Cabbage and fermented vegetables : From death rate heterogeneity in countries to candidates for mitigation strategies of severe COVID-19

Large differences in COVID-19 death rates exist between countries and between regions of the same country. Some very low death rate countries such as Eastern Asia, Central Europe, or the Balkans have a common feature of eating large quantities of fermented foods. Although biases exist when examining ecological studies, fermented vegetables or cabbage have been associated with low death rates in European countries. SARS-CoV-2 binds to its receptor, the angiotensin-converting enzyme 2 (ACE2). As a result of SARS-CoV-2 binding, ACE2 downregulation enhances the angiotensin II receptor type 1 (AT(1)R) axis associated with oxidative stress. This leads to insulin resistance as well as lung and endothelial damage, two severe outcomes of COVID-19. The nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is the most potent antioxidant in humans and can block in particular the AT(1)R axis. Cabbage contains precursors of sulforaphane, the most active natural activator of Nrf2. Fermented vegetables contain many lactobacilli, which are also potent Nrf2 activators. Three examples are: kimchi in Korea, westernized foods, and the slum paradox. It is proposed that fermented cabbage is a proof-of-concept of dietary manipulations that may enhance Nrf2-associated antioxidant effects, helpful in mitigating COVID-19 severity.Peer reviewe

Nrf2-interacting nutrients and COVID-19 : time for research to develop adaptation strategies

There are large between- and within-country variations in COVID-19 death rates. Some very low death rate settings such as Eastern Asia, Central Europe, the Balkans and Africa have a common feature of eating large quantities of fermented foods whose intake is associated with the activation of the Nrf2 (Nuclear factor (erythroid-derived 2)-like 2) anti-oxidant transcription factor. There are many Nrf2-interacting nutrients (berberine, curcumin, epigallocatechin gallate, genistein, quercetin, resveratrol, sulforaphane) that all act similarly to reduce insulin resistance, endothelial damage, lung injury and cytokine storm. They also act on the same mechanisms (mTOR: Mammalian target of rapamycin, PPAR gamma:Peroxisome proliferator-activated receptor, NF kappa B: Nuclear factor kappa B, ERK: Extracellular signal-regulated kinases and eIF2 alpha:Elongation initiation factor 2 alpha). They may as a result be important in mitigating the severity of COVID-19, acting through the endoplasmic reticulum stress or ACE-Angiotensin-II-AT(1)R axis (AT(1)R) pathway. Many Nrf2-interacting nutrients are also interacting with TRPA1 and/or TRPV1. Interestingly, geographical areas with very low COVID-19 mortality are those with the lowest prevalence of obesity (Sub-Saharan Africa and Asia). It is tempting to propose that Nrf2-interacting foods and nutrients can re-balance insulin resistance and have a significant effect on COVID-19 severity. It is therefore possible that the intake of these foods may restore an optimal natural balance for the Nrf2 pathway and may be of interest in the mitigation of COVID-19 severity

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Morphological variation in Staurastrum rotula (Zygnemaphyceae, Desmidiales) in the deepest natural Brazilian lake: essence or accident?

For many decades, polymorphism and its consequences have only been studied from the taxonomic point of view. Presently, interest has switched to the environmental causes of morphological variation and its consequences in the form and essence of the species. This study aimed at evaluating desmids morphological modifications of Staurastrum rotula Nordstedt during inter-annual succession patterns in two warm monomitic tropical lakes: Dom Helvécio (19°45′- 19°48′45″S, 42°33′45″W) and Carioca (19°45′20″S, 42°37′12″W). The effect of thermal stability and light and nutrients availability was based on samples collected monthly from January 2002 to December 2006 compared the morphological modifications. Results indicated that morphological variation, asexual reproduction, theratological forms, mucilaginous envelope and fungal infection were highest in Lake Dom Helvécio and coincided with the biomass increase of species with complex morphology between September and March (stratification period). The Zmix oscillation, wind and rainfall occurring at the end of the mixing period and beginning of the stratification were suggested as autochthonous and allochthonous disturbance agents, respectively, identified as inducers of asexual reproduction and consequently of the morphological variation. It was suggested that incidence of parasitism may act as a potential controlling agent for the Staurastrum rotula population size. It was concluded that morphological variation represents accidents in the original form, i.e. in the desmid species essence, promoting the existence of ecoforms, not of new infraspecific taxa

Morphological variation in Staurastrum rotula (Zygnemaphyceae, Desmidiales) in the deepest natural Brazilian lake: essence or accident?

For many decades, polymorphism and its consequences have only been studied from the taxonomic point of view. Presently, interest has switched to the environmental causes of morphological variation and its consequences in the form and essence of the species. This study aimed at evaluating desmids morphological modifications of Staurastrum rotula Nordstedt during inter-annual succession patterns in two warm monomitic tropical lakes: Dom Helvécio (19°45′- 19°48′45″S, 42°33′45″W) and Carioca (19°45′20″S, 42°37′12″W). The effect of thermal stability and light and nutrients availability was based on samples collected monthly from January 2002 to December 2006 compared the morphological modifications. Results indicated that morphological variation, asexual reproduction, theratological forms, mucilaginous envelope and fungal infection were highest in Lake Dom Helvécio and coincided with the biomass increase of species with complex morphology between September and March (stratification period). The Zmix oscillation, wind and rainfall occurring at the end of the mixing period and beginning of the stratification were suggested as autochthonous and allochthonous disturbance agents, respectively, identified as inducers of asexual reproduction and consequently of the morphological variation. It was suggested that incidence of parasitism may act as a potential controlling agent for the Staurastrum rotula population size. It was concluded that morphological variation represents accidents in the original form, i.e. in the desmid species essence, promoting the existence of ecoforms, not of new infraspecific taxa