From Testicle to Brain: A Case of Disseminated Tuberculosis.

Tuberculosis remains a major cause of death by infection in the world. Disseminated tuberculosis occurs most frequently in the context of reactivation of a previously latent infection and is invariably lethal if untreated. Age, late presentation, and serious underlying disease are strong death predictors. We report the case of a 72-year-old male patient who presented to the emergency room with sudden onset hemiparesis and aphasia, with no acute lesions on contrast CT. Two months prior to the current event, the patient had undergone surgery for a testicular abscess in a different hospital. Since the surgery, he had progressive and unexplained weight loss and dysphagia. The medical team reviewed patient records from this hospital and the one where the surgery took place and concluded that the histopathology results from the surgery were not reviewed in the post-surgery follow-up consult and that the diagnosis of genitourinary tuberculosis was never made. This disease, untreated, evolved into disseminated tuberculosis with central nervous system involvement, causing the neurological deficits the patient presented and leading to his death. Surveillance and notification systems exist for individual and public health safeguarding. In the present case, failure to review the pathology report after surgery, coupled with the absence of notification from the laboratory, delayed the diagnosis and led to patient death. This report suggests a need for continuous system improvement, with integrated healthcare records and interinstitutional communication channels, in order to minimize information loss, diagnostic delays, and public health risks.

Impact of Seasonal and Organ-Related Fluctuations on the Anthelmintic Properties and Chemical Profile of Cladium mariscus (L.) Pohl Extracts.

The use of plants and their metabolites stands as a promising option to tackle parasitic infections by gastrointestinal nematodes (GIN) in integrated control strategies. Still, the influence of environmental and phenological factors, and their interactions, in the wild on the metabolomics and biological properties of target plant species, is often disregarded. In this work, we hypothesized that variations in the anthelmintic (AH) properties and chemical composition of extracts from the salt tolerant species Cladium mariscus L. Pohl (sawgrass) may be influenced by seasonal factors and organ-parts. To test this hypothesis, acetone/water extracts were prepared from dried biomass obtained from aerial organs collected from sawgrass in consecutive seasons and tested against Haemonchus contortus and Trichostrongylus colubriformis by the larval exsheathment inhibition assay (LEIA) and egg hatching inhibition assay (EHIA). To ascertain the role of plant organ, the activity of leaves and inflorescences extracts from summer samples was compared. The role of polyphenols in the anthelmintic activity depending on GINs and fluctuations across seasons and plant organs was assessed using polyvinylpolypyrrolidone (PVPP), coupled with an in-depth chemical profiling analysis using high-performance liquid chromatography completed with electrospray ionization mass spectrometric detection (HPLC-ESI-MSn). Main differences in anthelmintic activities were observed for summer and autumn samples, for both assays. Moreover, inflorescences' extracts were significantly more active than those from leaves against both parasite species on EHIA and against H. contortus on LEIA. Application of PVPP totally inhibit the AH effects based on EHIA and only partly for LEIA. Non-treated PVPP extracts were predominantly composed of flavan-3-ols, proanthocyanidins, luteolin and glycosylated flavonoids, while two flavonoid glycosides were quantified in all PVPP-treated samples. Thus, the activity of such compounds should be further explored, although some unknown metabolites remain to be identified. This study reinforces the hypothesis of the AH potential of sawgrass and of its polyphenolic metabolites uses as nutraceutical and/or phytotherapeutic drugs.

Disclosing the bioactive metabolites involved in the in vitro anthelmintic effects of salt-tolerant plants through a combined approach using PVPP and HPLC-ESI-MSn.

Strategies to reduce dependence on synthetic drugs for the treatment of gastrointestinal nematodes (GIN) infections in ruminants include the search for novel anthelmintic scaffolds on plants, yet salt-tolerant plants remain overlooked. This study aims to evaluate the in vitro anthelmintic properties of selected salt-tolerant plants against GIN, and identify the potential bioactive secondary metabolites involved. For that purpose, 80% acetone/water extracts were prepared from dried biomass of aerial organs of nine salt-tolerant plant species and tested against Haemonchus contortus and Trichostrongylus colubriformis by the Larval Exsheathment Inhibition Assay (LEIA) and Egg Hatching Inhibition Assay (EHIA). Pistacia lentiscus, Limoniatrum monopetalum, Cladium mariscus and Helychrisum italicum picardi were the most active in both GIN and life stages. To investigate the role of polyphenols in the anthelmintic activity, four selected extracts were treated with polyvinylpolypyrrolidone (PVPP), and non-treated and treated samples were further characterized by high-performance liquid chromatography with electrospray ionization mass spectrometric detection (HPLC-ESI-MSn). While polyphenols seem responsible for the EHIA properties, they are partially accountable to LEIA results. Several phenolics involved in the anthelmintic effects were identified and discussed. In sum, these species are rich sources of anthelmintic compounds and, therefore, are of major interest for nutraceutical and/or phytotherapeutic applications against GIN in ruminants.

Optimising cardiovascular care of patients with multiple myeloma.

Multiple myeloma (MM) is the third most common haematological malignancy, with increasing prevalence over recent years. Advances in therapy have improved survival, changing the clinical course of MM into a chronic condition and meaning that management of comorbidities is fundamental to improve clinical outcomes. Cardiovascular (CV) events affect up to 7.5% of individuals with MM, due to a combination of patient, disease and treatment-related factors and adversely impact survival. MM typically affects older people, many with pre-existing CV risk factors or established CV disease, and the disease itself can cause renal impairment, anaemia and hyperviscosity, which exacerabate these further. Up to 15% of patients with MM develop systemic amyloidosis, with prognosis determined by the extent of cardiac involvement. Management of MM generally involves administration of multiple treatment lines over several years as disease progresses, with many drug classes associated with adverse CV effects including high rates of venous and arterial thrombosis alongside heart failure. Recommendations for holistic management of patients with MM now include routine baseline risk stratification including ECG and echocardiography and administration of thromboprophylaxis drugs for patients treated with immunomodulatory drugs. Close surveillance of high-risk patients with collaboration between haematology and cardiology is required, with prompt investigation in the event of CV symptoms, in order to identify and treat complications early. Decisions regarding discontinuation of cardiotoxic therapies should be made in a multidisciplinary setting, taking into account the severity of the complication, prognosis, expected benefits and the availability of effective alternatives.

Seasonal Variations of the Nutritive Value and Phytotherapeutic Potential of Cladium mariscus L. (Pohl.) Targeting Ruminant's Production.

In our endeavor to identify salt-tolerant plants with potential veterinary uses in ruminants' production strategies, we focused on Cladium mariscus L. Pohl (sawgrass), due to its high total phenolic and tannin content, anti-radical properties, and ethnomedicinal uses. Aerial parts were collected along the year in Southern Portugal and evaluated for the nutritional profile and in vitro organic matter digestibility (IVOMD), aiming for its use as feed. Acetone extracts were appraised for total contents in phenolics (TPC), flavonoids (TFC), and tannins (CTC), as well as the chemical composition by HPLC-DAD and in vitro antioxidant and anti-inflammatory properties, targeting its exploitation as phytotherapeutic products. Sawgrass biomass has a limited nutritive value, due to its high neutral detergent fiber (NDF; 596-690 g kg-1 dry matter (DM)) and acid detergent fiber (ADF; 330-418 g kg-1 DM) contents, low crude protein (51.8-87.3 g kg-1 DM) and IVOMD (172-317 g kg-1 organic matter (OM)). Despite differences among seasons, the mineral profile was adequate. The extracts were rich in TPC (88-112 mg g-1), CTC (115-169 mg g-1), and TFC (18.5-20.2 mg g-1), and displayed significant antioxidant capacity, particularly in summer and autumn, whilst no seasonal influence was detected for anti-inflammatory properties (30% reduction of nitric oxide production). Eleven phenolics were quantified: chlorogenic, ferulic, and syringic acids were the most abundant, especially in the autumn sample. Overall, despite the low nutritional interest, sawgrass extracts hold the potential as a source of antioxidant and anti-inflammatory phenolic compounds.

A systematic review on the ethnoveterinary uses of mediterranean salt-tolerant plants: Exploring its potential use as fodder, nutraceuticals or phytotherapeutics in ruminant production.

ETHNOPHARMACOLOGICAL RELEVANCE: Salt-tolerant plants are well adapted to the harsh conditions of the Mediterranean region, where have been used traditionally as food and medicines for human and animals. In addition, various species are currently recognized as sources of metabolites with pharmacological, cosmetical and nutraceutical interest. Nevertheless, ethnoveterinary data on salt-tolerant plants are dispersed in the literature and there are few discussions on its veterinary potential. Having in mind the rising interest on organic farming, alternatives to chemical substances in livestock production and concern for animal health and welfare practices, these plants may represent an untapped resource for animal management and veterinary purposes. In this sense, the purpose of this work is to summarize the ethnoveterinary knowledge on salt-tolerant plants described in the Mediterranean region, raising awareness to the potential of this group of plants to be used in veterinary science, targeting especially ruminants. MATERIAL AND METHODS: Literature search (2000-2020) was conducted using Web of Science and Science Direct databases. Ethnoveterinary reports (EVR) concerning salt-tolerant plants were summarized and filtered for ruminants. From the final 29 publications, EVR concerning therapeutic uses were categorized according to its ATCvet code and results analyzed. RESULTS: A total of 221 EVR were identified from 39 plants, belonging to 21 plant families, targetting ruminants. Ten EVR (4.5%) concerned uses of salt-tolerant species as animal feed, while around 75% of therapeutic uses was represented by three categories: alimentary tract and metabolism (QA; n = 75), dermatologicals (QD; n = 53) and genitourinary system and sex hormones (QG; n = 41). Pistacia lentiscus L., Foeniculum vulgare Mill., Dittrichia viscosa (L.) Greuter, Plantago major L. and Hordeum vulgare L. were the most cited species in the latter categories. CONCLUSIONS: The ethnoveterinary knowledge on salt-tolerant species hints some plants of veterinary pharmacological potential, but other species deserve further notice. This information should serve as a basis and, coupled with the currently available scientific data on bioactive properties and chemical composition of salt-tolerant species, inspire additional research on the exploitation of this botanical group, as sources of novel products for ruminant nutrition, health and quality of its products.

Mineral Content of Various Portuguese Breads: Characterization, Dietary Intake, and Discriminant Analysis.

The chemical composition and daily mineral intake (DMI) of six macro (calcium, magnesium, sodium, potassium, phosphorous, and chloride) and four microminerals (copper, iron, manganese, and zinc) were determined in four types of Portuguese breads (white wheat, maize, wheat/maize, and maize/rye breads). Samples were processed with microwave assisted digestion and mineral composition was determined with a high-resolution continuum-source atomic absorption spectrometer with flame and graphite furnace. Bread contributes to an equilibrated diet since it is rich in several minerals (0.21 mg/100 g of copper in wheat bread to 537 mg/100 g of sodium in maize/rye bread). Maize/rye bread presented the highest content of all minerals (except phosphorous and chloride), while the lowest levels were mainly found in wheat bread. Median sodium concentrations (422-537 mg/100 g) represented more than 28% of the recommended daily allowance, being in close range of the maximum Portuguese limit (550 mg/100 g). Maize/rye bread exhibited the highest DMI of manganese (181%), sodium (36%), magnesium (32%), copper (32%), zinc (24%), iron (22%), potassium (20%), and calcium (3.0%). A Principal Component Analysis (PCA) model based on the mineral content allowed the differentiation among white wheat, maize, and maize/rye bread. Zinc, magnesium, manganese, iron, phosphorus, potassium, copper, and calcium proved to be good chemical markers to differentiate bread compositions.

Report of in vitro antileishmanial properties of Iberian macroalgae.

Here is reported the anti Leishmania infantum activity of 48 hexane, CH2Cl2 and MeOH extracts from 16 macroalgae collected on the Iberian Coast. Seven hexane and CH2Cl2 Cystoseira baccata, Cystoseira barbata, Cystoseira tamariscifolia, Cystoseira usneoides, Dictyota spiralis and Plocamium cartilagineum extracts were active towards promastigotes (IC50 29.8-101.8 µg/mL) inducing strong morphological alterations in the parasites. Hexane extracts of C. baccata and C. barbata were also active against intracellular amastigotes (IC50 5.1 and 6.8 µg/mL, respectively). Fatty acids, triacylglycerols, carotenoids, steroids and meroterpenoids were detected by nuclear magnetic resonance (NMR), and gas chromatography in the Cystoseira extracts. These results suggest that Cystoseira macroalgae contain compounds with antileishmanial activity, which could be explored as scaffolds to the development of novel sources of antiparasitic derivatives.

First report of the in vitro antileishmanial properties of extremophile plants from the Algarve Coast.

This work reports for the first time the in vitro anti Leishmania infantum activity of acetone and dichloromethane (DCM) extracts from 25 extremophile plants from Southern Portugal. DCM extracts from Inula chritmoides and Spergularia rubra were active against axenic promastigotes and intracellular amastigotes, had anti-inflammatory properties on lipopolysaccharide (LPS)-stimulated macrophages, inhibited acetylcholinesterase and had no haemolytic activity on human erythrocytes. Eleven phenolics were identified by high-performance liquid chromatography with diode-array detection (HPLC-DAD) in I. crithmoides and one phenolic in S. rubra. Isolation and identification of the active molecules is in progress.

Unlocking the in vitro anti-inflammatory and antidiabetic potential of Polygonum maritimum.

CONTEXT: Several Polygonum species (Polygonaceae) are used in traditional medicine in Asia, Europe and Africa to treat inflammation and diabetes. OBJECTIVE: Evaluate the in vitro antioxidant, anti-inflammatory and antidiabetic potential of methanol and dichloromethane extracts of leaves and roots of the halophyte Polygonum maritimum L. MATERIAL AND METHODS: Antioxidant activity was determined (up to 1 mg/mL) as radical-scavenging activity (RSA) of 2,2-diphenyl-1-picrylhydrazyl (DPPH), 2,2'-azino-bis(3-ethylbenzothiazoline-6-sulphonic acid) (ABTS), copper (CCA) and iron (ICA) chelating activities and iron reducing power (FRAP). NO production was measured in lipopolysaccharide (LPS)-stimulated macrophages for 24 h at concentrations up to 100 µg/mL and antidiabetic potential was assessed by α-amylase and α-glucosidase inhibition (up to 10 mg/mL) assays. The phytochemical composition of the extracts was determined by gas chromatography-mass spectrometry (GC-MS). RESULTS: The methanol leaf extract had the highest activity against DPPH• (IC50 = 26 µg/mL) and ABTS+• (IC50 = 140 µg/mL), FRAP (IC50 = 48 µg/mL) and CCA (IC50 = 770 µg/mL). Only the dichloromethane leaf extract (LDCM) showed anti-inflammatory activity (IC50 = 48 µg/mL). The methanol root (IC50 = 19 µg/mL) and leaf (IC50 = 29 µg/mL) extracts strongly inhibited baker's yeast α-glucosidase, but LDCM had higher rat's α-glucosidase inhibition (IC50 = 2527 µg/mL) than acarbose (IC50 = 4638 µg/mL). GC-MS analysis identified ß-sitosterol, stigmasterol, 1-octacosanol and linolenic acid as possible molecules responsible for the observed bioactivities. CONCLUSIONS: Our findings suggest P. maritimum as a source of high-value health promoting commodities for alleviating symptoms associated with oxidative and inflammatory diseases, including diabetes.

Biological Activities and Chemical Composition of Methanolic Extracts of Selected Autochthonous Microalgae Strains from the Red Sea.

Four lipid-rich microalgal species from the Red Sea belonging to three different genera (Nannochloris, Picochlorum and Desmochloris), previously isolated as novel biodiesel feedstocks, were bioprospected for high-value, bioactive molecules. Methanol extracts were thus prepared from freeze-dried biomass and screened for different biological activities. Nannochloris sp. SBL1 and Desmochloris sp. SBL3 had the highest radical scavenging activity against 1,1-diphenyl-2-picrylhydrazyl, and the best copper and iron chelating activities. All species had potent butyrylcholinesterase inhibitory activity (>50%) and mildly inhibited tyrosinase. Picochlorum sp. SBL2 and Nannochloris sp. SBL4 extracts significantly reduced the viability of tumoral (HepG2 and HeLa) cells with lower toxicity against the non-tumoral murine stromal (S17) cells. Nannochloris sp. SBL1 significantly reduced the viability of Leishmania infantum down to 62% (250 µg/mL). Picochlorum sp. SBL2 had the highest total phenolic content, the major phenolic compounds identified being salicylic, coumaric and gallic acids. Neoxanthin, violaxanthin, zeaxanthin, lutein and ß-carotene were identified in the extracts of all strains, while canthaxanthin was only identified in Picochlorum sp. SBL2. Taken together, these results strongly suggest that the microalgae included in this work could be used as sources of added-value products that could be used to upgrade the final biomass value.

Espresso beverages of pure origin coffee: mineral characterization, contribution for mineral intake and geographical discrimination.

Espresso coffee beverages prepared from pure origin roasted ground coffees from the major world growing regions (Brazil, Ethiopia, Colombia, India, Mexico, Honduras, Guatemala, Papua New Guinea, Kenya, Cuba, Timor, Mussulo and China) were characterized and compared in terms of their mineral content. Regular consumption of one cup of espresso contributes to a daily mineral intake varying from 0.002% (sodium; Central America) to 8.73% (potassium; Asia). The mineral profiles of the espresso beverages revealed significant inter- and intra-continental differences. South American pure origin coffees are on average richer in the analyzed elements except for calcium, while samples from Central America have generally lower mineral amounts (except for manganese). Manganese displayed significant differences (p<0.05) among the countries of each characterized continent. Intercontinental and inter-country discrimination between the major world coffee producers were achieved by applying canonical discriminant analysis. Manganese and calcium were found to be the best chemical descriptors for origin.

The influence of prebrushing mouthwashes on plaque removal in children.

PURPOSE: The purpose of this study was to verify the influence of prebrushing mouthwashes on dental plaque removal in children. METHODS: This study had a double-blind, randomized, controlled, crossover, 25-day experimental design, including 38 12- to 14-year-olds. Four solutions were used as prebrushing mouthwashes (Colgate Plax Magic, Listerine Cool Blue Agent, water and dye, and water) by each participant with seven days' washout. The plaque index was evaluated before and after tooth-brushing during the experimental period. RESULTS: Intergroup comparisons showed no significant differences in plaque reduction among evaluated solutions (Friedman test, P>.78). Significantly more plaque was present before vs. after tooth-brushing (Wilcoxon rank test, P<.001), independent of the surface (buccal or lingual/palatal). CONCLUSION: Use of prebrushing mouthwashes by children does not influence plaque removal by tooth-brushing.

The effect of instruction to synchronize over step frequency while walking with auditory cues on a treadmill.

Walking to a pacing stimulus has proven useful in motor rehabilitation, and it has been suggested that spontaneous synchronization could be preferable to intentional synchronization. But it is still unclear if the paced walking effect can occur spontaneously, or if intentionality plays a role. The aim of this work is to analyze the effect of sound pacing on gait with and without instruction to synchronize, and with different rhythmic auditory cues, while walking on a treadmill. Firstly, the baseline step frequency while walking on a treadmill was determined for all participants, followed by experimental sessions with both music and footstep sound cues. Participants were split into two groups, with one being instructed to synchronize their gait to the auditory stimuli, and the other being simply told to walk. Individual auditory cues were generated for each participant: for each trial, cues were provided at the participant's baseline walking frequency, at 5% and 10% above baseline, and at 5% and 10% below baseline. This study's major finding was the role of intention on synchronization, given that only the instructed group synchronized their gait with the auditory cues. No differences were found between the effects of step or music stimuli on step frequency. In conclusion, without intention or cues that direct the individual's attention, spontaneous gait synchronization does not occur during treadmill walking.

Espresso coffee residues: a valuable source of unextracted compounds.

Espresso spent coffee grounds were chemically characterized to predict their potential, as a source of bioactive compounds, by comparison with the ones from the soluble coffee industry. Sampling included a total of 50 samples from 14 trademarks, collected in several coffee shops and prepared with distinct coffee machines. A high compositional variability was verified, particularly with regard to such water-soluble components as caffeine, total chlorogenic acids (CGA), and minerals, supported by strong positive correlations with total soluble solids retained. This is a direct consequence of the reduced extraction efficiency during espresso coffee preparation, leaving a significant pool of bioactivity retained in the extracted grounds. Besides the lipid (12.5%) and nitrogen (2.3%) contents, similar to those of industrial coffee residues, the CGA content (478.9 mg/100 g), for its antioxidant capacity, and its caffeine content (452.6 mg/100 g), due to its extensive use in the food and pharmaceutical industries, justify the selective assembly of this residue for subsequent use.

Effects of a Lactobacillus salivarius probiotic intervention on infection, cold symptom duration and severity, and mucosal immunity in endurance athletes.

The purpose of this study was to examine the effects of a probiotic supplement during 4 mo of spring training in men and women engaged in endurance-based physical activities on incidence of upper respiratory tract infections (URTI) and mucosal immune markers. Sixty-six highly active individuals were randomized to probiotic (n = 33) or placebo (n = 33) groups and, under double-blind procedures, received probiotic (PRO: Lactobacillus salivarius, 2 × 1010 bacterium colony-forming units) or placebo (PLA) daily for 16 wk. Resting blood and saliva samples were collected at baseline and after 8 and 16 wk. Weekly training and illness logs were kept. Fifty-four subjects completed the study (n = 27 PRO, n = 27 PLA). The proportion of subjects on PRO who experienced 1 or more wk with URTI symptoms was not different from that of those on PLA (PRO .58, PLA .59; p = .947). The number of URTI episodes was similar in the 2 groups (PRO 1.6 ± 0.3, PLA 1.4 ± 0.3; p = .710). Severity and duration of symptoms were not significantly different between treatments. Blood leukocyte, neutrophil, monocyte, and lymphocyte counts; saliva IgA; and lysozyme concentrations did not change over the course of the study and were not different on PRO compared with PLA. Regular ingestion of L. salivarius does not appear to be beneficial in reducing the frequency of URTI in an athletic cohort and does not affect blood leukocyte counts or levels of salivary antimicrobial proteins during a spring period of training and competition.

Disfunçäo de ATM em crianças de 4 a 7 anos: prevalência de sintomas e correlaçäo destes com fatores predisponentes / TMJ dysfuntion in 4 to 7-year-old children: prevalence of symptoms and their correlation with predisposing factors

A prevalência de sintomas e fatores predisponentes de disfunçäo de ATM foi estudada em 180 crianças com idade entre 4 e 7 anos, através da análise de questionários respondidos pelos responsáveis. A prevalência de sintomas foi de 32,22 por cento, enquanto os fatores predisponentes estiveram presentes em 80,55 por cento da amostra. Näo foram comprovadas diferenças significantes entre os sexos ou faixa etária para nenhum dado pesquisado. O sintoma mais comum foi a dor de cabeça freqüente (19,45 por cento), seguido pela dor de ouvido (11,66 por cento). Foi verificada uma alta prevalência de hábitos parafuncionais (72,22 por cento), principalmente respiraçäo bucal (41,11 por cento) e bruxismo (33,88 por cento). Nenhum fator predisponente isolado foi correlacionado com a disfunçäo articular, apesar de existir uma correlaçäo significante entre o número de sintomas e o número de fatores, principalmente no sexo masculino, em todas as faixas etárias, com exceçäo dos 7 anos