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Jua (juá in Portuguese) is an underexplored fruit from Brazil's northeast. This fruit is rich in antioxidant substances. However, there is a dearth of information about jua's bioactive potential. The present study evaluated two extraction methods (continuous agitation and ultrasound-assisted extraction-UAE) and employed three different solvents (water, ethanol, and acetone) to efficiently recover soluble phenolic compounds. Aqueous extracts obtained by UAE showed the highest total phenolic content (TPC) and antiradical activity. Besides being an eco-friendly procedure, extraction and/or solubility in an aqueous medium is also important for food application. Ellagic acids were the predominant phenolics (80%) found in aqueous jua pulp extract obtained by UAE, as determined by HPLC, while its TPC was 405.8 gallic acid equivalent per gram of fruit. This extract also exhibited a higher scavenging activity towards peroxyl radicals when compared to that of several other fruits from the literature, including grape, strawberry, cranberry, and walnuts, which are known references in terms of antioxidants. This is the first report that demonstrates jua pulp's potential as an alternative source of ellagic acid and other phenolic acids and flavonoids. Therefore, the outcome of this study provides new information that can be useful for functional food and nutraceutical industries.
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Antioxidantes , Ziziphus , Antioxidantes/análisis , Antioxidantes/farmacología , Ácido Ascórbico , Brasil , Ácido Elágico , Extractos Vegetales , Polifenoles/análisis , AguaRESUMEN
Several studies have demonstrated that peptides obtained from the proteins of different bean species have the potential to act on therapeutic targets of noncommunicable chronic diseases or NCDs. However, peptides with great structural diversity can be obtained from the hydrolysis of proteins present in foods. Therefore, the present review had the objective of identifying, in silico, the possibility of obtaining peptides with potential biological activity from the storage globulin proteins of the bean species Phaseolus vulgaris (L.), Vigna angularis (Willd.), Vigna radiata (L.) and Vigna unguiculata (L.) Walp., using the UniProtKB, BIOPEP and PeptideRanker databases, as well as reviewing available research reports that showed evidence bioactive properties of peptides obtained from beans via in vitro assays. For all the species studied, the highest frequency of the occurrence of bioactive fragments was found for the inhibition of dipeptidyl peptidase-IV, followed by the inhibition of the angiotensin-converting enzyme and by antioxidant activity. The inhibition of the two enzymes is the therapeutic target of drugs used for type 2 diabetes mellitus (T2DM) and for hypertension, respectively, while the antioxidant activity can prevent the development of several chronic diseases related to oxidative stress.
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Diabetes Mellitus Tipo 2 , Inhibidores de la Dipeptidil-Peptidasa IV , Inhibidores de la Enzima Convertidora de Angiotensina , Enfermedad Crónica , Diabetes Mellitus Tipo 2/prevención & control , Humanos , PéptidosRESUMEN
BACKGROUND: Task-shifting and technology in psychological interventions are two solutions to increasing access to mental health intervention and overcoming the treatment gap in low and middle-income countries. The CONEMO intervention combines a smartphone app with support from non-specialized professionals, aiming to treat depression in patients with diabetes and/or hypertension. The aim of this paper is to describe the process of recruitment, training and supervision of the non-specialized professionals who participated in the CONEMO task-shifting intervention in Brazil and Peru. METHODS: We described and analyzed data related to the recruitment, training and supervision of 62 nurse assistants from the health system in Sao Paulo, Brazil, and three hired nurses in Lima, Peru. The data were collected from information provided by nurses and nurse assistants, supervisor records from supervision meetings and the CONEMO platform database. RESULTS: We found that task-shifting was feasible using existing resources in Sao Paulo and additional human resources in Lima. Training and supervision were found to be crucial and well received by the staff; however, time was a limitation when using existing human resources. Ensuring technological competence prior to the start of the intervention was essential. Group supervision meetings allowed non-specialized professionals to learn from each other's experiences. CONCLUSION: Carefully considering recruitment, training and supervision of non-specialized professionals is important for effective task-shifting when delivering an mHealth intervention for depression. Opportunities and challenges of working in different health systems are described, which should be considered in future implementation, either for research or real settings. Trial registration NCT028406662 (Sao Paulo), NCT03026426 (Peru).
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Depresión , Enfermeras y Enfermeros , Brasil , Depresión/terapia , Humanos , Salud Mental , PerúRESUMEN
Importance: Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown. Objective: To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension. Design, Setting, and Participants: Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in São Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018). Interventions: An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n = 440 participants in 10 clusters in São Paulo; n = 217 participants in Lima) vs enhanced usual care (n = 440 participants in 10 clusters in São Paulo; n = 215 participants in Lima). Main Outcomes and Measures: The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months. Results: Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in São Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159/391 participants) in the digital intervention group vs 28.6% (114/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P = .001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108/205 participants) in the digital intervention group vs 34.1% (70/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P < .001). At 6-month follow-up, differences across groups were no longer statistically significant. Conclusions and Relevance: In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months. Trial Registration: ClinicalTrials.gov: NCT02846662 (São Paulo) and NCT03026426 (Lima).
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Terapia Conductista/métodos , Depresión/terapia , Diabetes Mellitus/psicología , Hipertensión/psicología , Aplicaciones Móviles , Telemedicina , Adulto , Brasil , Depresión/complicaciones , Depresión/enfermería , Femenino , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Perú , Teléfono InteligenteRESUMEN
This research aimed to obtain a hematological and biochemical profile of buffalos (Bubalus bubalis) bred in a region of the Brazilian Legal Amazon. A total of 73 animals of mixed races, divided into three groups, were studied: group 1 (G1) comprised animals up to 11 months old; in group 2 (G2), subjects were 12 to 23 months old; and, in group 3 (G3), they were 24 months old and older. We performed the hematological analysis manually, and, for the biochemistry, we used biochemical analyzers. Age of the animals has influenced the monocyte count. The counting of these cells was higher (p > 0.05) in younger animals (G1). There was no difference (p > 0.05) in hematological parameters concerning sex. In regard to biochemistry, we found that age influenced results for albumin and urea. Animals from G1 had higher albumin values when compared to G2 and G3. Serum urea values were higher in animals from G3. Regarding the serum mineral parameters, there were no significant results when the different age groups and both sexes were compared. Thus, the hematological and biochemical values obtained can work as a reference for the bubaline species of animals bred in the studied region, under the same management and breeding conditions. Sex and age of the animals are necessary for the interpretation of the tests.
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Bison , Hematología , Animales , Brasil , Búfalos , Femenino , Masculino , Valores de ReferenciaRESUMEN
Reports of rotavirus excretion in calves usually result from cross-sectional studies, and in face of the conflicting results regarding protection of calves born to vaccinated dams against diarrhea, the aim of the present study was to evaluate rotavirus excretion in dairy calves born to vaccinated or unvaccinated dams, to identify the genotypes of bovine rotavirus group A (RVA) strains isolated from these animals as well as to investigate characteristics of the disease in naturally occurring circumstances throughout the first month of life. Five hundred fifty-two fecal samples were taken from 56 calves, 28 from each farm and, in the vaccinated herd, 11/281 samples (3.91%) taken from six different calves tested positive for RVA while in the unvaccinated herd, 3/271 samples (1.11%) taken from 3 different calves tested positive. The genotyping of the VP7 genes showed 91.2% nucleotide sequence identity to G6 genotype (NCDV strain), and for the VP4 gene, strains from the vaccinated herd were 96.6% related to B223 strain, while strains from the unvaccinated herd were 88% related to P[5] genotype (UK strain). Genotypes found in this study were G6P[11] in the vaccinated herd and G6P[5] in the unvaccinated herd. All calves infected with rotavirus presented an episode of diarrhea in the first month of life, and the discrepancy between the genotypes found in the commercial vaccine (G6P[1] and G10P[11]) and the rotavirus strains circulating in both vaccinated and unvaccinated herds show the importance of keeping constant surveillance in order to avoid potential causes of vaccination failure.
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Enfermedades de los Bovinos/virología , Infecciones por Rotavirus/veterinaria , Vacunas contra Rotavirus , Rotavirus/aislamiento & purificación , Vacunación/veterinaria , Animales , Animales Recién Nacidos , Secuencia de Bases , Bovinos , Enfermedades de los Bovinos/prevención & control , Estudios Transversales , Diarrea/virología , Heces/virología , Genotipo , Estudios Longitudinales , Filogenia , Rotavirus/genética , Infecciones por Rotavirus/prevención & control , Infecciones por Rotavirus/virologíaRESUMEN
In this work, cassava starch was modified by treatment with sodium hypochlorite (NaClO) at different concentrations (0.8, 2.0 and 5.0 % of active chlorine) and selected physicochemical properties of the oxidized starches were investigated. The native and modified samples were evaluated considering moisture, carboxyl content, apparent viscosity, susceptibility to syneresis, mid-infrared spectroscopy and crystallinity index. The treatment with NaClO resulted in alterations in carboxyl content of the oxidized starches that increased with increasing concentration of the oxidant. Oxidized starches also showed higher susceptibility to syneresis, as assessed by the release of liquid during freezing and thawing. Apparent viscosity analysis showed decrease in peak viscosity of the oxidized starches. X-ray diffractograms showed that the oxidation influenced the extent of cassava starch relative crystallinity found to lie between 34.4 % (native) and 39.9 % (2.0 % active chlorine). The infrared spectra are sensitive to structural changes on starch macromolecules and presented characteristic peaks as C-O-C of the six carbon glucose ring absorbs at 1,150-1,085 cm(-1) and due to axial deformation these bands changed with the crystal structure of the starch samples.
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The fermentation of milk containing 0%, 3%, 6%, and 9% (w/v) yacon root flour (YRF) by Lacticaseibacillus casei LC-1 and Lactiplantibacillus plantarum BG-112 was evaluated for bacterial survival and antioxidant activity (AA) before and after simulated gastrointestinal digestion. After 28 days of refrigerated storage, samples of the beverages were analyzed for cell viability, AA (using ferric ion reducing antioxidant power (FRAP) and (ABTS), and molecular mass profile of proteins (using electrophoresis). The presence of 9% YRF increased bacterial survival during 28 days of storage and passage through the gastrointestinal tract for both L. casei and L. plantarum, which showed a greater capacity to reduce ferric ions compared to 0% YRF, and the ability to capture free radicals increased from below 5 mM to over 15 mM TE after digestion. Milk proteins are hydrolyzed during digestion, and the generation of bioactive peptides with AA may explain the increase in AA levels. Since peptides are generated from milk proteins, YRF did not influence AA after digestion. These results showed that fermentation of milk by L. casei and L. plantarum with YRF increased the chances of these bacteria reaching the colon in adequate quantities. After simulated digestion, the beverages showed improved AA due to milk protein hydrolysis.
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CONTEXT: There is limited knowledge about the disparities between the sexes in obesity prevalence and associated cardiovascular complications in low- and middle-income countries (LMICs). OBJECTIVE: We undertook a systematic review and meta-analysis to assess sex-specific disparities in the prevalence of obesity and cardiometabolic diseases in LMICs, the burden in women, and variations by region, country's income status, setting, and time. METHODS: We searched major databases from inception to March 2023. Two independent reviewers selected the studies, assessed their quality, and extracted data. We used DerSimonian and Laird random-effects models to obtain pooled estimates of odds ratios and 95% CI for the association between sex and obesity and cardiometabolic diseases, and multilevel random-effects logistic regression models to estimate the prevalence of relevant outcomes (PROSPERO CRD42019132609). RESULTS: We included 345 studies (3 916 276 individuals). The odds of obesity were 2.72-fold higher in women than men (OR 2.72; 95% CI, 2.54-2.91). The sex-specific disparities varied by region, with the greatest disparities in Sub-Saharan Africa (OR 3.91; 95% CI, 3.49-4.39). Among women in LMICs, 23% (95% CI, 21%-25%) had obesity, 27% (95% CI, 24%-29%) had hypertension, and 7% (95% CI, 6%-9%) had type 2 diabetes. The prevalence of obesity and type 2 diabetes in women varied by region, country's income, and setting, with the highest prevalence in the Middle East and North Africa, upper-middle-income countries and urban settings. The odds of hypertension (OR 2.41; 95% CI, 1.89-3.08) and type 2 diabetes (OR 2.65; 95% CI, 1.76-3.98) were doubled in women with vs without obesity. CONCLUSION: There is an urgent need for a women-centred and region-stratified approach to tackle obesity awareness, treatment, and prevention in women in LMICs.
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Diabetes Mellitus Tipo 2 , Hipertensión , Masculino , Humanos , Femenino , Diabetes Mellitus Tipo 2/epidemiología , Países en Desarrollo , Obesidad/epidemiología , Hipertensión/epidemiología , Renta , PrevalenciaRESUMEN
Brain abscesses in ruminants often arise from primary infection foci, leading to an unfavorable prognosis for affected animals. This highlights the need for comprehensive studies on brain abscesses across different ruminant species. We retrospectively investigated medical records of epidemiological, clinical, neuroimaging, anatomopathological, and bacteriological findings in six ruminants (three goats, two cows, and one sheep) diagnosed with brain abscesses. All animals studied were female. Apathy (50%), compulsive walking (33%), decreased facial sensitivity (33%), head pressing (33%), seizures (33%), semicomatous mental status (33%), strabismus (33%), unilateral blindness (33%), and circling (33%) represented the most common neurologic signs. Leukocytosis and neutrophilia were the main findings in the hematological evaluation. Cerebrospinal fluid (CSF) analysis revealed predominant hyperproteinorrachia and pleocytosis. In three cases, computed tomography or magnetic resonance imaging were used, enabling the identification of typical abscess lesions, which were subsequently confirmed during postmortem examination. Microbiological culture of the abscess samples and/or CSF revealed bacterial coinfections in most cases. Advanced imaging examinations, combined with CSF analysis, can aid in diagnosis, although confirmation typically relies on postmortem evaluation and isolation of the causative agent. This study contributes to clinicopathological aspects, neuroimages, and bacteriological diagnosis of brain abscesses in domestic ruminants.
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OBJECTIVE: To ascertain whether sociodemographic and health-related characteristics known from previous research to have a substantive impact on recovery from depression modified the effect of a digital intervention designed to improve depressive symptoms (CONEMO). METHODS: The CONEMO study consisted of two randomized controlled trials, one conducted in Lima, Peru, and one in São Paulo, Brazil. As a secondary trial plan analysis, mixed logistic regression was used to explore interactions between the treatment arm and subgroups of interest defined by characteristics measured before randomization - suicidal ideation, race/color, age, gender, income, type of mobile phone, alcohol misuse, tobacco use, and diabetes/hypertension - in both trials. We estimated interaction effects between the treatment group and these subgroup factors for the secondary outcomes using linear mixed regression models. RESULTS: Increased effects of the CONEMO intervention on the primary outcome (reduction of at least 50% in depressive symptom scores at 3-month follow-up) were observed among older and wealthier participants in the Lima trial (p = 0.030 and p = 0.001, respectively). CONCLUSION: There was no evidence of such differential effects in São Paulo, and no evidence of impact of any other secondary outcomes in either trial. CLINICAL TRIAL REGISTRATION: NCT02846662 (São Paulo, Brazil - SP), NCT03026426 (Lima, Peru - LI).
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Depresión , Factores Socioeconómicos , Telemedicina , Humanos , Masculino , Femenino , Brasil , Adulto , Persona de Mediana Edad , Perú , Depresión/terapia , Depresión/psicología , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To evaluate quality indicators of the Neonatal Screening Referral Service of the state of Mato Grosso (NSRS-MT) from 2005 to 2019. METHODS: Cross-sectional, retrospective, exploratory, descriptive, and observational study from 2005 to 2019. The following parameters were analyzed: age of newborns at the first collection, time between sample collection and arrival at the laboratory, time between the arrival and release of results and time between requesting the second sample and arrival at the NSRS. The population coverage of the program and the incidence of each clinical situation screened were also analyzed. RESULTS: NSRS-MT coverage was analyzed and recorded as 76%. The incidence was analyzed for congenital hypothyroidism (CH) 1:1867, phenylketonuria (PKU) 1:33,311, sickle cell disease (SCD) 1:2004, cystic fibrosis (CF) 1:12,663, congenital adrenal hyperplasia (CAH) 1:15,843, and biotinidase deficiency (DB) 1:25,349. The median age (days) at the first consultation was: 44 for HC, 22 for PKU, 60 for DF, 52 for FC, 79 for HAC and 79 for DB. The mean time between exam collection and delivery to the NSRS was 8.4 days; between the arrival and release of results, 9 days; and for the return of recalls, 59 days. CONCLUSIONS: Regarding the coverage of the target population and collection at the ideal age, the NSRS-MT presents values below the national average. However, regarding the mean age at the time of the first consultation, the state's performance is better than the national.
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Anemia de Células Falciformes , Fenilcetonurias , Recién Nacido , Humanos , Tamizaje Neonatal , Estudios Transversales , Estudios Retrospectivos , Fenilcetonurias/diagnóstico , Fenilcetonurias/epidemiologíaRESUMEN
Visceral Leishmaniasis is a serious public health problem and dogs are considered to be the main source of infection in urban areas. In Brazil, this disease is present in all regions, but with high concentration of cases in the Northeast, and the state of Maranhão is considered to be an endemic region. The aim of this study was to conduct an epidemiological, spatial, molecular and serological survey on Leishmania infantum among domestic dogs in the municipality of Belágua, Maranhão. Blood samples were collected from dogs and questionnaires were applied to their owners to obtain epidemiological data and risk factors relating to this zoonosis in the region. The coordinates of the dogs' homes were obtained to produce a disease risk map. Serological diagnoses were made using the indirect immunofluorescence reaction (IFAT) and the dual-path platform chromatographic immunoassay test (DPP®) (Bio-Manguinhos/FIOCRUZ, Brazil). A molecular investigation was undertaken using the polymerase chain reaction (PCR). Georeferencing was performed using the global positioning system (GPS) and cases of canine visceral leishmaniasis in the municipality were spatially represented and analyzed using QGIS version 3.16.6 (QGIS Development Team, 2021). A total of 205 blood samples were collected, of which 122 (59.51%) were seroreactive for L. infantum through IFAT, while the DPP test showed 84 reactive samples (40.97%). IFAT and DPP detected 16 positive animals simultaneously. One sample that was seroreactive through IFAT was also positive through PCR. In the clinical evaluation, it was observed that among the seropositive dogs, 112 (91.80%) were symptomatic and 10 (8.20%) were asymptomatic. In the spatial analysis, the Kernel density estimator enabled determination of the place at greatest risk of occurrence of the disease. The areas with the highest concentrations of cases were in districts with large quantities of precarious housing and lack of basic sanitation. This was the first report on the occurrence of L. infantum among dogs in the municipality of Belágua. The results show that canine visceral leishmaniasis is well dispersed in this municipality, thus putting at risk the human population.
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Enfermedades de los Perros , Leishmania infantum , Leishmaniasis Visceral , Humanos , Animales , Perros , Brasil/epidemiología , Leishmaniasis Visceral/epidemiología , Leishmaniasis Visceral/veterinaria , Zoonosis , Ecosistema , Enfermedades de los Perros/epidemiologíaRESUMEN
INTRODUCTION: Low dietary calcium intake is a risk factor for pre-eclampsia, a major contributor to maternal and perinatal mortality and morbidity worldwide. Calcium supplementation can prevent pre-eclampsia in women with low dietary calcium. However, the optimal dose and timing of calcium supplementation are not known. We plan to undertake an individual participant data (IPD) meta-analysis of randomised trials to determine the effects of various calcium supplementation regimens in preventing pre-eclampsia and its complications and rank these by effectiveness. We also aim to evaluate the cost-effectiveness of calcium supplementation to prevent pre-eclampsia. METHODS AND ANALYSIS: We will identify randomised trials on calcium supplementation before and during pregnancy by searching major electronic databases including Embase, CINAHL, MEDLINE, CENTRAL, PubMed, Scopus, AMED, LILACS, POPLINE, AIM, IMSEAR, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform, without language restrictions, from inception to February 2022. Primary researchers of the identified trials will be invited to join the International Calcium in Pregnancy Collaborative Network and share their IPD. We will check each study's IPD for consistency with the original authors before standardising and harmonising the data. We will perform a series of one-stage and two-stage IPD random-effect meta-analyses to obtain the summary intervention effects on pre-eclampsia with 95% CIs and summary treatment-covariate interactions (maternal risk status, dietary intake, timing of intervention, daily dose of calcium prescribed and total intake of calcium). Heterogeneity will be summarised using tau2, I2 and 95% prediction intervals for effect in a new study. Sensitivity analysis to explore robustness of statistical and clinical assumptions will be carried out. Minor study effects (potential publication bias) will be investigated using funnel plots. A decision analytical model for use in low-income and middle-income countries will assess the cost-effectiveness of calcium supplementation to prevent pre-eclampsia. ETHICS AND DISSEMINATION: No ethical approvals are required. We will store the data in a secure repository in an anonymised format. The results will be published in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD42021231276.
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Preeclampsia , Femenino , Humanos , Embarazo , Calcio/uso terapéutico , Calcio de la Dieta , Análisis Costo-Beneficio , Suplementos Dietéticos , Metaanálisis en Red , Preeclampsia/prevención & controlRESUMEN
OBJECTIVES: Daily calcium supplements are recommended for pregnant women from 20 weeks' gestation to prevent pre-eclampsia in populations with low dietary calcium intake. We aimed to improve understanding of barriers and facilitators for calcium supplement intake during pregnancy to prevent pre-eclampsia. DESIGN: Mixed-method systematic review, with confidence assessed using the Grading of Recommendations, Assessment, Development and Evaluations-Confidence in the Evidence from Reviews of Qualitative research approach. DATA SOURCES: MEDLINE and EMBASE (via Ovid), CINAHL and Global Health (via EBSCO) and grey literature databases were searched up to 17 September 2022. ELIGIBILITY CRITERIA: We included primary qualitative, quantitative and mixed-methods studies reporting implementation or use of calcium supplements during pregnancy, excluding calcium fortification and non-primary studies. No restrictions were imposed on settings, language or publication date. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias. We analysed the qualitative data using thematic synthesis, and quantitative findings were thematically mapped to qualitative findings. We then mapped the results to behavioural change frameworks to identify barriers and facilitators. RESULTS: Eighteen reports from nine studies were included in this review. Women reported barriers to consuming calcium supplements included limited knowledge about calcium supplements and pre-eclampsia, fears and experiences of side effects, varying preferences for tablets, dosing, working schedules, being away from home and taking other supplements. Receiving information regarding pre-eclampsia and safety of calcium supplement use from reliable sources, alternative dosing options, supplement reminders, early antenatal care, free supplements and support from families and communities were reported as facilitators. Healthcare providers felt that consistent messaging about benefits and risks of calcium, training, and ensuring adequate staffing and calcium supply is available would be able to help them in promoting calcium. CONCLUSION: Relevant stakeholders should consider the identified barriers and facilitators when formulating interventions and policies on calcium supplement use. These review findings can inform implementation to ensure effective and equitable provision and scale-up of calcium interventions. PROSPERO REGISTRATION NUMBER: CRD42021239143.
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Preeclampsia , Femenino , Embarazo , Humanos , Preeclampsia/prevención & control , Calcio/uso terapéutico , Suplementos Dietéticos , Calcio de la Dieta , Atención Prenatal/métodosRESUMEN
Context: Polycystic ovary syndrome (PCOS) etiology remains to be elucidated, but familial clustering and twin studies have shown a strong heritable component. Objective: The purpose of this study was to identify rare genetic variants that are associated with the etiology of PCOS in a preselected cohort. Methods: This prospective study was conducted among a selected group of women with PCOS. The study's inclusion criteria were patients with PCOS diagnosed by the Rotterdam criteria with the following phenotypes: severe insulin resistance (IR), normoandrogenic-normometabolic phenotype, adrenal hyperandrogenism, primary amenorrhea, and familial PCOS. Forty-five patients were studied by target sequencing, while 8 familial cases were studied by whole exome sequencing. Results: Patients were grouped according to the inclusion criteria with the following distribution: 22 (41.5%) with severe IR, 13 (24.5%) with adrenal hyperandrogenism, 7 (13.2%) with normoandrogenic phenotype, 3 (5.7%) with primary amenorrhea, and 8 (15.1%) familial cases. DNA sequencing analysis identified 1 pathogenic variant in LMNA, 3 likely pathogenic variants in INSR, PIK3R1, and DLK1, and 6 variants of uncertain significance level with interesting biologic rationale in 5 genes (LMNA, GATA4, NR5A1, BMP15, and FSHR). LMNA was the most prevalent affected gene in this cohort (3 variants). Conclusion: Several rare variants in genes related to IR were identified in women with PCOS. Although IR is a common feature of PCOS, patients with extreme or atypical phenotype should be carefully evaluated to rule out monogenic conditions.
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Protein extracts from green and roasted coffee beans and from spent coffee grounds (SCG) were evaluated as bioactive peptides sources. The in silico approach revealed a high frequency of the occurrence (A) of dipeptidyl peptidase-IV (DPP-IV) (0.62) and angiotensin I-converting enzyme (ACE) inhibitor peptides (0.44) in the 11S coffee globulin, which could be released after digestion. After in vitro digestion of the protein, the green bean and SCG proteins were more susceptible to proteolysis, releasing smaller polypeptides (3.4 kDa), which showed higher anti-hypertensive potentials (IC50 = 0.30 and 0.27 mg soluble protein/mL). However, the antioxidant capacity only increased for the roasted coffee and SCG extracts due to antioxidant groups formed during roasting. The heat treatment applied during coffee brewing increased the sensitivity of the SCG extract to proteolysis, leading to their high anti-hypertensive and antioxidant potentials. Therefore, the 11S coffee globulin is a precursor of a series of bioactive peptides.
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Café/química , Culinaria , Péptidos/aislamiento & purificación , Péptidos/farmacología , Extractos Vegetales/aislamiento & purificación , Extractos Vegetales/farmacología , Inhibidores de la Enzima Convertidora de Angiotensina/aislamiento & purificación , Inhibidores de la Enzima Convertidora de Angiotensina/farmacología , Antioxidantes/aislamiento & purificación , Antioxidantes/farmacología , Dipeptidil Peptidasa 4 , Inhibidores de la Dipeptidil-Peptidasa IV/farmacologíaRESUMEN
INTRODUCTION: The probability of improvement in the upper airway space (UAS) with orthognathic surgery should be considered during the surgical-orthodontic treatment decision, providing not only an esthetic, but also a functional benefit for the patient. OBJECTIVE: The purpose of this study was to evaluate the 3D changes in the upper airway space after maxillomandibular advancement surgery (MMA). METHODS: A retrospective analysis of 56 patients, 21 male and 35 female, with a mean age of 35.8 ± 10.7 years, who underwent MMA was performed. Pre- and postoperative cone-beam computed tomography scans (CBCT) were obtained for each patient, and the changes in the UAS were compared using Dolphin Imaging 11.7 software. Two parameters of the pharyngeal airway space (PAS) were measured: airway volume (AV) and minimum axial area (MAA). Paired t-test was used to compare the data between T0 and T1, at 5% significance level. RESULTS: There was a statistically significant increase in the UAS. Bimaxillary advancement surgery increased the AV and the MAA, on average, by 73.6 ± 74.75% and 113.5 ± 123.87%, respectively. CONCLUSION: MMA surgery tends to cause significant increase in the UAS; however, this increase is largely variable.
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Cirugía Ortognática , Procedimientos Quirúrgicos Ortognáticos , Cefalometría , Tomografía Computarizada de Haz Cónico , Estética Dental , Femenino , Humanos , Imagenología Tridimensional , Masculino , Faringe/diagnóstico por imagen , Estudios RetrospectivosRESUMEN
Eutrophication is one of the environmental problems arising from the increase of essential nutrient concentrations, mainly phosphorus and nitrogen. In contrast to excess phosphorus, the depletion of phosphate rock deposits used for the production of fertilizers compromises the food supply. Therefore, the development of technologies that propose the recovery of the phosphorus contained in eutrophic environments for its later use for agricultural fertilization purposes is very important to ensure global food security. This work aimed to evaluate the toxic potential of the sawdust (biosorbent previously used for phosphorus adsorption) in order to enable its application in agriculture. For this, toxicity experiments with Lactuca sativa (lettuce) and Allium cepa (onion) seeds were performed. The phytotoxic potential was assessed by means of the seed germination index and physiological parameters such as radicle and hypocotyl growth. Cytotoxicity, genotoxicity, and mutagenicity tests were also performed on onion seeds. From statistical tests, it was possible to affirm that the sawdust did not promote inhibition of seed germination and radicle and hypocotyl growth. No genotoxicity, cytotoxicity and, mutagenicity were observed, which allowed to state that the sawdust is not toxic to the onion species, which reinforces the possibility of application of the biosorbent for soil fertilization purposes. Therefore, the use of sawdust for phosphorus biosorption with the subsequent agricultural application is promising and quite important from a global food security point of view.
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Lactuca , Cebollas , Fertilizantes , Germinación , Fósforo , SueloRESUMEN
BACKGROUND: Mobile health interventions provide significant strategies for improving access to health services, offering a potential solution to reduce the mental health treatment gap. Economic evaluation of this intervention is needed to help inform local mental health policy and program development. OBJECTIVE: This paper presents the protocol for an economic evaluation conducted alongside 2 randomized controlled trials (RCTs) to evaluate the cost-effectiveness of a psychological intervention delivered through a technological platform (CONEMO) to treat depressive symptoms in people with diabetes, hypertension, or both. METHODS: The economic evaluation uses a within-trial analysis to evaluate the incremental costs and health outcomes of CONEMO plus enhanced usual care in comparison with enhanced usual care from public health care system and societal perspectives. Participants are patients of the public health care services for hypertension, diabetes, or both conditions in São Paulo, Brazil (n=880) and Lima, Peru (n=432). Clinical effectiveness will be measured by reduction in depressive symptoms and gains in health-related quality of life. We will conduct cost-effectiveness and cost-utility analyses, providing estimates of the cost per at least 50% reduction in 9-item Patient Health Questionnaire scores, and cost per quality-adjusted life year gained. The measurement of clinical effectiveness and resource use will take place over baseline, 3-month follow-up, and 6-month follow-up in the intervention and control groups. We will use a mixed costing methodology (ie, a combination of top-down and bottom-up approaches) considering 4 cost categories: intervention (CONEMO related) costs, health care costs, patient and family costs, and productivity costs. We will collect unit costs from the RCTs and national administrative databases. The multinational economic evaluations will be fully split analyses with a multicountry costing approach. We will calculate incremental cost-effectiveness ratios and present 95% CIs from nonparametric bootstrapping (1000 replicates). We will perform deterministic and probabilistic sensitivity analyses. Finally, we will present cost-effectiveness acceptability curves to compare a range of possible cost-effectiveness thresholds. RESULTS: The economic evaluation project had its project charter in June 2018 and is expected to be completed in September 2021. The final results will be available in the second half of 2021. CONCLUSIONS: We expect to assess whether CONEMO plus enhanced usual care is a cost-effective strategy to improve depressive symptoms in this population compared with enhanced usual care. This study will contribute to the evidence base for health managers and policy makers in allocating additional resources for mental health initiatives. It also will provide a basis for further research on how this emerging technology and enhanced usual care can improve mental health and well-being in low- and middle-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT12345678 (Brazil) and NCT03026426 (Peru); https://clinicaltrials.gov/ct2/show/NCT02846662 and https://clinicaltrials.gov/ct2/show/NCT03026426. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26164.