N-acetylcysteine (NAC) is a medicine widely used to treat paracetamol overdose and as a mucolytic compound. It has a well-established safety profile, and its toxicity is uncommon and dependent on the route of administration and high dosages. Its remarkable antioxidant and anti-inflammatory capacity is the biochemical basis used to treat several diseases related to oxidative stress and inflammation. The primary role of NAC as an antioxidant stems from its ability to increase the intracellular concentration of glutathione (GSH), which is the most crucial biothiol responsible for cellular redox imbalance. As an anti-inflammatory compound, NAC can reduce levels of tumor necrosis factor-alpha (TNF-α) and interleukins (IL-6 and IL-1β) by suppressing the activity of nuclear factor kappa B (NF-κB). Despite NAC’s relevant therapeutic potential, in several experimental studies, its effectiveness in clinical trials, addressing different pathological conditions, is still limited. Thus, the purpose of this chapter is to provide an overview of the medicinal effects and applications of NAC to human health based on current therapeutic evidence.

Resumo O objetivo deste artigo é avaliar a prevalência e os fatores associados à ausência de aleitamento materno na alta hospitalar em uma maternidade pública de Maceió, Alagoas, Brasil. Estudo transversal realizado com puérperas sob alta hospitalar assistidas na maternidade do hospital universitário da capital. Foram calculadas razões de prevalência (RP) e respectivos intervalos de confiança de 95% (IC95%) por regressão de Poisson com emprego de modelo hierarquizado. Aproximadamente 20% das puérperas não estavam amamentando. Hábito tabagista na gravidez [RP = 5,20; (IC95% = 1,75-15,33); p = 0,003]; intercorrências na gestação [RP = 3,50; (IC95% = 1,04-11,77); p = 0,042] e falta de informações sobre aleitamento materno no pré-natal [RP = 5,44; (IC95% = 1,78-16,67); p = 0,003] foram fatores desfavoráveis à amamentação. A prática de aleitamento materno dentro da maternidade está aquém do ideal. Evidencia-se a importância do pré-natal, visando fornecer orientações quanto à prevenção do tabagismo na gestação e aconselhamento sobre aleitamento materno, com atenção especial àquelas puérperas que tiveram intercorrências na gestação.

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Objective. To compare redox imbalance and inflammation biomarkers in umbilical cords from pregnancies with and without preeclampsia (PE) and to analyse their relationships with perinatal outcomes. Methods. A controlled cross-sectional study was conducted in Maceió, Alagoas, Brazil, that involved pregnant women with PE and a group of women without the disease, through the application of a standardized questionnaire. After delivery, umbilical cord samples were collected to measure antioxidant defense, products from oxidative damage, and inflammation biomarkers such as myeloperoxidase (MPO), interleukin- (IL-) 6, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-α). Statistical analyses were performed using Stata version 13.0 software and IBM Statistical Package for the Social Sciences (SPSS) 20.0, adopting a 95% confidence level ( α = 0.05 ), with the chi-square test, the Wilcoxon–Mann–Whitney test, and the multinomial and Poisson regression tests. Results. One hundred PE pregnant women and 50 women without the disease were studied. The umbilical cords from PE pregnancies showed higher levels of reduced glutathione (GSH) ( p ≤ 0.001 ), glutathione peroxidase (GPx) ( p = 0.016 ), and malondialdehyde (MDA) ( p = 0.028 ) and lower levels of IL-6 ( p = 0.030 ) and TNF-α ( p ≤ 0.001 ) than the other group, with some associations among these biomarkers with perinatal outcomes. Conclusion. The higher levels of GSH and GPx, in addition to the lower levels of IL-6 and TNF-α, found in the PE umbilical cord, may result from adaptive mechanisms to maintain the oxidative and inflammatory balance; however, despite these changes, the damage to the cell membranes was not minimized, as the MDA level was higher in women with PE than in women without the disease. This implies that a redox imbalance is present, confirming that other physiological and adaptive mechanisms are being activated to preserve foetal health. Therefore, the present work unveils an important role of the umbilical cord in controlling redox imbalance and inflammation in PE pregnancies. Our results reinforce the necessity for continuous research on GSH as a protective compound for the perinatal outcome, especially in PE women.

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