Influence of Lactase on the In Vitro and In Vivo Antiglycaemic Effects of Onion Flavonoids

Introduction Lactase in addition to its role in the digestion of lactose available in milk and dairy products is implicated in the metabolism of a range of phenolic phytochemicals in the gut. Experiments with Caco-2 cells have shown that these cells which mimic the intestinal mucosa indicate that quercetin glucosides and quercetin aglycone (widely consumed in onions and apples) block glucose uptake from the gut by competing with glucose for the sodium-dependent SGLT-1 and sodium-independent GLUT-2 transporters respectively (Johnston et al., 2005a, Schulze et al., 2015). It has been suggested that dietary phenolics that block glucose uptake from the gut may reduce the risk of type 2 diabetes. However, the ability of quercetin glucosides to block SGLT-1 is lost or reduced when the glucoside moiety is cleaved off during lactase hydrolysis. It is currently unknown if lactose-tolerant individuals deglycosylate quercetin to a greater extent than lactose-intolerant individuals and therefore are less able to reduce glucose uptake from the intestine. The aim of in vitro study was to model human gut condition for glucose transport by using Caco-2 cell models and to model role of human intestinal LPH by incubation of Caco-2 cells with quercetin flavonoids and purified β-galactosidases and in vivo was to investigate whether lactose-tolerant and lactose-intolerant subjects show differences in the uptake of glucose. Methods Caco-2 cells were cultured in DMEM full medium in 24 well plates. Thereafter, glucose uptake assay was conducted by using 3H-glucose in the presence and absence of sodium, to assess the effect of flavonoids such as phloridzin, quercetin 4́-glucoside, quercetin 3,4́-diglucoside, quercetin 3́-glucoside, and quercetin aglycone on glucose uptake. Transwell inserts were also used to demonstrate the bidirectional permeability through Caco-2 monolayers, transport of glucose from apical (SGLT-1) to basolateral side (GLUT-2). -galactosidase enzyme assay was conducted by using -galactosidase from Aspergillus oryzae, Caco-2 cells were treated with 100 μM quercetin glucosides, 25% w/v onion extract and -galactosidase in order to model the hydrolysis of flavonoids by lactase in the small intestine. HPLC was carried out to determine if quercetin glucosides are found in onion extract and test whether -galactosidase is active and result in deglycosylation of substrates such as individual quercetin glucosides and quercetin glucosides in onion extract. For the clinical study, lactose intolerance was identified by the hydrogen breath test (Gastrolyzer), and blood glucose levels were measured by taking finger-prick blood samples in several intervals (0, 15, 30, 60, 90, 120) minutes using an EKF glucose analyser. Results Findings from the current in vitro research confirm that phloridzin is an inhibitor of sodium-dependent conditions (SGLT-1) transporter with 80% reduction, this therefore was used as a positive control. Quercetin 4́-glucoside and quercetin 3,4́-diglucoside at (100μM) significantly decreased the uptake of glucose in the presence of sodium with up to 75% reduction compared to control p 0.5), whilst quercetin aglycone significantly inhibited the glucose uptake with 50% reduction compared to control at significance levels of (p = 0.02). HPLC data identified quercetin 3,4́-diglucoside and quercetin 4́-glucoside with RT = 4.082 min and 11.392 min in the onion extract by showing peaks at similar ranges with RT= 4.114 min and 11.385 min with their standards, and the concentration of quercetin 4́-glucoside was measured as the highest level (42μg/ml) in onion extract compared to 3,4́-glucoside and quercetin 3-glucoside. Further HPLC illustrated that, after incubation of quercetin glucosides and onion extract with -galactosidase Aspergillus oryzae for 20, 40 and 60 minutes, the peaks occurred at similar RT =16.453 min and 16.441 min respectively in accordance with standard quercetin (RT=16.239 min), suggesting the deglycosylation of these compounds with -galactosidase from Aspergillus oryzae. According to findings from the clinical study, reduction of peak glucose levels by an onion meal was higher in lactose-intolerant people than lactose-tolerant people (44.2% versus 19.3%, p = 0.042). Also, the area under the blood glucose curve was reduced more in lactose-intolerant people compared to lactose-tolerant people, however was not statistically significant (54.5% versus 42.1%, p = 0.425). Discussion Our result suggests that quercetin 4́-glucoside and quercetin 3,4́-diglucosides and onion extract were the main inhibitors of glucose uptake in sodium-dependent conditions (SGLT-1). Whereas, quercetin aglycone inhibited GLUT-2 glucose transport on Caco-2 cell monolayers under sodium independent conditions. Our findings were in accordance to several previous studies (Boyer et al., 2005, Kwon et al., 2007, Schulze et al., 2015). Notably, in vitro studies were conducted to model whether the in vivo study is likely to succeed or not. Findings from our human study showed that glucose uptake was blocked by the onion solution and a diet containing quercetin glucosides (onion meal) may be of greater benefit for glycaemic control in lactose-intolerant people than in lactose-tolerant people

The Gut Microbiota and Probiotics in Celiac Disease

Celiac disease (CD) is an immune-mediated enteropathy that occurs in genetically predisposed individuals associated with gluten intake. Currently, the only effective treatment for CD is life-lasting elimination of gluten from the diet, but adhering to it throughout life is burdensome. In addition, strict compliance with a gluten-free diet (GFD) does not lead to a complete restoration of intestinal microbiota. Although gluten is known to be a trigger in CD, various studies have demonstrated that the gut microbiota is involved in gluten metabolism, regulation of intestinal barrier permeability, and modulation of the immune response. Therefore, the gut microbiota has an important role in the pathogenesis, progression, and clinical manifestations of CD. This evidence supports the hypothesis that probiotics act as a strategy to modulate the intestinal microbiota into an anti-inflammatory state. Probiotics such as some bacterial species of the genera Bifidobacterium and Lactobacillus can protect the epithelial cells from gliadin-induced damage and improve symptoms and quality of life in GFD-treated patients, as an adjunctive treatment. This narrative review aims to discuss the recent scientific evidence of the relationship between the intestinal microbiota changes in CD and to understand the role of probiotics in CD treatment

Factors affecting the choice of treatment center by infertile couples: A cross-sectional study in Yazd Reproductive Sciences Institute

Background: Infertility is one of the critical health issues in Iran. There are more than 70 specialized infertility treatment centers in Iran, of which the Yazd Reproductive Sciences Institute, is one of the most important ones. Objective: This study aimed to determine the factors influencing infertile couples’ choice of Yazd Reproductive Sciences Institute. Materials and Methods: This cross-sectional study was conducted on 275 infertile couples aged 18 and older, referring to Yazd Reproductive Sciences Institute, Yazd, Iran from September 2021 to March 2022. Data were gathered using a 2-part questionnaire. Data analysis was done through SPSS software. We used descriptive statistics, Kruskal- Wallis, Mann-Whitney, and t test for data analysis. Results: Most participants were individuals who came from other provinces of Iran (74.9%) and were referred to the Yazd Reproductive Sciences Institute. Among the 4 categories that influenced couples’ decision to choose this center, factors related to the personnel and treatment staff received the highest score (75.83), while personal factors received the lowest score (65.76). The average score for factors related to doctors was 72.90, and for factors related to the center, it was 73.65. The satisfaction with personnel and treatment staff varied based on participants’ education levels, with those who had lower levels of education reporting higher levels of satisfaction (p < 0.001). Conclusion: The primary factors contributing to the success of the Yazd Reproductive Sciences Institute in attracting clients were the dedication and expertise of the staff, as well as the esteemed reputation of the doctors at the center. Key words: Infertility, Fertility clinics, Yazd, Iran

Indirect Calorimetry during the COVID-19 Pandemic: Practical Guidance for Infection Control

Introduction: Indirect calorimetry (IC) is the optimal tool for the assessment of the resting energy expenditure, as well as the reference standard for energy expenditure measurement. During the outbreak of coronavirus, performing respiratory tests such as IC has become challenging. The current guidance was designed to prevent the virus spread at calorimetry centers. Methods: This protocol was devised in accordance with the latest recommendations of the World Health Organization (WHO) and Centers for Disease Control (CDC), as well as the related articles. Conclusion: Due to the specific features of COVID-19, unnecessary ICs should be avoided in the hotspots of the disease. If these tests must be performed, adherence to the validated infection control recommendations is critical

Pattern of Antipsychotic Use and Its Determinants in Razi Psychiatric Hospital

Objectives: The aim of this study was to investigate the prevalence and its determinants of Antipsychotic Use in patients with psychiatric disorders. Materials and Methods: This study was on patients with psychiatric disorder that have discharged from the hospital. We have assessed all patients with psychiatric interview and evaluation of their psychiatric documentations. Results: 90.7% of all of patients had taken antipsychotic medications and antipsychotic polypharmacy was in 27.2% of these patients. The most prevalent component of antipsychotic polypharmacy was consisting of Chlorpromazine, Halopreidol and Chlorpromazine, Risperidone and then Chlorpromazine, Olanzapine respectively. There were significant relations between pattern of antipsychotic use and gender, occupation status, type of psychiatric ward, duration of hospitalization and cost of treatment but no relationship with age, educational status and duration of illness. Discussion: This study suggests that prevalence of antipsychotic polypharmacy is high in in-patient psychiatric patients

Pattern of Psychotropic Drug Prescription in the Elderly with Chronic Schizophrenia

Objectives: Psychotropic drug use in the elderly with chronic schizophrenia is an important issue in the field of psychiatry. The main goal of this study was to clarify the pattern of such drug use in these patients, in order to consider such therapy plan and focus on its cost attributing measures, for a more reasonable quality of care program. Methods: In this descriptive study, participants included 52 elderly patients at Tehran’s Razi Mental Hospital who had chronic schizophrenia in the residual phase. Selected patients were taking at least two psychotropic drugs equivalent to 500mg Chlorpromazine. We prepared the list of the drugs used by completing the pre-designed questionnaire charts. Data were analyzed with SPSS 17. Results: In one case (1.92%) the entries were Risperidone, Chlorpromazine, Fluphenazine Decanoate, & Thiothixene). In 11 cases (21.2%) there were three entries and in 40 cases (76.8%) there were two. The Chlorpromazine equivalent dose in each group ranged from the lowest dose (750 mg) to the highest (5600 mg). The highest Chlorpromazine dose (5600 mg) equivalent per milligram belonged to the four entries of (Risperidone, Chlorpromazine, Fluphenazine Decanoate & Thiothixene). The lowest Chlorpromazine dose (750 mg) was seen in 3 entries of Risperidone, Chlorpromazine & Fluphenazine Decanoate. Discussion: There was a high prevalence of using more than two psychotropic medications from the first atypical antipsychotic category. Less frequently, the second and the third typical antipsychotics were used. We recommend further research into more feasible patterns of psychotropic prescriptions, lowering the amount of medication use and considering their cost-benefits in the elderly with chronic schizophrenia

Additional file 1 of Low plasma vitamin D is associated with increased 28-day mortality and worse clinical outcomes in critically ill patients

Additional file 1: Table S1. APCHE II (Acute Physiologic and Chronic Health Evaluation II) score content. Table S2. SOFA (Sequential Organ Failure Assessment) score content. Table S3. mNUTRIC (modified Nutrition Risk in Critically ill) score content

Does propolis have any effect on rheumatoid arthritis? A review study

Rheumatoid arthritis (RA) is a chronic autoimmune disease in which inflammation and oxidative stress play a key role in its pathophysiology. Complementary therapies along with medications may be effective in the control of RA. Propolis is a natural substance extracted from beehives, which have confirmed anti-inflammatory and antioxidant effects. The present study aimed to review the possible effects of propolis on inflammation, oxidative stress, and lipid profile in patients with RA. English articles in online databases such as PubMed‑Medline, AMED, Google Scholar, EMBASE, Scopus, and Web of Science databases were searched. Pieces of evidence show that supplementation with propolis may have therapeutic effects on RA patients. Due to increased inflammation and oxidative stress in the affected joints of RA patients, propolis could inhibit the inflammatory cascades by inhibiting the nuclear factor kappa B pathway and reducing reactive oxygen species, malondialdehyde, and interleukin-17 by increasing some antioxidants. Therefore, inflammation and pain reduce, helping improve and control RA in patients. Further investigations are required with larger sample sizes and different doses of propolis to demonstrate the definite effects of propolis on various aspects of RA