Prevention of human milk-acquired cytomegalovirus infection in very-low-birth-weight infants
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Abstract Background The aim of the study was to determine the rate of cytomegalovirus virolactia in the human milk (HM) of mothers of VLBW infants, compare the CMV infection rates and the changes in CMV DNA viral load and nutrient profile among different HM preparation methods. Methods A prospective randomized controlled study was performed in infants with gestational age < 32 weeks or birth-weight < 1500 g admitted to neonatal intensive care unit of Asan Medical Center and Haeundae Paik Hospital who were given mother’s own milk. Enrolled infants were randomized into three groups according to the HM preparation methods: freezing-thawing (FT), FT + low-temperature Holder pasteurization (FT + LP), and FT + high-temperature short-term pasteurization (FT + HP). Urine CMV culture and PCR were obtained at birth and at 4, 8, and 12 weeks. HM CMV culture and PCR were obtained at birth and at 3, 6, 9, and 12 weeks. Changes in macronutrients in HM was obtained at 4 ~ 6 weeks. Results Of 564 infants, 217 mothers (38.5%) produced CMV PCR positive milk. After exclusion, a total of 125 infants were randomized into the FT (n = 41), FT + LP (n = 42), and FT + HP (n = 42) groups, whose rate of HM-acquired CMV infection was 4.9% (n = 2), 9.5% (n = 4), and 2.4% (n = 1), respectively. Out of seven CMV infected infants, two infants fed with FT + LP HM developed CMV infection- associated symptoms. Ages at diagnoses were earlier (28.5 days after birth) and at younger post conceptional age (< 32 weeks) in comparison to infants with asymptomatic CMV infection. CMV DNA viral load significantly decreased after pasturizations, especially in FT + HP group. Conclusions HM-acquired symptomatic CMV infection rate is low and its impact on clinical course was not serious in our VLBW infants. However, evidences showing poor neurodevelopmental outcome in later life, we need to generate a guideline to protect VLBW infant form HM transmitted CMV infection. Based on our small sized study, we did not find any superiority in pasteurizing HM with frequently used LP in comparison to frozen or HP HM. More research is needed to determine the method and duration of pasteurization to reduce the HM-acquired CMV infection.Keywords:
Cytomegalovirus
Pasteurization
This study was designed to monitor some bacteriological and physical quality of milk from two dairy factories before and after pasteurization, and also to assess the compliance of this quality detected with the standard set by the Sudanese Standards and Meteorology Organization (SSMO). Two hundred and Twenty raw and pasteurized milk samples were collected from dairy factories and sale points in Khartoum State. The average total bacterial counts before pasteurization was1×10 5 -9×10 6 cfu/ml and after pasteurization it was 0-9×10 4 cfu/ml. Most of the market samples in day 1,3 and day 6 showed range of 0-1×10 4 cfu/ml. Staphylococci counts before pasteurization were found in range of less than 1×10 4 cfu/ml and after pasteurization were in the range of 0-9×10 cfu/ml. The Coliform counts before pasteurization were in the range of 1×10 3 -9×10 3 cfu/ml and immediately after pasteurization the range was reduced to 5- 1×10 2 cfu/ml. E.coli was identified from24%of the samples before pasteurization. Before pasteurization acidity was found to be 0.17%, directly after pasteurization the acidity was 0.15-0.16% but it was 0.16-0.17% in market samples.
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Long Term Neurodevelopmental outcomes of very low birth weight andextremely low birth weight infants
Objective
To determine the neurodevelopmental outcomes, functional limitations and medical
conditions associated with very low birth weight and extremely low birth weight infants.
Subjects and Methods
The neonatal intensive care unit (NICU) admission and outpatient clinic follow up
records of all newborns, treated at Shifa International Hospital from January 1, 2000 to
December 31, 2004 were analyzed. Infants weighing less than 1500 grams were included
in the study. Neonates with weight
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Outpatient clinic
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A study of the effect of pasteurization on goats' milk took place in order to compare the effectiveness of two pasteurization processes (low and high pasteurization) by assessing the procedure microbiologically and biochemically. The results revealed that both pasteurization processes were effective, showing microbial destruction of approximately 100%. With regard to the determination of phosphatase activity to monitor pasteurization, data in both cases were higher than the limit established for a well pasteurized milk, according to the method used. Machine milked milk showing a lower microbial content nearly achieved the standard level by batch pasteurization, 0.75 μg phenol/ml, but 2.5 μg phenol/ml by the high temperature short time (HTST) method. Phosphatase activity levels of 1.8 and 4.3 μg phenol/ml were the mean values obtained for low and high pasteurization respectively. Our results lead to the conclusion that the batch method for pasteurization of goats' milk is more efficient in terms of total bacterial count than the HTST method. Furthermore, the technique used for the determination of phosphatase activity does not seem to be adequate for pasteurization control of goats' milk, since in very rare situations were we able to attain the limit established.
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Milk is normally heat treated in order to obtain safe dairy products with an elongated shelf life as compared to raw milk. New methods, such as infusion pasteurization, for heat treatment of milk are currently being developed. This provides an opportunity for treating milk in a manner that creates different or improved functional properties compared to traditional indirect pasteurization.
Infusion pasteurization has a time-temperature profile characterized by very rapid heating to relatively high temperatures, short holding times and very rapid cooling, which may lead to products with different properties as compared to products subjected to the standard low pasteurization at 72°C for 15s.
Infusion pasteurization was performed on raw milk with two different holding times (0.1s and 0.7s) and for each holding time samples were drawn at three different temperatures (80°C, 100°C, and 120°C). Samples were compared to raw milk and to milk from the same batch subjected to a standard pasteurization at 72°C for 15s. The size of the casein micelles and the viscosity were measured in skimmed milk samples, using dynamic light scattering and capillary viscometri, respectively.
The results showed a broadening of the size distributions of the casein micelles as the temperature of the infusion pasteurization increased from 80°C to 120°C with no marked difference between the two holding times. The viscosity also increased with increasing intensity of the infusion pasteurization treatment. Little or no difference was seen between the raw milk, the standard pasteurization and the infusion treatments at 80°C regarding both casein micelle size and viscosity.
The observed changes in the investigated physical properties of the infusion pasteurization treated milk indicate that this novel pasteurization process might result in milk with altered functionality when used in the production of dairy products. This is currently under investigation.
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Despite the researchers’ efforts, the cause and development of breast cancer is still incompletely understood. Currently, in some reports, human cytomegalovirus has been referred as a risk factor for breast cancer. This study aimed to determine relative frequency of cytomegalovirus in tissue samples of women with breast cancer in Sanandaj County. In this study, to determine the relative frequency of the human cytomegalovirus (CMV) 50 formalin-fixed tissues of breast cancer, which all were invasive ductal carcinoma, were studied using the nested-polymerase chain reaction. In 26 cases of breast cancer tissues (26/50), human cytomegalovirus was detected. Seventeen cases of breast cancer tissues were in a moderately differentiated stage, and nine cases had poor-differentiated stage tissues that were positive for viral DNA. At older ages (>45 years) the prevalence rate of human cytomegalovirus DNA was higher, but no significant association was seen (p=0.16). In general, due to the high prevalence of the DNA of human cytomegalovirus (58%), in this study it is assumed that human cytomegalovirus (HCMV) has a contributing role in breast cancer; although more study is required to clearly define its part in this type of cancer.
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The possible correlation between cytomegalovirus, human herpesvirus types 6, 7 and cytomegalovirus-related clinical symptoms was studied in kidney transplant patients in Kuwait. Cytomegalovirus infection was diagnosed using the pp65 antigenemia assay. DNA of cytomegalovirus was detected by nested polymerase chain reaction (nested-PCR). PCR was also used to amplify the genes coding for structural proteins of human herpesvirus-6 (240 bp) and human herpesvirus-7 (186 bp). Glycoprotein B genotypes of cytomegalovirus were determined by restriction fragment length polymorphism. The average number of cells positive for cytomegalovirus pp65 antigen showed a steady increase with the severity of the cytomegalovirus-related symptoms. Furthermore, cytomegalovirus pp65 antigen positivity was significantly more frequent among recipients of cadaver kidney (45.5%) than among those who received live related kidneys (22.6%). Cytomegalovirus gB genotype 1 was detected more frequently (P<0.036) in recipients with live related donor kidney (38%) than in patients of cadaver kidney (13%). The genome of human herpesvirus-6 was detected at the same rate in patients with or without cytomegalovirus-related symptoms. However, the genome of human herpesvirus-7 was detected significantly more frequently (P<0.0001) in asymptomatic patients (41.7%) than in recipients with symptomatic cytomegalovirus infection (17%). We conclude that cytomegalovirus gB genotypes are not associated with the outcome of a cytomegalovirus infection in kidney transplant patients, that human herpesvirus-6 does not play a role in cytomegalovirus pathogenesis and that the role of human herpesvirus-7 in cytomegalovirus-related morbidity in kidney recipients remains unclear.
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Betaherpesvirinae
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Since murine cytomegalovirus (MCMV) was first described in 1954, it has been used to model human cytomegalovirus (HCMV) diseases. MCMV is a natural pathogen of mice that is present in wild mice populations and has been associated with diseases such as myocarditis. The species-specific nature of HCMV restricts most research to cell culture-based studies or to the investigation of non-invasive clinical samples, which may not be ideal for the study of disseminated disease. Initial MCMV research used a salivary gland-propagated virus administered via different routes of inoculation into a variety of mouse strains. This revealed that the genetic background of the laboratory mice affected the severity of disease and altered the extent of subsequent pathology. The advent of genetically modified mice and viruses has allowed new aspects of disease to be modeled and the opportunistic nature of HCMV infection to be confirmed. This review describes the different ways that MCMV has been used to model HCMV diseases and explores the continuing difficulty faced by researchers attempting to model HCMV congenital cytomegalovirus disease using the mouse model.
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Betaherpesvirinae
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Summary The keeping quality (KQ) of whole milks pasteurized at 72 °C, 78 °C or 83 °C for 20 s and stored at 12 or 7 °C was examined by assessment of the naturally contaminating thermoduric microflora and of the numbers of Gram-negative rods, a single strain of the latter being introduced deliberately by post pasteurization inoculation. A pasteurization temperature of 83 °C reduced the KQ at 7 °C by about 15% compared with pasteurization at 72 °C or 78 °C, with a 2 d loss in the absence, and aid loss in the presence, of the post pasteurization contamination. The KQ of milks stored at 12 °C was not significantly affected by the pasteurization temperature. Milks pasteurized at 78 °C tended to have a slightly better KQ than those pasteurized at 72 °C, especially at 7 °C. However, pasteurization at both 78 °C and 83 °C caused a reduction in cream rising and considerably increased the risk of cream plugging.
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It is unknown how often preterm infants in neonatal intensive care units achieve the American Academy of Pediatrics-recommended daily intake of 400 international units of Vitamin D. We studied 378 preterm infants with birth weight 1500 g or less admitted to our neonatal intensive care unit, 151 infants before and 227 infants after daily vitamin D-intake monitoring was introduced. Infants were stratified into 2 groups: extremely low birth weight (<1000 g) and Very low birth weight (1000-1500 g). Monitoring of daily intake coincided with significant improvement in vitamin D intake in both extremely low birth weight and very low birth weight groups.
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