnikova V, Bachez P, Arbex MA, Galvão T, Rabahi M, Pereira GR, Sales R, Silva DR, Saffie MM, Miranda RC, Cancino V, Carbonell M, Cisterna C, Concha C, Cruz A, Salinas NE, Revillot ME, Farias J, Fernandez I, Flores X, Gallegos P, Garavagno A, Guajardo C, Bahamondes MH, Merino LM, Muñoz E, Muñoz C, Navarro I, Navarro J, Ortega C, Palma S, Pardenas AM, Pereira G, Castillo PP, Pinto M, Pizarro R, Rivas F, Rodriguez P, Sánchez C, Serrano A, Soto A, Taiba C, Venegas M, Vergara MS, Vilca E, Villalon C, Yucra E, Li Y, Cruz A, Guelvez B, Plaza R, Tello K, Andréjak C, Blanc FX, Dourmane S, Froissart A, Izadifar A, Rivière F, Schlemmer F, Gupta N, Ish P, Mishra G, Sharma S, Singla R, Udwadia ZF, Manika K, Diallo BD, Hassane-Harouna S, Artiles N, Mejia LA, Alladio F, Calcagno A, Centis R, Codecasa LR, D Ambrosio L, Formenti B, Gaviraghi A, Giacomet V, Goletti D, Gualano G, Kuksa L, Danila E, Diktanas S, Miliauskas S, Ridaura RL, López F, Torrico MM, Rendon A, Akkerman OW, Piubello A, Souleymane MB, Aizpurua E, Gonzales R, Jurado J, Loban A, Aguirre S, de Egea V, Irala S, Medina A, Sequera G, Sosa N, Vázquez F, Manga S, Villanueva R, Araujo D, Duarte R, Marques TS, Grecu VI, Socaci A, Barkanova O, Bogorodskaya M, Borisov S, Mariandyshev A, Kaluzhenina A, Stosic M, Beh D, Ng D, Ong C, Solovic I, Dheda D, Gina P, Caminero JA, Cardoso-Landivar J, de Souza Galvão ML, Dominguez-Castellano A, García-García JM, Pinargote IM, Fernandez SQ, Sánchez-Montalvá A, Huguet ET, Murguiondo MZ, Bruchfeld J, Bart PA, Mazza-Stalder J, Tiberi S, Arrieta F, Heysell S, Logsdon J, Young L. TB and COVID-19 co-infection: rationale and aims of a global study. Int J Tuberc Lung Dis 2021; 25:78-80. [PMID: 33384052 DOI: 10.5588/ijtld.20.0786] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | | | | | - G Fox
- New South Wales, Australia
| | - W Ezz
- New South Wales, Australia
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Gurgel Assis MS, Fernandes Pedrosa TC, de Moraes FS, Caldeira TG, Pereira GR, de Souza J, Ruela ALM. Novel Insights to Enhance Therapeutics With Acyclovir in the Management of Herpes Simplex Encephalitis. J Pharm Sci 2021; 110:1557-1571. [PMID: 33450220 DOI: 10.1016/j.xphs.2021.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022]
Abstract
Acyclovir is an antiviral drug poorly absorbed in the gastrointestinal tract due to its hydrophilicity, with low oral bioavailability (~20%). Although acyclovir is prescribed in the management of herpes simplex encephalitis (HSE), the disease has a poor prognosis, particularly if the treatment is delayed, reaching mortality rates of 70% if left untreated. Thus, high acyclovir doses are administered by intravenous (IV) infusion, usually at a dosage of 10 mg kg-1 8-hourly in adults with normal renal function. However, the mortality related to HSE treated with acyclovir remains high (~20%) and permanent sequelae are commonly reported after 1 year (~50%). This review analyzed clinical trials following IV acyclovir administration. Novel insights aiming to improve drug bioavailability were reviewed, including acyclovir or its prodrugs, leading to the systemic distribution of the drug or drug targeting. Much research effort has been made to improve antiviral therapy, searching for delivery systems increasing acyclovir bioavailability by non-invasive pathways, such as oral and nasal pathways, or parenterally administered nanotechnology-based systems leading to drug targeting. Nanocarriers administered by non-invasive pathways represent feasible alternatives to treat HSE, even though not be industrially manufactured yet.
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Affiliation(s)
- Maria Silvia Gurgel Assis
- Department of Pharmacy, School of Pharmacy, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | | | - Fernanda Segurasse de Moraes
- Department of Pharmacy, School of Pharmacy, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - Tamires Guedes Caldeira
- Graduate Program in Pharmaceutical Sciences-CiPharma, School of Pharmacy, UFOP, Minas Gerais, Brazil
| | - Gislaine Ribeiro Pereira
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
| | - Jacqueline de Souza
- Department of Pharmacy, School of Pharmacy, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil
| | - André Luís Morais Ruela
- Department of Pharmacy, School of Pharmacy, Federal University of Ouro Preto (UFOP), Ouro Preto, Minas Gerais, Brazil.
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Matarazzo AP, Elisei LMS, Carvalho FC, Bonfílio R, Ruela ALM, Galdino G, Pereira GR. Mucoadhesive nanostructured lipid carriers as a cannabidiol nasal delivery system for the treatment of neuropathic pain. Eur J Pharm Sci 2021; 159:105698. [PMID: 33406408 DOI: 10.1016/j.ejps.2020.105698] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 12/04/2020] [Accepted: 12/28/2020] [Indexed: 12/21/2022]
Abstract
The therapeutic potential of cannabidiol (CBD) has been explored to treat several pathologies, including those in which pain is prevalent. However, the oral bioavailability of CBD is low owing to its high lipophilicity and extensive first-pass metabolism. Considering the ability of the nasal route to prevent liver metabolism and increase brain bioavailability, we developed nanostructured lipid carriers (NLCs) for the nasal administration of CBD. We prepared particles with a positively charged surface, employing stearic acid, oleic acid, Span 20Ⓡ, and cetylpyridinium chloride to obtain mucoadhesive formulations. Characterisation of the CBD-NLC dispersions showed uniform nano-sized particles with diameters smaller than 200 nm, and high drug encapsulation. The mucoadhesion of cationic particles has been related to interactions with negatively charged mucin. Next, we added in-situ gelling polymers to the CBD-NLC dispersion to obtain a CBD-NLC-gel. A thermo-reversible in-situ forming gel was prepared by the addition of PluronicsⓇ. CBD-NLC-gel was characterised by its gelation temperature, rheological behaviour, and mucoadhesion. Both formulations, CBD-NLC and CBD-NLC-gel, showed high mucoadhesion, as assessed by the flow-through method and similar in vitro drug release profiles. The in vivo evaluation showed that CBD-NLC dispersion (without gel), administered intranasally, produced a more significant and lasting antinociceptive effect in animals with neuropathic pain than the oral or nasal administration of CBD solution. However, the nasal administration of CBD-NLC-gel did not lessen mechanical allodynia. These findings demonstrate that in-situ gelling hydrogels are not suitable vehicles for highly lipophilic drugs such as CBD, while cationic CBD-NLC dispersions are promising formulations for the nasal administration of CBD.
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Affiliation(s)
- Ananda Pulini Matarazzo
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
| | | | - Flávia Chiva Carvalho
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
| | - Rudy Bonfílio
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
| | | | - Giovane Galdino
- Science of Motricity Institute, Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil
| | - Gislaine Ribeiro Pereira
- Faculty of Pharmaceutical Sciences, Federal University of Alfenas (UNIFAL-MG), Alfenas, Minas Gerais, Brazil.
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Martins I, Lambert M, Pereira AFS, de Faria HD, de Lima EC, Pereira GR. Serum analysis in women and in vitro skin assay for the assessment of exposure to parabens in antiperspirants. Environ Sci Pollut Res Int 2020; 27:4219-4226. [PMID: 31828701 DOI: 10.1007/s11356-019-07038-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/11/2019] [Indexed: 06/10/2023]
Abstract
The present study assessed the exposure to methylparaben (MP) and propylparaben (PP) from antiperspirants in serum of 24 women aged 20-30 years old and an in vitro skin assay. An effective liquid chromatography-tandem mass spectrometry method for the determination of MP and PP levels in serum was developed and validated in the range of 10-100 μg/L; the method was fast, simple, sensitive, linear, precise, and accurate. In addition, a simple and rapid liquid chromatography-ultraviolet detection method for the determination of MP and PP levels in antiperspirants was developed and validated in the range of 2-26 mg/L, which presented satisfactory linearity, precision, and accuracy. Using these two methods, 20 commercial antiperspirants were evaluated, and only three showed MP and PP in the formulation. The antiperspirant containing 0.2% and 0.1% w/w MP and PP, respectively, was given to the volunteers, to estimate the internal dose, and submitted to a pig ear skin permeation assay in Franz diffusion cells, presenting a permeation flux of 32% for MP and 71% for PP. In this assay, both MP and PP permeated the skin; however, there was no correlation between antiperspirant use and paraben serum concentration in the volunteers. Graphical abstract.
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Affiliation(s)
- Isarita Martins
- Laboratory of Toxicants and Drug Analyses, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Gabriel Monteiro Street, 700, Alfenas, 37130-000, Brazil.
| | - Mayara Lambert
- Laboratory of Toxicants and Drug Analyses, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Gabriel Monteiro Street, 700, Alfenas, 37130-000, Brazil
| | - Ana Flávia Souza Pereira
- Laboratory of Toxicants and Drug Analyses, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Gabriel Monteiro Street, 700, Alfenas, 37130-000, Brazil
| | - Henrique Dipe de Faria
- Laboratory of Toxicants and Drug Analyses, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Gabriel Monteiro Street, 700, Alfenas, 37130-000, Brazil
| | | | - Gislaine Ribeiro Pereira
- Laboratory of Liberation Systems, Faculty of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
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Lacerda GJS, Piantino BL, Gonzaga EV, Naves VDML, Pedreiro LN, Gremião MPD, Pereira GR, Carvalho FC. Evaluation of polyelectrolyte and emulsion covalent crosslink of chitosan for producing mesalasine loaded submicron particles. BRAZ J PHARM SCI 2019. [DOI: 10.1590/s2175-97902019000217847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Reis IC, Codeço CT, Câmara DCP, Carvajal JJ, Pereira GR, Keppeler EC, Honório NA. Diversity of Anopheles spp. (Diptera: Culicidae) in an Amazonian Urban Area. Neotrop Entomol 2018; 47:412-417. [PMID: 29470810 DOI: 10.1007/s13744-018-0595-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Abstract
The genus Anopheles encompasses several species considered as vectors of human infecting Plasmodium. Environmental changes are responsible for behavior changes in these vectors and therefore the pattern of malaria transmission. To better understand the dynamics of malaria transmission, this study aimed at identify the species of adult anophelines found in a malaria endemic urban area of the Amazon region, Mâncio Lima, located in the Acre State Brazil. Using Shannon-type light traps installed at 11 collection points near fish ponds, a total of 116 anophelines were collected belonging to nine species. Anopheles darlingi Root 1926 and An. albitarsis s.l. Lynch-Arribalzaga 1878 were the most abundant and predominant species. Despite the low number of captured adult anophelines, the occurrence of An. darlingi throughout all urban area and the presence of secondary vectors reinforce the need of a permanent and continuous entomological surveillance.
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Affiliation(s)
- I C Reis
- Lab de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brasil.
- Núcleo Operacional Sentinela de Mosquitos Vetores - Nosmove/Fiocruz, Rio de Janeiro, Brasil.
| | - C T Codeço
- Programa de Computação Científica -PROCC, Fiocruz, Rio de Janeiro, Brasil
| | - D C P Câmara
- Lab de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brasil
- Núcleo Operacional Sentinela de Mosquitos Vetores - Nosmove/Fiocruz, Rio de Janeiro, Brasil
| | - J J Carvajal
- Lab de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brasil
- Núcleo Operacional Sentinela de Mosquitos Vetores - Nosmove/Fiocruz, Rio de Janeiro, Brasil
| | - G R Pereira
- Núcleo Operacional Sentinela de Mosquitos Vetores - Nosmove/Fiocruz, Rio de Janeiro, Brasil
| | - E C Keppeler
- Centro Multidisciplinar, Univ Federal do Acre, Rio Branco, Acre, Brasil
| | - N A Honório
- Lab de Mosquitos Transmissores de Hematozoários, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brasil
- Núcleo Operacional Sentinela de Mosquitos Vetores - Nosmove/Fiocruz, Rio de Janeiro, Brasil
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Ruela ALM, de Figueiredo EC, Carvalho FC, de Araújo MB, Pereira GR. Adsorption and release of nicotine from imprinted particles synthesised by precipitation polymerisation: Optimising transdermal formulations. Eur Polym J 2018. [DOI: 10.1016/j.eurpolymj.2018.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Perissinato AG, Morais Ruela AL, Pereira GR, Garcia JS, Trevisan MG. Simple Strategy to Protect Lactase Activity in Solid Formulation. Curr Drug Deliv 2018; 15:215-218. [PMID: 28521673 DOI: 10.2174/1567201814666170518125802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/07/2016] [Accepted: 10/12/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Lactose intolerance is characterized by the absence of the enzyme lactase (beta-galactosidase) and affects two thirds of the world adult population. Our aim was to evaluate a lactase gastro-resistant formulation to ensure increased activity in the action site of the enzyme (lumen of the small intestine). Simultaneously, we also evaluated the commercial product stability and enzyme activity, because the product containing beta-galactosidase is classified as food supplement according to the Food and Drug Administration (FDA), so it is free to pass quality testing, efficacy and stability. So, it is possible that contain some irregularities as to the content and enzymatic activity. METHODS The dissolution assay was performed using a dissolution test system and commercial product and the gastro-resistant formulation were evaluated according to a method adapted to the conditions recommended by United States Pharmacopeia (US Pharmacopeia) for gastro-resistant formulations. For the assessment of enzymatic activity throughout the dissolution test was employed the official method of lactase assay described in US Pharmacopoeia. This method is based on a colorimetric reaction which the substrate reacts with the enzyme generate a colored product further analyzed by UVVisible spectrophotometry. RESULTS When carrying out dissolution test in commercial product it is noted that the existing formulation is not able to protect the enzyme from degrading action of gastric environment (a loss of 86.0 ± 0.8% of lactase activity was observed). Our proposed gastro-resistant pharmaceutical form there was no loss of activity during the acid step and the end of the dissolution test the found activity was 95 ± 1.3%. CONCLUSION The formulations proposed in this work using hypromellose capsules ensure the enzymatic activity of lactase, preventing its contact with the acid medium. For the other side, the results of commercial tablets for lactase release indicate a significant loss of enzyme activity due to the immediate release of the enzyme in the simulated gastric fluids.
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Affiliation(s)
| | - Andre Luis Morais Ruela
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | - Gislaine Ribeiro Pereira
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
| | | | - Marcello Garcia Trevisan
- Department of Food and Drugs, School of Pharmaceutical Sciences, Federal University of Alfenas, Alfenas, Brazil
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Argenti LE, Parmeggiani BS, Leipnitz G, Weber A, Pereira GR, Bustamante-Filho IC. Effects of season on boar semen parameters and antioxidant enzymes in the south subtropical region in Brazil. Andrologia 2018; 50:e12951. [PMID: 29388232 DOI: 10.1111/and.12951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2017] [Indexed: 12/16/2022] Open
Abstract
Although boar semen productivity is affected by seasonality, its effects are not equal among different regions which raise concerns regarding the profitability of boar stud farms. Therefore, the goals of this study were (i) to evaluate the seasonal effect on semen production in a commercial boar stud farm located in a subtropical climate region and (ii) to verify whether the activities of superoxide dismutase and glutathione peroxidase in spermatozoa and seminal plasma were associated with seminal traits of fresh and cooled semen. Nine boars were collected twice per season, and routine seminal parameter analyses were performed together with superoxide dismutase and glutathione peroxidase activities in seminal plasma and spermatozoa. Despite a reduction in sperm concentration in spring and summer, most seminal parameters were constant year-round. Temperature-humidity index was higher in the summer compared to spring, autumn and winter (p < .05). Superoxide dismutase activity in spermatozoa was increased in summer compared to autumn and winter (p < .05). The activities of both enzymes in seminal plasma and spermatozoa glutathione peroxidase remained unaltered throughout the seasons. In conclusion, seasonality showed little influence in overall boar seminal parameters despite microclimatic differences among seasons, and spermatozoa collected during summer increased superoxide dismutase activity.
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Affiliation(s)
- L E Argenti
- Biotechnology Laboratory, Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari - UNIVATES, Lajeado, RS, Brazil
| | - B S Parmeggiani
- Biochemistry Department, Post-Graduate Program in Biological Sciences: Biochemistry, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - G Leipnitz
- Biochemistry Department, Post-Graduate Program in Biological Sciences: Biochemistry, Institute of Basic Health Sciences, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - A Weber
- Biotechnology Laboratory, Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari - UNIVATES, Lajeado, RS, Brazil
| | - G R Pereira
- Department of Animal Production, Post-Graduate Program in Health and Ruminant Production, University of Northern Paraná, Arapongas, PR, Brazil
| | - I C Bustamante-Filho
- Biotechnology Laboratory, Post-Graduate Program in Biotechnology, Universidade do Vale do Taquari - UNIVATES, Lajeado, RS, Brazil
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Ruela ALM, Perissinato AG, Lino MEDS, Mudrik PS, Pereira GR. Evaluation of skin absorption of drugs from topical and transdermal formulations. BRAZ J PHARM SCI 2016. [DOI: 10.1590/s1984-82502016000300018] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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15
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Ruela ALM, Figueiredo EC, Perissinato AG, Lima ACZ, Araújo MB, Pereira GR. In vitro evaluation of transdermal nicotine delivery systems commercially available in Brazil. BRAZ J PHARM SCI 2013. [DOI: 10.1590/s1984-82502013000300020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The aim of this study was to develop and validate a method for evaluating the release and skin permeation from transdermal nicotine patches using the vertical diffusion cell (VDC). The VDC is an experimental apparatus employed in research, development, and the pharmaceutical field because it can simulate conditions closest to those established in clinical trials. Two transdermal nicotine delivery systems marketed in Brazil to release 14 mg over 24 hours were evaluated. Release studies were carried out using a regenerated cellulose dialysis membrane and permeation studies were carried out using excised porcine ear skin. The results indicated that nicotine release from both evaluated patches follows Higuchi's release kinetics, while skin permeation studies indicated zero-order release kinetics. Nicotine release rates were different between both evaluated patches, but drug permeation rates were not significantly different. According to validation studies, the method was appropriate for evaluating in vitro performance of nicotine patches. The proposed method can be applied to in vitro comparative studies between different commercial nicotine patches and may be used as an auxiliary tool in the design of new transdermal nicotine delivery systems.
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Santos OMM, Santos ALA, Pereira GR, Bonfilio R, de Araújo MB. A Dissolution Test for Finasteride in Immediate-Release Capsules. DISSOLUT TECHNOL 2013. [DOI: 10.14227/dt200313p25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pereira GR, Rocha HS, Anjos MJ, Lima I, Lopes RT. Elemental distribution images in prostate samples by X-ray fluorescence microtomography. Appl Radiat Isot 2011; 70:1379-83. [PMID: 22206909 DOI: 10.1016/j.apradiso.2011.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Revised: 12/09/2011] [Accepted: 12/09/2011] [Indexed: 10/14/2022]
Abstract
An X-ray transmission microtomography (CT) system combined with an X-ray fluorescence microtomography (XRFμCT) system was implemented in the Brazilian Synchrotron Light Laboratory (LNLS), in order to determine the elemental distribution in prostate samples aiming at establishing a correlation between the concentration of some elements and the characteristics and pathology of the tissues. The CT images were reconstructed using a filtered-back projection algorithm and the XRFμCT images were reconstructed using a filtered-back projection algorithm with absorption corrections.
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Affiliation(s)
- G R Pereira
- Non-destructive Testing, Corrosion and Welding Laboratory, PEMM/COPPE/UFRJ, Rio de Janeiro, Brazil
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18
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Mendonça TF, Barros EGD, Pereira GR, Araújo MBD, Bonfilio R. Development and validation of a dissolution test for diltiazem hydrochloride in immediate release capsules. QUIM NOVA 2011. [DOI: 10.1590/s0100-40422011000300027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Gehring PAF, Santos OMM, Pereira GR, Araújo MBD, Bonfilio R. Estabelecimento de condições para ensaio de dissolução de cápsulas de cinarizina empregando planejamento fatorial. QUIM NOVA 2011. [DOI: 10.1590/s0100-40422011000300017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Bonfilio R, Favoretto LB, Pereira GR, Azevedo RDCP, Araújo MBD. Comparative study of analytical methods by direct and first-derivative UV spectrophotometry for evaluation of losartan potassium in capsules. BRAZ J PHARM SCI 2010. [DOI: 10.1590/s1984-82502010000100017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Losartan potassium is an antihypertensive non-peptide agent, which exerts its action by specific blockade of angiotensin II receptors. The aim of the present study was the validation and application of analytical methods for the quality control of losartan potassium 50 mg in pharmaceutical capsules, using direct and first-derivative UV spectrophotometry. Based on losartan potassium spectrophotometric characteristics, a signal at 205 nm of the zero-order spectrum and a signal at 234 nm of the first-derivative spectrum, were found adequate for quantification. The results were used to compare these instrumental techniques. The linearity between the signals and concentrations of losartan potassium in the ranges of 3.0-7.0 mg L-1 and 6.0-14.0 mg L-1 for direct and first-derivative spectrophotometry in aqueous solutions, respectively, presented a correlation coefficient (r) of 0.9999 in both cases. The methods were applied for losartan potassium in capsule dosage obtained from local pharmacies, and were shown to be efficient, easy to apply and low cost. These methods do not use polluting reagents and require relatively inexpensive equipment.
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Affiliation(s)
- Rudy Bonfilio
- Universidade Estadual Paulista Júlio de Mesquita Filho
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Abstract
The main of this work is to determine the elemental distribution in breast and prostate tissue samples in order to verify the concentration of some elements correlated with characteristics and pathology of each tissue observed by the X-ray transmission microtomography (microCT). The experiments were performed at the X-ray fluorescence beamline of the Brazilian Synchrotron Light Laboratory. The microCT images were reconstructed using a filtered-back-projection algorithm and the XRF microtomographies were reconstructed using a filtered-back-projection algorithm with absorption corrections.
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Affiliation(s)
- G R Pereira
- Nuclear Instrumentation Laboratory (LIN), COPPE, UFRJ, Rio de Janeiro, Brazil
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Bonfilio R, Mendonça TF, Pereira GR, Araújo MBD, Tarley CRT. Losartan potassium dissolution test for drug release evaluation in pharmaceutical capsules using HPLC and UV spectrophotometry. QUIM NOVA 2010. [DOI: 10.1590/s0100-40422010000200026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Bonfilio R, Tarley CRT, Pereira GR, Salgado HRN, de Araújo MB. Multivariate optimization and validation of an analytical methodology by RP-HPLC for the determination of losartan potassium in capsules. Talanta 2009; 80:236-41. [DOI: 10.1016/j.talanta.2009.06.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Revised: 06/02/2009] [Accepted: 06/27/2009] [Indexed: 11/25/2022]
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Ruela ALM, Araújo MB, Pereira GR. Desenvolvimento e validação de um método analítico rápido por cromatografia líquida de alta eficiência para determinação de nimesulida em estudos de liberação in vitro. QUIM NOVA 2009. [DOI: 10.1590/s0100-40422009000100031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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25
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Borges-Pereira J, Zauza PL, Galhardo MC, Pereira GR, Cunha RV. [Chagas' disease in a urban population of the health district of Rio Verde, Mato Grosso do Sul State, Brazil]. Rev Soc Bras Med Trop 2001; 34:459-66. [PMID: 11600912 DOI: 10.1590/s0037-86822001000500009] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
In order to evaluate some aspects of the Chagas' disease on urban population of the 12 municipalities of the sanitarian district of Rio Verde, Mato Grosso do Sul state, on 1998 we carried out a serological survey investigating anti-T. cruzi IgG by indirect immunofluorescence on blood samples collected on filter paper of 14,709 resident persons, confirmed by indirect hemagglutination and ELISA in serum. The parasitaemia was evaluated by indirect xenodiagnosis on 134 chagasic patients and the morbidity evaluated by anamnesis, physical exam and electrocardiogram in 191 pairs of chagasic/non-chagasic patients. The seropositivity was 1.83% (0.93% in autochtonous, 5.01% in alochtonous), xenodiagnosis was positive in 17.2% of the individuals (12.3% in autochtonous, 20.8% in alochtonous) and 24.6% of the seropositive patients presented chronic chagasic cardiopathy (19.1% in autochtonous, 27.8 in alochtonous). The analysis of the dates showed that alochtonous population is the main responsible for presence of the infection and morbidity of Chagas disease in the studied area.
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Affiliation(s)
- J Borges-Pereira
- Departamento de Medicina Tropical, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, RJ, Brasil
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26
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McElhinney DB, Hedrick HL, Bush DM, Pereira GR, Stafford PW, Gaynor JW, Spray TL, Wernovsky G. Necrotizing enterocolitis in neonates with congenital heart disease: risk factors and outcomes. Pediatrics 2000; 106:1080-7. [PMID: 11061778 DOI: 10.1542/peds.106.5.1080] [Citation(s) in RCA: 248] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Necrotizing enterocolitis (NEC) is primarily a disease of the premature infant. Among children born at term, however, congenital heart disease may be an important predisposing factor for this condition. To determine risk factors for NEC in patients with congenital heart disease, we conducted a case-control study of neonates with cardiac disease admitted to the cardiac intensive care unit at our center during the 4-year period from January 1995 to December 1998. METHODS Cardiac diagnosis and age at admission were analyzed for association with NEC among the 643-patient inception cohort. Demographic, preoperative, and operative variables were recorded retrospectively in 21 neonates with congenital heart disease who developed NEC and 70 control neonates matched by diagnosis and age at admission. Using parametric and nonparametric analysis, cases and controls were compared with respect to previously identified risk factors for NEC. RESULTS Among the entire cohort of 643 neonates with heart disease admitted to the cardiac intensive care unit, diagnoses of hypoplastic left heart syndrome (odds ratio [OR] = 3.8 [1.6-9.1]) and truncus arteriosus or aortopulmonary window (OR = 6.3 [1.7-23.6]) were independently associated with development of NEC by multivariable analysis. In the case-control analysis, earlier gestational age at birth (36.7 +/- 2. 7 weeks vs 38.1 +/- 2.3 weeks), prematurity (OR = 3.9 [1.2-12.5]), highest dose of prostaglandin >0.05 microg/kg/minute (OR = 3.9 [1. 2-12.5]), and episodes of low cardiac output (meeting specific laboratory criteria) or clinical shock (OR = 6.5 [1.8-23.5]) correlated with the development of NEC. Earlier gestational age and episodes of low output were the only factors that remained significantly associated with NEC by multivariable analysis. Although there was no difference in hospital mortality between patients with and without NEC, mean hospital stay was significantly longer in those who developed NEC (36 +/- 22 days vs 19 +/- 14 days). CONCLUSIONS The risk of NEC in neonates with congenital heart disease is substantial. Factors associated with an elevated risk of NEC in infants with heart disease include premature birth, hypoplastic left heart syndrome, truncus arteriosus, and episodes of poor systemic perfusion or shock. Heightened suspicion is warranted in newborns with these risk factors.
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MESH Headings
- Case-Control Studies
- Causality
- Cohort Studies
- Comorbidity
- Enterocolitis, Necrotizing/diagnosis
- Enterocolitis, Necrotizing/drug therapy
- Enterocolitis, Necrotizing/epidemiology
- Female
- Gestational Age
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/epidemiology
- Heart Defects, Congenital/surgery
- Hospitalization
- Humans
- Infant, Newborn
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/epidemiology
- Intensive Care Units, Neonatal
- Length of Stay
- Male
- Multivariate Analysis
- Outcome Assessment, Health Care
- Prostaglandins E/administration & dosage
- Prostaglandins E/therapeutic use
- Risk Factors
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Affiliation(s)
- D B McElhinney
- Division of Cardiology, the Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA
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27
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Harris MC, Pereira GR, Myers MD, Cardin AJ, Razdan B, Pleasure J, Bell LM. Candidal arthritis in infants previously treated for systemic candidiasis during the newborn period: report of three cases. Pediatr Emerg Care 2000; 16:249-51. [PMID: 10966343 DOI: 10.1097/00006565-200008000-00008] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- M C Harris
- Division of Neonatology, The Children's Hospital of Philadelphia, PA 19104, USA.
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28
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Mattes RD, Maone T, Wager-Page S, Beauchamp G, Bernbaum J, Stallings V, Pereira GR, Gibson E, Russell P, Bhutani V. Effects of sweet taste stimulation on growth and sucking in preterm infants. J Obstet Gynecol Neonatal Nurs 1996; 25:407-14. [PMID: 8791228 DOI: 10.1111/j.1552-6909.1996.tb02445.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To evaluate the effect of sweet taste stimulation in augmenting the reported growth-enhancing effects of nonnutritive sucking in preterm infants who are gavage-fed. DESIGN Random assignment of preterm infants to receive stimulation by one of three methods during each feeding until totally orally fed. SETTING Hospital intensive-care and infant transitional units. PATIENTS Eligibility criteria included body weight greater than or equal to 1,250 g, gestational age younger than 34 weeks, growth parameters appropriate for gestational age, tolerating at least 100 kcals/kg/day by gavage feeding with evidence of weight gain, and no clinical evidence of health complications. Data are presented for 42 infants who completed 14 days of treatment. INTERVENTIONS Exposure to a sweet pacifier, a latex pacifier, or maternal heartbeat sounds during gavage feedings. MAIN OUTCOME MEASURES Growth, time to total oral feeding, and sucking responses. RESULTS No significant differences in sucking measures were noted among treatment groups. Differences in progression time to total oral feedings and weight gain favored the sweet-pacifier group but were not statistically significant. CONCLUSIONS Oral stimulation of gavage-fed, preterm infants during a 2-week hospitalization was not sufficient to elicit a significant improvement in growth efficiency, progression to total oral feedings, or sucking maturation. Additional studies may show a beneficial effect of chemosensory stimulation in preterm infants.
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Affiliation(s)
- R D Mattes
- Purdue University, Department of Foods and Nutrition, West LaFayette, IN 47907-1264, USA
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29
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Pereira GR. Nutritional care of the extremely premature infant. Clin Perinatol 1995; 22:61-75. [PMID: 7781256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
In summary, the nutritional care of extremely premature babies includes special attention to glucose homeostasis and fluid and electrolyte balance in the immediate postnatal period. Parenteral nutrition should be started routinely on the 2nd or 3rd day of life, if the infant is metabolically stable, and continued until the infant is receiving sufficient enteral feedings to promote growth. If not clinically contraindicated, minimal enteral feedings should be started before the end of the first week of life. The decision to either advance or maintain minimal enteral feedings at a constant level should take into account the clinical status of the infant. Fortified preterm human milk is the preferred feeding and premature infant formulas, the best substitute. Multivitamin supplements may be necessary, depending on formula intake. Iron supplements can be initiated as early as 2 weeks of age and high levels of intake appear to be necessary during erythropoietin therapy.
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Affiliation(s)
- G R Pereira
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, USA
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Pereira GR, Baumgart S, Bennett MJ, Stallings VA, Georgieff MK, Hamosh M, Ellis L. Use of high-fat formula for premature infants with bronchopulmonary dysplasia: metabolic, pulmonary, and nutritional studies. J Pediatr 1994; 124:605-11. [PMID: 8151479 DOI: 10.1016/s0022-3476(05)83143-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The use of dietary fat in preference to carbohydrate offers the theoretic advantage of diminishing carbon dioxide production and thus the respiratory quotient, which may be beneficial for babies with chronic lung disease. Ten premature infants (birth weight (mean +/- SEM), 1.13 +/- 0.12 kg; postnatal age, 9 +/- 1 weeks) with bronchopulmonary dysplasia were alternately fed a high-fat and a high-carbohydrate formula each for 1 week, in randomized order. Lower rates of carbon dioxide production (6.6 +/- 0.3 versus 7.4 +/- 0.4 ml/kg per minute; p < 0.05), and consequently lower respiratory quotients (0.80 +/- 0.02 versus 0.94 +/- 0.01 ml/kg per minute; p < 0.005), were observed during the administration of the high-fat formula. There were no significant differences in results of pulmonary function tests with the use of either formula. Both formulas were equally well tolerated and able to promote adequate growth and normal biochemical profiles. However, weight gain was significantly greater with the administration of the high-carbohydrate formula, possibly because of an increase in the accretion of body fat. We conclude that the short-term use of high-fat formula for infants with bronchopulmonary dysplasia decreases carbon dioxide production while maintaining adequate growth and nutritional status.
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Affiliation(s)
- G R Pereira
- Department of Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital of Philadelphia 19104
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Abstract
In a two-phased retrospective study, clinical factors associated with the development of necrotizing enterocolitis (NEC) in neonates were identified. The first phase found 13 infants with NEC who had been treated more frequently with enteral theophylline (P < .025) and fed higher volumes (> 150 mL/kg/day; P < .05) than controls of comparable birthweight and postnatal age. Seven of the 13 infants with NEC, weighing < 1,250 g at birth, had previously received intravenous aminophylline and been changed to enteral theophylline within six days before the onset of NEC. Prolonged rupture of membranes was more prevalent (P < .025) in infants with birthweight > 1,250 g who developed NEC in the first week of life. Maternal preeclampsia helped protect against the development of NEC (P < .05). In the second study phase, 59 infants with birthweights < 1,250 g were evaluated for gastrointestinal disturbance within five days of the introduction of any enteral medication. The frequencies of NEC, NEC scare, and feeding intolerance were greater in infants treated with enteral theophylline than in those treated with all other enteral medications combined (P < .05). This two-phased study confirms the multifactorial etiology of NEC and indicates that the administration of enteral theophylline to young infants < 1,250 g may be a predisposing factor to GI disturbances and NEC. These findings warrant a further prospective investigation.
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Affiliation(s)
- C A Hufnal-Miller
- Department of Pediatrics, University of Pennsylvania, School of Medicine, Children's Hospital of Philadelphia
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Troyer WA, Pereira GR, Lannon RA, Belik J, Yoder MC. Association of maternal lithium exposure and premature delivery. J Perinatol 1993; 13:123-7. [PMID: 8515304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Lithium is widely used and the treatment of choice for patients with manic-depressive illness. For pregnant patients with manic-depressive illness, however, the use of lithium during the first trimester of pregnancy may present an increased risk for fetal maldevelopment. We have recently cared for several large-for-gestational-age, prematurely born infants whose mothers were treated with lithium throughout pregnancy. To determine whether maternal lithium use during pregnancy may predispose to the onset of premature labor and fetal macrosomia, we reviewed records from the International Register of Lithium Babies and from a cohort of manic-depressive pregnant women. More than one third (36%) of infants reported to the International Register were born prematurely, and 37% of the premature infants were large for gestational age; 15% of the term infants were born large for gestational age. In the cohort group, manic-depressive mothers who received lithium during pregnancy had a 2.5-fold higher incidence of premature births than manic-depressive pregnant patients who did not receive lithium treatment. The incidence of large-for-gestational-age births in lithium-treated women in the cohort was not different from that of the general population or from manic-depressive women not treated with lithium. In summary, an association between maternal lithium therapy and premature delivery is reported. We recommend that women receiving lithium therapy during pregnancy be closely monitored for the onset of premature labor.
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Affiliation(s)
- W A Troyer
- Section of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis 46202-5210
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Abstract
The efficacy and safety of using umbilical venous catheters vs. peripheral venous catheters for the delivery of parenteral nutrition was studied in 129 critically ill premature infants who were treated in a neonatal intensive care unit for the first 3 weeks of life. Infants who received parenteral nutrition by umbilical venous catheter had greater parenteral caloric intake, lower physiologic weight loss and greater weight gain during the study as compared to infants who received parenteral nutrition by peripheral vein. While the overall incidence of sepsis was comparable in both groups (19% vs 19.7%), benign and transient episodes of hyperglycemia were seen more commonly in infants receiving parenteral nutrition by umbilical catheters. None of the hyperglycemic infants, however, required insulin therapy. The incidence of other metabolic complication was comparable in both groups. At follow up, no evidence of portal hypertension was detected in any of the infants up to 66 months of age treated with umbilical venous catheters. We conclude that the use of umbilical venous catheter allows for a comparably safe and a more appropriate parenteral nutrition support than peripheral catheters in critically ill premature neonates.
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Affiliation(s)
- G R Pereira
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, School of Medicine 19104
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Spear ML, Amr S, Hamosh M, Pereira GR, Corcoran LG, Hamosh P. Lecithin:cholesterol acyltransferase (LCAT) activity during lipid infusion in premature infants. J Pediatr Gastroenterol Nutr 1991; 13:72-6. [PMID: 1919954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Plasma cholesterol and lecithin concentrations are regulated by the serum enzyme lecithin: cholesterol acyltransferase (LCAT). LCAT activity is low in cord blood of premature infants, suggesting that in these infants the hypercholesterolemia associated with Intralipid infusion might be due to low LCAT activity. The serum LCAT activity has not been quantitated in preterm infants receiving intravenous fat emulsions. We have therefore quantitated LCAT activity in eleven premature infants maintained on total parenteral nutrition (TPN). Ten infants were studied during the first 2 weeks after birth; they received daily infusions of Intralipid at a rate of 0.5-2.0 g/kg/day over 15 h. One infant received 3.8 g/kg/day during the second week. In addition to LCAT, serum apoprotein A1 (the cofactor of LCAT), cholesterol, triglycerides, and free fatty acids were quantitated. Blood specimens were taken before the start of the infusion and 15-45 min before its completion. The LCAT activity and apoprotein A1 concentrations remained, respectively, 21-24% and 30-35% of adult levels. However, serum cholesterol levels remained in the normal range during the fat infusion. It remains to be established whether low LCAT activity and apoprotein A1 levels are due to the administration of Intralipid (which lowers LCAT activity in rats), to the lack of enteral feedings, or to prematurity per se. Our data suggest that administration of Intralipid at a rate not exceeding 1-2 g/kg/day does not impair the clearing of Intralipid-lecithin and the metabolism of cholesterol.
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Affiliation(s)
- M L Spear
- Division of Neonatology, Medical Center of Delaware, Newark
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Pereira GR, Baker L, Egler J, Corcoran L, Chiavacci R. Serum myoinositol concentrations in premature infants fed human milk, formula for infants, and parenteral nutrition. Am J Clin Nutr 1990; 51:589-93. [PMID: 2108579 DOI: 10.1093/ajcn/51.4.589] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Myoinositol concentration was studied in serum of 65 neonates and their mothers at the time of birth, in samples of various types of feedings for infants, and in serial serum samples of 15 premature infants receiving human milk, formulas for infants, or parenteral nutrition over a 3-wk period. At birth the serum concentration of myoinositol was greater in neonates than in their mothers (108 +/- 10 vs 52 +/- 6 mumol/L, respectively, means +/- SEM, p less than 0.01). In feedings for infants, the concentrations of myoinositol were significantly greater in human milk than in formulas or parenteral nutrition solutions (1840 +/- 451 vs 420 +/- 110 vs 100 +/- 8 mumol/L, respectively, p less than 0.001). Over a 3-wk period the serum concentration of myoinositol increased in infants receiving human milk but not in those receiving formulas or parenteral nutrition. Serum concentrations of myoinositol in neonates are greater than in adults and are directly influenced by myoinositol intake.
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Affiliation(s)
- G R Pereira
- Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia
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37
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Abstract
Critically ill premature infants often require lipid emulsions with parenteral nutrition until enteral feedings can be safely initiated. Because thrombocytopenia has been listed as a potential side effect of fat emulsions, we examined the effect of varying doses of intravenous fat infusions on platelet concentrations in premature infants. An initial validation study demonstrated no artifactual effect of fat infusions on the electronic cell counter method of platelet enumeration. We observed no adverse effect of fat emulsions administered at doses of 0.8 to 3.3 g/kg/day on platelet concentration either during short-term (48 hr) or long-term study periods (4 weeks).
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Affiliation(s)
- M L Spear
- Section of Neonatology, Christiana Hospital, Newark, Delaware 19718
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Pereira GR, Ziegler MM. Nutritional care of the surgical neonate. Clin Perinatol 1989; 16:233-53. [PMID: 2498023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The surgical neonate is at great risk of developing nutritional deficiencies. However, recent advances in nutritional support, including the development of special elemental diets, infant formulas, nutritional supplements and more suitable additives for parenteral nutrition, have allowed health professionals effectively to prevent the occurrence of malnutrition in sick neonates. Strict monitoring of dietary intake, growth velocity, and biochemical parameters are essential while providing nutritional support. The complication of parenteral nutrition can be reduced by following standard recommendations for preparing solutions, caring for the central and the peripheral catheters, and biochemically monitoring the infant. The organization of a hospital nutrition support service composed of physicians, nurses, nutritionists, and pharmacists is essential in establishing guidelines for the safe delivery of nutritional therapy and in educating hospital personnel and parents on how to best meet the nutritional needs of the surgical neonate.
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Affiliation(s)
- G R Pereira
- University of Pennsylvania School of Medicine, Philadelphia
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Georgieff MK, Sasanow SR, Chockalingam UM, Pereira GR. A comparison of the mid-arm circumference/head circumference ratio and ponderal index for the evaluation of newborn infants after abnormal intrauterine growth. Acta Paediatr Scand 1988; 77:214-9. [PMID: 3354332 DOI: 10.1111/j.1651-2227.1988.tb10632.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We studied the accuracy of the ponderal index and the mid-arm circumference/head circumference ratio for detecting newborn infants who were likely to be symptomatic because of aberrant intrauterine growth. Sixty infants were evaluated because of suspected intrauterine growth retardation; both the mean ponderal index and mid-arm circumference/head circumference ratio were significantly lower in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants (p less than 0.05). However, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (80% vs. 47%; p = 0.007). An additional 60 infants were evaluated because of suspected abnormal intrauterine growth acceleration. The mean mid-arm circumference/head circumference ratio, but not the ponderal index, was significantly higher in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants (p less than 0.005). Again, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (79% vs. 33%; p less than 0.001). The mid-arm circumference/head circumference ratio is more accurate than the ponderal index for the evaluation of potentially symptomatic newborn infants who suffered abnormal fetal growth. The ponderal index is not useful for the detection of symptomatic large-for-dates infants.
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Affiliation(s)
- M K Georgieff
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis
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Spear ML, Stahl GE, Hamosh M, McNelis WG, Richardson LL, Spence V, Polin RA, Pereira GR, Hamosh P. Effect of heparin dose and infusion rate on lipid clearance and bilirubin binding in premature infants receiving intravenous fat emulsions. J Pediatr 1988; 112:94-8. [PMID: 3121830 DOI: 10.1016/s0022-3476(88)80129-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The effect of heparin dose and infusion rate on plasma lipids, lipases, and unbound bilirubin was investigated in 22 premature infants with physiologic jaundice. Infants were randomly assigned to receive low or high intravenous doses (24 vs 137.3 U/day) of heparin. Each patient then received 2 g/kg/day of 10% Intralipid on 2 successive days: one day during a 15-hour period and the other day over 24 hours, with the order assigned randomly. The results demonstrate a significantly greater change in serum-free fatty acids in infants receiving the high heparin dose during the 15-hour lipid infusion period. Lipoprotein lipase activity rose more with the high heparin dose and equally at either infusion rate. We conclude that lipid infusions of 2 g/kg/day with low heparin dosage infused over 24 hours resulted in less elevation in serum-free fatty acids. There were no adverse effects on unbound bilirubin at either infusion rate or heparin dosage.
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MESH Headings
- Bilirubin/metabolism
- Drug Administration Schedule
- Fat Emulsions, Intravenous/administration & dosage
- Heparin/administration & dosage
- Humans
- Infant, Low Birth Weight/metabolism
- Infant, Newborn
- Infant, Premature, Diseases/metabolism
- Infant, Premature, Diseases/therapy
- Infusions, Intravenous/methods
- Jaundice, Neonatal/metabolism
- Jaundice, Neonatal/therapy
- Lipid Metabolism
- Parenteral Nutrition, Total
- Random Allocation
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Affiliation(s)
- M L Spear
- Division of Neonatology, Medical Center of Delaware, Newark
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Abstract
Nutritional intakes, transthyretin (prealbumin) levels, and anthropometric measurements were measured weekly in 26 preterm infants from week 2 of life throughout hospitalization. A sustained significant increase in protein intake occurred in 14 infants over a 2-week period. When mean protein intake increased, mean transthyretin levels increased during the same week (p less than 0.001), followed 1 week later by significant increases in mean weight, occipitofrontal head circumference (OFC), and mid-arm circumference (MAC). In the other 12 infants, a sustained significant decrease in protein intake occurred over 2 weeks. When mean protein intake decreased (p less than 0.01), transthyretin levels decreased during the same week (p less than 0.05), followed 1 week later by significant decreases in mean weight and MAC growth. Over all hospitalization weeks (n = 95), rates of weight gain were more significantly associated with previous trends in transthyretin levels (p = 0.007) than with protein intake alone (p = 0.08). In particular, declines in rates of weight gain were predicted significantly more frequently by the prior week's transthyretin trend (70%) than by the trend in protein intake (47%). In growing premature infants, changes in transthyretin levels occur 1 week before changes in anthropometric measurements. Changes in transthyretin levels are more predictive than changes in protein intake alone for monitoring growth velocity in preterm infants.
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Affiliation(s)
- M K Georgieff
- Department of Pediatrics, University of Minnesota School of Medicine, Minneapolis
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Berkow SE, Spear ML, Stahl GE, Gutman A, Polin RA, Pereira GR, Olivecrona T, Hamosh P, Hamosh M. Total parenteral nutrition with intralipid in premature infants receiving TPN with heparin: effect on plasma lipolytic enzymes, lipids, and glucose. J Pediatr Gastroenterol Nutr 1987; 6:581-8. [PMID: 3123635 DOI: 10.1097/00005176-198707000-00016] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Plasma lipolytic activity (lipoprotein lipase and hepatic lipase), free fatty acids (FFA), triglycerides, cholesterol, and glucose levels were measured in 21 premature infants [gestational age 26-37 weeks (mean +/- SEM 30.4 +/- 0.63 weeks), aged 1-8 days (mean +/- SEM 3.00 +/- 0.35 days)]. All infants were maintained on total parenteral nutrition with heparin (1 U/ml) and were given Intralipid, 1, 2, and 3 g/kg/day, over 15 h on days 1, 2, and 3, respectively. Blood samples were drawn before and at the end of Intralipid administration. Baseline plasma lipolytic activity, before the start of lipid infusion, was 1.54 +/- 0.24 U/ml (1 U = 1 mumol [3H]oleic acid released from tri[3H]olein/h). Lipolytic activity increased after lipid infusion to 4.04 +/- 0.96, 4.32 +/- 0.63, and 6.09 +/- 1.00 U/ml on days 1, 2, and 3 of the study. Hepatic lipase amounted to 38-47% of total lipolytic activity. During the 3 days of lipid infusion, there were dose-dependent increases in plasma FFA, triglyceride, and cholesterol. Whereas FFA and triglyceride concentrations returned to prelipid infusion levels 9 h after stopping the infusion of Intralipid, 1, 2, or 3 g/kg, there was a cumulative increase in plasma cholesterol and glucose concentrations. The close correlation between FFA concentrations and plasma lipolytic activity (r = 0.655, p less than 0.001) suggests considerable intravascular lipolysis. The positive correlation between plasma FFA and triglycerides (r = 0.632, p less than 0.001) and FFA and cholesterol (r = 0.582, p less than 0.001) indicate, however, that intravascular lipolysis does not prevent the lipemia associated with Intralipid infusion to low birth weight infants.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S E Berkow
- Department of Pediatrics, Georgetown University Medical Center, Washington, D.C. 20007
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Sasanow SR, Georgieff MK, Pereira GR. Mid-arm circumference and mid-arm/head circumference ratios: standard curves for anthropometric assessment of neonatal nutritional status. J Pediatr 1986; 109:311-5. [PMID: 3734968 DOI: 10.1016/s0022-3476(86)80393-6] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Two hundred four neonates, 25 to 42 weeks estimated gestational age (EGA), were measured on day 2 or 3 of life for upper mid-arm circumference (MAC) and head circumference. Regression analysis was used to construct standard curves for MAC versus EGA and mid-arm circumference/head circumference ratio (MAC/HC) versus EGA. Correlation coefficients were 0.93 for MAC versus EGA, and 0.84 for MAC/HC versus EGA. MAC, MAC/HC, and head circumference were also highly correlated with birth weight. These measurements may more accurately assess intrauterine growth and body proportionality at birth than weight, length, and head circumference.
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Georgieff MK, Sasanow SR, Mammel MC, Pereira GR. Mid-arm circumference/head circumference ratios for identification of symptomatic LGA, AGA, and SGA newborn infants. J Pediatr 1986; 109:316-21. [PMID: 3734969 DOI: 10.1016/s0022-3476(86)80394-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Mid-arm circumference/head circumference ratios (MAC/HC) and birth weights obtained in 73 neonates were studied to compare which of these growth measurements could more accurately predict risk of metabolic complications resulting from either acceleration or retardation of fetal growth. The MAC/HC ratio was more sensitive than birth weight in distinguishing symptomatic large for gestational age (LGA) infants who were born to diabetic mothers from other LGA infants who were asymptomatic, and symptomatic from asymptomatic small for gestational age infants. In addition, the MAC/HC ratio identified symptomatic appropriate for gestational age (AGA) infants born to diabetic mothers and AGA infants with signs and symptoms of growth retardation. The MAC/HC is more useful than birth weight in assessing newborn infants at risk for the metabolic complications associated with fetal growth disorders.
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Georgieff MK, Sasanow SR, Mammel MC, Ophoven J, Pereira GR. Cord prealbumin values in newborn infants: effect of prenatal steroids, pulmonary maturity, and size for dates. J Pediatr 1986; 108:972-6. [PMID: 3754892 DOI: 10.1016/s0022-3476(86)80942-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We assessed cord prealbumin concentrations in 214 appropriate for gestational age newborn infants, 21 small for gestational age infants, and 27 large for gestational age infants to establish normal values and to assess the effect of intrauterine growth, prenatal steroids, and pulmonary maturity on prealbumin levels. Cord prealbumin values were significantly correlated with increasing gestational age (r = 0.33; P less than 0.001) and birth weight (r = 0.40, P less than 0.001) in the AGA neonates. Neonates born before 37 weeks gestation had significantly lower prealbumin levels than those born at term (P less than 0.001). The SGA infants had significantly lower levels than age-matched AGA controls (P less than 0.01), and LGA infants had significantly higher levels than age-matched AGA controls (P less than 0.001). In preterm infants, those with exposure to prenatal steroids (betamethasone or premature rupture of membranes) had significantly higher prealbumin values than control infants of comparable age and weight (P less than 0.001). Infants without respiratory distress syndrome had higher levels than those of comparable age and weight with hyaline membrane disease (P less than 0.05). This study demonstrates that a correlation of gestational age and birth weight exists with cord prealbumin levels, and that the large variability at each gestational age may be accounted for in part by appropriateness of size for dates, prenatal steroid exposure, and pulmonary maturity.
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Pereira GR, Zucker AH. Nutritional deficiencies in the neonate. Clin Perinatol 1986; 13:175-89. [PMID: 3514049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This article reviews common nutritional deficiencies that have been identified in newborn infants, including deficiencies of protein; vitamins A, D, K, C, and E; calcium and phosphorus; folate; zinc; and copper. The etiology, clinical presentation, diagnosis, and treatment of these nutritional deficiencies are discussed.
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Abstract
The assessment of growth parameters remains one of the most practical and valuable tools to estimate nutritional status in neonates. Growth assessment in full-term infants is performed by using charts developed by the National Center for Health and Statistics. The assessment of post-natal growth in premature infants is controversial and can be performed by using either intrauterine or extrauterine standards. The selection of appropriate growth charts should be based on clinical, demographic, ethnic, and socioeconomic similarities of the population used for reference. Daily energy intakes ranging from 100 to 120 kcal/kg/day have been recommended for full-term infants, while higher intakes ranging from 114 to 181 kcal/kg/day have been recommended for premature neonates. Full-term infants should be nursed or nipple fed on demand; however, premature infants should ideally be tube fed by intermittent gastric feeding (gavage). Continuous gastric and transpyloric feedings are indicated in selected infants. Human milk is a preferred food for full-term infants during the first six months of life; however, this precept does not suggest that all infants who are exclusively breast-fed will grow adequately. Preterm human milk is also a preferred food for the low birthweight infant, provided nutritional supplements are used. It is unclear whether the supplementation of vitamin D, iron, and fluoride in full-term breast-fed infants should be started at birth, at the time of initiation of solid foods, or at the age of six months. The routine supplementation of multivitamins, folic acid, and vitamin E to all low birthweight infants is controversial. Most investigators suggest vitamin supplementation be given until the intake of formula or breast milk is sufficient to meet daily requirements. Vitamin E appears to exert a protective effect in premature infants against the development of severe retinopathy. The supplementation of vitamin E should be dependent upon the serum vitamin E concentration. It is controversial whether iron supplementation for premature infants should be initiated soon after birth or at two months of age, or whether higher doses of iron should be given to very low birthweight infants. If iron supplementation is started at birth, vitamin E status should be closely monitored. Although the optimal intakes of calcium and phosphorus in infant feedings have not been firmly established, the levels of calcium and phosphorus in human milk appear to be inadequate for the growing low birthweight infant.(ABSTRACT TRUNCATED AT 400 WORDS)
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Sasanow SR, Spitzer AR, Pereira GR, Heaf L, Watkins JB. Effect of gestational age upon prealbumin and retinol binding protein in preterm and term infants. J Pediatr Gastroenterol Nutr 1986; 5:111-5. [PMID: 3080576 DOI: 10.1097/00005176-198601000-00020] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The relationships between maternal and umbilical cord levels of prealbumin and retinol binding protein (RBP) were studied in 68 mothers and in their appropriate-for-gestational-age neonates delivered between 25 and 42 weeks gestation. Arterial and venous concentrations of prealbumin and RBP in cord sera were also studied in a subsample of eight infants. In cord sera, prealbumin and RBP levels increased with gestational age (prealbumin, r = 0.47; RBP, r = 0.40, p less than 0.01), and were significantly different in neonates born at term compared to those born prematurely (mean +/- SD, prealbumin 12.0 +/- 3.9 mg/dl vs. 8.8 +/- 2.3 mg/dl, p less than 0.001; RBP, 2.3 +/- 0.8 vs. 1.8 +/- 0.5 mg/dl, p less than 0.005). No significant differences between arterial and venous concentrations of prealbumin and RBP were observed in cord blood. In maternal blood, serum prealbumin and RBP concentrations did not increase with length of gestation (25-42 weeks). Maternal prealbumin was not correlated significantly with infants' cord serum levels; the correlation coefficient for RBP was 0.29, p less than 0.05. Maternal prealbumin and RBP serum levels were approximately twice the values seen in neonates born both at term and prematurely. Although the difference between premature and full-term cord levels of prealbumin and RBP may reflect an increase in hepatic protein synthesis that occurs with maturation of the fetus and/or a change in placental function after 37 weeks gestation, neither of these factors sufficiently explains the variance in neonatal prealbumin and RBP levels.
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Georgieff MK, Hoffman JS, Pereira GR, Bernbaum J, Hoffman-Williamson M. Effect of neonatal caloric deprivation on head growth and 1-year developmental status in preterm infants. J Pediatr 1985; 107:581-7. [PMID: 3930680 DOI: 10.1016/s0022-3476(85)80028-7] [Citation(s) in RCA: 63] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The effects of neonatal illness and caloric intake on head growth velocity and on 1-year developmental outcome were studied in 73 appropriate (AGA) and small for gestational age (SGA) premature infants of (mean +/- SD) 30 +/- 2 weeks gestation who received intensive care during the neonatal period. Head growth from birth to 1 year of corrected age was characterized by a triphasic curve initiated by a period of growth arrest or suboptimal growth followed by a period of catch-up growth and terminated by a period of growth along standard curves. Head growth arrest or suboptimal head growth were directly related to the duration of the initial period of caloric deprivation (less than 85 kcal/kg/day) and to the duration of mechanical ventilation. Catch-up head growth was influenced by the duration of the preceding period of caloric deprivation in all infants and by the caloric intake during that phase only in SGA infants; catch-up growth was unrelated to the duration of mechanical ventilation. Head growth along standard curves occurred in all infants by 3 months of corrected age and persisted up to 1 year of corrected age. Infants calorically deprived the longest (AGA 4 to 6 weeks, SGA 2 to 3 weeks) had head growth along standards at curves below -1 SD on the growth chart; all other groups had this phase of head growth at curves between the mean and -1 SD. Infants calorically deprived for more than 4 weeks had developmental scores below normal ranges by 1 year of corrected age.
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Oberkotter LV, Pereira GR, Paul MH, Ling H, Sasanow S, Farber M. Effect of breast-feeding vs formula-feeding on circulating thyroxine levels in premature infants. J Pediatr 1985; 106:822-5. [PMID: 3923178 DOI: 10.1016/s0022-3476(85)80366-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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