Electrochemical study of simple coumarin and its determination in aqueous infusion of Mikania glomerata

The present study aims the development and application of an electrochemical method for simple coumarin determination in aqueous media by using a boron-doped diamond electrode (BDDE). The studies were carried out at pH 8.0 by cyclic voltammetry (CV) and registered an irreversible reduction process controlled by diffusion with the peak potential recorded around -1.6 V. The square wave voltammetry analysis (SWV) showed the reversible behavior of the electrochemical reduction of coumarin at the same pH. Additionally, the reversibility of the process was improved by increasing the solution pH. The chronoamperometry study showed that the coumarin reduction process involves two electrons. From the optimized SWV parameters, the analytical curve was constructed in a linear range between 0.5 × 10-5 and 10.0 × 10-5 mol L-1. The limits of detection and quantification were 1.5 × 10-6 mol L-1 and 4.5 × 10-6 mol L-1, respectively. The coumarin was determined in an aqueous infusion of Mikania glomerata, showing recovery values between 92 and 104%.O presente estudo teve por objetivos o desenvolvimento e a aplicação de um método eletroquímico para a determinação da cumarina simples em meio aquoso utilizando o eletrodo de diamante dopado com boro (BDDE). Os estudos foram realizados em pH 8,0 utilizando a voltametria cíclica (CV) e observou-se um processo de redução irreversível controlado por difusão com um pico de redução em torno de -1,6 V. Entretanto, foi possível observar por voltametria de onda quadrada (SWV) que no mesmo pH a redução da cumarina possui um caráter reversível. Além disso, esta reversibilidade se tornou mais evidente com o aumento do pH da solução. Um estudo cronoamperométrico mostrou que o processo de redução da cumarina envolve dois elétrons. A partir dos parâmetros otimizados da SWV uma curva analítica foi construída no intervalo linear de 0,5 × 10-5 a 10,0 × 10-5 mol L-1. Os limites de detecção e de quantificação foram 1,5 × 10-6 mol L-1 e 4,5 × 10-6 mol L-1, respectivamente. A cumarina foi determinada em amostras de Mikania glomerata (infusão aquosa) com valores de recuperação entre 92 e 104%.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP) Instituto de Ciências Ambientais, Químicas e Farmacêuticas Departamento de Ciências Exatas e da TerraUniversidade Federal do ABC Centro de Ciências Naturais e HumanasUNIFESP, Instituto de Ciências Ambientais, Químicas e Farmacêuticas Depto. de Ciências Exatas e da Terra2008/50588-6SciEL

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

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

Development of modified electrodes based on self assembled films of polypirrole and carbon nanotubes composites for pesticides monitoring

In this work polypyrrole (PPy) and its respective composite with functionalized multiwalled carbon nanotubes (PPy-MWCNT) was obtained by the chemical polymerization of the monomer pyrrole (PPy) in aqueous solution by the dropwise addition of a solution of ammonium persulfate (PSA). The obtained PPy as well as its composite (PPy-MWCNT) were used to prepare two self-assembled films (SA) by the immersion of ITO blades (Inidium Tin Oxide) into PPy and PPy-MWCNT dispersions with alternated immersions into Polystyrene sulfonate (PSS) dispersion, thus resulting in a bilayer. The SA films were produced with ten bilayers (alternated layers of PPy or its composite). The obtained films were characterized by Fourrier Transformed Infrared Spectroscopy (FTIR), UV-Visible analysis, voltammetric analyses (square wave and cyclic voltammetry) and Scanning Electron Microscopy (SEM). The SA films were evaluated to determine the chlorothalonil pesticide which is commonly used as anti-fouling agent in marine environments. The SWV results showed a reduction peak at around -0.8 to 1.2 V (according to pH). It was also observed a synergic effect of the composite film (PPy-MWCNT/PSS) to determine the chlorothalonil by increase of the peak currents.Sao Paulo Research Foundation [FAPESP 2014/23858-3]CAPESDepartamento de Ciências do Mar, Universidade Federal de São Paulo, Av. Almirante Saldanha da Gama, 89. CEP 11030-400, Santos – SP, BrazilDepartamento de Ciências Exatas e da Terra, Universidade Federal de São Paulo, Rua Prof. Arthur Riedel, 275, CEP 09972-270, Diadema – SP, BrazilDepartamento de Ciências do Mar, Universidade Federal de São Paulo, Av. Almirante Saldanha da Gama, 89. CEP 11030-400, Santos – SP, BrazilDepartamento de Ciências Exatas e da Terra, Universidade Federal de São Paulo, Rua Prof. Arthur Riedel, 275, CEP 09972-270, Diadema – SP, BrazilFAPESP: 2014/23858-3Web of Scienc

Layer-by-Layer Films Based on Carbon Nanotubes and Polyaniline for Detecting 2-Chlorophenol

Electrochemical sensors made with layer-by-layer (LbL) films of functionalized multi-walled carbon nanotubes (MWCNT5-COO-) and polyaniline (PAni) deposited onto ITO substrates were used to detect 2-chlorophenol. Concentrations down to ppm level could be detected with square wave voltammetry (SWV), owing to synergistic effects between PAni and nanotubes, whose molecular-level interactions in the LbL films were inferred using FTIR and Raman spectroscopy. Significantly, the Raman spectra of MWCNTs-COO-/PAni LbL films indicated that the conducting properties of PAni were preserved upon adsorption on the ITO substrates, with homogeneous nanocomposites being formed according to Scanning Electron Microscopy (SEM) images.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Univ Fed Sao Carlos, PPG Ciencia Mat, BR-18052780 Sao Carlos, SP, BrazilUniv Estadual Paulista, UNESP POSMAT, BR-17033660 Bauru, SP, BrazilUniv Estadual Paulista, FCT, UNESP, BR-19060900 Presidente Prudente, SP, BrazilUniversidade Federal de São Paulo, Inst Ciencias Ambientais Quim & Farmaceut, BR-09910720 São Paulo, SP, BrazilUniversidade Federal de São Paulo, Inst Ciencias Ambientais Quim & Farmaceut, BR-09910720 São Paulo, SP, BrazilWeb of Scienc

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)