First determination of mineral composition of the leaf Chicory (Cichorium intybus L.) used in human nourishment in the Midwest of Brazil and comparasion with dietary reference intakes for children and adults

Introduction: Radicchio (Cichorium intybus L.) is a leaf chicory and is grown as a leaf vegetable which usually has white-veined red or purple leaves and it belongs to the Asteraceae family. In several countries is consumed mainly as salad, but no studies on their elemental composition  has been done, principally in Brazil. Objective: The aim of present work was to measure the macroelements (Na, K, Ca, Mg and P) and microelements (Cr, Cu, Fe, Mn, Mo, Zn, Al, Cd, Ni, Co and Si) in the leaf Chicory used as human nourishment in the Campo Grande, State of Mato Grosso do Sul, Brazil. Method: Chemical digests of samples were prepared using HNO3 and H2O2 and then placed in the microwave digestion system. After digestion, the concentrations of the elements in Leaf Chicory were determined by the technique of Inductively Coupled Plasma - Optical Emission Spectrometer (ICP–OES, Thermo Scientific - iCAP 6000 Series). Results obtained of the concentrations of leaf chicory were compared with the dietary reference intakes. Results: Detected concentration of macroelements in leaf Chicory decreases in the order: K > P > Ca > Mg > Na. As well as the concentration of microelements decreases in the order: Fe > Al > Si > Mn > Zn > Cu > Cr > Ni > Cd > Mo > Co. Leaf Chicory is excellent source of K, Ca, Mg, P, Cr, Cu, Fe, Mn, Mo and Zn for children and adults. On the other hand, leaf chicory is not considered a source of sodium for children and adults. Concentration of K, Cr, Fe, and Al are above the limit recommended limit by FAO/WHO (1984) and others countries. Conclusions: Leaf Chicory has macro and microelements in ample amount; it can be used as an important part of people's diets. Since it not exceed allowable limits set by WHO and FAO, RDA/AI and UL. Competent organs have not evaluated concentrations of elements as Al, Cd, Ni, Co and Si in order to establish a tolerable upper intake level or RDA/AI for human. The lack of studies of adverse effects following excess intake of a nutrient does not mean that adverse effects do not occur. Keywords: Leaf Chicory; Radicchio; Inductively Coupled Plasma Mass Spectrometry (ICP-OES)

Convalescent plasma for COVID-19 in hospitalised patients : an open-label, randomised clinical trial

Background: The effects of convalescent plasma (CP) therapy in hospitalised patients with coronavirus disease 2019 (COVID-19) remain uncertain. This study investigates the effect of CP on clinical improvement in these patients. Methods: This is an investigator-initiated, randomised, parallel arm, open-label, superiority clinical trial. Patients were randomly (1:1) assigned to two infusions of CP plus standard of care (SOC) or SOC alone. The primary outcome was the proportion of patients with clinical improvement 28 days after enrolment. Results: A total of 160 (80 in each arm) patients (66.3% critically ill, 33.7% severely ill) completed the trial. The median (interquartile range (IQR)) age was 60.5 (48–68) years; 58.1% were male and the median (IQR) time from symptom onset to randomisation was 10 (8–12) days. Neutralising antibody titres >1:80 were present in 133 (83.1%) patients at baseline. The proportion of patients with clinical improvement on day 28 was 61.3% in the CP+SOC group and 65.0% in the SOC group (difference −3.7%, 95% CI −18.8–11.3%). The results were similar in the severe and critically ill subgroups. There was no significant difference between CP+SOC and SOC groups in pre-specified secondary outcomes, including 28-day mortality, days alive and free of respiratory support and duration of invasive ventilatory support. Inflammatory and other laboratory marker values on days 3, 7 and 14 were similar between groups. Conclusions: CP+SOC did not result in a higher proportion of clinical improvement on day 28 in hospitalised patients with COVID-19 compared to SOC alone

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Cinnamomum zeylanicum, Origanum vulgare, and Curcuma longa Essential Oils: Chemical Composition, Antimicrobial and Antileishmanial Activity

The resistance mechanisms of bacteria and protozoans have evidenced the need of discover new compounds with potential pharmaceutical activity against pathogenic microorganisms. Medicinal plants have been for centuries a promising alternative as sources of new drugs. The objective of this work was to evaluate the chemical composition, antimicrobial and antileishmanial activities of Cinnamomum zeylanicum, Origanum vulgare, and Curcuma longa essential oils. Chemical analysis was performed by gas chromatography-mass spectrometry. Antimicrobial activity was performed by disk diffusion and minimum inhibitory concentration (MIC) test. Antileishmanial activity was performed against antipromastigote and intracellular amastigote of Leishmania amazonensis. Cytotoxic and nitrite production were realized in BALB/c peritoneal macrophages. The major compounds of the essential oils were cinnamic aldehyde (46.30%) in C. zeylanicum, cis-p-menth-2-en-1-ol (33.88%) and linalyl acetate (13.90%) in O. vulgare, and turmerone (55.43%) in C. longa. The MIC showed significant antimicrobial activity of C. longa essential oil against S. aureus (83.3 ± 14.43 µg/mL). Antipromastigote activity showed IC50 values >500 µg/mL to C. zeylanicum, 308.4 ± 1.402 µg/mL to O. vulgare, and 405.5 ± 1.119 µg/mL to C. longa essential oil. Activity against intracellular amastigote of L. amazonensis showed IC50 of 63.3 ± 1.369 µg/mL and cytotoxic was not observed, resulting in selectivity index higher than 15.79 to parasite. C. longa essential oil decreased nitrite production in peritoneal macrophages, but not in Leishmania-infected cells. The chemical composition of the three essential oils is directly associated to its potential biological action, as the antimicrobial activity. C. longa presented a potent antileishmanial activity against promastigote and intracellular amastigote of L. amazonensis, although this activity is not linked to nitric oxide, since C. longa essential oil inhibits its production

Ultrastructural and Physicochemical Characterization of a Non-Crosslinked Type 1 Bovine Derived Collagen Membrane

In this work, in vitro testing was used to study the properties of non-crosslinked type 1 bovine derived collagen membranes used in bone regeneration surgery. Collagen membranes were prepared, their surface roughness was quantified by interferometry, their morphology was observed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), their wettability was measured by the contact angle technique, their mechanical properties were investigated by tensile testing, their phase transformation temperatures were measured by Differential Scanning Calorimetry (DSC), and their biocompatibility was evaluated by immunological testing. The calorimetry tests showed that the membrane is formed only by type 1 collagen. The SEM observations showed that the morphology consists of layers of highly organized collagen fibers and patterns of striated fibrils typical of type 1 collagen. The small contact angle showed that the membrane is hydrophilic, with the possibility of rapid absorption of body fluids. The tensile tests showed that the membrane has enough elasticity, ductility, and mechanical strength for use in tissue regeneration. With the immunostaining technique, it was possible to confirm the membrane biocompatibility

Osteopontin and Vascular Endothelial Growth Factor-Immunoreactivity in Critical Bone Defects Matrix Production: A Nano-Hydroxyapatite/Beta-Tricalcium Phosphate and Xenogeneic Hydroxyapatite Comparison

The development of new bone substitutes has become an area of great interest in materials science. In fact, hydroxyapatite is the most commonly used biomaterial in defects that require bone reconstruction, and that is certainly why the discovery of new products with its formulation has been increasing continuously. The aim of this study was to analyze the biological behavior of a xenogeneic hydroxyapatite widely disclosed in the literature and a synthetic nano-hydroxyapatite/Beta tricalcium phosphate in critical defects in the calvaria of Wistar rats. For this, the groups were divided as follows: 24 adult male Wistar rats were used, weighing between 300 and 350 g, in three groups with eight animals each. In the CTRL group (control), only the clot was kept, without material insertion; in the Bioss group (bovine hydroxyapatite), Bio Oss®—Gleistlich® was introduced; and in the Blue Bone group (REG), the defect was filled in with synthetic nano-hydroxyapatite associated with betatriphosphate of calcium, Blue Bone®—Regener®. According to the results in Goldner’s Trichromics, we can observe a higher percentage of newly formed bone matrix in the REG group than in the CTRL and Bioss groups; in the VEGF, we had a more adequate cell modulation for blood vessel formation in the Blue Bone group (REG) compared to the Bioss and CTRL groups, while in osteopontin, a higher percentage of bone formation was observed in the Blue Bone group (REG) and Bioss group when compared to the CTRL group. We conclude that bone formation, mitosis-inducing cell modulation and main osteoblast activity were higher in the Blue Bone group (REG) than in the CTRL and Bioss groups

Identification of macroelements and microelements in the leaves of the Synadenium grantii Hook used as medicinal plant in the Brazil

Introduction: The Synadenium grantii Hook species is a medicinal plant of the Euphorbiaceae family and is popularly known in the Midwest regions of Brazil as leitosinha or janaúba. All the parts of Synadenium grantii Hook as stem, latex, leaves and flowers are used for the treatments of various disease, but no elemental composition has been done. Objective: The aim of present work was to measure the macroelements (K, Mg, Mo and P) and microelements (Cr, Cu, Fe, Mn, Mo, Zn, Si, Ni, Co, Cd and Al) in the leaves of medicinal plant Synadenium grantii Hook used in the treatment of diseases by rural and urban communities of the Campo Grande, State of Mato Grosso do Sul, Brazil. Method: The chemical digestions of samples were prepared utilizing HNO3 and H2O2 and microwave digestion system Speedwave Berghof, Germany. After digestion, the concentrations of the elements in leaves were determined by technique of Inductively Coupled Plasma – Optical Emission Spectrometer (ICP-OES) with a Dual Plasma (Thermo Scientific – iCAP 6000 Series) Results: Results demonstrated that the Synadenium grantii leaves are source of K but aren't the best source of Na and P. Its leaves are rich in elements such as Mg, Cr, Cu, Fe, Mn, Mo and Zn. The leaves of Synadenium grantii showed a high content of Mg values tolerable upper intake level. However, Fe, Na, P, Mn, Mo and Zn are below the values tolerable upper intake level. The leaves of this plants have elements as Ni, Cu, Cr, Cd above the permissible limit set by WHO and FAO. Conclusions: The gaps in knowledge about the level of contents in the Synadenium grantii was completed in this work and would serve as a tool for deciding the dosage of prepared from this plant with medicinal and nutritional purposes. Brazil should create legal standards for the use of medicinal plants based on internationally practiced requirements. Keywords: Medicinal plants, Synadenium grantii, inductively coupled plasma mass spectrometry

BK polyomavirus nephropathy in two kidney transplant patients with distinct diagnostic strategies for BK virus and similar clinical outcomes: two case reports

Abstract Background BK polyomavirus-associated nephropathy is an important cause of post-transplantation renal failure. We present two cases of BK polyomavirus-associated nephropathy who were submitted to contrasting strategies of clinical follow-up to BK polyomavirus reactivation, but progressed to a similar final outcome. Case presentation Case 1 is a 37-year-old white man whose graft had never presented a good glomerular filtration rate function, with episodes of tacrolimus nephrotoxicity, and no urinary monitoring for BK polyomavirus; stage B BK polyomavirus-associated nephropathy was diagnosed by biopsy at 14 months post-transplant. Despite clinical treatment (dosage decrease and immunosuppressive drug change), he progressed to stage C BK polyomavirus-associated nephropathy and loss of graft function 30 months post-transplant. Case 2 is a 49-year-old mulatto man in his second renal transplantation who was submitted to cytological urinary monitoring for BK polyomavirus; he presented early, persistent, and massive urinary decoy cell shedding and concomitant tacrolimus nephrotoxicity. Even with decreasing immunosuppression, he developed BK polyomavirus-associated nephropathy 1-year post-transplant. Loss of graft function occurred 15 months post-transplant. Conclusions Cytological urinary monitoring was an efficient strategy for monitoring BK virus reactivation. Decoy cell shedding may be related to BK polyomavirus-associated nephropathy when extensive and persistent. The presence of associated tacrolimus nephrotoxicity may be a confounding factor for the clinical diagnosis of BK polyomavirus-associated nephropathy

Repair of Critical Size Bone Defects Using Synthetic Hydroxyapatite or Xenograft with or without the Bone Marrow Mononuclear Fraction: A Histomorphometric and Immunohistochemical Study in Rat Calvaria

Bone defects are a challenging clinical situation, and the development of hydroxyapatite-based biomaterials is a prolific research field that, in addition, can be joined by stem cells and growth factors in order to deal with the problem. This study compares the use of synthetic hydroxyapatite and xenograft, used pure or enriched with bone marrow mononuclear fraction for the regeneration of critical size bone defects in rat calvaria through histomorphometric (Masson’s staining) and immunohistochemical (anti-VEGF, anti-osteopontin) analysis. Forty young adult male rats were divided into five groups (n = 8). Animals were submitted to critical size bone defects (Ø = 8 mm) in the temporoparietal region. In the control group, there was no biomaterial placement in the critical bone defects; in group 1, it was filled with synthetic hydroxyapatite; in group 2, it was filled with xenograft; in group 3, it was filled with synthetic hydroxyapatite, enriched with bone marrow mononuclear fraction (BMMF), and in group 4 it was filled with xenograft, enriched with BMMF. After eight weeks, all groups were euthanized, and histological section images were captured and analyzed. Data analysis showed that in groups 1, 2, 3 and 4 (received biomaterials and biomaterials plus BMMF), a significant enhancement in new bone matrix formation was observed in relation to the control group. However, BMMF-enriched groups did not differ from hydroxyapatite-based biomaterials-only groups. Therefore, in this experimental model, BMMF did not enhance hydroxyapatite-based biomaterials’ potential to induce bone matrix and related mediators