Foram realizados três experimentos para avaliar o grau de moagem do milho, sua substituição por subprodutos agroindustriais e o fornecimento de aditivos microbiológicos em rações para vacas leiteiras recebendo silagem de milho como volumoso. Experimento 1: Foram utilizadas trinta e seis vacas da raça Holandesa (330 DEL) para avaliar o fornecimento de aditivo microbiológico (Levucell SC20 da Lallemand Animal Nutrition) em rações com ou sem substituição parcial (50%) de milho finamente moído por polpa cítrica. Foi utilizado delineamento em Quadrados Latinos 4x4 repetidos. A ingestão de matéria seca, produção e composição do leite e teor de glicose plasmática não foram afetadas (P>0,05) pelos tratamentos. O nitrogênio uréico no leite foi maior (P<0,05) nos animais que receberam aditivo microbiológico. O nitrogênio uréico no plasma foi reduzido pela substituição parcial do milho pela polpa cítrica (P<0,05). A substituição parcial do milho por polpa cítrica não teve efeito negativo sobre o desempenho de vacas produzindo em média 19 kg/d de leite. Experimento 2: Foram utilizadas vinte e oito vacas da raça Holandesa (230 DEL) para avaliar os efeitos de vários teores de amido na matéria seca da ração sobre o desempenho lactacional dos animais. O teor de amido variou através da substituição do milho moído fino pela polpa cítrica. Os tratamentos foram: 15% (AM15), 20% (AM20), 25% (AM25) e 30% de amido (AM30). Foi utilizado delineamento em Quadrados Latinos 4x4 repetidos. As produções de leite foram 27,94; 29,17; 31,11 e 29,64 kg/d para os tratamentos AM15, AM20, AM25 e AM30, respectivamente, apresentando efeito cúbico significativo (P<0,05). Para produção de gordura, proteína, lactose e sólidos totais do leite também houve efeito cúbico (P<0,05). Para teor de proteína, sólidos totais e nitrogênio uréico no leite houve efeito linear (P<0,05). Não houve efeito dos tratamentos sobre teor de gordura do leite e glicose e nitrogênio uréico plasmáticos (P>0,05). Vacas produzindo em torno de 30 kg/d apresentaram melhor desempenho quando alimentadas com rações contendo 25% de amido, não havendo vantagem no fornecimento de rações com teor de amido de 30%. Experimento 3: Foram utilizadas trinta e duas vacas da raça Holandesa (160 DEL) para comparar o grau de moagem do milho (fino ou grosso) em combinação com polpa cítrica peletizada ou casca de soja nas rações. Os tratamentos foram: milho moído fino + polpa cítrica (MFPC), milho moído grosso + polpa cítrica (MGPC), milho moído fino + casca de soja (MFCS), milho moído grosso + casca de soja (MGCS). Foi utilizado delineamento em Quadrados Latinos 4x4 repetidos. A ingestão de matéria seca, produção de leite, teores de gordura, proteína e lactose do leite, glicose e nitrogênio uréico plasmáticos não foram afetados pelos tratamentos (P>0,05). Houve efeito significativo da interação grau de moagem versus tipo de subproduto (P<0,05) para produção de leite corrigido para gordura, produção de gordura e de sólidos totais do leite. O grau de moagem do milho e o tipo de subproduto não afetaram o desempenho de vacas leiteiras com produção ao redor de 24 kg/d. / Three experiments were conducted to assess the effects of corn grain grinding, byproducts and yeast culture supplementation in dairy cow rations containing corn silage as forage. Experiment 1: Thirty six lactating Holstein cows (330 days in milk - DIM) were used to study the supplementation of yeast culture (Levucell SC20 - Lallemand Animal Nutrition) in dairy rations with partial (50%) replacement of finely ground corn by dried citrus pulp. A repeated 4x4 Latin Square design was used. Dry matter intake, milk yield and composition and plasma glucose were not affected (P>0,05) by treatments. Milk urea nitrogen was raised by yeast culture supplementation (P<0,05). Plasma urea nitrogen was reduced by feeding citrus pulp in partial replacement of corn (P<0,05). The partial replacement of finely ground corn by dried citrus pulp did not affect the cows performance with 19 kg/d milk yield. Experiment 2: Twenty eight lactating Holstein cows (230 DIM) were used to evaluate the effects on performance of varying contents of starch in the ration. Starch contents was varied by replacing fine ground corn by dried citrus pulp. Treatments were: 15% (AM15), 20% (AM20), 25% (AM25) e 30% of starch (AM30) in the ration dry matter. A repeated 4x4 Latin Square design was used. Milk yield was 27,94; 29,17; 31,11 e 29,64 kg/d for treatments AM15, AM20, AM25 and AM30, respectively, with cubic effect (P<0,05). Milk fat, protein, lactose and total solids yield were affected cubically (P<0,05). Linear effects were detected for protein, total solids and milk urea nitrogen contents (P<0,05). Milk fat contents, plasma urea nitrogen and glucose were not affected by treatments (P>0.05). Cows producing about 30 kg/d got better performance when fed with rations 25% starch contents. Did not have advantage by supplying 30% starch contents rations. Trial 3: Thirty two mid lactating Holstein cows (160 DIM) were used to study the effects on performance of corn grain grinding (coarse or fine) and its combination with dried citrus pulp or soy hulls. A repeated 4x4 Latin Square design was used. The treatments were: fine ground corn + citrus pulp (MFPC), coarse ground corn + citrus pulp (MGPC), fine ground corn + soy hulls (MFCS), coarse ground corn + soy hulls (MGCS). Treatments did not affect DMI, milk yield, milk fat, protein and lactose contents, plasma urea N and glucose (P>0.05). The interaction corn grain grinding and byproduct source was significative for fat corrected milk, fat and total solids yield (P<0,05). Corn grain grinding and byproduct variety did not affect the cows performance with 24 kg/d milk yield.

Orientador: José de Anchieta Castro e Horta Júnior / Resumo: O estado nutricional materno durante períodos críticos de desenvolvimento da prole (fetal e neonatal) é considerado um importante indutor de Programação. No sistema nervoso central, as alterações poderiam ocorrer especialmente em áreas importantes para o controle do comportamento alimentar, como o núcleo do trato solitário (NTS) que se desenvolve durante o período embrionário. A sinalização relacionada à saciedade é mediada pelos aferentes primários glutamatérgicos provenientes do estômago e duodeno, imunorreativos ao transportador vesicular de glutamato – tipo 2 (VGLUT2) e modulada por diversos neuropeptídeos como o hormônio concentrador de melanina (MCH) e o transcrito regulado pela cocaína e anfetamina (CART). Assim, nosso objetivo foi comparar a organização citoarquitetônica e a imunorreatividade ao MCH, ao CART e ao VGLUT2 no NTS de ratos cujas mães foram submetidas à restrição calórica durante a gestação e lactação. Para sua execução, foram realizados acasalamentos de ratos adultos da linhagem Wistar para obtenção das proles, as quais foram objeto de estudo. Após a detecção da prenhez, as fêmeas foram separadas para a formação de dois grupos experimentais: grupo controle (GC), dieta normal ad libitum, e grupo restrição calórica (GR), dieta de 50% de restrição em relação ao grupo controle durante os períodos de gestação e lactação. Os filhotes machos, provenientes dos grupos restrição (GR) e controle (GC), foram divididos em quatro subgrupos etários (n=5) de 21, 28, 50 e... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Maternal nutritional status during critical periods of offspring development (fetal and neonatal) is considered an important Programming inductor. In the central nervous system, alterations could occur especially in areas important for food behavior control, such as the nucleus of the solitary tract (NTS) that develops during the embryonic period. Signs related to satiety are mediated by glutamatergic primary afferents from the stomach and duodenum, immunoreactive to the vesicular glutamate transporter type 2 (VGLUT2) and modulated by various neuropeptides such as melanin concentrating hormone (MCH) and the transcript regulated by cocaine and amphetamine (CART). So, our objective was to compare the cytoarchitectonic organization and immunoreactivity to MCH, CART and VGLUT2 in the NTS of rats whose mothers were subjected to caloric restriction during pregnancy and lactation. For their execution, mating of adult Wistar rats was carried out to obtain proles, which were the object of study. After detection of pregnancy, the females were separated to form two experimental groups: control group (CG), normal ad libitum diet, and caloric restriction group (GR), a 50% restriction diet in relation to the control group during pregnancy and lactation periods. The male offspring from the restriction (GR) and control (CG) groups were divided into four age groups (n = 5) of 21, 28, 50 and 90 days. The number of animals from each offspring, postnatal weight 1, weight and naso-anal length, fo... (Complete abstract click electronic access below) / Mestre

Made available in DSpace on 2016-01-26T12:51:17Z (GMT). No. of bitstreams: 1 martaalvessilva_dissert.pdf: 549964 bytes, checksum: a2653c4e5e2e501c52633e2234ae8fb5 (MD5) Previous issue date: 2007-08-14 / The benefits of breast feeding both for the mother and for the child, as well as the harm caused by the lack of it or the early weaning are largely divulged by the literature. In Brazil the rates of breast feeding are low for the population in general and mainly in the case of prematurity due to the very characteristics of mothers and of prematures. This work aimed at characterizing mothers of newborns and prematures identifying their knowledge about breast feeding. Casuistic and method: The study has been approved by the Ethics Committee. Research a 104 mothers who had their deliveries at Hospital de Base in Sao Jose do Rio Preto, and who fulfilled the inclusion criteria and who were characterized under the sociodemografic variables, gestation and delivery data, general aspects, general and specific knowledge about breast feeding under normal and prematurity conditions were researched from March to April, 2002. Results: Sample of 80 mothers of newborns infants being group I and 24 mothers premature infants being group II, who were young, poorly educated, with low income without professional occupation. Caesareans were prevalent in group I and normal delivery in group II, but with high rate of caesarians in both groups. Neither mothers from group I nor from group II planned their pregnancy, but carried out the prenatal in time. Concerning the general aspects of breast feeding, despite the fact that most mothers did not receive information, they are willing to breast feed and can manage to do it. Mothers from both groups show superficial knowledge about the benefits of breast feeding for the mother-child health, for when questioned in depth they contradict the pointed knowledge, also they lack of knowledge on how to handle breast feeding in prematurity situation. Conclusion: Both groups presented similar characterization showing the need of intervention and of support just after delivery and follow-up of hospital discharge. / Os benefícios do aleitamento materno, tanto para mãe quanto para a criança, bem como o prejuízo causado pela sua ausência ou o desmame precoce são amplamente divulgados pela literatura. No Brasil as taxas de aleitamento materno são baixas para a população em geral e principalmente em situação de prematuridade devido às características próprias das mães e dos prematuros. Este trabalho teve por objetivo caracterizar mães de recém-nascidos a termo e prematuros identificando seu conhecimento sobre o aleitamento materno. Casuística e método: O estudo foi aprovado pelo Comitê de Ética em Pesquisa; foram pesquisadas 104 mães que realizaram parto no Hospital de Base de São José do Rio Preto, no período de março a abril de 2002 e que atenderam aos critérios de inclusão e caracterizadas sob as variáveis sócio-demográficas, dados de gestação e parto, aspectos gerais, conhecimentos gerais e específicos do aleitamento materno em condições normais e de prematuridade. Resultados: Amostra composta de 80 mães de recém-nascidos a termo compondo o grupo I e 24 mães de recém-nascidos prematuros o grupo II, jovem, de pouca escolaridade, baixa renda e sem ocupação profissional. Houve prevalência de cesariana no grupo I e parto normal no grupo II, mas com alto índice de cesariana nos dois grupos. Tanto as mães do grupo I quanto do grupo II não planejaram a gravidez, porém realizaram o pré-natal precocemente. Com relação aos aspectos gerais do aleitamento materno, apesar da maioria das mães não ter recebido informação, demonstram desejo de amamentar e referem condição de fazê-lo. As mães de ambos os grupos apresentam conhecimento superficial sobre os benefícios do aleitamento para a saúde materno-infantil, pois quando questionadas em profundidade, contradizem o conhecimento apontado, bem como desconhecem o manejo do aleitamento em situação de prematuridade. Conclusão: Os dois grupos apresentam caracterização semelhante indicando a necessidade de intervenção e suporte no período pós-parto imediato e continuação na alta hospitalar.

Made available in DSpace on 2016-01-26T12:51:28Z (GMT). No. of bitstreams: 1 vivianecuri_tese.pdf: 3356542 bytes, checksum: 3e315d421d5b2c78bdb72380eb601099 (MD5) Previous issue date: 2010-11-29 / Alcoholism is a public health problem worldwide, involving thousands of men and women, bringing serious consequences as a disease in all organs of the human body, especially the stomach, liver, heart and brain. The consumption of alcoholic beverages for infants and mothers have attracted the attention of researchers in recent decades, with significant. Objective: This study aimed to evaluate the effects of ethanol in the junctional epithelium, adamantine epithelium, epithelium of attached gingiva and periodontal ligament of the upper first molar of the rat, during lactation. Materials and Methods: To this end, we used mice with a day of postnatal life, whose mothers received 20% ethanol in drinking water and rats whose mothers do not received ethanol during the entire lactation. After 21 days, the chicks were sacrificed with anesthetic overdose (Hypnol 3%). The heads were separated and fixed in a solution of "alfac" (alcohol 80% -85 ml, 10 ml of formalin and acetic acid 5-ml), embedded in paraffin and frontal serial sections were stained with hematoxylin and eosin. The cuts were focused light microscope (100x) fitted with a camera lucida. The nuclei of cells from tissue fragments were designed on paper with increased end of 1000x. and 50 nuclei of each structure were outlined with black pencil for later measurement of larger (D) and smaller (d)diameters. Once determined the diameters were estimated karyometric following parameters: geometric mean diameter ratio D / d, perimeter, area, volume, relationship between volume and area, eccentricity, shape coefficient and contour índex. This work also was done using a grid printed on paper. The images were drawn on the grid. In order to assess the volumes and cell cytoplasm, the nucleus / xxiv cytoplasm ratio, the numerical cell density, relation to the external surface / basal layer, the thickness of epithelial layers and the density of the surface was sometimes used the count of the points and sometimes the number of intersections and applied to stereological equations appropriate for each of these variables. All data collected were submitted to non-parametric statistics (Wilcoxon-Mann-Whitney). Results: Histologically, the superior maxillar molar tooth of the rat treated with ethanol was not erupted or partially eruído; the junctional epithelium was reduced and the adamant epithelium was in full function and consists of high palisade cells. The epithelium of attached gingiva was more slender and composed of smaller cells. In the Periodontal ligament was possible to observe bigger and disorganizedfibers. The nuclei of the epithelia studies have shown decreased values after Karyometry, for larger and smaller medium diameters, volume, area, perimeter, and the relation V / A. Stereologically could be observed in the junctional epithelium, adamantine and the attached gingiva, less voluminous cell with scarce cytoplasm leading to a greater number of cells per mm3 of tissue. The disorganized periodontal ligament showed larger fibers with smaller number per mm3. Conclusion: In this study, ethanol resulted in a framework of epithelial hypotrophy, indicating a direct action on the junctional and adamantineepithelium, epithelium of attached gingiva and periodontal ligament. / O alcoolismo é um problema de saúde pública mundial, envolvendo milhares de homens e mulheres, trazendo conseqüências graves como doença em todos os órgãos do corpo do humano, em especial o estômago, o fígado, o coração e o cérebro. O consumo de bebidas alcoólicas por lactantes e lactentes vem despertando a atenção dos pesquisadores, nas últimas décadas, com achados significantes. Objetivo: Este trabalho teve como objetivo avaliar os efeitos do etanol no epitélio juncional, epitélio adamantino, epitélio da gengiva inserida e ligamento periodontal do primeiro molar superior do rato, durante a lactação. Materiais e Métodos: Para tal, foram utilizados ratos com um dia de vida pós-natal, cujas mães receberam etanol a 20% na água do bebedouro e ratos cujas mães não receberam o etanol, durante toda a lactação. Ao final de 21 dias, os filhotes foram sacrificados com sobredosagem anestésica (Hypnol a 3%). As cabeças foram separadas e fixadas em solução de alfac (álcool 80%-85 ml, formalina-10 ml e ácido acético-5 ml), incluídas em parafina e os cortes frontais seriados foram corados com hematoxilina e eosina. Os cortes foram focalizados ao microscópio de luz (100x) munido de uma câmara clara. Os núcleos das células dos tecidos estudados foram projetados sobre papel com aumento final de 1000x. e 50 núcleos de cada estrutura foram contornados com lápis preto para posterior medição dos diâmetros maior (D) e menor (d). Uma vez determinados os diâmetros, foram estimados os seguintes parâmetros cariométricos: diâmetro geométrico médio, relação entre D/d, perímetro, área, volume, relação entre volume e área, xxi excentricidade, coeficiente de forma e índice de contorno. Neste trabalho também, foi utilizada uma grade impressa sobre papel. As imagens obtidas foram desenhadas sobre a grade. Com a finalidade de se avaliar os volumes citoplasmáticos e celular, a relação núcleo/citoplasma, a densidade numérica celular, a relação superfície externa/ camada basal, a espessura das camadas epiteliais e a densidade da superfície, foi utilizada ora a contagem de pontos ora o número de intersecções e aplicadas às equações estereológicas apropriadas para cada uma dessas variáveis. Todos os dados colhidos foram submetidos à estatística não-paramétrica (teste de Wilcoxon-Mann-Whitney). Resultados: Histologicamente, o dente molar do maxilar superior do rato tratado com etanol não estava erupcionado ou então, parcialmente erupcionado; o epitélio juncional estava reduzido e o epitélio adamantino presente estava em plena função e constituído de células altas em paliçada. O epitélio da gengiva inserida era mais delgado e constituído de células menores. No ligamento periodontal foi possível observar fibras desorganizadas e maiores. Os núcleos dos epitélios estudados mostraram valores diminuídos, após cariometria, para os diâmetros maior, menor e médio; volume, área, perímetro e relação V/A. Estereologicamente foi possível observar, nos epitélios juncional, adamantino e da gengiva inserida, células menos volumosas com citoplasma mais escasso levando a um maior número de células por mm3 de tecido. O ligamento periodontal desorganizado mostrou fibras mais volumosas e com menor número por mm3. Conclusões: Neste estudo, o etanol ocasionou um quadro de hipotrofia epitelial, indicando uma xxii ação direta nos epitélios juncional e adamantino, epitélio de gengiva inserida bem como no ligamento periodontal.

Made available in DSpace on 2016-01-26T12:51:31Z (GMT). No. of bitstreams: 1 eliasnaimkassis_tese.pdf: 1206838 bytes, checksum: 890b2f6915170e129c35065467aeb0f2 (MD5) Previous issue date: 2011-02-11 / The ingestion of alcohol by a mother during lactation changes the composition of the milk, resulting in the origin of ethanol and acetaldehyde in the milk, and turns more severe the effects of the ethanol in infant rats. Objective: This work aimed to study the effects of ethanol at the palatine bone and palatine epithelium of young infants in 21 days of postnatal life, administered to the experimental rats during lactation. Materials and Methods: The experimental rats received ethanol at 20% in the drinking fountain ad libitum during those 21 day of nursing. Another group of animals received an amount of water similar to that group without ethanol. The infant rats were put to death with an extra dose of anesthesia in their 21 days of life. Their heads were separated from their body, put in 85mls of a 80% alcohol solution, 10 ml of formalin and 5ml of acetic acid, the palate area was cut in serial sections by frontal plans, in the same level were the molar are located, the cuts were about 6 micrometers and were treated with hematoxylin-eosin. The nuclear parameters of the palate epithelium, the cytoplasmatic volume and cellular, the relation nucleon/cytoplasm, numerical density and superficial, the thickness of the epithelium were all estimate. The average body weight of the infant rats in the ethanol group was 20,20 g and the other group average weight was 34,86gr. Histologically, the palate epithelium was thinner and it had more numbers of smaller cells with a bigger nucleon. The palate bone had more delicate and less trabeculo calcificated, and smaller osteocyte. Conclusion: In this experiment, the ethanol induced a epithelial hypotrophy condition and palate bone more delicate and less calcificated, showing a direct affect in the cells and trabeculo palate and also the poor development of the intoxicated infant rats. / A ingestão materna de etanol durante a lactação altera a composição do leite, resulta no aparecimento do etanol e acetaldeído no leite, e exacerba os efeitos do etanol nos filhotes da rata. Objetivo: Este trabalho teve o objetivo de estudar os efeitos do etanol, ao epitélio palatino e osso palatino de filhotes lactantes em 21 dias de vida pós-natal, administrados nas ratas-mães durante a lactação. Materiais e Métodos: Para tal, foram utilizadas ratas que receberam etanol a 20% no bebedouro ad libitum durante os 21 dias de lactação. Os animais controles receberam um volume similar de água sem álcool. Os filhotes foram sacrificados com sobre dosagem anestésica no 21º dia. As cabeças foram separadas, fixadas em solução fixadora de álcool 80%- 85ml, formalina- 10 ml e ácido acético- 5ml, a região palatina foi seccionada seriadamente em planos frontais, ao nível dos molares, e os cortes de 6 micrometros foram tratados com hematoxilina-eosina . Os parâmetros nucleares do epitélio palatino foram estimados, assim como os volumes citoplasmáticos e celulares, relação núcleo/citoplasma, densidades numérica e superficial, e espessura epitelial. O peso corporal médio do filhote foi de 34,86 g no grupo controle e 20,20 g no tratado. Histologicamente, o epitélio palatino mostrou-se mais adelgaçado, constituído de células abundantes e menores com núcleos maiores. O osso palatino mostrou trabéculas mais delicadas e menos calcificadas e com osteócitos de menor tamanho. Conclusões: Neste experimento, o etanol, induziu no quadro de hipotrofia epitelial e osso palatino mais delicado e pouco calcificado, indicando uma ação direta nas células e trabéculas do palato, além de retardar o desenvolvimento de filhotes intoxicados.

Orientador: José de Anchieta de Castro e Horta Júnior / Resumo: A associação do baixo peso ao nascer com alto risco de doenças como obesidade, diabete tipo 2 e doenças cardiovasculares na vida adulta levaram à hipótese da “Origem Desenvolvimentista da Saúde e Doença” (DOHaD). Nessa hipótese, Programação se refere às adaptações executadas pelo organismo frente a insultos ocorridos durante seu desenvolvimento, gerando efeitos permanentes ou não na estrutura e função de órgãos. A nutrição materna durante o desenvolvimento do indivíduo é considerada um importante indutor de Programação, visto que a deficiência de nutrientes, durante a prenhez e a lactação, provoca alterações significativas no peso corpóreo, no balanço energético, na ingestão alimentar e na expressão de neuropeptídeos. O hormônio concentrador de melanina (MCH) e o transcrito regulado pela cocaína e anfetamina (CART) são neuropeptídeos expressos na área hipotalâmica lateral (LHA), que participam da regulação do balanço energético e do comportamento alimentar, nos quais o MCH desempenha papel orexígeno e o CART, anorexígeno. Nosso objetivo foi analisar o número e a distribuição de neurônios MCH e CART e sua ultraestrutura na LHA de ratos cujas mães foram submetidas à restrição alimentar durante a prenhez e lactação. Fêmeas prenhes Wistar foram separadas em dois grupos experimentais: grupo controle (GC), dieta padrão ad libitum, e grupo restrição calórica (GR), dieta de 50% de restrição em relação ao grupo controle durante os períodos de prenhez e lactação. Foram avaliados o núme... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The association between lower birth weight and an increased risk of obesity, diabetes type 2 and cardiovascular diseases in adult life led to Developmantal Origins of Health and Disease (DOHaD) hypothesis. In this hypothesis, programming is related to the adjustments performed by the organism to insults occurring at key stages of their development, which may lead to long-lasting effects in the organs structure and function. Maternal nutrition during critical periods of individual development is considered an important Programming inductor, since the nutrient deficiency during pregnancy and lactation causes significant changes in body weight, energy balance, food intake and neuropeptides expression. The melanin-concentrating hormone (MCH) and the cocaine- and amphetamine-regulated transcript (CART) are neuropeptides expressed in the lateral hypothalamic area (LHA) that are involved in the regulation of energy balance and feeding behavior in which MCH plays an orexigenic role and CART an anorexigenic one. Thus, our aim was to analyze the number and the distribution of MCH and CART and the ultrastructure of these neurons in the LHA of rats whose mothers were subjected to food restriction during pregnancy and lactation. After pregnancy confirmation, female Wistar rats were divided in two groups: control group (CG), ad libitum standard diet, and caloric restriction group (RG), 50% diet restriction compared to the control group during pregnancy and lactation. After birth, the numbe... (Complete abstract click electronic access below) / Doutor

Globally, ~17 million women and ~2.1 million children are living with HIV. Sub-Saharan Africa accounts for 70% of HIV-infected (HIV+) persons. Mother-To-Child Transmission of HIV (MTCT) during pregnancy, delivery and breastfeeding, is the main route of HIV infection in children. The World Health Organisation recommends lifelong antiretroviral therapy (ART) for all HIV+ pregnant and breastfeeding mothers to prevent MTCT, and breastfeeding for ≥24 months for optimal child health in resource limited settings (Option B+ strategy). Initiation of ART in HIV+ adults is associated with a 2-6% decrease in areal bone mineral density (aBMD) regardless of ART regimen, but data are limited in pregnant and lactating women. Tenofovir, a preferred first-line drug in Option B+ ART regimen, is associated with 1-2% greater decreases in aBMD. Pregnancy and lactation are associated with physiological changes in maternal bone mineral density, but most evidence shows that this is recovered after cessation of breastfeeding. The hypothesis of this thesis is that ART may accentuate the normal process of bone mobilisation during pregnancy and lactation, leading to bone loss that is not recovered in the mother and/or compromised infant growth and bone mineral accretion. The primary objective of this research was to investigate if HIV+ women experience greater reductions in bone mineral compared to HIV-uninfected (HIV-) counterparts. Two groups of pregnant women, 95 HIV+ on ART (Tenofovir-Lamivudine-Efavirenz, previously ART naïve) and 96 HIV- were followed prospectively in Kampala, Uganda. Data were collected at 36 wks gestation (PG36), 2 (PP2) and 14 wks postpartum (PP14). Dual-energy x-ray absorptiometry was used to measure bone phenotype (aBMD, bone mineral content (BMC), bone area (BA), and size-adjusted BMC (SA-BMC, adjusted for height or length, weight and BA) of the whole body (WB) and lumbar spine (LS) in mother-baby pairs, and total hip (TH) in mothers. The primary outcome was the difference between groups in % change (± SE) in maternal LS aBMD between PP2 and PP14. Secondary outcomes included changes in maternal markers of bone formation (P1NP and BAP) and resorption (CTX), serum 25-hydroxy vitamin D (25(OH)D), parathyroid hormone (PTH), plasma and urine concentrations of creatinine (Cr), calcium (Ca), phosphate (PO4) and magnesium (Mg), urine mineral:creatinine ratios, TmCa/GFR and TMP/GFR, respectively), breastmilk mineral composition (Ca, P, Na, K and Na/K ratio); and infant growth Z-scores and bone mineral. Statistical models were adjusted for potential confounders. Median maternal age was 24.5 (IQR 21.1, 26.9) yrs. Mean gestation was 40.9±1.8 wks and not significantly different between groups. All women were breastfeeding at PP2 and PP14. More HIV+ women reported exclusive breastfeeding (PP2: 82.9% v 58.7%, p=0.0008; PP14: 86.7% v 66.2%, p=0.002). Body weight was 4-5% lower in HIV+ women. By PP14, mean duration of ART was 29.3±5.1 wks, adherence was > 95%, and the median CD4 count was 403 (IQR 290-528) cells/mm3. Maternal aBMD decreased between PP2 and PP14 at all skeletal sites in both groups as expected in lactation. Reductions in LS aBMD were not significantly different between groups (-1.8±0.4% vs -2.5±0.4%, p=0.3). However, HIV+ women had a significantly greater reduction in TH aBMD which persisted after adjustment for body size (-3.7±0.3% vs -2.7±0.3%, p=0.04). Median serum 25(OH)D was 67.4 nmol/L (IQR 54.8, 83.7) at PG36 and 57.6 nmol/L (48.7, 70.1) at PP14 with no significant difference between groups. Changes in 25(OH)D and PTH from PG36 to PP14 were not significantly different between groups (25(OH)D: -13.9±4.1% vs -11.1±3.1%; PTH: +60.0±6.4% vs +57.6±6.4%; both p > 0.05). However, HIV+ women had 33-35% greater plasma PTH concentrations at both PG36 and PP14. Bone formation and resorption markers increased in both groups between PG36 and PP14. HIV+ women had greater increases (CTX: +74.6±5.9% vs +56.2±5.9%; P1NP: +100.3±5.0% vs +72.6±5.0%; BAP: +67.2±3.6% vs +57.1±3.6%, all p < 0.05). They also had a greater decrease in plasma Ca (-6.6±0.5% vs-3.8±0.5%, p≤0.0001) and greater increase in plasma phosphate (+14.4±2.0% vs +7.7±2.0%, p=0.02). Changes in plasma Cr and Mg, TmP/GFR and urine mineral:creatinine ratios were not significantly different between the groups. However, at both PG36 and PP14, HIV+ had significantly lower mean plasma Ca (PG36: -1.0±0.5%; PP14: -4.1±0.6%) and TmP/GFR (PG36: -11.4±3.1%; PP14: -7.2±3.0%) but higher PTH (PG36: +33.0±7.0%; PP14: +35.3±7.6%) compared to HIV- women (all p < 0.05). Mean breastmilk Ca decreased between PP2 and PP14, and the changes were not different between the groups (-19.9±3.0% vs -24.2±3.1%, p=0.3). There were no significant changes in breastmilk phosphorus (P) in both groups, but HIV+ women had significantly higher concentrations (PP2: +9.7±3.8%, p=0.01; PP14:+9.6±3.5 %, p=0.007). Breastmilk P was significantly correlated with maternal plasma [CTX] in a separate ANCOVA model (β = +0.13±0.04% per 1% increase in CTX, p=0.0003). Mean breastmilk Na, K concentrations and Na/K decreased between PP2 and PP14 in both groups. However, HIV+ women had a smaller decrease in breastmilk Na (-44.3±8.9% vs -72.6±9.0%, p=0.03). They also had a trend towards smaller reduction in Na/K ratio (-22.2±9.3% vs -46.6.6±9.5%, p=0.07). Babies born to HIV+ mothers (HIV-exposed infants, HEI) had significantly lower gains in weight +53.0±1.4% vs +57.5±1.4%, p=0.02) compared to HIV-unexposed infants (HUI), and also lower weight-for-age (-0.47±0.16, p=0.003) and length-for-age (-0.53±0.18, p=0.005) Z-scores at PP14. HEI had a slower gain in WB BMC (+51.2±1.9% vs +57.3±1.9%, p=0.02), but the difference was not significant after adjustment for body size (-6.0±3.5% vs -7.6±3.8%, p=0.2); showing that the bone mineral accretion was appropriate for achieved infant size. In contrast, HEI had a greater increase in LS BMC (+29.5±1.7% vs +24.4±1.7%, p=0.03), a difference which remained after size-adjustment (+9.4±5.8% vs +4.3±6.2%, p=0.02). This is the first study to compare changes in maternal aBMD and bone metabolism between HIV+ mothers on Option B+ ART and HIV- counterparts. The results show a greater reduction in TH aBMD in Ugandan HIV+ women on Option-B+ ART compared to HIV- in the first three months of lactation, consistent with their greater increases in bone turnover markers, lower TmP/GFR and plasma phosphate, and higher breastmilk phosphorus concentration. Also, HEI have slower growth and whole body bone mineral accretion compared to HUI. It is important to determine if these changes are temporary or have long-term consequences for the bone health of the mother and child.

Submitted by (lucia.rodrigues@ufrpe.br) on 2017-02-10T14:31:41Z No. of bitstreams: 1 Vania Freire Lemos.pdf: 1507844 bytes, checksum: cbb75eb979bd39586c08dadf5aea6579 (MD5) / Made available in DSpace on 2017-02-10T14:31:41Z (GMT). No. of bitstreams: 1 Vania Freire Lemos.pdf: 1507844 bytes, checksum: cbb75eb979bd39586c08dadf5aea6579 (MD5) Previous issue date: 2013-02-11 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The objective of this work was to evaluate dynamics of the proteinogram of blood serum and whey protein of Santa Ines sheep breed following the antipartum period and during lactation, and to compare/to quantify proteins detected at eletrophoresis of the whey protein from healthy and infectious mammary glands in different phases of lactation. Thrirty four sheeps submitted to half-intensive system with same sanitary and nutritional management has been followed. For accomplishment of proteinogram of the sheep, they had been investigated during approximately 10 days from antipartum and 15, 30, 60 and 90 days postpartum, moments where clinical examination of mammary gland was carried through. Blood serum was evaluated at antipartum moment and proteinogram of whey protein at subsequent moments. Bacteriological culture and biochemist characterization of milk samples for confirmation of healthy and infected glands was performed. Separation of protein fractions was carried through using sodium dodecil sulphate polyacrylamide gel eletrophoresis (SDS-PAGE). For the blood serum it was observed quantification of nine proteins with significant influence in IgG. At whey protein, influence of the phases of lactation was identified eigth proteins, having albumin, IgG and β - lactoglobulin.. Comparing healthy and infected glands it was verified that hatptoglobin and α-1 acid glycoprotein, lactoferrin, albumin and immunoglobulins IgA and IgG in whey protein act as potentials biomarkers of infection in mammary gland of ovine species. / Objetivou-se neste trabalho avaliar a dinâmica do proteinograma do soro sangüíneo e lácteo de ovelhas da raça Santa Inês acompanhadas no período que antecedeu o parto e durante a lactação e comparar/quantificar as proteínas detectadas no traçado eletroforético do soro lácteo de glândulas mamárias sadias e infectadas em diferentes fases da lactação. Foram acompanhadas 34 ovelhas submetidas ao sistema de criação semi-intensivo, com mesmo manejo higiênico, sanitário e nutricional. Para a realização do proteinograma as ovelhas foram investigadas durante, aproximadamente 10 dias que precedeu o parto e 15, 30, 60 e 90 dias após o parto, momentos em que foi realizado o exame clínico da glândula mamária. O proteinograma sangüíneo foi efetuado a partir do momento pré parto e o proteinograma do soro lácteo nos momentos subseqüentes. Realizou-se o cultivo bacteriológico e a caracterização bioquímica das amostras de leite para confirmação de glândulas sadias e infectadas. A separação das frações protéicas foi realizada utilizando-se eletroforese em gel de poliacrilamida contendo dodecil sulfato de sódio (SDS-PAGE). Para o soro sanguíneo observou-se a quantificação de nove proteínas observando influência significativa somente na IgG; no soro lácteo identificou-se oito proteínas havendo influência das fases de lactação na albumina, IgG e β - lactoglobulina. Ccomparando glândulas sadias e infectadas verificou-se que a hatptoglobina, α-1 glicoproteína ácida, lactoferrina, albumina e as imunoglobulinas IgA e IgG presentes no soro lácteo atuam como biomarcadores de infecção na glândula mamária na espécie ovina.

Foram realizados três experimentos visando avaliar diferentes estratégias de vedação. No experimento I, objetivou-se avaliar as características fermentativas e a estabilidade aeróbia das silagens de milho vedadas com diferentes tipos de filme plástico, aplicação na camada superior de aditivo químico ou microbiano e proteção do filme com terra, visando o controle da deterioração aeróbia. Houve diferença para o tipo de filme plástico utilizado, onde foi observado maiores valores de temperatura para as silagens vedadas com o filme de polietileno. As silagens aditivadas com benzoato de sódio ou Lactobacillus buchneri apresentaram menores perdas de matéria seca e menores valores de pH com relação a silagem não aditivada. Apenas em três amostras foram detectadas a presença de aflatoxina B1. No experimento II, objetivou-se avaliar estratégias de vedação, com base na proteção do filme plástico, visando o controle da deterioração aeróbia nas zonas periféricas do silo e o comportamento dessas silagens durante o período de aerobiose. No momento da abertura dos silos a contagem de leveduras foi maior para a silagem que não teve proteção sobre o filme plástico. A digestibilidade verdadeira in vitro da matéria seca apresentou diferença, sendo que as silagens que receberam proteção sobre a lona apresentaram os maiores valores em relação a silagem sem proteção sobre o filme plástico. No experimento III, objetivou-se avaliar diferentes tipos de filmes plásticos na vedação de silos horizontais e suas interferências relativas a qualidade das silagens, ao desempenho de vacas em lactação e qualidade do leite produzido. As maiores quantidades de silagem descartada foram para os tratamentos com a lona preta e lona dupla face. As maiores taxas de permeabilidade da lona ao oxigênio foram observadas para os filmes dupla face e preto de material virgem. A dieta que continha silagem proveniente do silo vedado com lona preta de material reciclado com proteção de bagaço apresentou o maior valor para a produção de leite, sendo a menor média verificada para o tratamento que continha filme plástico preto de material virgem. Ao longo das semanas de experimentação foi verificada a presença de aflatoxina B1 em todas as silagens. A partir do mês de agosto foi verificada positividade para aflatoxina M1 entre as amostras de leite. A dieta que continha silagem proveniente do silo vedado com lona preta de material reciclado e proteção de bagaço apresentou o maior valor de digestibilidade, tanto da matéria seca como da matéria orgânica das dietas. O polímero de poliamida, a proteção da lona com terra ou bagaço e o uso de aditivos como Lactobacillus buchneri ou benzoato de sódio reduzem a deterioração aeróbia de silagens de milho. A proteção da silagem contra o aquecimento, pelo uso da poliamida ou da proteção com bagaço, auxilia na obtenção de silagem de melhor qualidade e facilita o manejo pela redução da mão-de-obra no descarte de silagem deteriorada. O desempenho animal é afetado pela estratégia de vedação utilizada, podendo até mesmo afetar qualidade higiênica do leite produzido. / Three experiments were conducted to evaluate different strategies to cover the silo. The experiment I evaluate the fermentation profile and aerobic stability of com silage covered with different types of plastic sheets, applying additives in the top layer and, protecting the fi 1m with soil, to reduce the top losses in com silages. Higher temperature values were observed for the com silage covered with the polyethylene film. The use of additives showed lower DM losses and pH values in relation the control silage. The presence of aflatoxin 81 was detected in three samples only for the silage covered with polyethylene film, without additive and without soillayer over the top of the film. The experiment 11 was designed to study the effectiveness of covering methods to reduce the top losses in maize silages. The. yeast count was higher for control silage. The dry matter digestibility showed higher values for the protected silos in relation to unprotected treatment. The experiment 111 was designed to evaluate different plastic sheets to seal horizontal silos and their influence on the silage quality, Holstein dairy cows performance and milk quality. There was no difference between treatments for the fermentation profile. The silages temperature values in the silo top and top side increased in relation to samples in the panel center. The deteriorated discarded silage showed high values in silages covered with black virgin polyethylene and black-on-with polyethylene films. Those plastics films showed the highest rates of oxygen permeability. The diet containing silage from black recycled polyethylene with bagasse protection showed the highest value for milk yield, while the lowest milk yield was found to the black virgin polyethylene treatment. Over the experimentation period, the presence of aflatoxin 81 in silage was observed. The diet containing silage from black recycled film protect with bagasse treatment showed the highest digestibility of both dry matter and organic matter. The polyamide plastic film, the use of soil or sugarcane bagasse as a plastic film protection and, application of additives on the silo upper layer, reduce the com silage aerobic deterioration. Inhibiting the silage warming by using polyamide plastic film or sugarcane bagasse, helps in obtaining better quality silage management, reducing the costs and labor associated with the discarded silage. Animal performance is affected by the strategy used to seal the silage and may even affect hygienic quality of milk

<p>Care and treatment of women with inflammatory symptoms of the breast during lactation</p><p>Inflammation of the breast during lactation causes considerable discomfort to mothers and carries a risk of early abandonment of breastfeeding. Little is known about the effects of care interventions, including acupuncture, used for these mothers or about mothers’ experiences of the complaint. Aim: to study care and treatment given at a midwife-led breastfeeding clinic to mothers with inflammatory symptoms of the breast during lactation, to gain knowledge of mothers’ experiences of being afflicted by breast inflammation and to investigate factors which may be associated with the development of breast abscess. Methods: method triangulation was used to study different aspects of the phenomenon of inflammatory symptoms of the breast during lactation; two randomised controlled trials I (n = 88) and II (n = 210), a descriptive study III (n = 210), an interview study with a Grounded Theory approach IV (n = 14), and a population-based register study V (n = 1,454,068 singleton deliveries). Results: mothers’ symptoms were more effectively relieved when acupuncture was used but acupuncture treatment did not shorten contact with health services. Nine percent (I) and 15 % (II) respectively, of mothers were prescribed antibiotics. Twelve percent experienced renewed symptoms requiring health care contact within 6 weeks (III). Seven mothers (0.1% of breastfeeding mothers) developed breast abscess, which was comparable to the figure in the population-based study (V). The presence of Group B streptococci in the breast milk was related to longer contact with health care (II). Mothers’ “will to breastfeed” may make it possible for them to withstand physical and emotional difficulties caused by the illness. Mothers considered access to clinical expertise to be an important factor in their care (IV). Primiparous mothers, those over the age of 30 years and those who give birth after 41 weeks gestation appear to be at a significantly increased risk for the development of breast abscess (V).</p><p>Conclusions: mothers’ symptoms were more effectively dissipated when acupuncture treatment was used. However, acupuncture treatment did not shorten mothers’ contact with health care services. Interventions, including acupuncture treatment for relief of symptoms may help mothers to withstand their discomfort and await the body’s own anti-inflammatory response and therefore make it possible to substantially reduce the use of antibiotic therapy for this group. The results indicate a need for a better understanding of the influence on breastfeeding of hormones administered to birthing and breastfeeding women. The availability of immediate clinical expertise is an important factor for these mothers, which health care planners should be aware of. Information on potential breastfeeding problems should be improved.</p><p>Key words: acupuncture, antibiotics, breast abscess, breastfeeding, care interventions, inflammatory symptoms, lactation mastitis</p> / <p>Vård och behandling av kvinnor med inflammation i brösten under amningsperioden</p><p>Bröstinflammation orsakar stort obehag för ammande mödrar och innebär en risk för att amning avslutas i förtid. Det finns ringa kunskap om effekterna av interventioner, inkluderande akupunktur, som används vid vård av dessa kvinnor. Det saknas även kunskap om mödrarnas upplevelser av bröstinflammation. Syfte: att studera vård och behandling av kvinnor med bröstinflammation vid en amningsmottagning ledd av barnmorskor, att utveckla kunskap om mödrars upplevelser av att vara drabbad av bröst inflammation samt att undersöka faktorer som kan ha betydelse för utvecklandet av bröstabscess. Metoder: metodtriangulering användes för att studera olika aspekter av fenomenet bröstinflammation under amningsperioden; två randomiserade kontrollerade studier I (n = 88) and II (n = 210), en deskriptiv studie III (n = 210), en intervjustudie med en grounded theory ansats IV (n = 14) och en populationsbaserat registerstudie V (n = 1 454 068 enkelbörds förlossningar). Resultat: mödrarnas symptom lindrades mer effektivt med akupunktur akupunkturbehandling men förkortade inte deras kontakt med vården. Nio procent (I) respektive 15 % (II) av mödrarna fick antibiotika. Tolv procent fick recidiv vilket föranledde kontakt med vården inom 6 veckor (III). Sju mödrar (0,1 % av ammande mödrar) utvecklade bröstabscess (II), vilket överensstämde med resultat i den populationsbaserade studien (V). Förekomsten av Grupp B streptococcer i bröstmjölken var relaterad till längre vårdkontakt (II). Mödrarnas viljan att amma kan göra det möjligt för dem att uthärda fysiska och emotionella svårigheter som sjukdomen innebär (IV). Tillgång till klinisk expertis var en viktig del av vården för dessa kvinnor. Att vara förstföderska kan innebära en något större risk för utveckling av bröstabscess. Mödrar över 30 år samt de som föder efter graviditetsvecka 41 har också en ökad risk för abscess (V).</p><p>Slutsatser: mödrarnas symptom lindrades mer effektivt när akupunktur användes. Kontakten med vården blev dock inte förkortad av akupunkturbehandling. Interventioner som inkluderar akupunkturbehandling kan tillåta mödrar att invänta kroppens anti-inflammatoriska respons och kan därför möjliggöra en avsevärd minskning av antibiotika terapi för dessa mödrar. Resultaten visar behov av att bättre förstå hur amning påverkas av hormoner administrerade till kvinnor under förlossningsarbete och amningen. Tillgång till omedelbar klinisk expertis är en viktig faktor för dessa mödrar vilket hälso- och sjukvårdsplanerare bör vara medvetna om. Förbättrad information angående potentiella amningsproblem bör eftersträvas.</p><p>Nyckelord: akupunktur, amning, antibiotika, bröstabscess, bröstinflammation, interventioner, mastit, mjölkstockning</p>