Impaired Melatonin Secretion, Oxidative Stress and Metabolic Syndrome in Night Shift Work.

Metabolic syndrome has been associated in many studies with working in shifts. Even if the mechanistic details are not fully understood, forced sleep deprivation and exposure to light, as happens during night shifts, or irregular schedules with late or very early onset of the working program, lead to a sleep-wake rhythm misalignment, metabolic dysregulation and oxidative stress. The cyclic melatonin secretion is regulated by the hypothalamic suprachiasmatic nuclei and light exposure. At a central level, melatonin promotes sleep and inhibits wake-signals. Beside this role, melatonin acts as an antioxidant and influences the functionality of the cardiovascular system and of different metabolic processes. This review presents data about the influence of night shifts on melatonin secretion and oxidative stress. Assembling data from epidemiological, experimental and clinical studies contributes to a better understanding of the pathological links between chronodisruption and the metabolic syndrome related to working in shifts.

Beer and Microbiota: Pathways for a Positive and Healthy Interaction.

Beer is one of the most consumed drinks worldwide. It contains numerous categories of antioxidants, phenolic products, traces of group B vitamins, minerals (selenium, silicon, potassium), soluble fibers and microorganisms. Low or moderate beer consumption, with or without alcohol, showed positive effects on health by stimulating the development of a healthy microbiota. In the present review we focused on four components responsible with interaction with gut microbiota: microorganisms, polyphenols, fiber and melanoidins, their presence in usual beers and on perspectives of development of fortified beers with enhanced effects on gut microbiota. Though microorganisms rarely escape pasteurization of beer, there are new unpasteurized types that might bring strains with probiotic effects. The polyphenols from beer are active on the gut microbiota stimulating its development, with consequent local anti-inflammatory and antioxidant effects. Their degradation products have prebiotic action and may combat intestinal dysbiosis. Beer contains dietary fiber such as non-starchy, non-digestible carbohydrates (ß-glucans, arabinoxylans, mannose, fructose polymers, etc.) that relate with gut microbiota through fermentation, serving as a nutrient substrate. Another type of substances that are often considered close to fiber because they have an extremely low digestibility, melanoidins (melanosaccharides), give beer antioxidant and antibacterial properties. Though there are not many research studies in this area, the conclusion of this review is that beer seems a good candidate for a future functional food and that there are many pathways by which its ingredients can influence in a positive manner the human gut microbiota. Of course, there are many technological hinderances to overcome. However, designing functional beers fortified with fiber, antioxidants and probiotics, with a very low or no alcoholic content, will counteract the negative perception of beer consumption, will nullify the negative effects of alcohol, while simultaneously exerting a positive action on the gut microbiota.

Barriers and Facilitators of Romanian HPV (Human Papillomavirus) Vaccination.

BACKGROUND: Many countries had initial success with HPV vaccination campaigns worldwide. The HPV vaccine coverage during the COVID-19 pandemic dropped consistently. The aim of our research is to assess the barriers and facilitators of the current Romanian HPV vaccination campaign. METHODS: An analytical cross-sectional observational survey was conducted in the Romanian general population; a self-administered questionnaire was used. RESULTS: 1122 responders were interviewed; 666 (59.36%) were parents, and 67 (5.97%) HPV vaccinated themselves. A multinominal logistic regression carried out in the parents' category showed that women with university studies and informed from medical sources have greater chances to HPV vaccinate. Reticence regarding vaccination comes from the high cost of the vaccine and a lack of information. Only 118 (10.51%) vaccinated against HPV. From the logistic regression analysis, gender (ORa 0.461 = 95% CI: (0.196; 1.083)), geographic area of residence (ORa = 0.517; 95% CI: (0.331; 0.807)), and the inclusion of the HPV vaccine in the National Vaccination Program (ORa = 2.4; 95% CI: (1.361; 4.235)) were the factors found most associated with HPV vaccination. CONCLUSIONS: In the general population, the inclusion of HPV vaccination in the National Vaccination Program would be the most important facilitator of HPV vaccination in Romania. In parents that did not vaccinate their children, one important barrier to HPV vaccination was the high cost of the HPV vaccine and the lack of proper information. The acceptability of HPV vaccination in Romania is low; therefore, public health educational programs are needed.

Coronasomnia in Employees without a Direct Contact with COVID-19 Infected Patients in Their Workplace.

BACKGROUND: The aim of this analysis was to explore coronasomnia in second line workers. METHODS: Data were collected via in an online questionnaire. Patients with new onset or aggravation of insomnia were defined as cases and those without insomnia as controls. Differences among groups were studied by nonparametric tests; the correlation among variables was assessed using regression, followed by Bonferroni adjustment. RESULTS: There were 377 responders, grouped into 129 cases and 248 controls. Younger age (Odds Ratio = 0.97, p = 0.021), women (OR = 2.46, p = 0.016), workers belonging to a vulnerable group (OR = 2.36, p = 0.007), and those with previous history of insomnia (OR = 38.76, p = 0.00) were associated with coronasomnia. Increased home duties were directly related to insomnia (OR = versus home support which were indirectly associated). The constant preoccupation for SARS-CoV-2 media reports (OR = 3.6, p = 0.00009) and media consumption were components of the coronasomnia. In the adjusted models, the personal medical history, and the anxiety created by media alerts maintained their significance. CONCLUSION: Preventive measures to reduce the occurrence of insomnia in times of social stress in nonessential occupations should focus on health vulnerable groups, persons with previous history of insomnia and who develop anxiety from media.

Knowledge, Attitudes and Practices Regarding Antibiotic Use and Antibiotic Resistance: A Latent Class Analysis of a Romanian Population.

Considering the major limitations of the latest studies conducted in Romania on the knowledge, attitudes and practices (KAPs) of antibiotic use and antibiotic resistance, we conducted this study to assess this major public health threat. A cross-sectional survey based on a validated questionnaire was conducted among the general population of Romania for a period of 5 months, i.e., September 2021-January 2022. The questionnaire was distributed using Google Form and it covered demographic characteristics and KAP assessments consisting of 12 items on knowledge, 10 items on attitudes and 3 items on practices. Latent class analyses (LCAs) were conducted to group respondents based on their responses. The response rate was 77%, of which females responded in a greater number (n = 1251) compared to males (n = 674). For most of the respondents (67.32%, n = 1296), the education level was high school, while 23.58% (n = 454) of respondents were college graduates. One in three Romanians (33.3%) know the WHO predictions related to this topic. Overall, the Romanian population is less disciplined when it comes to completing antibiotic treatments, as 29.19% of the respondents stop the course of antibiotic administration if their symptoms improve. The key findings from the present study may help policy makers in designing targeted interventions to decrease confusion, ambiguity or misconceptions about antibiotic use.

Antioxidants in Hops: Bioavailability, Health Effects and Perspectives for New Products.

Hop plant (Humulus lupulus L.) has been used by humans for ages, presumably first as a herbal remedy, then in the manufacturing of different products, from which beer is the most largely consumed. Female hops cones have different useful chemical compounds, an important class being antioxidants, mainly polyphenols. This narrative review describes the main antioxidants in hops, their bioavailability and biological effects, and the results obtained by now in the primary and secondary prevention of several non-communicable diseases, such as the metabolic syndrome related diseases and oncology. This article presents in vitro and in vivo data in order to better understand what was accomplished in terms of knowledge and practice, and what needs to be clarified by additional studies, mainly regarding xantohumol and its derivates, as well as regarding the bitter acids of hops. The multiple protective effects found by different studies are hindered up to now by the low bioavailability of some of the main antioxidants in hops. However, there are new promising products with important health effects and perspectives of use as food supplements, in a market where consumers increasingly search for products originating directly from plants.

Smoking Obstructive Sleep Apnea: Arguments for a Distinctive Phenotype and a Personalized Intervention.

BACKGROUND: This is the first study that aims to define smoking, with obstructive sleep apnea (OSA), as a phenotype (SOSA). Moreover, we wanted to demonstrate the deleterious effects of the continuation of smoking on OSA. METHODS: The cross-sectional study highlighted four dimensions of SOSA: the demographic and anthropometric features, the symptoms, the comorbidities, and the sleep study parameters. This study compared these characteristics between current smokers (CS), those who have never smoked (NS), and ex-smokers (ES) with OSA. RESULTS: More men (83.95% in CS, versus 66.67% in NS) and an earlier onset of OSA (average age = 50.05 in CS, versus 52.26 in NS, p = 0.04) were recorded among CS. The distinguishing symptom of CS was daytime sleepiness, with an Epworth score that was significantly higher than in NS. Chronic obstructive pulmonary disease (COPD) was significantly more prevalent in CS (38.27%) than in NS (1.51%) (p < 0.001). The severity of OSA, consisting of a higher apnea-hypopnea index, a higher oxygen desaturation index, and a longer time spent below 90% oxygen saturation during sleep was significantly influenced by smoking. CONCLUSIONS: The SOSA phenotype includes younger male patients with a higher waist circumference, suggesting central obesity. They have a higher prevalence of COPD and a greater severity of OSA, in correlation with the number of pack-years of smoking.

Success rate of methotrexate in the conservative treatment of tubal ectopic pregnancies.

An ectopic pregnancy (EP) involves the implantation of the gestational sac outside the uterine cavity. In the event of diagnosing an EP, the current medical approach is to avoid surgery and to preserve fertility whenever possible; therefore, methotrexate (MTX)-based therapy has become prominent in recent years. MTX, a drug usually used to treat severe forms of autoimmune diseases and several types of cancer, has proven its utility in the conservative treatment of EPs. The success rate of MTX correlates with lower values of ß subunit of human chorionic gonadotropin hormone (ß-hCG) serum levels, especially below 2,000 mUI/ml, side effects being insignificant. In the present study, the results obtained concerning the success rate of MTX in the conservative treatment of EPs were obtained at the Department of Obstetrics and Gynecology of the Bucharest University Emergency Hospital from January 2014 to December 2020. The aim of the present study was to highlight the necessity for revising current guidelines for ectopic pregnancy medical treatment in order to manage this pathology optimally and to select carefully the proper treatment, whether medical, surgical or expectant management, so that morbidity is reduced to a minimum.

Influence of pemphigoid gestationis on pregnancy outcome: A case report and review of the literature.

Pemphigoid gestationis is considered to be a rare pregnancy exclusive bullous disease, which modifies the course of the pregnancy, with difficulties in the management of the pruritus and skin lesions as well as a possible change in the neonatal outcome. Differential diagnosis of skin lesions and pruritus in pregnancy is challenging, and complementary investigations such as skin biopsy or laboratory tests are indispensable. The correct diagnosis and proper treatment could change the natural course of a pregnancy at risk and could improve maternal and fetal morbidity. We present the case of a patient with pemfigoid gestationis with the aim to highlight: i) the management of this pregnancy-associated skin disorder which transfers this pregnancy into a category of high obstetrical risk pregnancy; ii) the particularities of the course of the pregnancy; and iii) the importance in the differential diagnosis of pregnancy dermatoses. The particularity of this case of pemphigoid gestationis was the acute fetal distress in the absence of intrauterine growth restriction that is frequently found in this pathology, and the management of a rare pregnancy skin condition that currently has no standard treatment.

Determination of Acrylamide in Selected Foods from the Romanian Market.

Several processed food products may contain toxic compounds considered risk factors for human health. Known for its possible carcinogenic effects, acrylamide is an organic compound periodically analyzed by the entities responsible for consumer safety. Knowing the acrylamide content of food offers the possibility of implementing corrective measures when needed, targeted at lowering its level. The aim of the paper was to screen for the presence of acrylamide in four products consumed almost daily in Romania and calculate acrylamide exposure by consuming one serving. Expressed in µg/kg coffee has the highest average acrylamide content (199), followed by potato chips (134), pretzels (120), and bread (14). Results regarding the acrylamide content in one serving showed the highest levels of acrylamide in pretzels (10.20 µg/serving), followed by potato chips (4.00 µg/serving), coffee (2.20 µg/cup), and bread (0.40 µg/slice). The calculation of the acrylamide content for one serving of the studied products will facilitate the following studies on the dietary acrylamide intake of the Romanian population, studies which, to our knowledge, have not been performed so far.

Efficacy of supplementation with methylcobalamin and cyancobalamin in maintaining the level of serum holotranscobalamin in a group of plant-based diet (vegan) adults.

Plant-based nutrition has become extremely popular in the contemporary era. Its positive effects are sustained by many studies, but one of its risks is that it is almost completely devoid of vitamin B12. In the present study, we analyzed the effects of two types of vitamin B12 supplements, cyancobalamin and methylcobalamin on the level of active serum vitamin (holotranscobalamin) in a group of Romanian individuals (n=42) following a (vegan) plant-based diet. The results revealed that cyancobalamin gives better results in maintaining B12, as quantified by the holotranscobalamin value (median=150 pcg/l) when compared with methylcobalamin (median=78.5 pcg/l). The frequency of administration, regardless of the quantity in one dose, is another important factor in maintaining the holotranscobalamin level within suitable limits. More frequent intakes give more optimal results. Vegans trying to supplement with alternative products (algae, kombucha, other fermented products), had the lowest levels of holotranscobalamin, always bellow the recommended level of 35 pcg/l (median=29 pcg/l). Vegans must be educated on B12 supplementation, about the pharmaceutical forms on the market and their performances and on choosing the optimal plan in order to avoid the onset of B12 deficiency.

Adiponectin and Asthma: Knowns, Unknowns and Controversies.

Adiponectin is an adipokine associated with the healthy obese phenotype. Adiponectin increases insulin sensitivity and has cardio and vascular protection actions. Studies related to adiponectin, a modulator of the innate and acquired immunity response, have suggested a role of this molecule in asthma. Studies based on various asthma animal models and on the key cells involved in the allergic response have provided important insights about this relation. Some of them indicated protection and others reversed the balance towards negative effects. Many of them described the cellular pathways activated by adiponectin, which are potentially beneficial for asthma prevention or for reduction in the risk of exacerbations. However, conclusive proofs about their efficiency still need to be provided. In this article, we will, briefly, present the general actions of adiponectin and the epidemiological studies supporting the relation with asthma. The main focus of the current review is on the mechanisms of adiponectin and the impact on the pathobiology of asthma. From this perspective, we will provide arguments for and against the positive influence of this molecule in asthma, also indicating the controversies and sketching out the potential directions of research to complete the picture.

Inherited thrombophilia is significantly associated with severe preeclampsia.

Methods to prevent the development of pathologies due to placental dysfunctions, such as gestational hypertension and preeclampsia, are the main approaches for obtaining the best maternal and fetal antepartum and postpartum prognosis. During 5 years of study (January, 2015 to December, 2019), the cases of pregnancy and puerperium complicated with pathology due to placental dysfunction were analyzed. The main objective was to determine the magnitude of the impact of thrombophilia on the development of an entity of gestational hypertension disorder. We compared the impact of thrombophilia and its associated complications in patients with gestational hypertension with moderate and severe preeclampsia. Thus, we found obesity, thrombophilia, and underlying cardiac pathology to be significant risk factors for severe preeclampsia. Regarding the comparative analysis of the risk factors and complications associated with patients with mild preeclampsia compared with those with severe preeclampsia, the presence in severe preeclampsia of thrombophilia, endocrine, liver, and cardiac pathology was higher and, a higher rate of complications was observed; complications included fetal death, intrauterine growth restriction (IUGR), prematurity, fetal arrhythmia with acute fetal distress, HELLP syndrome, and placental abruption. Thrombophilia has a significant effect on the development of severe preeclampsia, and oligohydramnios as specific complication of mild preeclampsia. Factors indicating an increased risk of progression from mild preeclampsia to severe preeclampsia are in addition to inherited thrombophilia the underlying pathologies, namely cardiac, hepatic, and endocrine factors.

Phytotherapy in obstetrics - therapeutic indications, limits, and dangers.

The wide access to varied, attractive, and aggressively promoted information can induce pregnant women to think that any form of complementary therapy can be a saving solution for a medical problem because these therapies are natural, therefore, harmless. Updated information from literature about indications, benefits, limits, and risks of phytotherapy in pregnancy was presented. Valuable therapeutic resources with proven clinical efficacy (evidence-based medicine) were presented for each trimester of pregnancy, during labor, postpartum, but also during breastfeeding. For some phytotherapeutics, there are scientific studies. There is also a detailed presentation about some possibilities for therapeutic errors, which should be avoided during pregnancy. Positive results of phytotherapy deserve to be known and applied by the obstetrician for the certain benefit of future mothers.

Impact of obesity on the prognosis of hypertensive disorders in pregnancy.

The prevalence of pathologies due to placental dysfunction superimposed on pregnancy is constantly increasing. The prognosis of the cases complicated by gestational hypertension is usually good, significantly better compared with that of the cases associating preeclampsia. About half of the cases with gestational hypertension will progress to preeclampsia, the risk of decompensation being inversely proportional to the gestational age of the onset of gestational hypertension. The present study, analyzed the cases of pregnancy and postpartum complicated by pathologies related to placental dysfunction, during a period of 5 years. The risk factors analyzed were the presence of infections during pregnancy, diabetes, thrombophilia, pregnancy obtained by in vitro fertilization, abnormal adherence of the placenta, obesity, multiple pregnancy, the presence of an earlier hepatic, endocrine, renal, cardiac or autoimmune pathology, and the existence of an uterine malformation. Obesity appears with a significantly increased incidence in patients with gestational hypertension and middle preeclampsia. Intrauterine growth restriction appears with a significantly increased incidence in patients with mild preeclampsia. Complications such as prematurity, acute fetal distress and abruption of placentae had a significantly increased incidence in patients with severe preeclampsia. Thus, obese patients have a higher risk of moderate preeclampsia, following gestational hypertension and finally severe preeclampsia.

Dietary behavior during pregnancy.

During pregnancy, maternal diet is a modifiable factor that impacts the birth outcome. Since the nutritional needs of a pregnant women vary during preconception, gestational and breastfeeding period, it is necessary to adapt the diet and lifestyle, optimally under the personalized nutrition guidance of a specialist. High quality research regarding diet during pregnancy remains challenging as nutritional concerns also vary according to religion, financial income, age and education of the pregnant woman, as well as specific traditions of each country, limited number of dietitians with special training in maternal nutrition. The obstetrician usually plays a major role in dietary counselling and the use of nutritional monitoring tools can help identify pregnant women who may be at risk due to an inappropriate diet. The age of the pregnant women can be important when it comes to dietary and lifestyle changes. In this context, we addressed a questionnaire to 100 pregnant women in third trimester of pregnancy in order to evaluate a possible correlation between the age and the dietary behavior and lifestyle of a pregnant woman. Furthermore, the maternal compliance with dietary recommendations in pregnancy and the exposure to various risks due to unhealthy nutrition were also analysed in the study.

Dark Chocolate: To Eat or Not to Eat? A Review.

Dark chocolate is not the most popular chocolate; the higher concentration in antioxidants pays tribute to the increment in bitterness. The caloric density of dark chocolate is potentially lower but has a large variability according to recipes and ingredients. Nevertheless, in the last decade, the interest in dark chocolate as a potential functional food has constantly increased. In this review, we present the nutritional composition, factors influencing the bioavailability, and health outcomes of dark chocolate intake. We have extracted pro- and counter-arguments to illustrate these effects from both experimental and clinical studies in an attempt to solve the dilemma. The antioxidative and anti-inflammatory abilities, the cardiovascular and metabolic effects, and influences on central neural functions were selected to substantiate the main positive consequences. Beside the caloric density, we have included reports placing responsibility on chocolate as a migraine trigger or as an inducer of the gastroesophagial reflux in the negative effects section. Despite an extensive literature review, there are not large enough studies specifically dedicated to dark chocolate that took into consideration possible confounders on the health-related effects. Therefore, a definite answer on our initial question is, currently, not available.

Nutritional Considerations in Preventing Muscle Atrophy.

Muscle atrophy may occur under different circumstances throughout a person's life. These conditions include periods of immobilization of a limb or of the whole body and aging accompanied by the onset of sarcopenia. Muscle mass is reduced as a result of decreased protein synthesis or increased protein degradation. Most studies aim to prevent the degradation of muscle proteins, but the way in which protein synthesis can be stimulated is often neglected. This study will provide an up-to-date review regarding nutritional considerations and resistance exercise countermeasures in the prevention of muscle mass loss and recovery of muscle mass in muscle atrophy secondary to immobilization or in sarcopenic obesity. We do not address muscle atrophy in disease states associated with inflammation (rheumatoid arthritis, COPD, cancer cachexia, AIDS, burns, sepsis, and uremia) which are governed by particular mechanisms of muscle loss.

Scientific Opinion of Flavouring Group Evaluation 407 (FGE.407): 4-amino-5-(3-(isopropylamino)-2,2-dimethyl-3-oxopropoxy)-2-methylquinoline-3-carboxylic acid.

The EFSA Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids (CEF) was requested to deliver a scientific opinion on the implications for human health of the flavouring substance 4-amino-5-(3-(isopropylamino)-2,2-dimethyl-3-oxopropoxy)-2-methylquinoline-3-carboxylic acid [FL-no: 16.130], in the Flavouring Group Evaluation 407 (FGE.407), according to Regulation (EC) No 1331/2008 of the European Parliament and of the Council. The substance has not been reported to occur in natural source materials of botanical or animal origin. It is intended to be used as both the parent compound and its hemisulfate monohydrate salt as a flavouring substance with modifying properties in specific categories of food. The chronic dietary exposure to the substance estimated using the added portions exposure technique (APET), is calculated to be 882 µg/person per day for a 60-kg adult and 547 µg/person per day for a 15-kg 3-year-old child. There is no concern with respect to genotoxicity. A 90-day dietary administration study in rats showed no adverse effects for doses up to 100 mg/kg body weight (bw) per day, providing an adequate margin of safety. Developmental toxicity was not observed in a study with rats at the dose levels up to 1,000 mg/kg bw per day. The Panel concluded that [FL-no: 16.130] and its hemisulfate monohydrate salt are not expected to be of safety concern at the estimated levels of dietary exposure calculated using the APET approach. This conclusion applies only to the use of the substance as a flavour modifier as requested and when used at the levels as specified for foods from different food categories.

Safety assessment of the substance 'Tungsten Oxide' for use in food contact materials.

This scientific opinion of EFSA Panel on Food Contact Materials, Enzymes, Flavourings and Processing Aids (CEF Panel) deals with the risk assessment of the additive tungsten oxide, CAS No 39318-18-8 and FCM No 1064, for use in food contact materials as a reheat agent in polyethylene terephthalate (PET) at a maximum use level of 75 ppm (75 mg/kg PET). The substance is a mixture of tungsten oxides with tungsten at different oxidative levels. The average oxidation level of tungsten in the oxides is 2.86 corresponding to 19.93% oxygen content. Detailed information on impurities is provided as confidential. Specific migration from PET plaques with the substance at 150 mg/kg (double the maximum intended use level of 75 mg/kg) was determined into 95% ethanol, as a worst-case simulant for PET due to its swelling effect. Under these test conditions, the specific migration, measured as tungsten using ICP-MS, was at the level of 1 µg/kg. The Panel considered that due to the insolubility of the substance, this low migration will be typical for any foreseeable use as a reheat additive in PET. Two in vitro genotoxicity studies, a bacterial gene mutation test and an in vitro micronucleus assay, performed in accordance with the OECD Guidelines and in compliance with GLP, were provided by the applicant for the substance tungsten oxide and were considered negative by the CEF Panel. According to a scientific opinion on strategy for genotoxicity testing (EFSA, 2011), the three genotoxic endpoints, gene mutation, chromosomal and numerical aberrations, are covered by these two tests. The CEF Panel concluded that the substance tungsten oxide is not of safety concern for the consumer if the additive is used as a reheat agent in PET. For other technical functions or for use in other polymers, the migration should not exceed 50 µg/kg (expressed as tungsten).