Surviving severe COVID-19: Interviews with patients, informal carers and health professionals.

BACKGROUND: The COVID-19 pandemic has been associated with an unprecedented number of critical care survivors. Their experiences through illness and recovery are likely to be complex, but little is known about how best to support them. AIM: This study aimed to explore experiences of illness and recovery from the perspective of survivors, their relatives and professionals involved in their care. STUDY DESIGN: In-depth qualitative interviews were conducted with three stakeholder groups during the first wave of the pandemic. A total of 23 participants (12 professionals, 6 survivors and 5 relatives) were recruited from 5 acute hospitals in England and interviewed by telephone or video call. Data analysis followed the principles of Reflexive Thematic Analysis. FINDINGS: Three themes were generated from their interview data: (1) Deteriorating fast-a downhill journey from symptom onset to critical care; (2) Facing a new virus in a hospital-a remote place; and (3) Returning home as a survivor, maintaining normality and recovering slowly. CONCLUSIONS: Our findings highlight challenges in accessing care and communication between patients, hospital staff and relatives. Following hospital discharge, patients adopted a reframed 'survivor identity' to cope with their experience of illness and slow recovery process. The concept of survivorship in this patient group may be beneficial to promote and explore further. RELEVANCE TO CLINICAL PRACTICE: All efforts should be made to continue to improve communication between patients, relatives and health professionals during critical care admissions, particularly while hospital visits are restricted. Adapting to life after critical illness may be more challenging while health services are restricted by the impacts of the pandemic. It may be beneficial to promote the concept of survivorship, following admission to critical care due to severe COVID-19.

Physical activity for people living with dementia: carer outcomes and side effects from the perspectives of professionals and family carers.

BACKGROUND: Adherence to physical activity is challenging for people living with dementia, and largely dependent on carers' involvement. Carers are likely to support physical activity based on their perceived balance between benefits and potential side effects of such intervention for both patients and themselves. Professionals also have a role in terms of optimising such interventions not only for people with dementia but also their carers. AIMS: The present study aimed to identify the priorities of carers and professionals regarding (1) outcomes of physical activity for people living with dementia on carers and (2) side effects on patients and carers. METHODS: This was a two-round prioritisation exercise. In round one, participants were asked to rank, from most to least important, 2 lists of outcomes generated in a previous systematic review and qualitative study: (i) 10 outcomes on carers; (ii) 17 side effects on patients and carers. In round two, participants were asked to consider their own ranking in round one against the overall group ranking and re-rank both lists. RESULTS: 36 carers and 39 professionals completed both rounds. The carer outcomes ranked as highest priority were "carer feeling positive and satisfied", "carer improving wellbeing" and "making lives of carers easier". The most undesirable side effects were "becoming agitated and confused", "falling over" and "feeling discomfort and pain". DISCUSSION AND CONCLUSIONS: Carers and professionals value the potential reduction in carer burden that may occur as a consequence of the person with dementia engaging in physical activity. Behavioural and psychological symptoms, falls and pain are the most undesirable side effects of physical activity. Future research should aim to address, and consistently report on these outcomes.

Bilateral Traumatic Internal Carotid Artery Dissection after CrossFit Training.

Bilateral traumatic internal carotid artery (ICA) dissection after CrossFit training is an extremely rare and life-threatening condition associated with high risk of cerebral ischemia. Several imaging modalities are involved in its clinical evaluation and clinical decision-making. Anticoagulation and antiplatelet management, endovascular therapy, and open surgical intervention are the available options for ICA dissection treatment. This report details a bilateral traumatic ICA dissection after CrossFit training treated with antiplatelet and anticoagulation therapy.

Evaluating physical activity in dementia: a systematic review of outcomes to inform the development of a core outcome set.

Background: physical activity is recommended for people living with dementia, but evidence for the positive effects of physical activity is limited by the use of heterogeneous outcomes and measurement tools. This systematic literature review aimed to summarise previously reported outcomes and identify the measurement tools used most frequently in physical activity interventions for people with dementia. Methods: literature searches were conducted in April 2015, on Delphis and Medline. Qualitative, quantitative and mixed methods studies reporting on any type of physical activity, in any setting, across types of dementia, stages of disease progression and published from 2005 onwards were included. A content analysis approach was used to report on the frequency of reported outcomes and measurement tools. Results: the 130 included studies reported on 133 different outcome domains and 267 different measurement tools. 'Functional abilities and independence' (n = 69), 'Global cognitive function' (n = 65), 'Balance' (n = 43), 'Global behavioural symptoms of dementia' (n = 42) and 'Health-related quality of life' (n = 40) were the most frequently reported outcome domains. 'Enjoyment' was the outcome most frequently sought by patients and carers. Conclusion: the need for the development and implementation of a Core Outcome Set has been reinforced. Ahead of the completion of the Core Outcome Set, researchers and clinicians are advised to measure the impact of physical activity interventions on these frequently reported outcome domains.

A Comparative Study of Full-Thickness Blepharotomy Versus Transconjunctival Eyelid Lengthening in the Correction of Upper Eyelid Retraction in Graves' Orbitopathy.

BACKGROUND: The study was designed to compare the outcome of full-thickness blepharotomy and transconjunctival eyelid lengthening in the correction of upper eyelid retraction (UER) in patients with Graves' orbitopathy (GO). METHODS: This is a prospective randomized interventional study. Following ophthalmic examination, determination of the ocular surface disease index (OSDI) and photography, 27 patients with UER were randomly assigned to either graded full-thickness blepharotomy (G1) or transconjunctival Müller muscle recession and graded disinsertion of the levator palpebrae superioris muscle (G2). Six months later, patients were reevaluated. Digital images were analyzed with the assistance of customized software. A standardized "normal range" of upper eyelid height and contour was calculated based on healthy controls. The outcome of the two groups was compared. RESULTS: Forty-seven eyelids of 27 patients (19 female) with UER were included. Twenty-seven eyelids (15 patients) were allocated to G1 and 20 eyelids (12 patients) to G2. On average, surgery lasted 37.46 ± 5.73 min in G1 and 32.70 ± 8.39 min in G2. Based on the margin reflex distance, 93% of the eyelids in G1 and 85% in G2 were within the normal range after surgery. The corresponding figures for lid contour were 63 and 55%. Both groups displayed significant improvement in OSDI scores. No significant difference was observed in the overall comparison. CONCLUSIONS: The two surgical techniques were equally effective in the treatment of UER from GO. Postoperative contour outcomes were considerably worse in patients with severe UER than in patients with mild or moderate UER, regardless of group. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 . Study registered on ClinicalTrial.gov number: NCT01999790.

Lipolytic and proteolytic activity of Pseudomonas spp. isolated during milking and storage of refrigerated raw milk.

UNLABELLED: The aim of this study was to verify the presence of lipolytic and proteolytic Pseudomonas spp. during milking and storage of refrigerated raw milk. We also intended to compare samples collected during rainy and dry seasons, from farms with manual and mechanical milking systems. For this, samples of milkers' hands, cows' teats, water, expansion tanks, equipment, and utensils used during milking were analyzed regarding Pseudomonas spp. COUNT: Positive samples were tested for the production of lipolytic and proteolytic enzymes. Microorganisms of the genus Pseudomonas were isolated from all sampling points. A higher isolation rate of the bacterium was found in the rainy season except for 6 sampling points, with all of these associated with mechanical milking systems. Pseudomonas spp. exhibiting lipolytic activity were found to be predominant during the dry season, since no activity was detected during the rainy season in 26 of the 29 sampling sites. The highest number of lipolytic Pseudomonas isolates was obtained from water. Presence of lipase-producing Pseudomonas spp. was verified in 7 and 36% of the samples collected from farms with manual and mechanical milking, respectively. When analyzing raw milk collected from expansion tanks immediately (0 h) and 24h after milking, we observed that for dairy properties with manual milking process, 10% of the Pseudomonas isolates were positive for lipolytic activity. The percentage increased to 12% 48h after milking. Mean averages were 32, 33, and 39% immediately after, 24 and 48h after milking, respectively, for farms with mechanical milking. All sampling points showed the presence of proteolytic strains of Pseudomonas. The highest proteolytic activity was found during the rainy season, except for the samples collected from milkers' hands before milking, buckets, and teat cup inner surfaces after milking and from the water in dairy farms with mechanical milking system. Of these samples, 72, 56, and 50%, respectively, were positive for proteolysis during the dry season. For the water samples, a statistical difference was observed between mechanical (50%) and manual (7%) milking systems in the percentage of proteolytic activity. No production of proteolytic enzyme was detected in the samples from milkers' hands taken after milking and no statistically significant difference was found among manual (19.91%) and mechanical (47.85%) milking. During the rainy months, no proteolysis was detected in the samples taken from cows' teats after the predipping. It is evident, therefore, that preventive measures capable of minimizing the contamination with Pseudomonas spp. during milking and storage of refrigerated raw milk are needed, regardless of season.

Exploring the recovery journey of COVID-19 critical care survivors during the first year after hospital discharge.

Objectives: To explore the longitudinal recovery of patients admitted to critical care following COVID-19 over the year following hospital discharge. To understand the important aspects of the patients' recovery process and key elements of their caregivers' experiences during this time. Design: A longitudinal qualitative study using semi-structured interviews. Setting: Two acute hospitals in South East England and follow-up in the community. Participants: Six COVID-19 critical care survivors from the first wave of the pandemic (March-May 2020) and five relatives were interviewed 3 months after hospital discharge. The same six survivors and one relative were interviewed again at 1 year. Interviews were transcribed verbatim, anonymised and a reflexive thematic analysis was conducted. Results: Three themes were developed: (1) 'The cycle of guilt, fear and stigma'; (2) 'Facing the uncertainties of recovery' and (3) 'Coping with lingering symptoms - the new norm'. The first theme highlights survivors' reluctance to share their experiences associated with contracting the disease. The second theme, explores challenges faced by the survivors and their relatives in navigating the recovery process, given the unknown nature of the illness. The final theme illustrates the mechanisms survivors develop to come to terms with the remnants of their illness and critical care stay. Conclusions: The longitudinal nature of the study highlighted the persisting symptoms of long COVID-19, their impact on survivors and coping methods amidst the ongoing pandemic. Further research into the experiences of those affected in the first and subsequent waves of the COVID-19 pandemic, is desirable to help guide the formulation of the optimally supported recovery pathways.

High seroprevalence for SARS-CoV-2 infection in dogs: Age as risk factor for infection in shelter and foster home animals.

SARS-CoV-2 has caused 775 outbreaks in 29 animal species across 36 countries, including dogs, cats, ferrets, minks, non-human primates, white-tailed deer, and lions. Although transmission from owners to dogs has been extensively described, no study to date has also compared sheltered, foster home and owner dogs and associated risk factors. This study aimed to identify SARS-CoV-2 infection and anti-SARS-CoV-2 antibodies from sheltered, fostered, and owned dogs, associated with environmental and management risk factors. Serum samples and swabs were collected from each dog, and an epidemiological questionnaire was completed by the shelter manager, foster care, and owner. A total of 111 dogs, including 222 oropharyngeal and rectal swabs, tested negative by RT-qPCR. Overall, 18/89 (20.22%) dogs presented IgG antibodies against the N protein of SARS-CoV-2 by magnetic ELISA, while none showed a reaction to the Spike protein. SARS-CoV-2 antibodies showed an age-related association, with 4.16 chance of positivity in adult dogs when compared with young ones. High population density among dogs and humans, coupled with repeated COVID-19 exposure, emerged as potential risk factors in canine virus epidemiology. Dogs exhibited higher seropositivity rates in these contexts. Thus, we propose expanded seroepidemiological and molecular studies across species and scenarios, including shelter dogs.

Gastrointestinal Manifestations of Chagas Disease: A Systematic Review with Meta-Analysis.

The aims of this study were to estimate the prevalence of gastrointestinal manifestations among individuals with positive serology for Chagas disease (ChD) and to describe the clinical gastrointestinal manifestations of the disease. A systematic review with meta-analysis was conducted based on the criteria and recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The PubMed, Scopus, Virtual Health Library, Web of Science, and Embase databases were used to search for evidence. Two reviewers independently selected eligible articles and extracted data. RStudio® software was used for the meta-analysis. For subgroup analysis, the studies were divided according to the origin of the individuals included: 1) individuals from health units were included in the health care service prevalence analysis, and 2) individuals from the general population were included in the population prevalence analysis. A total of 2,570 articles were identified, but after removal of duplicates and application of inclusion criteria, 24 articles were included and 21 were part of the meta-analysis. Most of the studies were conducted in Brazil. Radiological diagnosis was the most frequent method used to identify the gastrointestinal clinical form. The combined effect of meta-analysis studies showed a prevalence of gastrointestinal manifestations in individuals with ChD of 12% (95% CI, 8.0-17.0%). In subgroup analysis, the prevalence for studies involving health care services was 16% (95% CI, 11.0-23.0%), while the prevalence for population-based studies was 9% (95% CI, 5.0-15.0%). Megaesophagus and megacolon were the main forms of ChD presentation in the gastrointestinal form. The prevalence of gastrointestinal manifestations of ChD was 12%. Knowing the prevalence of ChD in its gastrointestinal form is an important step in planning health actions for these patients.

Oxidative stress in malaria.

Malaria is a significant public health problem in more than 100 countries and causes an estimated 200 million new infections every year. Despite the significant effort to eradicate this dangerous disease, lack of complete knowledge of its physiopathology compromises the success in this enterprise. In this paper we review oxidative stress mechanisms involved in the disease and discuss the potential benefits of antioxidant supplementation as an adjuvant antimalarial strategy.

Is pinking susceptibility index a good predictor of white wines pinking phenomena?

The concentration of anthocyanins in white wines from different grape varieties (Prosecco, Sauvignon Blanc, Pinot Grey, Chardonnay, Síria) from diverse countries (Italy, Moldova, and Portugal) was determined. Anthocyanins, mainly malvidin-3-O-glucoside, were detected in all wines (from 0.7 to 704 µg/L). No correlation between anthocyanins concentration and the Pinking Susceptibility Index (PSI) was observed contrarily to the colour of wines exposed to oxygen (r = 0.871, p < 0.00005). The oxidation of wines with hydrogen peroxide resulted in the formation of various compounds. PSI was correlated with compounds absorbing in the 400-480 nm region, probably more related to the browning than the pinking phenomenon. The lack of correlation between the PSI and anthocyanins concentration in white wines can be due to the different chemical compositions of white wines that yield various compounds after oxidation that might not be related to the natural wine pinking phenomenon.

Using Smartwatches to Observe Changes in Activity During Recovery From Critical Illness Following COVID-19 Critical Care Admission: 1-Year, Multicenter Observational Study.

BACKGROUND: As a sequela of the COVID-19 pandemic, a large cohort of critical illness survivors have had to recover in the context of ongoing societal restrictions. OBJECTIVE: We aimed to use smartwatches (Fitbit Charge 3; Fitbit LLC) to assess changes in the step counts and heart rates of critical care survivors following hospital admission with COVID-19, use these devices within a remote multidisciplinary team (MDT) setting to support patient recovery, and report on our experiences with this. METHODS: We conducted a prospective, multicenter observational trial in 8 UK critical care units. A total of 50 participants with moderate or severe lung injury resulting from confirmed COVID-19 were recruited at discharge from critical care and given a smartwatch (Fitbit Charge 3) between April and June 2020. The data collected included step counts and daily resting heart rates. A subgroup of the overall cohort at one site-the MDT site (n=19)-had their smartwatch data used to inform a regular MDT meeting. A patient feedback questionnaire and direct feedback from the MDT were used to report our experience. Participants who did not upload smartwatch data were excluded from analysis. RESULTS: Of the 50 participants recruited, 35 (70%) used and uploaded data from their smartwatch during the 1-year period. At the MDT site, 74% (14/19) of smartwatch users uploaded smartwatch data, whereas 68% (21/31) of smartwatch users at the control sites uploaded smartwatch data. For the overall cohort, we recorded an increase in mean step count from 4359 (SD 3488) steps per day in the first month following discharge to 7914 (SD 4146) steps per day at 1 year (P=.003). The mean resting heart rate decreased from 79 (SD 7) beats per minute in the first month to 69 (SD 4) beats per minute at 1 year following discharge (P<.001). The MDT subgroup's mean step count increased more than that of the control group (176% increase vs 42% increase, respectively; +5474 steps vs +2181 steps, respectively; P=.04) over 1 year. Further, 71% (10/14) of smartwatch users at the MDT site and 48% (10/21) of those at the control sites strongly agreed that their Fitbit motivated them to recover, and 86% (12/14) and 48% (10/21), respectively, strongly agreed that they aimed to increase their activity levels over time. CONCLUSIONS: This is the first study to use smartwatch data to report on the 1-year recovery of patients who survived a COVID-19 critical illness. This is also the first study to report on smartwatch use within a post-critical care MDT. Future work could explore the role of smartwatches as part of a randomized controlled trial to assess clinical and economic effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.12968/ijtr.2020.0102.

Thymus hirtus Willd. ssp. algeriensis Boiss. and Reut: A Comprehensive Review on Phytochemistry, Bioactivities, and Health-Enhancing Effects.

Members of the Lamiaceae family are considered chief sources of bioactive therapeutic agents. They are important ornamental, medicinal, and aromatic plants, many of which are used in traditional and modern medicine and in the food, cosmetic, and pharmaceutical industries. In North Africa, on the Mediterranean side, there is the following particularly interesting Lamiaceous species: Thymus hirtus Willd. sp. Algeriensis Boiss. Et Reut. The populations of this endemic plant are distributed from the subhumid to the lower arid zone and are mainly employed as ethnomedicinal remedies in the following Maghreb countries: Algeria, Libya, Morocco, and Tunisia. In fact, they have been applied as antimicrobial agents, antispasmodics, astringents, expectorants, and preservatives for several food products. The species is commonly consumed as a tea or infusion and is used against hypercholesterolemia, diabetes, respiratory ailments, heart disease, and food poisoning. These medicinal uses are related to constituents with many biological characteristics, including antimicrobial, antioxidant, anticancer, anti-ulcer, anti-diabetic, insecticidal, and anti-inflammatory activities. This review aims to present an overview of the botanical characteristics and geographical distribution of Thymus algeriensis Boiss. Et Reut and its traditional uses. This manuscript also examines the phytochemical profile and its correlation with biological activities revealed by in vitro and in vivo studies.

Outcomes of physical activity for people living with dementia: qualitative study to inform a Core Outcome Set.

BACKGROUND: The need for a Core Outcome Set to evaluate physical activity interventions for people living with dementia, across stages of disease and intervention settings has been established. This qualitative study precedes the consensus phase of developing this Core Outcome Set and aims to: (i) compare the outcomes identified by patients, carers and professionals to those previously reported in the literature; (ii) and understand why certain outcomes are considered important. DESIGN AND METHODS: In-depth semi-structured interviews were conducted with people living with dementia, family carers and professionals (n=29). The outcomes identified in the interviews were mapped to a list of outcomes reported in a recent literature review. An in-depth thematic analysis was conducted to understand the importance of physical activity in dementia care. RESULTS: A comprehensive, inductively derived list of 77 outcomes, common across stages of dementia and intervention setting, was put together for the consensus phase of this Core Outcome Set: ten of these were new outcomes generated by this qualitative study. Five themes explained why stakeholders perceived physical activity outcomes as important for people living with dementia: "being well and staying well", "having a role towards others", "maintaining identity", "being connected to the present" and "delivering good quality care". CONCLUSION: Ten new outcomes of physical activity, not previously reported in recent literature, were identified. Physical activity is considered important to people living with dementia due to its positive impact on multiple health outcomes for both patients and carers.

Impact of capsaicin on aroma release: in vitro and in vivo analysis.

Capsaicin is the main bioactive compound in chili pepper that leads to the perception of "spiciness". However, the effect of capsaicin on aroma release in the nose remains unexplained. This is the first study designed to measure capsaicin's impact on aroma release during consumption. In vitro studies, using static headspace analysis by atmospheric pressure chemical ionization-mass spectrometry (APCI-MS), showed no impact of capsaicin (5 ppm) on the gas-liquid partitioning equilibria of a range of aroma compounds. However, a significant reduction in aroma release was observed in vivo, during oral melting of a model ice cube system (p < 0.05) included 5 ppm capsaicin. The total release of aroma into the nasal cavity was decreased, such that only 49% of 3-methylbutanal, 60% of 1-octen-3-ol and 83% of linalool was released. This is the first evidence of capsaicin's reduction effect on aroma release during consumption. It was also found that 5 ppm capsaicin increased saliva secretion by 75%, which may have led to the dilution of aroma compounds in the mouth and directly impacted the aroma release into the nasal cavity. The most hydrophilic compound (3-methylbutanal) was affected by capsaicin to a greater extent than the hydrophobic compound (linalool), the solvent effect of the additional saliva may explain this.

A Core Outcome Set to Evaluate Physical Activity Interventions for People Living With Dementia.

BACKGROUND AND OBJECTIVES: A core outcome set (COS) to evaluate physical activity (PA) interventions for people living with dementia is needed, as the development of guidelines is currently limited by important heterogeneity in this field of research. Development of COS often includes Delphi surveys, but people living with dementia are often excluded. This study aimed to reach consensus on this COS using a modified Delphi survey to enable the participation of people living with dementia. RESEARCH DESIGN AND METHODS: Two stakeholders groups took part in a Delphi survey (Group 1: people living with dementia and family caregivers; Group 2: professionals from different backgrounds, including physiotherapists, occupational therapists, and researchers). Caregivers and professionals completed the survey remotely. Participants living with dementia took part face-to-face, using a card sorting strategy. The consensus process was finalized with a consensus meeting. RESULTS: Ninety-five participants of both groups completed the modified Delphi. Of those, 11 attended the consensus meeting. The card sorting strategy was successful at including people living with dementia. Seven outcomes reached consensus: preventing falls; doing what you can do; staying healthy and fit; walking better, being able to stand up and climb stairs; feeling brighter; enjoying the moment; and, feeling useful and having a purpose. DISCUSSION AND IMPLICATIONS: Robust and innovative methodological strategies were used to reach a consensus on a COS (what to measure) to evaluate PA for people living with dementia. Future work will focus on the selection of the most appropriate tools to measure these outcomes (how to measure).

Environmental Awareness for Patients with COPD Undergoing Pulmonary Rehabilitation: Is It of Added Value?

Chronic obstructive pulmonary disease (COPD) is impacted by exposure to environmental contaminants. Improving health literacy on this topic might help to optimize health outcomes. We aimed to design and deliver a health-education session about the impact of environmental contaminants on respiratory symptoms and explore participants' perceptions on such session. Patients with COPD were recruited from a pulmonary rehabilitation (PR) program. Two focus groups were first conducted to explore knowledge amongst the group. Then, the session was designed and delivered, and three focus groups were conducted to obtain feedback from participants. Data were analyzed thematically by two independent researchers. Thirty-one patients (71 ± 8 years old, FEV1 = 47.6 ± 16.8% predicted; 74.2% male) were included. Prior to the session, participants recognized the importance of this topic and described avoidance strategies to deal with symptom triggering due to air pollution. After the session, participants had their knowledge validated, kept some avoidance strategies, but also adapted some "unavoidable" activities of daily living. Patients with COPD value education on this topic, and PR offers a friendly environment to discuss prevention and management strategies. Contents of the session are provided to help deliver these sessions. Future studies could investigate the effectiveness of this intervention on self-management and exacerbations of COPD.

Multitarget protection of Pterospartum tridentatum phenolic-rich extracts against a wide range of free radical species, antidiabetic activity and effects on human colon carcinoma (Caco-2) cells.

Pterospartum tridentatum is an edible endemic plant common in Portugal. Its flowers are used in culinary and are part of the popular medicine owing to its therapeutic properties. In this study, P. tridentatum flower infusion and hydroethanolic extracts were characterized concerning their phenolic composition and biological potential. By high-performance liquid chromatography method coupled to a diode array detector analysis were detected 13 phenolics. Genistein was the major one. Concerning the biological potential, the hydroethanolic extract was the most active against 2,2-diphenyl-1-picrylhydrazyl● and also as α-glucosidase inhibitor, while the infusion proved to be a remarkable free radical scavenger. Concerning human epithelial colorectal adenocarcinoma (Caco-2) cells, it was observed that both extracts displayed dose-dependent cytotoxicity on the viability of Caco-2 cells, presenting cytotoxic selectivity for these cancer cells when compared to the NHDF normal cell line. Additionally, they also showed protective effects against oxidative stress induced by tert-butyl hydroperoxide on Caco-2 cells. The obtained results suggest that these extracts may be interesting to enrich nutraceutical, pharmaceutical and food industries; however, more studies need to be done for their inclusion in pharmaceutical preparations and/or food additives. PRACTICAL APPLICATION: Pterospartum tridentatum is an endemic plant commonly used in folk medicine due to its depurative and hypoglycaemic properties. For this reason, we decided to determine the phenolic content of infusion and hydroethanolic extracts of P. tridentatum and their biological potential. The obtained results proved that P. tridentatum extracts are a rich source of bioactive compounds and possess great antioxidant and antidiabetic activities, ability to protect human erythrocytes against oxidative damage, inhibiting hemolysis, hemoglobin oxidation, and lipid peroxidation, and to interfere with Caco-2 cells growth and to protect these cells when subject to tert-butyl hydroperoxide oxidative stress conditions.

Evaluating the validity of dengue clinical-epidemiological criteria for diagnosis in patients residing in a Brazilian endemic area.

BACKGROUND: We evaluated the validity of clinical diagnosis compared with laboratory diagnosis of dengue in a retrospective sample of patients in São José do Rio Preto, Brazil. METHODS: Our sample included 148 299 clinically (56.3%) or laboratory-diagnosed (43.7%) dengue cases. We compared the sensitivity, specificity, positive and negative predictive value (PPV and NPV) of dengue patients' demographic and clinical characteristics with laboratory-based diagnosis. We used logistic regressions to estimate the correlation between clinical and laboratory diagnosis of dengue and a full set of dengue signs and symptoms. RESULTS: We found substantial variability in sensitivity and specificity of signs and symptoms ranging from 0.8-81.1 and 21.5-99.6, respectively. Thrombocytopenia exhibited the highest PPV (92.0) and lowest NPV (42.2) and was the only symptom showing agreement with laboratory-confirmed dengue (φ = 0.38). The presence of exanthema and thrombocytopenia led to a greater likelihood of concordant clinical and laboratory diagnoses (exanthema: OR: 4.23; 95% CI: 2.09 to 8.57; thrombocytopenia: OR: 4.02; 95% CI: 1.32 to 12.27). CONCLUSIONS: We found substantial variation in sensitivity, specificity, PPV and NPV of dengue signs and symptoms. For accuracy, clinical and laboratory diagnosis of dengue should be performed concurrently. When laboratory tests are not available, we suggest focusing on the clinical manifestations most associated with dengue.

Biotechnological potential of mangrove sediments: Identification and functional attributes of thermostable and salinity-tolerant ß-glucanase.

Microorganisms native to mangroves are expected to contain enzymes capable of hydrolyzing different carbon sources. However, most of these microorganisms aren't cultivable; hence, alternative techniques as metagenomics are tools for studying and obtaining some of the natural genomes, genes and enzymes of biotechnological interest. The ß-glucanase was produced using a metagenomic clone of mangrove sediments and detected by functional screening on carboxymethylcellulose substrate. The enzyme was purified by cation exchange chromatography. The peptides detected by mass spectrometry showed 20% identity with the polypeptide deduced from the genomic fragment sequenced. The ORF identified as BglfosD9 possessed 729 bp and the encoded protein showed predicted MW and pI of 28kD and 6.8, respectively. The enzyme was active in a wide range of pH (5-10) with optimum pH at 8, had relative activity greater than 50% at all temperatures tested (5-90 °C), was stable at temperatures of 5, 50 and 90 °C and showed excellent relative activity at high NaCl concentrations. This ß-glucanase also showed high relative activity in the presence of SDS and it could hydrolyze ß-glucan, CMC and Avicel as substrates. These findings support the idea of a new thermostable and active enzyme at basic pH from metagenomic library of mangrove sediment.