Sun Exposure and Vitamin D Supplementation in Relation to Vitamin D Status of Breastfeeding Mothers and Infants in the Global Exploration of Human Milk Study

Although vitamin D (vD) deficiency is common in breastfed infants and their mothers during pregnancy and lactation, a standardized global comparison is lacking. We studied the prevalence and risk factors for vD deficiency using a standardized protocol in a cohort of breastfeeding mother-infant pairs, enrolled in the Global Exploration of Human Milk Study, designed to examine longitudinally the effect of environment, diet and culture. Mothers planned to provide breast milk for at least three months post-partum and were enrolled at four weeks postpartum in Shanghai, China (n = 112), Cincinnati, Ohio (n = 119), and Mexico City, Mexico (n = 113). Maternal serum 25(OH)D was measured by radioimmunoassay (<50 nmol/L was categorized as deficient). Serum 25(OH)D was measured in a subset of infants (35 Shanghai, 47 Cincinnati and 45 Mexico City) seen at 26 weeks of age during fall and winter seasons. Data collected prospectively included vD supplementation, season and sun index (sun exposure × body surface area exposed while outdoors). Differences and factors associated with vD deficiency were evaluated using appropriate statistical analysis. vD deficiency in order of magnitude was identified in 62%, 52% and 17% of Mexican, Shanghai and Cincinnati mothers, respectively (p < 0.001). In regression analysis, vD supplementation (p < 0.01), obesity (p = 0.03), season (p = 0.001) and sites (p < 0.001) predicted maternal vD status. vD deficiency in order of  magnitude was found in 62%, 28%, and 6% of Mexican, Cincinnati and Shanghai infants, respectively (p < 0.001). Season (p = 0.022), adding formula feeding (p < 0.001) and a higher sun index (p = 0.085) predicted higher infant vD status. vD deficiency appears to be a global problem in mothers and infants, though the prevalence in diverse populations may depend upon sun exposure behaviors and vD supplementation. Greater attention to maternal and infant vD status starting during pregnancy is warranted worldwide.     

Hepatitis colestásica por amoxicilina

Drug-induced hepatotoxicity is a challenge in daily clinical practice. One of the most frequent causes is antibiotics. However, amoxicillin-induced liver injury is uncommon. We report the case of an 87-year-old man who developed cholestatic hepatitis after ingesting amoxicillin 500 mg/8 hours for dental disease. A review of the literature on this topic is provided.     

A Novel 31.1 kb α-Thalassemia Deletion (– –MEX3) Found in a Mexican Family

α-Thalassemia (α-thal), a genetic disease characterized by microcytosis, hypochromia and anemia, is predominantly caused by deletions of the α-globin genes, HBA2 and HBA1. In this study, we describe a novel 31.1?kb α-thal deletion, – –^MEX3 (NC_000016.10: g.151479_182582del), observed in a Mexican family, probably originated from non homologous recombination between two Alu sequences; the 5′ Alu element has been involved in at least two other α-thal deletions [– –^FIL (NG_000006.1: g.11684_43534del) and – –^KOL] and possesses a core homologous sequence next to the – –^MEX3 breakpoint. In addition, a 286?bp insertion in an Alu sequence downstream to the – –^MEX3 3′ breakpoint was found in the studied family, – –^FIL carriers, and healthy subjects, suggesting a common genetic variation in the Mexican population. We highlight the involvement of Alu elements and their core sequence in the origin of deletions in the α-globin gene cluster, and the importance of characterizing rare mutations, to better understand DNA rearrangement origins.     

The dynamics of cardiac defense: From attention to action

The attentional and motivational significance of cardiac defense is examined in two studies. In Study 1, cardiac defense was evoked by an intense acoustic stimulus in the context of either a visual search or a memory search task using letters as stimuli. Results showed a potentiation of the long latency acceleration of cardiac defense in the visual search task. In Study 2, participants performed the same visual search task using pleasant, neutral, and unpleasant pictures as stimuli. Results showed a further potentiation of the long latency acceleration of cardiac defense when the visual search task was performed with unpleasant, compared to pleasant or neutral pictures. These results indicate that cardiac defense has both attentional and motivational contributions, where the attentional significance is related to increased sensory processing, whereas the motivational significance is associated with preparation for active defense.     

Changes in Oxidative Stress and Insulin Resistance in Morbidly Obese Patients After Bariatric Surgery

Background  

The prevalence of morbid obesity has seen an increase in developed countries over recent years. Bariatric surgery is almost the only effective strategy for treating super morbidly obese patients. The objective of the study was to evaluate the effects of bariatric surgery on the evolution of the main variables related to diabetes and obesity, especially insulin resistance, parameters of oxidative stress, and inflammatory markers in the early stage after surgery.     

Powdered infant formula as a source of Salmonella infection in infants.

Powdered infant formula is not sterile and may be intrinsically contaminated with pathogens, such as Salmonella enterica, that can cause serious illness in infants. In recent years, at least 6 outbreaks of Salmonella infection in infants that have been linked to the consumption of powdered infant formula have been reported. Many of these outbreaks were identified because the Salmonella strains were unique in some way (e.g., a rare serotype) and a well-established Salmonella surveillance network, supported by laboratories capable of serotyping isolates, was in place. Another common feature of the outbreaks was the low level of salmonellae detected in the implicated formula (salmonellae may be missed in routine testing). These outbreaks likely represent only a small proportion of the actual number of Salmonella infections in infants that have been linked to powdered infant formula. Managing this problem requires a multidimensional approach in which manufacturers, regulators, and caregivers to infants can all play a role.