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The literature has shown the relevance of nutritional and metabolic aspects in patients with epilepsy. This study evaluated the relationship between clinical variables and plasma proteins and compared the variables between seizure frequency and neurological examination. A pilot study was carried out with eighty-four (n = 84) adults patients with epilepsy. The relationship between clinical variables of the disease (age at disease onset, neurological examination, current type and frequency of seizures, duration of disease, amount of antiseizure medications-ASM used and type and etiology of epilepsy) and plasma proteins (albumin and transferrin) was investigated. In the statistical analysis, the chi-square, Fisher, Mann-Whitney, Kruskal-Wallis tests, Spearman coefficient and univariate logistic regression were used. There was a significant association between the use of antiseizure medications (ASM) (p = 0.0105) and altered neurological examination (p = 0.0049), compared with the frequency of seizures, and between albumin and gender (p = 0.0005), and albumin and etiology of epilepsy (p = 0.0186). There was a significant low-intensity and inverse linear correlation (coefficient = -0.31363, p = 0.0037) between albumin and disease duration. In the logistic regression model, a significant association was only observed between the number of ASM and the frequency of seizures (p = 0.0120; OR = 3.368; 95% CI = 1.305-8.691). There was no association between plasma proteins and the outcomes of seizure frequency and neurological examination. The number of ASM and not protein metabolism was associated with frequency of seizures in patients with epilepsy.
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Anticonvulsivantes , Epilepsia , Convulsiones , Humanos , Masculino , Femenino , Anticonvulsivantes/uso terapéutico , Epilepsia/tratamiento farmacológico , Adulto , Convulsiones/tratamiento farmacológico , Persona de Mediana Edad , Proyectos Piloto , Adulto Joven , Anciano , Adolescente , Transferrina/metabolismoRESUMEN
Previous studies show changes in lipid metabolism in epilepsy. The aim of this study was to investigate the association between lipid profile and clinical variables in adult patients with epilepsy (APE). Seventy-two APE participated in this pilot study at an outpatient neurology service. The lipid profile (total cholesterol, low-density lipoprotein (LDL) cholesterol, very-low-density lipoproteins (VLDL) cholesterol, high-density lipoprotein (HDL) cholesterol and triglycerides), age at disease onset, disease duration, seizures frequency, and the number of antiseizure medications (ASM) used were investigated. Data were analyzed using the Chi-square, Fisher, Mann-Whitney, Spearman coefficient, and logistic regression tests. There were significant differences in HDL (p = 0.0023) and total cholesterol (p = 0.0452) levels in connection with the number of ASM used. There was a significant difference in seizure control among the different numbers of ASM used (p = 0.0382). Higher HDL values were found in females (p = 0.0170). The logistic regression showed that only the number of ASM used was associated with seizure control (p = 0.0408; OR = 2.800; 95% CI = 1.044; 7.509). The number of ASM taken and not the lipid profile was associated with seizure control in APE.
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Antimicrobial resistance is one of the major global health threats. Antimicrobial stewardship (AMS) has been set as a priority within international action plans to combat this issue. The region of Latin America and the Caribbean are recognized for their high antimicrobial resistance rates; nevertheless, a low number of studies describing implemented interventions for this topic have been published. This review aims to provide an overview of the status of AMS in our region, focusing on the main progress achieved and describing the different published efforts made by countries towards the implementation of antimicrobial stewardship programs (ASP). Common areas of intervention included were (a) education approaches, (b) antimicrobial guideline implementation and monitoring, (c) diagnostic stewardship, (d) technological tools: electronic clinical decision support systems in AMS, (e) pharmacy-driven protocols and collaborative practice agreements, and (f) economic impact. The search demonstrated the varied interventions implemented in diverse healthcare settings; the results accentuate their influence on antimicrobial consumption, antimicrobial resistance, clinical outcomes, and direct economic impact. The integration of multiple strategies within each hospital was highlighted as an essential key to ASP success. Even though the literature found demonstrated clear progress, there is still a special need for strengthening leadership from the top down, defining goals based on needs, and gaining support through policy and financing in LAC.
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In the last 2 years, different pharmacological agents have been indicated as potential inhibitors of SARS-CoV-2 in vitro. Specifically, drugs termed as functional inhibitors of acid sphingomyelinase (FIASMAs) have proved to inhibit the SARS-CoV-2 replication using different types of cells. Those therapeutic agents share several chemical structure characteristics and some well-known representatives are fluoxetine, escitalopram, fluvoxamine, and others. Most of the FIASMAs are primarily used as effective therapeutic agents to treat different pathologies, therefore, they are natural drug candidates for repositioning strategy. In this review, we summarize the two main proposed mechanisms mediating acid sphingomyelinase (ASM) inhibition and how they can explain the inhibition of SARS-CoV-2 replication by FIASMAs. The first mechanism implies a disruption in the lysosomal pH fall as the endosome-lysosome moves toward the interior of the cell. In fact, changes in cholesterol levels in endosome-lysosome membranes, which are associated with ASM inhibition is thought to be mediated by lysosomal proton pump (ATP-ase) inactivation. The second mechanism involves the formation of an extracellular ceramide-rich domain, which is blocked by FIASMAs. The ceramide-rich domains are believed to facilitate the SARS-CoV-2 entrance into the host cells.
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COVID-19 , SARS-CoV-2 , Esfingomielina Fosfodiesterasa , Humanos , Ceramidas/metabolismo , Fluoxetina/farmacología , SARS-CoV-2/efectos de los fármacos , Esfingomielina Fosfodiesterasa/antagonistas & inhibidores , Esfingomielina Fosfodiesterasa/metabolismoRESUMEN
Acid Sphingomyelinase (ASM) is a human phosphodiesterase that catalyzes the metabolism of sphingomyelin (SM) to ceramide and phosphocholine. ASM is involved in the plasma membrane cell repair and is associated with the lysosomal inner lipid membrane by nonbonding interactions. The disruption of those interaction would result in ASM release into the lysosomal lumen and consequent degradation of its structure. Furthermore, SARS-CoV-2 infection has been linked with ASM activation and with a ceramide domain formation in the outer leaflet of the plasma membrane that is thought to be crucial for the viral particles recognition by the host cells. In this study, we have explored in silico the behavior of fluoxetine and related drugs as potential inhibitors of ASM. Theoretically, these drugs would be able to overpass lysosomal membrane and reach the interactions that sustain ASM structure, breaking them and inhibiting the ASM. The analyses of docking data indicated that fluoxetine allocated mainly in the N-terminal saposin domain via nonbonding interactions, mostly of hydrophobic nature. Similar results were obtained for venlafaxine, citalopram, atomoxetine, nisoxetine and fluoxetine's main metabolite norfluoxetine. In conclusion, it was observed that the saposin allocation may be a good indicative of the drugs inhibition mechanism, once this domain is responsible for the binding of ASM to lysosomal membrane and some of those drugs have previously been reported to inhibit the phosphodiesterase by releasing its structure in the lysosomal lumen. Our MD data also provides some insight about natural ligand C18 sphingomyelin conformations on saposin.Communicated by Ramaswamy H. Sarma.
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COVID-19 , Esfingomielina Fosfodiesterasa , Humanos , Esfingomielina Fosfodiesterasa/metabolismo , Fluoxetina/farmacología , SARS-CoV-2/metabolismo , Esfingomielinas , Saposinas , Antidepresivos/farmacología , Ceramidas/metabolismoRESUMEN
The main strategy for the treatment of epilepsy is the use of pharmacological agents known as antiseizure medication (ASM). These drugs control the seizure onset and improves the life expectancy and quality of life of patients. Several ASMs are contraindicated during pregnancy, due to a potential teratogen risk. For this reason, the pharmacological treatments of the pregnant Women with Epilepsy (WWE) need comprehensive analyses to reduce fetal risk during the first trimester of pregnancy. The mechanisms by which ASM are teratogens are still under study and scientists in the field, propose different hypotheses. One of them, which will be addressed in this review, corresponds to the potential alteration of ASM on ion channels and proteins involved in relevant signaling and cellular responses (i.e., migration, differentiation) during embryonic development. The actual information related to the action of ASM and its possible targets it is poorly understood. In this review, we will focus on describing the eventual presence of some ion channels and synaptic proteins of the neurotransmitter signaling pathways present during early neural development, which could potentially interacting as targets of ASM. This information leads to elucidate whether these drugs would have the ability to affect critical signaling during periods of neural development that in turn could explain the fetal malformations observed by the use of ASM during pregnancy.
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BACKGROUND: Anterior sacral meningocele (ASM) is a defect in the closure of the neural tube. Patients can be asymptomatic or present with genitourinary, neurological, reproductive, or colorectal dysfunction. Magnetic resonance imaging (MRI) is the gold standard test because it can assess communication between the spinal subarachnoid space and the lesion and identify other abnormalities. Surgical correction is the definitive treatment because untreated cases have a mortality rate of more than 30%. OBSERVATIONS: A 24-year-old woman with Marfan syndrome presented with polyuria, recurrent urinary tract infections, and renal injury for 3 months along with a globose abdomen, with a palpable mass in the middle and lower third of the abdomen that was massive on percussion. MRI showed an ASM consisting of two cystic lesions measuring 15.4 × 14.3 × 15.8 and 6.7 × 6.1 × 5.9 cm, respectively, compressing the distal third of the right ureter and causing a hydroureteronephrosis. Drainage and ligature of the cystic lesion were performed. The urinary outcome was excellent, with full recovery after surgery. LESSONS: ASM should be suspected in all abdominal masses with progressive symptoms in the setting of Marfan syndrome. Computed tomography and MRI are important to investigate genitourinary anomalies or other types of dysraphism to guide the best surgical approach.
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Two sequential batch reactors (R1 and R2) of aerobic granular sludge (AGS) were inoculated with activated sludge of different origins. The objective was to investigate the granulation and the consistency between the structure of the microbial communities (16S rRNA amplicon sequencing) in each reactor and their metabolic performance (removal of C, N, and P). Both reactors were fed with acetate-based synthetic wastewater, targeting an anaerobic-aerobic cycle reputed to favor the phosphorus- and glycogen-accumulating organisms (PAO and GAO). Stable granulation was achieved in both reactors, where, instead of PAO, the dominant genera were ordinary heterotrophic organisms (OHO) such as Thauera, Paracoccus, and Flavobacterium known for their high capacity of aerobic storage of polyhydroxyalkanoates (PHA). Generally, there was good consistency between the metabolic behavior of each reactor and the bacterial genera detected. Both reactors showed high removals of C and complete nitrification (Nitrosomonas and Nitrospira detected) but a low level of simultaneous nitrification-denitrification (SND) during the aerated phase. The latter causes that nitrates were recycled to the initial phase, in detriment of PAO selection. Meanwhile, the study showed that selecting slow-growing OHOs (with aerobic storage capacity) favors stable granulation, revealing an alternative AGS technology for C and N removal.
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Aguas del Alcantarillado , Eliminación de Residuos Líquidos , Aguas del Alcantarillado/química , Reactores Biológicos/microbiología , ARN Ribosómico 16S , Fósforo/metabolismo , Bacterias/genética , Bacterias/metabolismo , Nitrógeno/análisis , DesnitrificaciónRESUMEN
RESUMO Neste trabalho, avaliou-se o uso do modelo matemático ASM3 para um sistema piloto de reator compartimentado anaeróbio/anóxico e aeróbio tipo MBBR, utilizado para a remoção simultânea de matéria orgânica e nitrogênio em esgoto doméstico. A simulação computacional foi implementada pelo software ASIM. Selecionou-se um conjunto padrão de parâmetros para o modelo, com uma combinação dos valores calibrados e dados da literatura. Com a modelagem computacional foi possível incluir as características operacionais próprias do sistema de tratamento e, embora o modelo não tenha tido sua capacidade de previsão dos parâmetros validada, foi possível verificar a aplicabilidade do ASM3 para as fases operacionais definidas neste estudo.
ABSTRACT In this work, the use of the ASM3 mathematical model for a pilot system of anaerobic/anoxic and aerobic MBBR compartmentalized reactor, for the simultaneous removal of organic matter and nitrogen in domestic sewage, was evaluated. The simulation was implemented by the ASIM software. A standard set of parameters was selected for the model, with a combination of calibrated values and literature data. With the computational modeling, it was possible to include the operational characteristics of the treatment system and, although the model capacity to predict the parameters could not be validated. Nevertheless, it was possible to verify the applicability of the ASM3 model for the operational phases defined in this study.
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Epidemics of coffee leaf rust (CLR) leads to great yield losses and huge depreciation of coffee marketing values, if no control measures are applied. Societal expectations of a more sustainable coffee production are increasingly imposing the replacement of fungicide treatments by alternative solutions. A protection strategy is to take advantage of the plant immune system by eliciting constitutive defenses. Based on such concept, plant resistance inducers (PRIs) have been developed. The Greenforce CuCa formulation, similarly to acibenzolar-S-methyl (ASM), shows promising results in the control of CLR (Hemileia vastatrix) in Coffea arabica cv. Mundo Novo. The molecular mechanisms of PRIs action are poorly understood. In order to contribute to its elucidation a proteomic, physiological (leaf gas-exchange) and biochemical (enzymatic) analyses were performed. Coffee leaves treated with Greenforce CuCa and ASM and inoculation with H. vastatrix were considered. Proteomics revealed that both PRIs lead to metabolic adjustments but, inducing distinct proteins. These proteins were related with photosynthesis, protein metabolism and stress responses. Greenforce CuCa increased photosynthesis and stomatal conductance, while ASM caused a decrease in these parameters. It was further observed that Greenforce CuCa reinforces the redox homeostasis of the leaf, while ASM seems to affect preferentially the secondary metabolism and the stress-related proteins. So, the PRIs prepare the plant to resist CLR but, inducing different defense mechanisms upon pathogen infection. The existence of a link between the primary metabolism and defense responses was evidenced. The identification of components of the plant primary metabolism, essential for plant growth and development that, simultaneously, participate in the plant defense responses can open new perspectives for plant breeding programs.
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RESUMO A necessidade crescente de alternativas para o tratamento e a disposição de lixiviados de aterros sanitários é uma realidade no Brasil, principalmente com os avanços estabelecidos pela Política Nacional de Resíduos Sólidos a partir de 2010 e consequentes metas de substituição de lixões por aterros sanitários. Uma alternativa empregada, devido à facilidade de implantação, é o cotratamento com esgoto sanitário, por meio do recebimento do lixiviado em estações de tratamento de esgoto (ETE). Este estudo avaliou a aplicabilidade do Activated Sludge Model No. 1 (ASM1) para lagoas aeradas promovendo o cotratamento de esgoto e lixiviado. Os cenários simulados consistiram em proporções crescentes de adição de lixiviado ao sistema - que variaram de 0 a 10% - e, para cada um deles, foi avaliado o desenvolvimento de biomassa heterotrófica e autotrófica, o consumo de demanda química de oxigênio (DQO) em diferentes frações, a nitrificação, o consumo de oxigênio e a alcalinidade. Os resultados das simulações geradas indicaram que o modelo foi otimista em relação ao período de partida do sistema e à adaptação das comunidades microbianas consideradas frente aos cenários progressivamente agressivos oferecidos pela maior presença de lixiviado. Porém, representou adequadamente o prejuízo à qualidade do efluente devido à matéria orgânica recalcitrante e aos problemas relacionados à manutenção da nitrificação, frente ao aumento da capacidade de aeração e da demanda de alcalinidade. O ASM1 teve boa aplicabilidade, portanto, como ferramenta para avaliar qualitativamente o comportamento de ETE ao receber lixiviado para cotratamento e corroborar os riscos associados a essa alternativa, necessitando, porém, de modificações e detalhamentos adicionais para otimização de sistemas reais.
ABSTRACT The growing necessity for alternative landfill leachate treatment and disposal is a reality in Brazil, mainly when the advancements of the National Policy on Solid Wastes (2010) established goals for replacing dumping grounds with landfills. Due to its simplicity, a usual alternative is to perform co-treatment of municipal sewage and landfill leachate in wastewater treatment plants (WWTPs). This study assessed the applicability of the Activated Sludge Model No 1 (ASM1) to aerated lagoons promoting sewage and leachate co-treating. The simulated scenarios consisted of increasing proportions of leachate addition to the system, ranging from 0 to 10%, and for each of them the development of heterotrophic and autotrophic biomass, COD consumption in different fractions, nitrification, oxygen consumption and alkalinity were evaluated. The simulation results showed that the model was optimistic regarding the treatment system startup and microbial communities adaptation when exposed to increasingly aggressive conditions due to leachate addition. However, it correctly represented the detrimental effects on effluent quality due to recalcitrant organic matter and the issues with maintaining proper nitrification regarding aeration capacity and alkalinity demands. ASM1 has good applicability, therefore, as a tool to qualitatively assess the behavior of WWTP when receiving leachate for co-treatment and corroborates the risks associated with this alternative, however, requiring further modifications and details to optimize real systems.
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Primates secrete large amounts of the precursor steroid dehydroepiandrosterone (DHEA); in humans, its levels are low during childhood and start declining after the fourth decade. It has been postulated that the progressive decline in DHEA levels may be related with the severity of asthma associated with age. To determine whether DHEA may regulate the airway smooth muscle (ASM) activity, isolated tracheal rings with and without epithelium from male guinea pigs were isometrically recorded to characterize the response of ASM to DHEA at different concentrations on KCl- and carbachol (CCh)-induced contraction as well as on ovalbumin (OVA)-induced contraction in sensitized guinea pigs. Additionally, we used barometric plethysmography in sensitized guinea pigs in order to compare changes of the lung resistance increased by the antigen challenge to OVA in the absence and presence of different doses of DHEA. DHEA concentration-dependently abolished the contraction to KCl, CCh and OVA, and no differences were found in preparations with and without epithelium. DHEA-induced relaxation was not modified by the suppression of protein synthesis or transcription, pharmacological inhibition of nitric oxide (NO) synthase, nor by antagonist of ß2-adrenergic receptors or an inhibitor of the 3ß-HSD enzyme. Likewise, Ca(2+)-induced contraction in Ca(2+)-free depolarized tissues was antagonized by DHEA, and the contraction to the L-type voltage-dependent calcium channel activator (Bay K 8644) was inhibited by DHEA. Furthermore, DHEA prevented OVA-induced increases in lung resistance. These results indicate that DHEA-induced relaxation in ASM is a nongenomic (membrane) action and is not produced after its bioconversion. The data suggest that DHEA-induced relaxation is an epithelium- and NO-independent mechanism that involves a blockade of voltage-dependent calcium channels and possible non-selective cation channels.
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Deshidroepiandrosterona/farmacología , Músculo Liso/efectos de los fármacos , Animales , Asma , Espasmo Bronquial/prevención & control , Cobayas , Técnicas In Vitro , Masculino , Relajación Muscular/efectos de los fármacos , Músculo Liso/fisiología , Tráquea/efectos de los fármacos , Tráquea/fisiologíaRESUMEN
The greenbug Schizaphis graminum (Rond.) (Hemiptera: Aphididae) is one of the main pestinsects of wheat (Triticum aestivum, L.). Resistance inducing agents as silicon (Si) and acibenzolar-s-methyl (ASM) can provide some protection against insects and diseases. The effect of Si and/or ASM on the development and probing behaviour of S. graminum in wheat plants was evaluated. Wheat plants (cultivar Embrapa 22) were treated with Si (silicic acid at the rate of 1%) and acibenzolar-S-methyl (ASM) at the rate of 0.5%. The effects of these treatments on greenbugs were analyzed by development parameters, honeydew excretion and probing behavior monitored by Electrical Penetration Graphs (EPG). The development and honeydew experiments consisted of ten replications each and EPG experiment was replicated 25 times. The application of both resistance inducing agents reduced fecundity, prolonged the duration of pre-reproductive period, and decreased honeydew production. Induced resistance was localized mainly at phloem level and caused a strong reduction of phloem sap ingestion, but some effect of ASM at parenchyma/mesophyll level could not be discounted as far fewer aphids reached the sieve elements.
O pulgão-verde Schizaphis graminum (Rond.) (Hemiptera: Aphididae) é um dos principais insetos- praga da cultura do trigo (Triticum aestivum, L.). Agentes que induzem resistência como silício e acibenzolars-methyl (ASM) podem fornecer proteção às plantas contra insetos e doenças. Avaliou-se o efeito do silício e/ ou ASM no desenvolvimento e comportamento alimentar de S. graminum em plantas de trigo. Plantas de trigo cultivar Embrapa 22 foram tratadas com silício (ácido silícico a 1%) e acibenzolar-S-methyl (ASM) a 0.5%. Os parâmetros estudados foram biologia, excreção de honeydew e comportamento alimentar (de prova) monitorado por meio da técnica Electrical Penetration Graphs (EPG). Para o estudo de biologia e excreção de honeydew foram usadas dez repetições e 25 para EPG. A aplicação de agentes indutores de resistência reduziu o número de ninfas, prolongando a duração de período de pré-reprodutivo e o número de gotas de honeydew. O efeito de resistência foi localizado principalmente no floema, com redução de ingestão de seiva elaborada.
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The greenbug Schizaphis graminum (Rond.) (Hemiptera: Aphididae) is one of the main pestinsects of wheat (Triticum aestivum, L.). Resistance inducing agents as silicon (Si) and acibenzolar-s-methyl (ASM) can provide some protection against insects and diseases. The effect of Si and/or ASM on the development and probing behaviour of S. graminum in wheat plants was evaluated. Wheat plants (cultivar Embrapa 22) were treated with Si (silicic acid at the rate of 1%) and acibenzolar-S-methyl (ASM) at the rate of 0.5%. The effects of these treatments on greenbugs were analyzed by development parameters, honeydew excretion and probing behavior monitored by Electrical Penetration Graphs (EPG). The development and honeydew experiments consisted of ten replications each and EPG experiment was replicated 25 times. The application of both resistance inducing agents reduced fecundity, prolonged the duration of pre-reproductive period, and decreased honeydew production. Induced resistance was localized mainly at phloem level and caused a strong reduction of phloem sap ingestion, but some effect of ASM at parenchyma/mesophyll level could not be discounted as far fewer aphids reached the sieve elements.
O pulgão-verde Schizaphis graminum (Rond.) (Hemiptera: Aphididae) é um dos principais insetos- praga da cultura do trigo (Triticum aestivum, L.). Agentes que induzem resistência como silício e acibenzolars-methyl (ASM) podem fornecer proteção às plantas contra insetos e doenças. Avaliou-se o efeito do silício e/ ou ASM no desenvolvimento e comportamento alimentar de S. graminum em plantas de trigo. Plantas de trigo cultivar Embrapa 22 foram tratadas com silício (ácido silícico a 1%) e acibenzolar-S-methyl (ASM) a 0.5%. Os parâmetros estudados foram biologia, excreção de honeydew e comportamento alimentar (de prova) monitorado por meio da técnica Electrical Penetration Graphs (EPG). Para o estudo de biologia e excreção de honeydew foram usadas dez repetições e 25 para EPG. A aplicação de agentes indutores de resistência reduziu o número de ninfas, prolongando a duração de período de pré-reprodutivo e o número de gotas de honeydew. O efeito de resistência foi localizado principalmente no floema, com redução de ingestão de seiva elaborada.
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Na busca por novos indutores de resistência contra a vassoura-de-bruxa no cacaueiro avaliou-se o efeito de vários nutrientes, acibenzolar-S-metil (ASM) e a combinação desses nutrientes com ASM. Os produtos e as misturas foram pulverizados 30 dias antes da inoculação nas mudas do clone SIC-23. Foram utilizados os produtos comerciais Supa-potássio®(silicato de potássio), Hortifós® PK (fosfito de potássio) e Broadacre® Mn (sulfato de manganês), testados nas dosagens 2,5 mL; 5,0 mL; 10 mL/L de água, isoladamente ou combinados com ASM (0,2g/L). O experimento foi conduzido no delineamento de blocos ao acaso, no esquema fatorial, com quatro repetições de doze plantas/parcela. A incidência da doença foi avaliada 60 dias após a inoculação. Somente o ASM promoveu controle significativo da vassoura-de-bruxa. Os nutrientes aplicados isoladamente não apresentaram efeito na severidade da doença. Por outro lado, o efeito protetor do ASM desapareceu quando este foi misturado ao Supa-potássio®, na dose de 5 ou 10 mL/L.
Aiming at improving the level of induction of resistance in cocoa, various nutrients, acibenzolar-S-methyl (ASM) and their combination were tested on cocoa seedlings, clone SIC-23, 30 days before inoculation. The commercial products Supa-potássio® (potassium silicate), Hortifós® PK (potassium phosphite) and Broadacre® Mn (manganese sulfate) were sprayed at doses of 2.5, 5.0 mL and 10.0 mL per liter of water, combined or not, with ASM® (0.2 g/L). The experiment was set in a randomized block design, in a factorial scheme, with four replicates of twelve plants each. Disease incidence was assessed 60 days after inoculation. Only ASM promoted significant control of the disease. Nutrients alone had no effect on disease incidence. On the other hand, the protective effect of ASM disappeared when this product was mixed to Supa-potássio at 5 or 10 mL/L.