Alkaline saline lakes: A chemical evolution experiment evaluating the stability of formaldehyde in an aqueous saline environment.

Formaldehyde condensation in the presence of a mineral catalyst and under alkaline conditions is considered to be a "messy" chemical system due to its dependence on the complex chemical equilibrium between the reaction intermediates, which has a significant impact on the final products. This chemical system is extremely important in prebiotic chemistry and has been proposed as a potential pathway for carbohydrate formation in the early Earth. Saline and soda lakes are alkaline systems that could concentrate and accumulate a wide variety of ions (such as phosphate) and clay minerals, which can catalyze prebiotic chemical reactions. These geological environments have recently been suggested as ideal environments in which prebiotic chemical reactions could have occurred. This study uses Lake Alchichica in Mexico as a physicochemical analog of an early Archean saline lake to examine the stability of formaldehyde in these aqueous saline environments. Formaldehyde decomposes into sugar-like and CHO molecules in alkaline, high-salinity environments depending on the minerals phases present. As phosphate ion (HPO4 2-) is available in the aqueous medium, the results of our experiments also imply that phosphorylation processes may have occurred in these natural settings.

Transcriptional changes impact hepatic proteome in autophagy-impaired liver.

Hepatic proteomes are intricately controlled through biosynthesis, extracellular secretion, and intrahepatic degradation. Autophagy governs lysosome-mediated intrahepatic degradation and the hepatic proteome. When autophagy is impaired, it leads to the accumulation of intrahepatic proteins, causing proteinopathy. This study investigates whether autophagy can modulate the hepatic proteome non-degradatively. Utilizing conditional, inducible, and hepatotoxin models of hepatic autophagy impairment, we assessed the overall hepatic proteome expression using Coomassie brilliant blue (CBB) staining and liquid chromatography-tandem mass spectrometry (LC/MS). We pinpointed and confirmed four specific hepatic proteins-Cps1, Ahcy, Ca3, and Gstm1-that were selectively modified in autophagy-deficient livers. Expression of Cps1, Ahcy, and Ca3 were significantly reduced, while Gstm1 expression increased in livers with autophagy impairment. Interestingly, these changes in hepatic protein levels were not due to defective autophagic degradation but were associated with alterations in mRNA transcript levels. Moreover, as a result of autophagic dysfunction, sustained activation of the nuclear erythroid-derived 2-like 2 (Nrf2) transcription factor, transcriptionally regulated the mRNA levels of these proteins. Our findings indicate that autophagy can influence hepatic proteins not solely via traditional degradative routes but also through non-degradative transcriptional processes by modulating Nrf2.

Elevated Vitamin B12, Risk of Cancer, and Mortality: A Systematic Review.

Vitamin B12 (B12) is a molecule involved in several biological. Abnormally high levels are frequently found, but their causes can be multiple, and consequences have not been clearly elucidated. The objective of this review was to summarize the current evidence on the associations of elevated B12 and the development of cancer, and all-cause mortality in adults. Six references looking at mortality and seven looking at cancer risk were included. The evidence suggests an association between elevated B12 with a higher risk of cancer, with risk ratios ranging 1,88 to 5,9. There was less consistent evidence linking vitamin B12 and mortality.

Elevated B12 levels exceeding 1000 pg/L, if sustained and unexplainable, warrant a comprehensive individual assessment of each patient. This evaluation should encompass various potential factors contributing to the elevation, aiming to effectively guide the diagnostic process of neoplastic diseases.Clinical longitudinal observational studies have suggested a potential link between heightened B12 levels and the risks of cancer and mortality. Nonetheless, these studies have been retrospective cohort studies, and lack a defined threshold point of B12 levels.Studies have documented a positive correlation between elevated levels of B12 and the incidence of lung, pancreatic, and liver cancers, as well as certain hematological neoplasms, particularly those related to the myeloid lineage. Conversely, a consistent negative association has been observed in the context of breast cancer. Findings concerning neoplasms of the lower gastrointestinal tract and prostate display contradictory outcomes.The diagnostic significance of elevated B12 levels among patients already diagnosed with cancer remains uncertain and could potentially be linked to reverse causality.

Intravenous Vitamin C as an Add-on Therapy for the Treatment of Sepsis in an Intensive Care Unit: A Prospective Cohort Study.

Background and Objectives: According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection". The increased presence of free radicals causes an increase in oxidative stress. Vitamin C is an essential water-soluble vitamin with antioxidant activity and immunoregulatory effects that plays a potential role in the treatment of bacterial infections. Our aim was to evaluate the effectiveness of adding vitamin C to the conventional treatment of sepsis to decrease its mortality rate. Materials and Methods: In a prospective cohort study, we included patients with a diagnosis of sepsis and a SOFA score ≥ 9 who were evaluated in an Intensive Care Unit at a secondary-care hospital. According to the intensive care specialist, they were treated using two different strategies: Group 1-patients with sepsis treated with conventional treatment without vitamin C; Group 2-patients with sepsis with the addition of vitamin C to conventional treatment. Results: We included 34 patients with sepsis. The incidence of mortality was 38%, and 47% of patients used vitamin C as an adjuvant to the basic treatment of sepsis. In the basal analyses, patients treated with use of vitamin C compared to patients treated without vitamin C required less use of glucocorticoids (75% vs. 100%, p = 0.039). At follow-up, patients treated without vitamin C had higher mortality than patients treated with vitamin C as an adjuvant for the treatment of sepsis (55.6% vs. 18.8%, p = 0.03). We observed that the use of vitamin C was a protective factor for mortality in patients with sepsis (RR: 0.54, 95% CI: 0.31-0.96, p = 0.03). Conclusions: The use of vitamin C as an adjuvant to treatment decreases the risk of mortality by 46% in patients with sepsis and SOFA ≥ 9 compared to patients treated without vitamin C as an adjuvant to sepsis.

Surveillance for Acute Flaccid Myelitis - United States, 2018-2022.

Acute flaccid myelitis (AFM) is a serious neurologic condition primarily affecting children; AFM can cause acute respiratory failure and permanent paralysis. AFM is a rare but known complication of various viral infections, particularly those of enteroviruses (EVs). Increases in AFM cases during 2014, 2016, and 2018 were associated with EV-D68 infection. This report examines trends in confirmed AFM cases during 2018-2022 and patients' clinical and laboratory characteristics. The number of AFM cases was low during 2019-2022 (28-47 cases per year); the number of cases remained low in 2022 despite evidence of increased EV-D68 circulation in the United States. Compared with cases during the most recent peak year (2018), fewer cases during 2019-2021 had upper limb involvement, prodromal respiratory or febrile illness, or cerebrospinal fluid pleocytosis, and more were associated with lower limb involvement. It is unclear why EV-D68 circulation in 2022 was not associated with an increase in AFM cases or when the next increase in AFM cases will occur. Nonetheless, clinicians should continue to suspect AFM in any child with acute flaccid limb weakness, especially those with a recent respiratory or febrile illness.

Is There a Relationship between Anthropometric Indices and Muscular, Motor, and Cardiorespiratory Components of Health-Related Fitness in Active European Older Adults?

The aging process induces alterations in the body, resulting in changes in both health-related fitness and specific anthropometric measures. These changes often pose health risks for older adults. The aim of the present study was to investigate whether there is an association between anthropometric indices and muscular, motor, and cardiorespiratory components of health-related fitness in active European older adults. This study included 2687 European older adults, comprising 1999 women and 688 men, with an average age of 70.05 ± 5.5 years. The assessment included health-related fitness using the Senior Fitness Test and anthropometric indices, such as the body adiposity index, body mass index, conicity index, waist-to-hip ratio, and waist-to-height ratio, among others. The results indicated that gender significantly influences the values of physical performance and anthropometric parameters, making them incomparable. The degree of correlation between anthropometric indices and muscular, motor, and cardiorespiratory components of fitness depends on each anthropometric index analysed. The anthropometric index most correlated with physical fitness performance parameters is the waist-to-height ratio (WHR), followed by the body mass index (BMI). Cardiorespiratory endurance and balance are the two physical parameters most correlated with anthropometric indices.

[Clinical experience in patients with intestinal failure: a cohort study in a third referral hospital]. / Experiencia clínica en pacientes con fallo intestinal: estudio de cohorte en un hospital de referencia.

Introduction: Introduction: intestinal failure (IF) is an organic failure classified into three types (I-III); it conditions inability to absorb nutrients and water, so parenteral nutrition (PN) is required. Objective: to evaluate the characteristics of hospitalized patients with IF, and their association with clinical and nutritional outcomes. Methods: historical cohort of hospitalized adults with IF and PN. Variables of the nutritional care process (screening, anthropometric, biochemical, clinical, nutritional), mortality and hospital stay were recorded. Results: six hundred and ninety-seven patients aged 56 (41-68) years, 327 women (46.8 %), with body mass index (BMI) 22.4 (18.3-25.9), were included. Diagnosis: 577 patients with IF-I, 96 patients with IF-II, and 24 patients with IF-III. The most frequent causes were malignant neoplasms, IF-I (26.7 %) and surgical complications in IF-II (21.9 %) and IF-III (37.5 %). The most common pathophysiology in all types of IF was motility disorders (40.6 % in IF-I; 43.8 % in IF-II; 33.8 % in IF-III). The majority of patients had high nutritional risk (92.4 %) and refeeding syndrome (65.6 % high and very high). In acute IF (FI-I) compared to prolonged IF (If-II/IF-III) there is a higher BMI (p = 0.039), visceral fat (p = 0.041) and over-hydration (p = 0.014), but they have a smaller phase angle (p = 0.004), with a lower adequacy percentage than what is prescribed in relation to their energy expenditure (p < 0.001). Conclusions: during the nutritional care process there are differences between the types of IF, which are relevant to optimize their multidisciplinary management and avoid related complications.

Introducción: Introducción: el fallo intestinal (FI) es un fallo orgánico clasificado en tres tipos (I-III). Condiciona incapacidad para absorber los nutrimentos y agua, por lo que se requiere nutrición parenteral (NP). Objetivo: evaluar las características de pacientes hospitalizados con FI y su asociación con desenlaces clínicos y nutricionales. Métodos: cohorte histórica de adultos hospitalizados con FI y NP. Se registraron variables del proceso de atención nutricia (tamizaje, antropométricas, bioquímicas, clínicas, nutricionales), mortalidad y estancia hospitalaria. Resultados: se incluyeron 697 pacientes, de 56 (41-68) años, 327 mujeres (46,8 %) e índice de masa corporal (IMC) 22,4 (18,3-25,9). Diagnóstico: 577 pacientes FI-I, 96 FI-II y 24 FI-III. Las causas más frecuentes fueron las neoplasias malignas en FI-I (26,7 %) y FI-II (21,9 %) y las complicaciones quirúrgicas en FI-III (37,5 %). La fisiopatología más común en todos los tipos de FI fue desórdenes de la motilidad (40,6 % en FI-I, 43,8 % en FI-II y 33,8 % en FI-III), con elevado riesgo nutricio (92,4 %) y de realimentación (65,6 % alto y muy alto). En el FI agudo (FI-I), en comparación con el prolongado (FI-II/FI-III), se tiene un mayor IMC (p = 0,039) y grasa visceral (p = 0,041) y están sobrehidratados (p = 0,014), pero cuentan con un menor ángulo de fase (p = 0,004) y tienen porcentaje de adecuación menor de lo que se prescribe en relación a su gasto energético (p < 0,001). Conclusiones: durante el proceso de atención nutricia existen diferencias entre los tipos de FI, que son relevantes para optimizar su manejo multidisciplinario y evitar las complicaciones relacionadas.

Characterizing Gender and Leadership Trends Among Mohs Micrographic Surgery Fellowship Directors.

BACKGROUND: Fellowship directors (FDs) play a key role in shaping Mohs micrographic surgery (MMS). Studies characterizing director trends are lacking and may provide a framework for improving gender diversity. OBJECTIVE: To explore characteristics of FDs and trends in gender of both fellows and FDs over time. MATERIALS AND METHODS: The authors compiled a comprehensive list of FDs and fellows for all Accreditation Council for Graduate Medical Education-accredited Micrographic Surgery & Dermatologic Oncology programs from 1996 to 2023. Publicly available data from various internet sources from February 1, 2023 to May 30, 2023 were used to assess characteristics of MMS FDs. RESULTS: The percentage of female FDs increased from 6% to 25% from 1996 to 2023. Female directors were more likely to select female fellows than male directors ( p = .0002) and had fewer years between fellowship completion and FD appointment (9.1 ± 4.7 years) compared with male directors (13.6 ± 8.8 years; p = .036). H-index, program type, and academic rank were similar between male and female directors. CONCLUSION: Although gender parity among MMS trainees has been achieved, discrepancies remain in the gender composition of FDs. Further studies are required to determine why women are underrepresented as FDs.

It is not just about prescription. A cohort study of the impact of enteral nutrition on mortality of hospitalized patients with COVID-19.

Introduction: Introduction: during COVID-19 pandemic, international societies released guidelines and recommendations for patients requiring nutritional support according to previous similar respiratory diseases. Objectives: the aim of the study was to evaluate the nutritional support provided by enteral nutrition (EN) in patients with COVID-19 infection, identify if the recommendations from international societies were met and their impact on mortality rate. Methods: a cohort study was conducted on adult patients with COVID-19 admitted to a tertiary hospital. Demographic, clinical, biochemical, and nutritional variables were obtained. A random-effect parametric survival-time model was performed to quantify the risk of death for each variable, and the Hausman test was used to confirm the model. Results: two hundred and twenty-nine patients were enrolled. The delivered energy was > 80 % of adequacy in the first two days, as suggested by international guidelines (11.7 ± 4.9 kcal/kg); however, an adequacy rate less than 60 % was achieved on day 14 (25.4 ± 7.4 kcal/kg). The protein adequacy was > 75 % on the first days of infusion (1.3 ± 0.3 g/kg); however, the infusion was < 50 % (1.5 ± 0.4 g/kg) after being extubated. Age, sex, and nutritional risk were related to higher mortality in patients with EN, whereas the infused energy and protein, the percentage of protein adequacy, arginine, and n-3 PUFA were associated with lower mortality. Conclusion: achieving at least 80 % of the energy and protein requirements, as well as n-3 PUFA and arginine supplementation could be associated with lower mortality in COVID-19 patients. More studies are needed to confirm the role of these nutrients on the mortality rate.

Introducción: Introducción: durante la pandemia de COVID-19, las sociedades internacionales publicaron guías y recomendaciones para pacientes que requieren apoyo nutricional basándose en lo previamente recomendado en enfermedades respiratorias similares. Objetivos: evaluar el soporte nutricional con nutrición enteral (NE) en pacientes con COVID-19 e identificar el cumplimiento de las recomendaciones hechas por las sociedades internacionales y su impacto en la tasa de mortalidad. Métodos: estudio de cohorte en adultos con COVID-19 ingresados en un hospital de tercer nivel. Se registraron variables demográficas, clínicas, bioquímicas y nutricionales. Se realizó un modelo de supervivencia de efectos aleatorios para cuantificar el riesgo de muerte para cada variable y la prueba de Hausman para confirmar el modelo. Resultados: se incluyeron 229 pacientes. La energía administrada fue > 80 % de adecuación en los dos primeros días (11,7 ± 4,9 kcal/kg); sin embargo, fue < 60 % el día 14 (25,4 ± 7,4 kcal/kg). La adecuación de proteínas fue > 75 % en los primeros días de infusión (1,3 ± 0,3 g/kg), pero < 50 % (1,5 ± 0,4 g/kg) después de ser extubado. La edad, el sexo y el riesgo nutricional se relacionaron con mayor mortalidad, mientras que la energía y proteína infundidas, el porcentaje de adecuación proteica, la arginina y el contenido de ácidos grasos poliinsaturados (AGPI) n-3 se asociaron con menor mortalidad. Conclusión: aunque se necesitan más estudios para confirmarlo, alcanzar al menos el 80 % de los requerimientos energéticos y proteicos, así como la suplementación de fórmulas con AGPI n-3 y arginina, podría asociarse con menor mortalidad en pacientes con COVID-19.

Total and segmental phase angle in a cohort of hospitalised patients with COVID-19: mortality prediction and changes throughout hospitalisation.

Body composition and phase angle (PhA) have been used to predict mortality in multiple diseases. However, little has been studied regarding segmental measurements, which could potentially help assess subtle changes in specific tissue segments. This study aimed to identify the total PhA cut-off point associated with mortality risk and changes in body composition within a week of hospitalisation in non-critical hospitalised patients with COVID-19. A cohort study was conducted where patients underwent to a complete nutritional assessment upon admission and after seven days, and followed up until hospital discharge or death. A receiver operating characteristic curve was constructed to determine the PhA cut-off point, and the Kaplan­Meier estimator was used to determine survival analysis. Segmental and complete body compositions on admission and after 7 d were compared. We included 110 patients (60 men) with a mean age of 50·5 ± 15·0 years and a median BMI of 28·5 (IQR, 25·6­33·5) kg/m2. The median length of hospital stay was 6 (IQR, 4­9) d, and the mortality rate was 13·6 %. The PhA cut-off point obtained was 4°, with significant differences in the survival rate (P < 0·001) and mortality (HR = 5·81, 95 % CI: 1·80, 18·67, P = 0·003). Segmental and whole-body compositions were negatively affected within one week of hospitalisation, with changes in the approach by the graphical method in both sexes. Nutritional status deteriorates within a week of hospitalisation. PhA < 4° is strongly associated with increased mortality in non-critical hospitalised patients with COVID-19.

A pulmonary rehabilitation program reduces hospitalizations in chronic obstructive pulmonary disease patients: A cost-effectiveness study.

BACKGROUND: Although pulmonary rehabilitation (PR) is recommended in patients with chronic obstructive pulmonary disease (COPD), there is a scarcity of data demonstrating the cost-effectiveness and effectiveness of PR in reducing exacerbations. METHODS: A quasi-experimental study in 200 patients with COPD was conducted to determine the number of exacerbations 1 year before and after their participation in a PR program. Quality of life was measured using the COPD assessment test and EuroQol-5D. The costs of the program and exacerbations were assessed the year before and after participation in the PR program. The incremental cost-effectiveness ratio (ICER) was estimated in terms of quality-adjusted life years (QALYs). RESULTS: The number of admissions, length of hospital stay, and admissions to the emergency department decreased after participation in the PR program by 48.2%, 46.6%, and 42.5%, respectively (P < 0.001 for all). Results on quality of life tests improved significantly (P < 0.001 for the two tests). The cost of PR per patient and the cost of pre-PR and post-PR exacerbations were €1867.7 and €7895.2 and €4201.9, respectively. The PR resulted in a cost saving of €1826 (total, €365,200) per patient/year, and the gain in QALYs was+0.107. ICER was -€17,056. The total cost was <€20,000/QALY in 78% of patients. CONCLUSIONS: PR contributes to reducing the number of exacerbations in patients with COPD, thereby slowing clinical deterioration. In addition, it is cost-effective in terms of QALYs.

Effect of the Addition of Fique Bagasse Cellulose Nanoparticles on the Mechanical and Structural Properties of Plastic Flexible Films from Cassava Starch.

One of the activities most representative of the agricultural sector in Colombia is the production of biodegradable fique fiber. The efficiency of the defiberization process of the fique leaves is very low since a mere 4% of the total weight of the leaf (cabuya) is used and marketed. The remaining 96%, composed of fique juice and bagasse, is considered to be waste and discarded, impacting the environment. The aim of this work was to study fique bagasse as a source of cellulose nanoparticles (CNCs). CNCs were obtained by acid hydrolysis and added at 10% to films made from cassava thermoplastic starch (TPS) by the casting method. Structural changes in the CNCs, TPS, and their mixtures were characterized by FTIR-ATR and their morphology and particle size by SEM and TEM microscopy, respectively. Thermal properties were analyzed using DSC and TGA, along with their effect on mechanical properties. Changes in the FTIR spectra indicated that the chemical method adequately removed hemicellulose and lignin from the fiber surface of fique bagasse. The CNCs showed a diameter and length of 7.5 ± 3.9 and 52.7 ± 18.1 nm, respectively, and TPS 10% CNC obtained an increase in mechanical strength of 116%. The obtainment of CNCs from lignocellulosic materials can thus be viewed as a favorable option for the subsequent reinforcement of a polymeric matrix.

n-3 Polyunsaturated Fatty Acid Supplementation Affects Oxidative Stress Marker Levels in Patients with Type II Intestinal Failure: A Randomized Double Blind Trial.

Type II intestinal failure (IF-II) is a condition in which the gastrointestinal tract is compromised. Liver complications may occur because of the pathology and/or prolonged use of parenteral nutrition (PN); oxidative stress has been implicated as one of the causes. Lipid emulsions containing n-3 polyunsaturated fatty acids (PUFAs) have been proposed for the treatment. We aimed to evaluate the effect of 7-day n-3 PUFA supplementation on oxidative stress in IF-II patients receiving PN. This was a randomized, controlled, double-blinded, pilot trial of adult patients with IF-II, receiving either conventional PN (control) or PN enriched with n-3 PUFAs (intervention). Twenty patients were included (14 men, 49 ± 16.9 years), with the ANCOVA analysis the glucose (p = 0.003), and direct bilirubin (p = 0.001) levels reduced; whereas the high-density lipoprotein cholesterol (HDL-C) increased (p = 0.017). In the random-effect linear regression analysis, a reduction (p < 0.0001) in the malondialdehyde (MDA) level was found in the intervention group when the covariables age, HDL-C level, and alanine aminotransferase activity were considered. After 1 week of PN supplementation with n-3 PUFAs, the marker levels of some oxidative stress, blood lipids, and hepatic biomarkers improved in patients with IF-II.

Simulation and Economic Analysis of the Biotechnological Potential of Biomass Production from a Microalgal Consortium.

The biomass of microalgae and the compounds that can be obtained from their processing are of great interest for various economic sectors. Chlorophyll from green microalgae has biotechnological applications of great potential in different industrial areas such as food, animal feed, pharmaceuticals, cosmetics, and agriculture. In this paper, the experimental, technical and economic performance of biomass production from a microalgal consortium (Scenedesmus sp., Chlorella sp., Schroderia sp., Spirulina sp., Pediastrum sp., and Chlamydomonas sp.) was investigated in three cultivation systems (phototrophic, heterotrophic and mixotrophic) in combination with the extraction of chlorophyll (a and b) on a large scale using simulation; 1 ha was established as the area for cultivation. In the laboratory-scale experimental stage, biomass and chlorophyll concentrations were determined for 12 days. In the simulation stage, two retention times in the photobioreactor were considered, which generated six case studies for the culture stage. Subsequently, a simulation proposal for the chlorophyll extraction process was evaluated. The highest microalgae biomass concentration was 2.06 g/L in heterotrophic culture, followed by mixotrophic (1.98 g/L). Phototrophic and mixotrophic cultures showed the highest chlorophyll concentrations of 20.5 µg/mL and 13.5 µg/mL, respectively. The simulation shows that higher biomass and chlorophyll production is attained when using the mixotrophic culture with 72 h of retention that we considered to evaluate chlorophyll production (a and b). The operating cost of the entire process is very high; the cultivation stage has the highest operating cost (78%), mainly due to the high energy consumption of the photobioreactors.

Epidemiology of SARS-CoV-2 transmission and superspreading in Salt Lake County, Utah, March-May 2020.

BACKGROUND: Understanding the drivers of SARS-CoV-2 transmission can inform the development of interventions. We evaluated transmission identified by contact tracing investigations between March-May 2020 in Salt Lake County, Utah, to quantify the impact of this intervention and identify risk factors for transmission. METHODS: RT-PCR positive and untested symptomatic contacts were classified as confirmed and probable secondary case-patients, respectively. We compared the number of case-patients and close contacts generated by different groups, and used logistic regression to evaluate factors associated with transmission. RESULTS: Data were collected on 184 index case-patients and up to six generations of contacts. Of 1,499 close contacts, 374 (25%) were classified as secondary case-patients. Decreased transmission odds were observed for contacts aged <18 years (OR = 0.55 [95% CI: 0.38-0.79]), versus 18-44 years, and for workplace (OR = 0.36 [95% CI: 0.23-0.55]) and social (OR = 0.44 [95% CI: 0.28-0.66]) contacts, versus household contacts. Higher transmission odds were observed for case-patient's spouses than other household contacts (OR = 2.25 [95% CI: 1.52-3.35]). Compared to index case-patients identified in the community, secondary case-patients identified through contract-tracing generated significantly fewer close contacts and secondary case-patients of their own. Transmission was heterogeneous, with 41% of index case-patients generating 81% of directly-linked secondary case-patients. CONCLUSIONS: Given sufficient resources and complementary public health measures, contact tracing can contain known chains of SARS-CoV-2 transmission. Transmission is associated with age and exposure setting, and can be highly variable, with a few infections generating a disproportionately high share of onward transmission.

Differential effects of high dose omega-3 fatty acids on metabolism and inflammation in patients with obesity: eicosapentaenoic and docosahexaenoic acid supplementation.

Background: Obesity is complicated by low-grade chronic inflammation characterised by increases in inflammatory proteins and cells in peripheral blood. It has been known that omega-3 fatty acids (FA) like eicosapentaenoic (EPA) and docosahexaenoic (DHA) could modulate the inflammatory process and improve metabolic markers. Objective: This study aimed to determine the effect of high-dose omega-3 FA on metabolic and inflammatory markers among patients with obesity and healthy volunteers. Methods: This prospective study included 12 women with obesity (body mass index [BMI] ≥ 35.0 kg/m2) and 12 healthy women (BMI < 24.0 kg/m2) who were supplemented with a dose of 4.8 g/day (3.2 g EPA plus 1.6 g DHA) for 3 months followed by no treatment for 1 month. Plasma metabolic and inflammatory markers and levels of mRNA transcripts of CD4+ T lymphocyte subsets were determined monthly. Results: None of the participants exhibited changes in weight or body composition after study completion. EPA and DHA supplementation improved metabolic (insulin, Homeostatic Model Assessment of Insulin Resistance [HOMA-IR], triglyceride [TG]/ high-density lipoprotein [HDL] ratio, TG, and arachidonic acid [AA]/EPA ratio) and tumor necrosis factor-alpha (TNF-α). Moreover, the levels of mRNA transcripts of T CD4+ lymphocyte subsets (TBX21, IFNG, GATA-3, interleukin [IL]-4, FOXP3, IL-10 IL-6, and TNF-α), were down-regulated during the intervention phase. After 1 month without supplementation, only insulin, HOMA-IR and the mRNA transcripts remained low, whereas all other markers returned to their levels before supplementation. Conclusion: Supplementation with high-dose omega-3 FAs could modulate metabolism and inflammation in patients with obesity without weight loss or changes in body composition. However, these modulatory effects were ephemeral and with clear differential effects: short-duration on metabolism and long-lasting on inflammation.