Implementation of plant extracts for cheddar-type cheese production in conjunction with FTIR and Raman spectroscopy comparison.

Plant extracts have demonstrated the ability to act as coagulants for milk coagulation at an adequate concentration, wide temperatures and pH ranges. This research is focused on the use of different vegetative extracts such as Citrus aurnatium flower extract (CAFE), bromelain, fig latex, and melon extract as economical and beneficial coagulants in the development of plant-based cheddar-type cheese. The cheddar-type cheese samples were subjected to physicochemical analysis in comparison to controlled cheese samples made from acetic acid and rennet. The fat, moisture, protein, and salt contents remained the same over the storage period, but a slight decline was observed in pH. The Ferric reducing antioxidant power (FRAP) increased with the passage of the ripening period. The FTIR and Raman spectra showed exponential changes and qualitative estimates in the binding and vibrational structure of lipids and protein in plant-based cheeses. The higher FTIR and Raman spectra bands were observed in acid, rennet, bromelain, and CAFE due to their firm and strong texture of cheese while lower spectra were observed in cheese made from melon extract due to weak curdling and textural properties. These plant extracts are economical and easily available alternative sources for cheese production with higher protein and nutritional contents.

Antibacterial Activity and Transcriptomic Analysis of Hesperetin against Alicyclobacillus acidoterrestris Vegetative Cells.

The aim of this research was to investigate the antimicrobial characteristics and mechanism of hesperetin against Alicyclobacillus acidoterrestris vegetative cells. The results presented show that hesperetin had effective antimicrobial activity on Alicyclobacillus acidoterrestris vegetative cells, minimum inhibition concentration (MIC) of 0.0625 g/L, and minimum bacterial concentration (MBC) greater than 2 g/L. Moreover, treatment of hesperetin caused significant damage to cell integrity, preventing the growth of Alicyclobacillus acidoterrestris vegetative cells, enhancing the leakage of nucleic acid and proteins, and destroying the vegetative cell morphology. To further investigate the mechanism, transcriptomic analysis was carried out, and 3056 differentially expressed genes (DEGs) were detected. Gene ontology (GO) enrichment analysis revealed that hesperetin inhibits Alicyclobacillus acidoterrestris by affecting the intracellular nitrogen metabolism and amino acid metabolism. The Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis explained that hesperetin was also able to prevent the growth of Alicyclobacillus acidoterrestris by affecting the processes of nutrient transport, energy metabolism, and flagella motility. These results provide new insights into the antimicrobial effects and mechanism of hesperetin against Alicyclobacillus acidoterrestris, which provides a new method for inactive Alicyclobacillus acidoterrestris in the juice industry.

Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock.

Cardiogenic shock (CS) is a clinical condition characterized by inadequate tissue perfusion in the setting of low cardiac output. CS is the leading cause of death following acute myocardial infarction (AMI). Several temporary mechanical support devices are available for hemodynamic support in CS until clinical recovery ensues or until more definitive surgical procedures have been performed. Veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) has evolved as a powerful treatment option for short-term circulatory support in refractory CS. In the absence of randomized clinical trials, the utilization of ECMO has been guided by clinical experience and based on data from registries and observational studies. Survival to hospital discharge with the use of VA-ECMO ranges from 28-67%. The initiation of ECMO requires venous and arterial cannulation, which can be performed either percutaneously or by surgical cutdown. Components of an ECMO circuit include an inflow cannula that draws blood from the venous system, a pump, an oxygenator, and an outflow cannula that returns blood to the arterial system. Management considerations post ECMO initiation include systemic anticoagulation to prevent thrombosis, left ventricle unloading strategies to augment myocardial recovery, prevention of limb ischemia with a distal perfusion catheter in cases of femoral arterial cannulation, and prevention of other complications such as hemolysis, air embolism, and Harlequin syndrome. ECMO is contraindicated in patients with uncontrolled bleeding, unrepaired aortic dissection, severe aortic insufficiency, and in futile cases such as severe neurological injury or metastatic malignancies. A multi-disciplinary shock team approach is recommended while considering patients for ECMO. Ongoing studies will evaluate whether the addition of routine ECMO improves survival in AMI patients with CS who undergo revascularization.

Outcomes of Prediabetes Compared with Normoglycaemia and Diabetes Mellitus in Patients Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis.

Background: Patients with prediabetes are at increased risk of coronary artery disease (CAD). However, the association between prediabetes and adverse clinical outcomes following percutaneous coronary intervention (PCI) is inconsistent, in contrast to outcomes in patients with diabetes mellitus (DM). Thus, this meta-analysis evaluated the impact of dysglycaemia on PCI outcomes. Methods: The PubMed, Embase, Cochrane, and ClinicalTrials.gov databases were systematically reviewed from inception of databases until June 2022. In 17 studies, outcomes of PCI in patients with prediabetes were compared with patients who were normoglycaemic, and patients with DM. The primary outcome was all-cause mortality at the longest follow-up. Results: Included were 12 prospective and five retrospective studies, with 11,868, 14,894 and 13,536 patients undergoing PCI in the prediabetes, normoglycaemic and DM groups, respectively. Normoglycaemic patients had a statistically lower risk of all-cause mortality, (risk ratio [RR] 0.66, 95% confidence interval [CI] 0.52-0.84), myocardial infarction (MI; RR 0.76, 95% CI 0.61-0.95) and cardiac mortality (RR 0.58, 95% CI 0.39-0.87) compared with prediabetic patients undergoing PCI at the longest follow-up. Patients with prediabetes had a lower risk of all-cause mortality (RR=0.72 [95% CI 0.53-0.97]) and cardiac mortality (RR =0.47 [95% CI 0.23-0.93]) compared with patients with DM who underwent PCI. Conclusion: Among patients who underwent PCI for CAD, the risk of all-cause and cardiac mortality, major adverse cardiovascular events and MI in prediabetic patients was higher compared with normoglycaemic patients but lower compared with patients with DM.

A case report of non-dominant right coronary artery occlusion: not always benign!

Background: Non-dominant right coronary artery (RCA) occlusion is uncommon and usually affects a small area of the myocardium. Rarely, it can complicate fatal outcomes such as shock, cardiac arrest, bradyarrhythmia, or tachyarrhythmia. Case summary: A 50-year-old man with no significant medical history presented with ventricular fibrillation (VF) cardiac arrest. He required prolonged cardiopulmonary resuscitation and multiple defibrillation shocks to achieve return of spontaneous circulation. ST elevation was noted on inferior leads. Due to refractory VF, extracorporeal membrane oxygenation (ECMO) was initiated followed by coronary angiography which demonstrated 100% acute occlusion of proximal RCA (small non-dominant), 90% stenosis of ramus intermedius (RI), and 80% stenosis of obtuse marginal (OM) arteries. Left ventricular ejection fraction was 35%. Percutaneous coronary intervention (PCI) of the RCA was performed with drug eluting stent. He had excellent clinical recovery without any neurological deficits. The ECMO was weaned off and decannulated within three days. Guideline directed medical therapy was administered. He remained hemodynamically stable and underwent staged PCI of RI and OM to achieve complete revascularization. Discussion: Non-dominant RCA lesions are usually considered benign. However, when acute RCA occlusion results in cardiac arrest as seen in our patient, prompt revascularization is necessary. Treatment of cardiogenic shock with appropriate pharmacological and mechanical therapies is important, such as ECMO in our patient.

Development and bioassessment of high nutria-omega 5 cookies through animal modeling.

The food industry generates a diverse range of waste byproducts during fruit processing, which can be repurposed to create functional foods and other valuable commodities. In this particular study, leftover agro-waste from pomegranate juice was valorized to obtain pomegranate seed oil (PSO), while utilizing sunflower oilseed cake to produce sunflower meal protein concentrate (SMPC). These two extracted components were then combined as ingredients to produce High Nutria Omega 5 (HNO5) cookies. To ensure the quality and viability of pomegranate seed oil, a comprehensive set of laboratory analytical procedures were employed to evaluate its characteristics. Subsequently, different ratios of pomegranate seed oil and sunflower meal protein concentrate were utilized to develop the HNO5 cookie products. These cookies underwent thorough sensory, physicochemical, storage, and proximate evaluations as well as efficacy studies to assess their overall nutritional quality and shelf-life properties. As compared to the control feed, the findings of the renal and liver functional tests indicated a favorable effect on ALT, AST, ALP, serum urea, creatinine, albumin, globulins, total proteins, and A/G ratio. The results revealed that PSO and SMPC cookies containing 15% PSO and 15% SMPC exhibited stability in numerous physicochemical and sensory assessments. The punicic acid in HNO5 cookies significantly reduced the effects of starvation in rats and progressively improved several metabolic processes and overall health profiles. Graphical Abstract.

Cardiogenic shock and severe secondary mitral regurgitation successfully treated with transcatheter edge-to-edge repair: a case report.

Background: Cardiogenic shock (CS) associated with severe mitral regurgitation (MR) forebodes a high risk of morbidity and mortality. Transcatheter edge-to-edge repair (TEER) is a rapidly evolving technique for severe MR in haemodynamically stable patients. However, the safety and efficacy of TEER for severe MR in CS are not well established. Case summary: An 83-year-old male presented with dyspnoea and was hospitalized for heart failure. Chest X-ray revealed pulmonary oedema. Transthoracic echocardiography showed severely depressed ejection fraction (EF) with severe secondary MR. Right heart catheterization confirmed a low cardiac index. Diuretics and inotropes were administered. Due to persistent hypotension, we could not wean inotropes. The patient was deemed high risk for surgery by the heart team, and a decision was made to proceed with TEER with MitraClip. Under transoesophageal echocardiography and fluoroscopic guidance, two MitraClips were deployed sequentially. The MR grade was reduced to two mild jets subsequently. The patient was weaned off inotropes and eventually discharged. At the 30-day follow-up, he was participating in physical activities such as golf. Discussion: Cardiogenic shock complicated by severe MR carries high mortality. With severe MR, the forward stroke volume is lower than the stated EF leading to poor organ perfusion. Inotropes and/or mechanical circulatory support devices are paramount for initial stabilization; however, they do not treat underlying MR. Transcatheter edge-to-edge repair with MitraClip has been shown to improve survival in CS patients with severe MR in observational studies. However, prospective trials are lacking. Our case demonstrates the utility of MitraClip to treat severe secondary MR refractory to medical therapy in a CS patient. The heart team must evaluate risks and benefits of this therapy in CS patients.

Effect of iron-fortified jamun leather on the Asunra-induced anemia in Sprague Dawley rats.

Introduction: Micronutrients such as minerals and vitamins are required in a minute quantity but play a pivotal role in the functioning of the body. Therefore, deficiency in one of them can lead to lethal health conditions. Iron deficiency anaemia is one of the most common micronutrient deficiencies across the world and is affecting women and children. Methods: The present study aimed to investigate the anti-anaemic effect of fortified jamun leather on anaemia biomarkers and haematology in anaemic female Sprague Dawley rats. A total of 40 Sprague Dawley rats were used in 4 groups. Iron deficiency anaemia was induced by oral administration of the Asunra drug. The treatments were fed at two dosage levels i.e., 40 and 60% iron-fortified leather. All animals were treated for 60 days and the parameters including biochemical, and histopathology of the kidney and liver were examined. Results: The experiment's findings showed that the group fed with iron-fortified leather (G3) succeeded significantly (P < 0.05) in restoring the serum iron (98.68 ± 2.88 µg/dL), haemoglobin (12.41 ± 0.32 g/dL), ferritin (24.54 ± 1.98 ng/mL) and haematocrit levels (39.30 ± 1.66%) at the end of the 60 days period. Additionally, the treated group's mean values for transferrin and total iron binding capacity were lower than those of the anaemic rats, indicating an improvement in iron levels. The microscopic analysis revealed that treatments had no toxic effects on the kidney and liver tissues, except in the diseased group, which had necrosis and irregular cell structure. Conclusion: Conclusively, iron-fortified jamun leather helped improve iron deficiency biomarkers and imparted a non-toxic effect on tissues in rats.

Protective Effect of Quercetin and Ginger (Zingiber officinale) Extract against Dimethoate Potentiated Fluoride-Induced Nephrotoxicity in Rats.

This study aimed to determine the potential of quercetin and Zingiber officinale (ZO) Roscoe extract to alleviate the renal damage induced by dimethoate (DM) and fluoride (F-) alone and by their combined exposure in rats. A total of 54 adult Wistar rats were randomly allocated to nine groups (n = 6). A sub-lethal dose of DM (1/10th of the median lethal dose) was administered by oral gavage alone and along with F- (4.5 ppm, three-fold the permissible limit) in their drinking water continuously for 28 days. Chromatographical analysis revealed the presence of quercetin, curcumin, and other phytochemicals with strong antioxidant properties in ZO-rhizome extract. Severe changes were observed in the levels of the renal biomarkers and histoarchitecture after co-administration of the toxicants, indicating greater kidney damage. The administration of ZO extract (300 mg/kg) along with either or both toxicants led to a significant restoration of the biochemical markers and renal antioxidant profile and histology.

Unraveling the role of natural functional oils in modulating osteoarthritis related complications.

Osteoarthritis (OA) is a common joint disease and has been studied extensively in recent years as no promising therapy available so far for its treatment and remains a great challenge for health care specialists. Although the identification of some major mechanisms that contribute to this disease suggests a plethora of bioactive agents in tackling the associated complications yet OA's pathophysiology is still poorly understood owing to complex mechanistic changes observed. Experimental research is now exploring a wide range of therapeutically effective agents in an effort to find a way to repair OA-related joint degeneration and halt it from getting worse. Data was acquired and reviewed from most relevant and recent studies. This review summarizes the studies that are currently available and focuses on how various unconventional functional oils affect osteoarthritis and the affected joint tissues. An analysis of the recent scientific literature allowed us to highlight the potential anti-arthritic properties of edible oils and their main constituents, which seems to suggest an interesting new potential therapeutic application. Due to eccentric nature of OA, it is necessary to concentrate initially on the management of symptoms. The evidence supporting functional oils chondroprotective potential is still accumulating, underpinning a global need for more sustainable natural sources of treatment. More clinical research that focuses on the consequences of long-term treatment, possible negative effects, and epigenetic implications is necessary to get optimistic results. However, different animal or clinical studies suggest that linolenic and linoleic fatty acids decreased chondrocyte oxidative stress, cartilage breakdown, and expression of inflammatory markers. Distinct fatty acids along with minor components of oils also reduced the generation of prostaglandins and decreased oxidative stress. Furthermore, the potential roles of the main components of edible oils and possible negative results (if any) are also reported. While no severe side effects have been reported for any edible oils. Overall, these studies identify and support the use of functional oils as an adjuvant therapy for the management of OA and as a means of symptomatic alleviation for OA patients. However, to prove the effectiveness or to draw precise conclusions, high-quality clinical trials are required.

Insights into the constellating drivers of satiety impacting dietary patterns and lifestyle.

Food intake and body weight regulation are of special interest for meeting today's lifestyle essential requirements. Since balanced energy intake and expenditure are crucial for healthy living, high levels of energy intake are associated with obesity. Hence, regulation of energy intake occurs through short- and long-term signals as complex central and peripheral physiological signals control food intake. This work aims to explore and compile the main factors influencing satiating efficiency of foods by updating recent knowledge to point out new perspectives on the potential drivers of satiety interfering with food intake regulation. Human internal factors such as genetics, gender, age, nutritional status, gastrointestinal satiety signals, gut enzymes, gastric emptying rate, gut microbiota, individual behavioral response to foods, sleep and circadian rhythms are likely to be important in determining satiety. Besides, the external factors (environmental and behavioral) impacting satiety efficiency are highlighted. Based on mechanisms related to food consumption and dietary patterns several physical, physiological, and psychological factors affect satiety or satiation. A complex network of endocrine and neuroendocrine mechanisms controls the satiety pathways. In response to food intake and other behavioral cues, gut signals enable endocrine systems to target the brain. Intestinal and gastric signals interact with neural pathways in the central nervous system to halt eating or induce satiety. Moreover, complex food composition and structures result in considerable variation in satiety responses for different food groups. A better understanding of foods and factors impacting the efficiency of satiety could be helpful in making smart food choices and dietary recommendations for a healthy lifestyle based on updated scientific evidence.

Clinical, Nutritional, and Functional Evaluation of Chia Seed-Fortified Muffins.

Health-protective functional foods are gaining popularity in the world of nutrition because they promote excellent health while decreasing pharmaceutical burdens. Chia seeds (CS) (Salvia hispanica L.), the greatest vegetative source of α-linolenic acid, bioactive proteins, and fibers, are among the top unconventional oilseeds shown to have bounteous benefits against various non-communicable diseases. Purposely, this study was designed to integrate roasted CS powder into white-flour-based ordinary bakery goods to improve their nutritional and nutraceutical profiles. CS efficacy in normal and hyperlipidemic Sprague-Dawley rats resulted in mitigating blood glucose, triglycerides, total cholesterol, and low-density lipoprotein cholesterol while elevating high-density lipoprotein cholesterol, hematocrit, hemoglobin, red blood cell counts, and platelets. The nutritional profiling of chia-fortified muffins indicated significant increases of 47% in fat, 92% in fiber, 15% in protein, and 62% in minerals. The farinographic experiments of CS-blends revealed generally improved dough quality features with a significant rise in the degree of softening as fortification levels increased. A marketable recipe for CSF-muffins with several degrees of fortification demonstrated a significant rise in fat, 92% rise in fiber, 15% rise in protein, and 62% rise in minerals. Sensorial evaluation by trained taste panelists revealed a maximum appraisal of the 15% chia-fortified muffins due to aroma, appearance, and overall acceptability, and were forwarded for being acceptable for commercialization.

Influence of guar gum and chitosan enriched with lemon peel essential oil coatings on the quality of pears.

Pear is a typically climacteric fruit and highly perishable with a low shelf life owing to extreme metabolic activity after harvesting. The present study aimed to reduce weight loss and improve the firmness of pear during storage. The lemon peel essential oil (LPEO) has gained considerable attention due to being the richest source of bioactive compounds that behaved as a natural antioxidant agent, being cost-effective, and being generally recognized as safe. Edible coatings equipped with a natural antioxidant agent and renewable biopolymers have gained more research fame owing to their involvement in the direction of biodegradability and food safety. In this work, edible skin coating materials (ESCMs) embedded by chitosan (1%) and guar gum (2%) were fabricated, and afterward, five concentrations of LPEO (1, 1.5, 2, 2.5, and 3.0%) were incorporated individually into the ESCMs. Findings revealed that LPEO-ESCMs significantly reduced the weight loss and improved the firmness of pear up to 45 days of storage at 4 ± 2°C. Furthermore, the LPEO-ESCMs have enhanced the antioxidant capacity, antibacterial efficiency, and malondialdehyde level of pear during storage time. It was concluded that 3% of LPEO-ESCMs improved the overall acceptability of pear fruits. Taken together, the novel insights of guar gum and chitosan-based ESCMs entrapped with LPEO will remain a subject of research interest for researchers in the future.

Functional and Nutraceutical Significance of Amla (Phyllanthus emblica L.): A Review.

Phyllanthus emblica L. (also popularly known as amla) is a tree native to the India and Southeast Asia regions that produces fruits rich in bioactive compounds that could be explored as part of the increasing interest in naturally occurring compounds with biological activity. Thus, this review aims to highlight the nutritional aspects, rich phytochemistry and health-promoting effects of amla. Scientific evidence indicates that polyphenols are central components in fruits and other sections of the amla tree, as well as vitamin C. The rich composition of polyphenol and vitamin C imparts an important antioxidant activity along with important in vivo effects that include improved antioxidant status and activity of the endogenous antioxidant defense system. Other potential health benefits are the anti-hyperlipidemia and antidiabetic activities as well as the anticancer, anti-inflammatory, digestive tract and neurological protective activities. The promising results provided by the studies about amla bioactive compounds support their potential role in assisting the promotion of health and prevention of diseases.

Sjogren syndrome presenting as atrioventricular block in an adult.

A woman in her late teens with a history of Juvenile idiopathic arthritis (JIA) and ongoing sicca symptoms presented with syncope. Upon admission, she was found to be bradycardic with a second-degree atrioventricular (AV) block. After infectious, structural and metabolic aetiologies had been ruled out, she was worked up for rheumatologic causes.Our patient had elevated titres of anti-Sjogren syndrome (SS) antibodies anti-Ro antibodies and was diagnosed with AV block secondary to SS. She was treated with a permanent pacemaker. Patient was followed up in clinic where she denied further syncopal episodes and was started on secretagogues for sicca symptoms.

Clinical predictors of symptom improvement failure in gastroparesis.

Background: The aim of this study was to determine clinical predictors of gastroparesis outcomes. Methods: Between September 30, 2009 and January 31, 2020, we identified patients with gastroparesis diagnosed based on a 99mTc sulfur-labeled gastric emptying test. The patients who had no symptom improvement at 4 and 12 weeks were considered to have failed to show clinical improvement. Logistic regression was used to compute the association between different factors and clinical outcomes. Results: We identified 320 patients (mean age 47.5±5.3 years, 70.3% female, 71.3% Whites). Failure of clinical improvement was seen in 34.7% patients at 4 weeks and 27.5% at 12 weeks after the gastroparesis diagnosis. At 4 weeks, chronic kidney disease (adjusted odds ratio [aOR] 2.62, 95% confidence interval [CI] 1.31-5.26; P=0.007) and body mass index (BMI) <18.5 kg/m2 (aOR 9.90, 95%CI 2.98-32.93; P<0.001) were associated with a lack of improvement, whereas type 2 diabetes mellitus (T2DM) was associated with better clinical outcomes (aOR 0.50, 95%CI 0.25-0.99; P=0.047). At 12 weeks, subjects who had undergone post-bariatric surgery had no improvement of their gastroparesis symptoms (aOR 2.43, 95%CI 1.01-5.82; P=0.047), whereas T2DM was associated with clinical improvement (aOR 0.46, 95%CI 0.22-0.95; P=0.035). The subgroup analysis showed that BMI <18.5 kg/m2 in non-diabetics and peripheral neuropathy in diabetics were associated with persistent symptoms. Conclusions: Gastroparesis patients with T2DM had significant symptom improvement. A history of bariatric surgery and renal failure were associated with worse clinical improvement. Peripheral neuropathy in diabetics was associated with persistent symptoms.

Bifascicular block in unexplained syncope is underrecognized and under-evaluated: A single-center audit of ESC guidelines adherence.

BACKGROUND: The presence of bifascicular block on electrocardiography suggests that otherwise-unexplained syncope may be due to complete heart block. European Society of Cardiology (ESC) recommends investigating it with electrophysiology study (EPS). PPM is indicated if high-degree atrioventricular block is inducible. Long term rhythm monitoring with implantable loop recorder (ILR) is recommended if EPS is negative. We evaluated adherence to these guidelines. METHODS: This is a single-center retrospective audit of adult patients with bifascicular block hospitalized for unexplained syncope between January 2018 and August 2019 under general medicine service. Patients with an alternative explanation for syncope were excluded. Guideline adherence was assessed by formal cardiology consult and whether EPS followed by ILR and/or PPM were offered. RESULTS: 65 out of 580 adult patients (11.2%) admitted to general medicine service for syncope had a bifascicular block; 29 (5%) were identified to have bifascicular block and unexplained syncope. Median age was 77 ±10 years; 9 (31%) were female, and 6 (20.7%) patients had at least one prior hospital visit for syncope at our academic medical center. Cardiology was consulted on 17 (58.6%) patients. Two patients were evaluated by EPS (1 refused) followed by ILR. Overall, 3 out of 29 patients (10.3%) received guideline-directed evaluation during the hospitalization based on ESC guidelines. None of the patients received empiric PPM during the index hospitalization. CONCLUSION: Among patients admitted to the general medicine service with unexplained syncope and bifascicular block, a minority (10.3%) underwent guideline-directed evaluation per ESC recommendations. Cardiology was consulted in 58.6% of cases.