A randomized clinical trial of lipid metabolism modulation with fenofibrate for acute coronavirus disease 2019

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cytotoxicity may involve inhibition of peroxisome proliferator-activated receptor alpha. Fenofibrate activates peroxisome proliferator-activated receptor alpha and inhibits SARS-CoV-2 replication in vitro. Whether fenofibrate can be used to treat coronavirus disease 2019 (COVID-19) infection in humans remains unknown. Here, we randomly assigned inpatients and outpatients with COVID-19 within 14 d of symptom onset to 145 mg of oral fenofibrate nanocrystal formulation versus placebo for 10 d, in a double-blinded fashion. The primary endpoint was a severity score whereby participants were ranked across hierarchical tiers incorporating time to death, mechanical ventilation duration, oxygenation, hospitalization and symptom severity and duration. In total, 701 participants were randomized to fenofibrate (n = 351) or placebo (n = 350). The mean age of participants was 49 ± 16 years, 330 (47%) were female, mean body mass index was 28 ± 6 kg/m2 and 102 (15%) had diabetes. Death occurred in 41 participants. Compared with placebo, fenofibrate had no effect on the primary endpoint. The median (interquartile range) rank in the placebo arm was 347 (172, 453) versus 345 (175, 453) in the fenofibrate arm (P = 0.819). There was no difference in secondary and exploratory endpoints, including all-cause death, across arms. There were 61 (17%) adverse events in the placebo arm compared with 46 (13%) in the fenofibrate arm, with slightly higher incidence of gastrointestinal side effects in the fenofibrate group. Overall, among patients with COVID-19, fenofibrate has no significant effect on various clinically relevant outcomes ( NCT04517396 ).

A Randomized Trial of Lipid Metabolism Modulation with Fenofibrate for Acute Coronavirus Disease 2019

Background Abnormal cellular lipid metabolism appears to underlie SARS-CoV-2 cytotoxicity and may involve inhibition of peroxisome proliferator activated receptor alpha (PPARα). Fenofibrate, a PPAR-α activator, modulates cellular lipid metabolism. Fenofibric acid has also been shown to affect the dimerization of angiotensin-converting enzyme 2, the cellular receptor for SARS-CoV-2. Fenofibrate and fenofibric acid have been shown to inhibit SARS-CoV-2 replication in cell culture systems in vitro . Methods We randomly assigned 701 participants with COVID-19 within 14 days of symptom onset to 145 mg of fenofibrate (nanocrystal formulation with dose adjustment for renal function or dose-equivalent preparations of micronized fenofibrate or fenofibric acid) vs. placebo for 10 days, in a double-blinded fashion. The primary endpoint was a ranked severity score in which participants were ranked across hierarchical tiers incorporating time to death, duration of mechanical ventilation, oxygenation parameters, subsequent hospitalizations and symptom severity and duration. ClinicalTrials.gov registration: NCT04517396. Findings: Mean age of participants was 49 ± 16 years, 330 (47%) were female, mean BMI was 28 ± 6 kg/m 2 , and 102 (15%) had diabetes mellitus. A total of 41 deaths occurred. Compared with placebo, fenofibrate administration had no effect on the primary endpoint. The median (interquartile range [IQR]) rank in the placebo arm was 347 (172, 453) vs. 345 (175, 453) in the fenofibrate arm (P = 0.819). There was no difference in various secondary and exploratory endpoints, including all-cause death, across randomization arms. These results were highly consistent across pre-specified sensitivity and subgroup analyses. Conclusion Among patients with COVID-19, fenofibrate has no significant effect on various clinically relevant outcomes.

POS1489-HPR ASSESSMENT OF TREATMENT ADHERENCE IN A COHORT OF RHEUMATOID ARTHRITIS PATIENTS TREATED WITH SUBCUTANEOUS ANTI-TNF WHO WERE EXPOSED TO A COMPREHENSIVE CARE MODEL

Background

Rheumatoid arthritis (RA) is an autoimmune, chronic, and inflammatory disease, which can be treated with effective medications, but requires a high level of adherence to treatment. Offering a comprehensive care model by a multidisciplinary team could increase the adherence levels of these patients and improves disease outcomes.

Objectives

Compare the level of adherence to treatment before and after the implementation of a comprehensive care model in a cohort of patients with RA, treated with subcutaneous anti-TNF, in a reference center in Bogotá-Colombia.

Methods

An analytical study was conducted before and after the implementation of a comprehensive care model on a cohort of patients over 18 years of age, diagnosed with RA, who have been prescribed management with a subcutaneous anti-TNF by their doctor during the last 12 months. Convenience sequential sampling was performed to reach a defined sample size of 130 patients to estimate a baseline versus final adherence difference of 20%, at an alpha value of 5% and a beta value of 20%. The comprehensive care model (CCM) consisted of the approach by a multidisciplinary team, offering a comprehensive care not fragmented, based on evidence (guidelines and protocols) and proposing a treatment by objectives (T2T). Adherence was measured using the CQR-19 scale, with a cut-off point ≥80.7 to consider an adherent patient.

Results

The cohort consisted of 131 patients who were followed semiannually for 24 months, and who were incorporated into the CCM. 83.9% were women (n=110), in an age range between 30 and 84 years (Average: 62; DS: 9.9 years). 37.4% of patients were treated with etanercept (n=49), 29% with golimumab (n=38) and 33.6% with adalimumab (n=44). The median baseline of CQR-19 was 87.7 points (RIQ:84.2-91.2); while at month 24 it reached 91.2 points (RIQ: 87.7-94.7). The difference between the distributions was statistically significant (p<0.00). According to the cut-off point for CQR-19, the baseline percentage of adherent patients was 87.8% (n=115) and increased to a percentage of 96.2% at 24 months of follow-up (n=126). The difference between these two percentages of adherence was 8.39% (95% CI: 1.9-14.9%) (p: 0.012). The results of a generalized linear model binomial family, for the outcome of difference in proportions (PD) of basal and final adherence, are presented in Table 1. The estimator is adjusted for activity level (DAS28), disability level (HAQ) and anti-TNF. Golimumab appears to have an effect that increases adherence by 4.5% compared to adalimumab and etanercept, adjusting for the other predictors.

Table 1.

Model of the effect of MAI on adherence to treatment.

Dependent variable: Adhesion according to cut-off point CQR-19(≥80.7). Proportion Difference (DP) EstimatorVariableDPCI 95%P-valueIntervention: MAI9,4%3,2-15,5%0,003Golimumab vs. Etanercept-Adalimumab4,5%0,5-8,5%0,024DAS28(-)0,85%(-)3.2% to 14.9%0,47HAQ0,00(-)0.03% to 0.045%0,85

MLG-Binomial family. Identity function.

Conclusion

The CCM, after a follow-up of 24 months in patients with RA in treatment with subcutaneous anti-TNF increases the percentage of adherence by 9.4%, adjusting for treatment, activity level and degree of disability. Golimumab appears to have an effect that increases adherence by 4.5% compared to adalimumab and etanercept, adjusting for the other predictors.

Disclosure of Interests

Wilberto Rivero: None declared, GUILLERMO SÁNCHEZ: None declared, Fernando Rodriguez: None declared, Laura Villarreal: None declared, Diana Buitrago-Garcia: None declared, CARLOS CASTRO: None declared, Pedro Santos-Moreno Speakers bureau: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Consultant of: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Grant/research support from: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly

POS1491-HPR THE USEFULNESS OF THE PATIENT ACTIVITY SCORE-PASS-II TO ASSESS DISEASE ACTIVITY DURING THE COVID-19 LOCKDOWN IN PATIENTS WITH RHEUMATOID ARTHRITIS

Background

Many measurement tools are designed to assess disease activity for Rheumatoid Arthritis (RA) patients. One of the most used tools is the Disease Activity Score- DAS28 which assesses the number of painful joints, erythrocyte sedimentation, and a patient’s global assessment. The assessment is performed by a clinician and requires laboratory exams. Unfortunately, from March to August 2019, Colombia had one of the strictest responses to the COVID-19 pandemic according to the COVID-19 stringency Index(1). One of the main restrictions was the preventive isolation of older populations, especially those with comorbidities. These restrictions challenged the rheumatology practice because face-to-face consultations were not possible. Due to the above, measurements like the PAS-II score should be used to assess disease activity during the pandemic.

Objectives

To describe disease activity according to the Patient Activity Score- PAS-II score patients with RA and compare its results to the most recent DAS28 assessment before the COVID-19 pandemic.

Methods

We conducted a descriptive study; patients were followed during the COVID-19- lockdown in a video consultation. The PAS-II score was applied to assess disease activity as an alternative to the DAS28 assessment. The patients were part of an educational program, clinical charts were reviewed to collect the study variables. We collected demographic data and DAS28 before the pandemic started. We present a descriptive analysis of DAS28 severity and the results obtained by the PASS-II score.

Results

The educational program enrolled 250 participants; 196 patients had complete data. 93% of participants were women, mean age was 64 years IQR (54-67). 43% of participants were married or had a civil union, 26% were single, 20% divorced, and 11% were widowed. Regarding educational level, 25% had finished elementary school and 39% high school; the remaining 36% had higher education. When we compared the last DAS28 assessed by a rheumatologist between January, and March 2019, 67% of patients were in remission, while in July 2019, the PASS-II score reported that 7% of patients were in remission and 75% had low or minimal activity. Figure 1- Table 1.

Figure 1.

Table 1.DISEASE ACTIVITIYDAS28PASS-IIRemission67%6%Low (Minimal)14%75%Moderate15%18.5%High/Severe4%0.5%

Conclusion

The PASS score is a helpful tool to assess disease activity in patients with RA, especially in situations where the patient cannot see a rheumatologist in a face-to-face consultation; however, patients in severe disease activity should not delay the consultation with a clinician. As other studies have demonstrated, patient-reported outcome measures should be adopted in clinical practice as an alternative for treat- to- targe strategies(2). Further studies should be conducted to assess the impact of the pandemic in countries with high levels of restrictions in the course of RA.

References

[1]Hale T, Angrist N, Goldszmidt R, Kira B, Petherick A, Phillips T, et al. A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker). Nature Human Behaviour. 2021;5(4):529-38.

[2]Salaffi F, Di Carlo M, Farah S, Marotto D, Atzeni F, Sarzi-Puttini P. Rheumatoid Arthritis disease activity assessment in routine care: performance of the most widely used composite disease activity indices and patient-reported outcome measures: Comparison of disease activity indices in RA. Acta Biomedica Atenei Parmensis. 2021;92(4):e2021238.

Acknowledgements

This project was funded by the Ministry of Science, Technology and Innovation MINCIENCIAS. Grant number: 695180763684

Disclosure of Interests

Fernando Rodriguez: None declared, Diana Buitrago-Garcia: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Speakers bureau: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Consultant of: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Grant/research support from: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly

POS1459 THE IMPLEMENTATION OF AN EDUCATIONAL PROGRAM TO IMPROVE PHARMACOLOGICAL ADHERENCE IN PATIENTS WITH RHEUMATOID ARTHRITIS. RESULTS FROM A QUASI-EXPERIMENTAL STUDY

Background

Pharmacological therapy is the principal intervention in rheumatoid arthritis (RA) patients. Currently, adherence to DMARDs therapy is a challenge that needs to be addressed[1]. On the other hand, educational programs have shown an improvement in the health status of RA patients[2].

Objectives

This study aimed to determine if a 12-month educational program developed for patients with RA can improve medication adherence.

Methods

A quasi-experimental design was conducted. Patients who attend a specialized center in RA were invited to participate in an educational program. The program was called UNIVERSITAR: PATIENT UNIVERSITY. An interdisciplinary team provided educational workshops for the patients; we included coaching sessions and leisure activities such as yoga and art lessons to avoid a conventional classroom program and provide a dynamic program. A rheumatologist with experience in centers of excellence for RA led the team. Patients attended during a year. Follow-up was planned at 6 and 12 months after enrollment. Medication adherence was assessed using the self-reported 8-item Morisky Medication Adherence Scale (MMAS-8). Patients were considered adherent when they scored 8 points, moderately adherent with a score of 6 or 7, and non-adherent with less than 6 points. The Wilcoxon signed-rank test was used to evaluate differences in MMAS-8 scores between baseline and 16 and 12-months. We also assessed if there were changes in DAS 28 in the participants who improved the level of adherence.

Results

In total, 252 patients were enrolled in the study, and 206 completed the follow-up at 6 and 12 months (82%). The median age was 60 years IQR (54-67), 94% were female. In our study, 54% of patients received conventional and 46% Biological therapy. The proportion of patients with high adherence at baseline was 11%, at 6-months was 17% and at 12-month was 19%. At the end of the follow-up, 49% of the participants moved from being non-adherent to a moderate or high adherence level. When we compared the MMAS scores at baseline and follow-up, they showed a significant improvement (P<0.05) Figures 1-2. The majority of participants (65%) were in remission at baseline, according to DAS28. Therefore, we found no differences between the level of adherence and DAS28.

Conclusion

Our educational program improved medication adherence among patients with RA. Educational interventions are helpful to sustain remission in patients with RA. Further studies focused only on patients with moderate and high disease activity are necessary to assess the impact on clinical outcomes.

References

[1]Monchablon C, Gondé H, Pouplin S, Varin R, Vittecoq O, Lequerré T. Assessment of adherence to disease-modifying anti-rheumatic drugs in rheumatoid arthritis. Clin Rheumatol. 2020;39(1):207-16.

[2]Tan YK, Teo P, Saffari SE, Xin X, Chakraborty B, Ng CT, et al. A musculoskeletal ultrasound program as an intervention to improve disease modifying anti-rheumatic drugs adherence in rheumatoid arthritis: a randomized controlled trial. Scand J Rheumatol. 2022;51(1):1-9.

Acknowledgements

This project was funded by the Ministry of Science, Technology and Innovation MINCIENCIAS. Grant number: 695180763684

Disclosure of Interests

Pedro Santos-Moreno Speakers bureau: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Consultant of: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Grant/research support from: Pfizer, Janssen, Abbvie, Biopas-UCB, Bristol, Roche, Novartis, Lilly, Diana Buitrago-Garcia: None declared, Fernando Rodriguez: None declared, GUILLERMO SÁNCHEZ: None declared

AB0900-HPR THE EXPECTATIONS AND EXPERIENCES OF PATIENTS WITH RHEUMATOID ARTHRITIS AFTER ENROLLING INTO AN EDUCATIONAL PROGRAM. RESULTS FROM A MIXED STUDY APPROACH

Background:

Rheumatoid arthritis (RA) is a high-cost disease, usually diagnosed at a productive age in life. RA brings significant changes in a patient’s life. On an emotional level, the patient perceives a strong impact that generates disorientation, denial, depression, hopelessness, anger and fear due to the uncertainty of the development of the disease and the doubt of the turn that his life will take. However, each patient has different ways of coping with the disease and adapting to it (1,2). These changes require attention from health personnel. In this regard, different studies have reported the effect of educational, support and empowerment programs for patients on reducing the effects of the disease and the benefits are oriented towards improving lifestyles by improving self-care (3,4).

Objectives:

To describe the experience of patients with rheumatoid arthritis, their perception and expectations about entering a multicomponent educational program in a specialized center in Bogotá - Colombia.

Methods:

For this study a concurrent mixed design was used, in which quantitative and qualitative methods are applied simultaneously, we invited patients with rheumatoid arthritis who attended a specialized center in Bogotá - Colombia who enrolled in an education program called UNIVERSITAR. The quantitative phase included a descriptive analysis and the application of the expectations scale adapted from Borkovec and Nau (5); this scale collects information about the level of expectations and satisfaction of the program. The scale ranges from 0 (not at all) to 10 (very much). Immediately after the application of the scale, the participants were invited to a focus group that allowed the dialogue on the perception and expectations of the participants regarding the program, through a dynamic process in which the participants exchanged their ideas and opinions. A group interview script was used, aimed at identifying the patients’ experiences with their diagnosis and their expectations regarding the program. Two focus groups were held with an average duration of one hour; the discussion was recorded on audio and transcribed in its entirely.

Results:

We included 31 participants and were distributed in two focus groups. The median age of the participants was 60 years IQR (54-67), 92% were female. 77% of participants reported high scores for the satisfaction regarding the program. In the qualitative phase two categories emerged that speak of the experience of the participants with the disease. They highlighted the appearance of this disease in their lives in an unexpected way, the doubts and uncertainties that were generated from the diagnosis and the implications that this condition causes health in their everyday life. However, in the second category, the expectations and motivations of the participants towards the educational program are highlighted, and the factors that influence their participation and their motivation to train and empower themselves to make decisions and as expert patients, capable of educate, guide and support other patients with the same diagnosis.

Conclusion:

The expectations and perceptions of the patients are of great importance, since through these the conditions with which these educational programs provide interventions and a better quality of life to these patients can be improved.

Disclosure of Interests:

None declared

Polycystin-1 mitigates damage and regulates CTGF expression through AKT activation during cardiac ischemia/reperfusion

During ischemia/reperfusion (I/R), cardiomyocytes activate pathways that regulate cell survival and death and release factors that modulate fibroblast-to-myofibroblast differentiation. The mechanisms underlying these effects are not fully understood. Polycystin-1 (PC1) is a mechanosensor crucial for cardiac function. This work aims to assess the role of PC1 in cardiomyocyte survival, its role in profibrotic factor expression in cardiomyocytes, and its paracrine effects on I/R-induced cardiac fibroblast function. In vivo and ex vivo I/R and simulated in vitro I/R (sI/R) were induced in wild-type and PC1-knockout (PC1 KO) mice and PC1-knockdown (siPC1) neonatal rat ventricular myocytes (NRVM), respectively. Neonatal rat cardiac fibroblasts (NRCF) were stimulated with conditioned medium (CM) derived from NRVM or siPC1-NRVM supernatant after reperfusion and fibroblast-to-myofibroblast differentiation evaluated. Infarcts were larger in PC1-KO mice subjected to in vivo and ex vivo I/R, and necrosis rates were higher in siPC1-NRVM than control after sI/R. PC1 activated the pro-survival AKT protein during sI/R and induced PC1-AKT-pathway-dependent CTGF expression. Furthermore, conditioned media from sI/R-NRVM induced PC1-dependent fibroblast-to-myofibroblast differentiation in NRCF. This novel evidence shows that PC1 mitigates cardiac damage during I/R, likely through AKT activation, and regulates CTGF expression in cardiomyocytes via AKT. Moreover, PC1-NRVM regulates fibroblast-to-myofibroblast differentiation during sI/R. PC1, therefore, may emerge as a new key regulator of I/R injury-induced cardiac remodeling.

Evaluation of a sanitizing washing step with different chemical disinfectants for the strawberry processing industry

Strawberries are often consumed fresh or only receive minimal processing, inducing a significant health risk to the consumer if contamination occurs anywhere from farm to fork. Outbreaks of foodborne illness associated with strawberries often involve a broad range of microbiological agents, from viruses (human norovirus) to bacteria (Salmonella spp. and Listeria monocytogenes). The addition of sanitizers to water washes is one of the most commonly studied strategies to remove or inactivate pathogens on berries as well as avoid cross contamination due to reuse of process wash water. The risk posed with the safety issues of by-products from chlorine disinfection in the fruit industry has led to a search for alternative sanitizers. We evaluated the applicability of different chemical sanitizers (peracetic acid (PA), hydrogen peroxide (H₂O₂), citric acid (CA), lactic acid (LA) and acetic acid (AA)) for the inactivation of S. enterica, L. monocytogenes and murine norovirus (MNV-1) on strawberries. A control treatment with chlorine (NaClO) (100 ppm) was included. For each sanitizer, different doses (40, 80 and 120 ppm for PA and 1, 2.5 and 5% for H₂O₂, LA, AA and CA) and time (2 and 5 min) were studied in order to optimize the decontamination washing step. The best concentrations were 80 ppm for PA, 5% for H₂O₂ and 2.5% for organic acids (LA, AA and CA) after 2 min treatment. Results indicate that the sanitizers selected may be a feasible alternative to chlorine (100 ppm) for removing selected pathogenic microorganisms (P > 0.05), with reductions about ≥2 log for bacterial strains and ≥ 1.7 log for MNV-1. As the washing water may also increase the microbial counts by cross-contamination, we observed that no pathogenic bacteria were found in wash water after 5% H₂O₂ and 80 ppm PA after 2 min treatment. On the other hand, we also reported reductions about total aerobic mesophyll (TAM) (0.0-1.4 log CFU/g) and molds and yeasts (M&Y) (0.3-1.8 log CFU/g) with all alternative sanitizers tested. Strawberries treated did not shown significant differences about physio-chemical parameters compared to the untreated samples (initial). For this study, the optimal sanitizer selected was PA, due to the low concentration and cost needed and its microbiocidal effect in wash water and fruit. Notwithstanding the results obtained, the effect of PA in combination with other non-thermal technologies such as water-assisted ultraviolet (UV-C) light should be studied in future research to improve the disinfection of strawberries.

AB1296-HPR PREVALENCE OF COMORBIDITIES IN A COHORT OF PATIENTS IN AN EDUCATIONAL MULTIDISCIPLINARY PROGRAM

Background:

Rheumatoid arthritis (RA) is a chronic inflammatory and complex disease. Patients with RA face other diseases that might lead to increase morbidity. In patients with RA it has been stablished a high prevalence of comorbidities and their risk factors (1).

Objectives:

The aim of this study was to evaluate the prevalence of comorbidities in Colombian patients with RA enrolled in an educational multidisciplinary program and possible correlation with disease activity

Methods:

We performed a cross-sectional study; we included patients with confirmed diagnosis of rheumatoid arthritis in a specialized RA center. We collected sociodemographic data, and markers of disease activity DAS28. We collected data regarding the history of comorbidities such as hypertension, dyslipidemia, osteoporosis, type 2 diabetes mellitus, hypothyroidism, malignancies, among others. We performed a descriptive analysis, variables with a normal distribution were described using mean and standard deviation (SD), and non- normal distributed variables were described using median and interquartile range. Categorical variables were presented as rates. We evaluated the relationship between disease activity and comorbidities.

Results:

We included 251 patients; mean age was 59 ± 9.8 years old, with a high proportion of women 93%; median disease duration was 15 years RIQ (8-20); in this study, 145 (65%) of patients were in remission; 35 (11%) had low, 44 (20%) moderate and 10 (4%) high disease activity. Regarding pharmacological therapy, 55% were receiving conventional DMARDs. The prevalence of comorbidities was 85%, the most common were high blood pressure 25% followed by hypothyroidism 12% and diabetes 10%, 0.7% of patients had malignancies such as thyroid cancer or breast cancer, 1.29% of patients had renal comorbidities. Among comorbidities related to RA 30% had osteoporosis and 20% arthrosis. We did not find a statistical association between DAS28 and comorbidities.

Conclusion:

As other studies have shown, there is a high prevalence of comorbidities among RA patients, mainly high blood pressure. Due to the above, it is relevant to evaluate the risks factors of patients with RA, especially cardiovascular risks. We consider that a multidisciplinary program represents an opportunity not only to educate patients about healthy life styles and the management of RA, but also other diseases in order to increase the empowering of the health status in these poly pathological patients(2).

References:

[1]Gullick NJ, Scott DL. Co-morbidities in established rheumatoid arthritis. Best practice & research Clinical rheumatology. 2011;25(4):469-83.

[2]Galarza-Delgado DA, Azpiri-Lopez JR, Colunga-Pedraza IJ, Cardenas-de la Garza JA, Vera-Pineda R, Wah-Suarez M, et al. Prevalence of comorbidities in Mexican mestizo patients with rheumatoid arthritis. Rheumatology international. 2017;37(9):1507-11.

Acknowledgments:

This project has been funded by a collaboration between the Ministry of Science, Technology and Innovation COLCIENCIAS (contract 746-2018), the Fundación Universitaria de Ciencias de la Salud and Biomab - Center for Rheumatoid Arthrtitis

Disclosure of Interests:

Michael Cabrera: None declared, Fernando Rodriguez: None declared, Diana Buitrago-Garcia: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.

AB1279-HPR A DESCRIPTIVE STUDY RELATED TO THE ADHERENCE BEFORE AND AFTER ENROLLING IN A MULTIDISCIPLINARY EDUCATIONAL PROGRAM

Background:

Rheumatoid arthritis (RA) is an inflammatory, chronic disease. It leads to deformity and destruction of joints through the erosion of cartilage and bone. Patients with RA report to suffer symptoms in hands, joints, swelling, loss of motion, muscle weakness among others.(1).Centers of excellence in RA have proposed a multidisciplinary model of care with an initial diagnosis, treatment prescription and follow-up with a rheumatologist, periodic consultations with a physiatrist, psychologist, physiotherapist, occupational therapy, nutrition and a patient focused program(2). With this model of care, the patient is seen as a whole, and the expectation is to achieve the best results in the management of RA. However, if the patient does adhere the model becomes ineffective.

Objectives:

The aim of this to report the attendance to a multidisciplinary model of care for patients with RA that attend to a specialized center in Colombia, before and after enrolling in a educational program.

Methods:

We performed a descriptive study. Patients enrolled our educational program in July 2019. In our institution patients are followed-up under T2T standards and a multidisciplinary approach, as part of our model of care they have periodic consultations with a rheumatology, physiatrist, psychologist, physiotherapist, occupational therapy and nutrition. We collected sociodemographic data, DAS28, and compare the attendance to each specialty at the beginning and at 6-month follow-up. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. We compared disease activity and adherence at the beginning of the program and after six months of attendance.

Results:

We included 229 patients; mean age was 59 years ±10; 93% were female. At the beginning of our program, mean DAS28 was 2.57 ± 1.19, from all patients 65% were at remission, 11% at low disease activity 19% at moderate disease activity and, 5% at severe disease activity. Regarding adherence to our model, the medical specialty with the highest attendance was rheumatology (30%) followed by, physical therapy (16%) physiatrist consultation (15%) psychology (13%) and, occupational therapy (11%); the specialty with the lowest attendance was nutrition (8%). After six months of attendance to the educational program, we found an increasing number of patients in remission 67%, low disease activity 15%, moderate disease activity 18%, we did not have patients with severe DA28. Regarding the medical specialties, we found a 3% rise in the attendance to the nutrition consultation and psychology consultation. We did not find statistical association between disease activity and adherence to the model.

Conclusion:

These results are a clear example of how an educational program is capable of increasing awareness and improving the clinical outcomes and adherence to a multidisciplinary model for approaching RA. As other studies have shown(3), patient education interventions improve adherence to medication and to attendance to health care specialists.

References:

[1]Santos-Moreno P, Castaneda O, Garro B, Flores D, Sanchez G, Castro C. From the model of integral attention to the creation of centers of excellence in rheumatoid arthritis. Clinical rheumatology. 2015;34 Suppl 1:S71-7.

[2]Taibanguay N, Chaiamnuay S, Asavatanabodee P, Narongroeknawin P. Effect of patient education on medication adherence of patients with rheumatoid arthritis: a randomized controlled trial. Patient preference and adherence. 2019;13:119-29.

Acknowledgments:

This project has been funded by a collaboration between the Ministry of Science, Technology and Innovation COLCIENCIAS (contract 746-2018), the Fundación Universitaria de Ciencias de la Salud and Biomab - Center for Rheumatoid Arthritis

Disclosure of Interests:

Diana Buitrago-Garcia: None declared, Fernando Rodriguez: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.

AB1340-HPR PATIENTS’ OUT-OF-POCKET EXPENSES ANALYSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS ENROLLED IN A EDUCATIONAL PROGRAM

Background:

The increasing health and economic burdens of deaths and disabilities from non-communicable diseases (NCDs) are emerging as major concerns worldwide, particularly for low- and middle-income countries (LMICs)(1). Rheumatoid arthritis (RA) NCD is considered as one of the most common causes of disability. RA affects from 0.5% to 1% of the worldwide population. Little is known about the out-of-pocket (OOP) expenditures for prescription of pharmacological treatment for patients with RA, including drugs, diagnostic tests, mobility aids among others.

Objectives:

To describe the out of pocket costs in patients with rheumatoid arthritis

Methods:

We performed a cross-sectional study among patients who are participating in an educational program in a specialized center for RA. We collected sociodemographic variables; in addition, we collected data related to the expenditures in drugs, diagnostic tests and mobility aids that were not covered by the health system. Descriptive epidemiology was done, we calculated means, and standard deviations for continuous variables and categorical variables were presented as rates. The costs are presented in the US dollars with the average exchange rate for 2019

Results:

We included 181 patients, 92% were female. Mean age was 59 years ±9.5. Regarding occupation, 24% were employees, 40% were economically inactive, and 36% were pensioners. Most of patients 45% had a low income, 43 % middle income and only 12% high income according to the Colombian socioeconomic classification. Most of out of pocket expenses (47%) were associated to the acquisition of medical devices such as reading glasses or orthopedic braces. Secondly, the OOP expenses were related to medications (38%) such as antibiotics prednisone or pain control medications. Finally, 25% of patients reported that they had pay for their diagnostic tests such as x rays or laboratory tests. When assessed the costs patients expended between 30-100 USD purchasing aid devices, medications or laboratory tests.

Conclusion:

In the Colombian context OPP are relevant and represent an important expenditure for patients with RA especially for those who have low or middle income. Due to the above, it is important to find alternatives in order to help vulnerable segments of the population. Additionally, OPP needed to be taken into account due to its association with treatment adherence(2).

References:

Datta BK, Husain MJ, Fatehin S. The crowding out effect of out-of-pocket medication expenses of two major non-communicable diseases in Pakistan. International health. 2020;12(1):50-9.

Acknowledgments:

This project has been funded by a collaboration between the Ministry of Science, Technology and Innovation COLCIENCIAS (contract 746-2018), the Fundación Universitaria de Ciencias de la Salud and Biomab - Center for Rheumatoid Arthritis

Disclosure of Interests:

Diana Buitrago-Garcia: None declared, Fernando Rodriguez: None declared, GUILLERMO SÁNCHEZ: None declared, Pedro Santos-Moreno Grant/research support from: I have received research grants from Abbvie, Biopas-UCB, Janssen, Novartis, Pfizer., Speakers bureau: I have been a speaker for Abbvie, Biopas-UCB, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi.

[Measurement, monitoring and knowledge of blood pressure: May Measurement Month, Colombia 2017]

AIM

To describe the findings of implementing May Measurement Month 2017 in the adult Colombian population to raise awareness of the importance of blood pressure measuring, monitoring, and awareness.

MATERIALS AND METHODS

May Measurement Month is a cross-sectional survey that follows the directives of the International Society of Hypertension and the World Hypertension League, which gathers information on cardiovascular risk factors and blood pressure readings. Its implementation in Colombia was lead by the Santander Ophthalmological Foundation (FOSCAL) and the Latin American Society of Hypertension (LASH) with the support of the Colombian Network for the Prevention of Cardiovascular Diseases and Diabetes (RECARDI).

RESULTS

Data was collected from 11 departments on 21,797 people, 58.7% of whom were female, with an average age of 40.5±17.7 years. The overall prevalence of high blood pressure (HBP) was 20.8% (self-reported antihypertensive treatment or systolic blood pressure reading [systolic blood pressure≥140mmHg]). Of the total number of hypertensives, 46.5% had systolic blood pressure readings classified as uncontrolled (systolic blood pressure<140mmHg), and 26.4% were unaware that they were hypertensive who, in this report, we consider to be new cases of HBP.

CONCLUSION

The prevalence of (elevated) blood pressure is high in this young adult population, whose lack of awareness of HBP is also high, and HBP in those aware of their condition is poorly controlled. These results highlight the need to implement effective detection programmes for hypertensive patients and to establish standardised treatments to improve HBP control as a strategy to reduce cardiovascular events.

May Measurement Month 2017: an analysis of blood pressure screening results in Colombia-Americas

Despite the availability of efficient methods to evaluate blood pressure (BP) and of safe and efficient medication to treat and control hypertension, the levels of awareness, treatment and control are very low globally, particularly in low- and middle-income countries. To highlight the importance of improving these rates, the International Society of Hypertension (ISH) endorsed by the World Hypertension League have implemented the May Measurement Month initiative. We present here the results obtained in Colombia. The Fundación Oftalmológica de Santander (FOSCAL) led the implementation of this strategy in Colombia and 11 departments participated. The data collection followed the guidelines of the ISH. The information collected was compiled for the report generation and the submission to the Technical Secretariat of the ISH. Data cleaning was performed locally by FOSCAL. Data were collated and analysed centrally. A total of 22 258 participants (58.8% female) were included in the analysis. Mean age was 40.9 ± 17.7 years. Age and sex-standardized BP excluding participants receiving BP medications was 118/74.3 mmHg, and in those on treatment 125/78 mmHg. High BP was present in 5036 (22.8%) individuals, 1637 of 18 644 (8.8%) who were not receiving anti-hypertensive medications were hypertensive, and 961 of 3359 (28.6%) receiving treatment were not controlled. These results highlight the need to develop innovative promotion strategies at individual and population levels to increase the awareness of the importance of BP, and the consequences of not having well-controlled hypertension. This initiative is an effective and easy to implement strategy that should be maintained in the coming years.

Irrigating Lettuce with Wastewater Effluent: Does Disinfection with Chlorine Dioxide Inactivate Viruses?

Reclaimed water obtained from urban wastewater is currently being used as irrigation water in water-scarce regions in Spain. However, wastewater can contain enteric viruses that water reclamation treatment cannot remove or inactivate completely. In the present study, greenhouse-grown baby lettuce ( L.) was irrigated with secondary treatment effluent from a wastewater treatment plant untreated and treated using chlorine dioxide (ClO). The effect of ClO treatment on the physicochemical characteristics and the presence of enteric viruses in irrigation water and lettuce was assessed. The presence of human noroviruses genogroups I and II (NoV GI and NoV GII), and human astroviruses (HAstV), was analyzed by real-time polymerase chain reaction (RT-qPCR). Additionally, to check for the loss of infectivity induced by the disinfection treatment, positive samples were re-analyzed after pretreatment with the intercalating dye PMAxx before RNA extraction and RT-qPCR. There were no significant differences in the proportion of positive samples and the concentration of enteric viruses between treated and untreated reclaimed water without PMAxx pretreatment ( > 0.05). A significantly lower concentration of NoV GI was detected in ClO-treated water when samples were pretreated with PMAxx ( < 0.05), indicating that inactivation was due to the disinfection treatment. Laboratory-scale validation tests indicated the suitability of PMAxx-RT-qPCR for discrimination between potentially infectious and ClO-damaged viruses. Although the applied ClO treatment was not able to significantly reduce the enteric virus load of the secondary effluent from the wastewater treatment plant, none of the lettuce samples analyzed ( = 36) was positive for the presence of NoV or HAstV.

Improving efficiency of viability-qPCR for selective detection of infectious HAV in food and water samples

AIM

To improve the efficacy of intercalating dyes to distinguishing between infectious and inactivated hepatitis A virus (HAV) in food.

METHODS AND RESULTS

Different intercalating dyes were evaluated for the discrimination between infectious and thermally inactivated HAV suspensions combining with the RT-qPCR proposed in the ISO 15216. Among them, PMAxx was the best dye in removing the RT-qPCR signal from inactivated HAV. Applied to lettuce and spinach, PMAxx-Triton pretreatment resulted in complete removal of the RT-qPCR signal from inactivated HAV. Likewise, this study demonstrates that this pretreatment is suitable for the discrimination of inactivated HAV in shellfish without further sample dilution. In mussels and oysters, the developed viability RT-qPCR method reduced the signal of inactivated HAV between 1·7 and 2·2 logs at high inoculation level, and signal was completely removed at low inoculation level.

CONCLUSIONS

This study showed that the use of PMAxx is an important improvement to assess HAV infectivity by RT-qPCR. It was shown that PMAxx-Triton pretreatment is suitable for the analysis of infectious HAV in complex food samples such as vegetables and shellfish.

SIGNIFICANCE AND IMPACT OF THE STUDY

The PMAxx-Triton pretreatment can be easily incorporated to the ISO norm for infectious virus detection.

Effect of green tea extract on enteric viruses and its application as natural sanitizer

In this work, the effect of green tea extract (GTE) was assessed against murine norovirus (MNV) and hepatitis A virus (HAV) at different temperatures, exposure times and pH conditions. Initially, GTE at 0.5 and 5 mg/ml were individually mixed with each virus at 5 log TCID50/ml and incubated 2 h at 37 °C at different pHs (from 5.5 to 8.5). GTE affected both viruses depending on pH with higher reductions observed in alkaline conditions. Secondly, different concentrations of GTE (0.5 and 5 mg/ml) were mixed with viral suspensions and incubated for 2 or 16 h at 4, 25 and 37 °C at pH 7.2. A concentration-, temperature- and exposure time-dependent response was showed by GTE in suspension tests, where complete inactivation was achieved after overnight exposure at 37 °C for both viruses and also at 25 °C for HAV. In addition, antiviral effect of GTE proved efficient in the surface disinfection tests since 1.5 log reduction and complete inactivation were recorded for MNV and HAV on stainless steel and glass surfaces treated with 10 mg/ml GTE for 30 min, analyzed in accordance with ISO 13697:2001. GTE was also evaluated as a natural disinfectant of produce, showing 10 mg/ml GTE reduced MNV and HAV titers in lettuce and spinach by more than 1.5 log after 30 min treatment. The results show a potential of GTE as natural disinfectant able to limit enteric viral (cross-)contaminations conveyed by food and food-contact surfaces.

Adaptive arrival cost update for improving Moving Horizon Estimation performance

Moving horizon estimation is an efficient technique to estimate states and parameters of constrained dynamical systems. It relies on the solution of a finite horizon optimization problem to compute the estimates, providing a natural framework to handle bounds and constraints on estimates, noises and parameters. However, the approximation of the arrival cost and its updating mechanism are an active research topic. The arrival cost is very important because it provides a mean to incorporate information from previous measurements to the current estimates and it is difficult to estimate its true value. In this work, we exploit the features of adaptive estimation methods to update the parameters of the arrival cost. We show that, having a better approximation of the arrival cost, the size of the optimization problem can be significantly reduced guaranteeing the stability and convergence of the estimates. These properties are illustrated through simulation studies.

Curcumin-Mediated Photodynamic Inactivation of Norovirus Surrogates

Photodynamic inactivation (PDI) is extensively used to inactivate different type of pathogens through the use of photosensitizers (PS). Curcumin has been identified as an excellent natural photosensitizer with some potential applications in the food industry. The aim of this study was to assess the antiviral activity of photoactivated curcumin on norovirus surrogates, feline calicivirus (FCV), and murine norovirus (MNV). Initially, different concentrations of curcumin (13.5-1358 µM) were individually mixed with each virus at titers of ca. 6-7 log TCID₅₀/ml and photoactivated by LED blue light with light dose of 3 J/cm². Results showed that photoactivated curcumin at 50 µg/mL reduced FCV titers by almost 5 log after incubation at 37 °C for 30 min. Lower antiviral activity (0.73 log TCID₅₀/mL reduction) was reported for MNV. At room temperature, curcumin at 5 µg/mL reduced FCV titers by 1.75 log TCID₅₀/mL. These results represent a step forward in improving food safety using photoactivated curcumin as an alternative natural additive to reduce viral contamination.

Efficacy of Cinnamaldehyde Against Enteric Viruses and Its Activity After Incorporation Into Biodegradable Multilayer Systems of Interest in Food Packaging

Cinnamaldehyde (CNMA), an organic compound that gives cinnamon its flavor and odor, was investigated for its virucidal activity on norovirus surrogates, murine norovirus (MNV) and feline calicivirus (FCV), and hepatitis A virus (HAV). Initially, different concentrations of CNMA (0.1, 0.5 and 1 %) were individually mixed with each virus at titers of ca. 6-7 log10 TCID50/ml and incubated 2 h at 4 and 37 °C. CNMA was effective in reducing the titers of norovirus surrogates in a dose-dependent manner after 2 h at 37 °C, while HAV titers were reduced by 1 log10 after treatment with 1 % of CNMA. When incubation time was extended, HAV titers were reduced by 3.4 and 2.7 log10 after overnight incubation at 37 °C with 1 and 0.5 % of CNMA, respectively. Moreover, this paper analyzed, for the first time, the antiviral activity of adding an active electrospun interlayer based on zein and CNMA to a polyhydroxybutyrate packaging material (PHB) in a multilayer form. Biodegradable multilayer systems prepared with 2.60 mg/cm(2) (~9.7 %) of CNMA completely inactivated FCV according to ISO 22196:2011, while MNV titers were reduced by 2.75 log10. When the developed multilayer films were evaluated after one month of preparation or at 25 °C, the antiviral activity was reduced as compared to freshly prepared multilayer films evaluated at 37 °C. The results show the excellent potential of this system for food contact applications as well as for active packaging technologies in order to maintain or extend food quality and safety.

Iterated non-linear model predictive control based on tubes and contractive constraints

This paper presents a predictive control algorithm for non-linear systems based on successive linearizations of the non-linear dynamic around a given trajectory. A linear time varying model is obtained and the non-convex constrained optimization problem is transformed into a sequence of locally convex ones. The robustness of the proposed algorithm is addressed adding a convex contractive constraint. To account for linearization errors and to obtain more accurate results an inner iteration loop is added to the algorithm. A simple methodology to obtain an outer bounding-tube for state trajectories is also presented. The convergence of the iterative process and the stability of the closed-loop system are analyzed. The simulation results show the effectiveness of the proposed algorithm in controlling a quadcopter type unmanned aerial vehicle.

Evaluation of viability PCR performance for assessing norovirus infectivity in fresh-cut vegetables and irrigation water

Norovirus (NoV) detection in food and water is mainly carried out by quantitative RT-PCR (RT-qPCR). The inability to differentiate between infectious and inactivated viruses and the resulting overestimation of viral targets is considered a major disadvantage of RT-qPCR. Initially, conventional photoactivatable dyes (i.e. propidium monoazide, PMA and ethidium monoazide, EMA) and newly developed ones (i.e. PMAxx and PEMAX) were evaluated for the discrimination between infectious and thermally inactivated NoV genogroup I (GI) and II (GII) suspensions. Results showed that PMAxx was the best photoactivatable dye to assess NoV infectivity. This procedure was further optimized in artificially inoculated lettuce. Pretreatment with 50μM PMAxx and 0.5% Triton X-100 (Triton) for 10min reduced the signal of thermally inactivated NoV by ca. 1.8 logs for both genogroups in lettuce concentrates. Additionally, this pretreatment reduced the signal of thermally inactivated NoV GI between 1.4 and 1.9 logs in spinach and romaine and lamb's lettuces and by >2 logs for NoV GII in romaine and lamb's lettuce samples. Moreover this pretreatment was satisfactorily applied to naturally-contaminated water samples with NoV GI and GII. Based on the obtained results this pretreatment has the potential to be integrated in routine diagnoses to improve the interpretation of positive NoV results obtained by RT-qPCR.

Non-covalent stacking interactions directing the structural and photophysical features of mono- and dinuclear cyclometalated palladium(ii) complexes

Cyclometallated Pd(ii) complexes with different stackings show emission in solid state in relationship to them.

Kinetics of Cr(III) and Cr(VI) removal from water by two floating macrophytes

The aim of this work was to compare Cr(III) and Cr(VI) removal kinetics from water by Pistia stratiotes and Salvinia herzogii. The accumulation in plant tissues and the effects of both Cr forms on plant growth were also evaluated. Plants were exposed to 2 and 6 mg L(-1) of Cr(III) or Cr(VI) during 30 days. At the end of the experiment, Cr(VI) removal percentages were significantly lower than those obtained for Cr(III) for both macrophytes. Cr(III) removal kinetics involved a fast and a slow component. The fast component was primarily responsible for Cr(III) removal while Cr(VI) removal kinetics involved only a slow process. Cr accumulated principally in the roots. In the Cr(VI) treatments a higher translocation from roots to aerial parts than in Cr(III) treatments was observed. Both macrophytes demonstrated a high ability to remove Cr(III) but not Cr(VI). Cr(III) inhibited the growth at the highest studied concentration of both macrophytes while Cr(VI) caused senescence. These results have important implications in the use of constructed wetlands for secondary industrial wastewater treatment. Common primary treatments of effluents containing Cr(VI) consists in its reduction to Cr(III). Cr(III) concentrations in these effluents are normally below the highest studied concentrations in this work.

Clinical outcomes in a cohort of Colombian patients with rheumatoid arthritis treated with Etanar, a new biologic type rhTNFR:Fc

OBJECTIVES

To evaluate the clinical response at 12 month in a cohort of patients with rheumatoid arthritis treated with Etanar (rhTNFR:Fc), and to register the occurrence of adverse effects.

METHODS

This is a multicentre observational cohort study. It included patients over 18 years of age with an active rheumatoid arthritis diagnosis for which the treating physician had begun a treatment scheme of 25 mg of subcutaneous etanercept (Etanar ® 25 mg: biologic type rhTNFR:Fc), twice per week. Follow-up was done during 12 months, with assessments at weeks 12, 24, 36 and 48. Evaluated outcomes included tender joint count, swollen joint count, ACR20, ACR50, ACR70, HAQ and DAS28.

RESULTS

One-hundred and five (105) subjects were entered into the cohort. The median of tender and swollen joint count, ranged from 19 and 14, respectively at onset to 1 at the 12th month. By month 12, 90.5% of the subjects reached ACR20, 86% ACR50, and 65% ACR70. The median of DAS28 went from 4.7 to 2, and the median HAQ went from 1.3 to 0.2. The rate of adverse effects was 14 for every 100 persons per year. No serious adverse effects were reported. The most frequent were pruritus (5 cases), and rhinitis (3 cases).

CONCLUSIONS

After a year of following up a patient cohort treated with etanercept 25 mg twice per week, significant clinical results were observed, resulting in adequate disease control in a high percentage of patients with an adequate level of safety.

Application of viability PCR to discriminate the infectivity of hepatitis A virus in food samples

Transmitted through the fecal-oral route, the hepatitis A virus (HAV) is acquired primarily through close personal contact and foodborne transmission. HAV detection in food is mainly carried out by quantitative RT-PCR (RT-qPCR). The discrimination of infectious and inactivated viruses remains a key obstacle when using RT-qPCR to quantify enteric viruses in food samples. Initially, viability dyes, propidium monoazide (PMA) and ethidium monoazide (EMA), were evaluated for the detection and quantification of infectious HAV in lettuce wash water. Results showed that PMA combined with 0.5% Triton X-100 (Triton) was the best pretreatment to assess HAV infectivity and completely eliminated the signal of thermally inactivated HAV in lettuce wash water. This procedure was further evaluated in artificially inoculated foods (at concentrations of ca. 6×10(4), 6×10(3) and 6×10(2)TCID50) including lettuce, parsley, spinach, cockles and coquina clams. The PMA-0.5% Triton pretreatment reduced the signal of thermally inactivated HAV between 0.5 and 2 logs, in lettuce and spinach concentrates. Moreover, this pretreatment reduced the signal of inactivated HAV by more than 1.5 logs, in parsley and ten-fold diluted shellfish samples inoculated at the lowest concentration. Overall, this pretreatment (50 μM PMA-0.5% Triton) significantly reduced the detection of thermally inactivated HAV, depending on the initial virus concentration and the food matrix.

Evaluation of Natural Compounds of Plant Origin for Inactivation of Enteric Viruses

Essential oils (EOs) and some of their main compounds have demonstrated extensive antimicrobial activity in a wide range of food spoilage or pathogenic fungi, yeast and bacteria. The aim of this study was to assess the antiviral activity of Zataria multiflora Boiss. (zataria) and Origanum vulgare (oregano) EOs on hepatitis A virus (HAV) and the effect of thymol, an active compound of Thymus vulgaris and oregano, on norovirus surrogates, feline calicivirus (FCV) and murine norovirus (MNV), and HAV. Initially, each virus at titers of ca. 6 log TCID50/ml was exposed to different concentrations of natural compounds and incubated for 2 h at 37 °C. Treatment with oregano and zataria EOs resulted in slight reductions on HAV infectivity with a maximum reduction of less than 0.5 log TCID50/ml at 0.1 % zataria EO. Thymol was effective in reducing the titers of norovirus surrogates in a dose-dependent manner. Concentrations of thymol at 0.5 and 1 % reduced FCV titers to undetectable levels, while for MNV, thymol at concentrations of 1 and 2 % resulted in reductions of 1.66 and 2.45 log TCID50/ml, respectively. However, for HAV, no effect was observed at any of the concentrations tested. These results improve the knowledge about the antiviral activity of EO and their compounds and their potential in food sanitation.

The effect of carvacrol on enteric viruses

Carvacrol, a monoterpenic phenol, is said to have extensive antimicrobial activity in a wide range of food spoilage or pathogenic fungi, yeast and bacteria. The aim of this study was to assess its antiviral activity on norovirus surrogates, feline calicivirus (FCV), murine norovirus (MNV), and hepatitis A virus (HAV), as well as its potential in food applications. Initially, different concentrations of carvacrol (0.25, 0.5, 1%) were individually mixed with each virus at titers of ca. 6-7 log TCID50/ml and incubated 2h at 37°C. Carvacrol at 0.5% completely inactivated the two norovirus surrogates, whereas 1% concentration was required to achieve ca. 1 log reduction of HAV. In lettuce wash water, carvacrol efficacy on MNV was dependent on the chemical oxygen demand (COD), with no effect over 300 ppm. A 4 log reduction in FCV infectivity was observed when 0.5% carvacrol was used to sanitize lettuce wash water, regardless of COD. Carvacrol was also evaluated as a natural disinfectant of produce, showing 1% carvacrol reduced inoculated NoV surrogates titers in lettuce by 1 log after 30 min contact. These results represent a step forward in improving food safety by using carvacrol as an alternative natural additive to reduce viral contamination in the fresh vegetable industry.

Nitrogen deposition in Spain: modeled patterns and threatened habitats within the Natura 2000 network

The Mediterranean Basin presents an extraordinary biological richness but very little information is available on the threat that air pollution, and in particular reactive nitrogen (N), can pose to biodiversity and ecosystem functioning. This study represents the first approach to assess the risk of N enrichment effects on Spanish ecosystems. The suitability of EMEP and CHIMERE air quality model systems as tools to identify those areas where effects of atmospheric N deposition could be occurring was tested. For this analysis, wet deposition of NO3(-) and NH4(+) estimated with EMEP and CHIMERE model systems were compared with measured data for the period 2005-2008 obtained from different monitoring networks in Spain. Wet N deposition was acceptably predicted by both models, showing better results for oxidized than for reduced nitrogen, particularly when using CHIMERE. Both models estimated higher wet deposition values in northern and northeastern Spain, and decreasing along a NE-SW axis. Total (wet+dry) nitrogen deposition in 2008 reached maxima values of 19.4 and 23.0 kg N ha(-1) year(-1) using EMEP and CHIMERE models respectively. Total N deposition was used to estimate the exceedance of N empirical critical loads in the Natura 2000 network. Grassland habitats proved to be the most threatened group, particularly in the northern alpine area, pointing out that biodiversity conservation in these protected areas could be endangered by N deposition. Other valuable mountain ecosystems can be also threatened, indicating the need to extend atmospheric deposition monitoring networks to higher altitudes in Spain.

Are the intertidal fish highly resistant to UV-B radiation? A study based on oxidative stress in Girella laevifrons (Kyphosidae)

Sea chub, Girella laevifrons, is a coastal fish that inhabits high intertidal rockpools along the coast of Chile. The intertidal pools where the juveniles live, are an extreme environment with high levels of ultraviolet (UV) radiation, becoming harmful to the organisms, due to oxidative stress generated by reactive oxygen species. For this reason organisms develop adaptations that allow them to survive in this complex environment. The search of biomonitor species, sensitive to UV radiation is very important in aquatic ecosystems, mainly in the southern hemisphere where depletion of the ozone layer and the consequent increase of UV radiation, have become an environmental problem. The aim of this study was to evaluate the effect of ultraviolet radiation in G. laevifrons and its possible use as UV-B radiation biomonitor specie in intertidal systems, which are very important for the Chilean fisheries. The effect of UV radiation exposure on juvenile G. laevifrons was measured through oxidative stress parameters. Catalase's activity increased with the time of exposure, unlike superoxide dismutase's activity which peaked at 2h, decreasing towards the 5th hour of irradiation. The superoxide dismutase activity in muscle tissue did not show significant differences. The lipid peroxidation and DNA damage increased in relation to exposition times. Tissue muscle's DNA damage was shown only at 5h of exposure. Significant differences between the two organs in the antioxidant capacity were observed, the liver of G. laevifrons exhibited the higher antioxidant capacity. It can be concluded that this specie exhibits effective protection mechanisms against UV radiation exposure and it is not appropriate specie as a biomonitor in intertidal systems.