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

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

Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock

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

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

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

Halogens engineering-based design of agonists for boosting expression of frataxin protein in Friedreich's ataxia

OBJECTIVE

Decreased expression of the mitochondrial protein frataxin is the cause of the neurodegenerative disorder Friedreich's ataxia. In patients with cardiac disorders, the death rate of this disease is very high, up to 66%. In order to combat Friedreich ataxia, which is a potentially toxic disorder, de novo drug discovery and design have been created utilizing the approach of compound engineering with halogens. This study aimed to investigate the potential for effective treatment of Friedreich ataxia.

MATERIALS AND METHODS

The screening of twenty different agonist compounds was carried out in order to find the most promising agonist compound that may be used for molecular docking prediction against the Frataxin Protein. The compound with the lowest binding energies is then optimized by halogens. The final candidate's drug-like properties are identified through Absorption, Distribution, Metabolism, Excretion, and Toxicity (ADMET) profiling. Lipinski's rule of five was checked. Molecular dynamic stimulations were evaluated.

RESULTS

The most potent agonist compound was identified out of twenty different compounds utilizing a docking approach against the Frataxin Protein. The compound with the lowest binding energies was next subjected to optimization by halogens. The optimized agonist 9-[1-[(1S, 5R)-8, 8-dimethyl-8-azoniabicyclo[3.2.1]octan-3-yl]triazol-4-yl]fluoren-9-ol  has higher binding energy of -10.4Kcal/mol with molecular weight of 705.63 g/mol. Drug-like properties are identified through ADMET profiling, having water solubility of about -7.59, skin permeation -7.08 cm/s, bioavailability score 0.17, and high GI absorption. The candidate fulfills the Lipinski rule of five and portrays efficient molecular dynamic stimulations.

CONCLUSIONS

The selected agonist is one of the most potent compounds in increasing Frataxin protein expression. Furthermore, optimization with halogens can be a productive approach to improve the candidate's drug efficacy. The development of effective medications for the treatment of Friedreich ataxia would be aided by the results of these computational investigations.

Side chain inset of neurogenerative amino acids to metalloproteins: a therapeutic signature for huntingtin protein in Huntington's disease

OBJECTIVE

Huntington's disease is a dominant autosomal inherited neurodegenerative disease that results in progressive impairment, characterized by dementia, chorea, and behavioral and cognitive decline. The objective of this study was to investigate the potential activity of metalloproteins against the huntingtin protein using various insertion-based engineering computational methods. Metalloproteins, metal protein complexes involved in important biochemical and physiological processes, were explored as potential drug candidates for Huntington's disease.

MATERIALS AND METHODS

A total of 18 metalloproteins were selected as drug candidates and studied to assess their potential inhibitory effects on the huntingtin protein. The screening process was based on the lowest binding energy. The metalloprotein with the lowest docking score was chosen for side chain insertion of neurogenerative amino acids. The engineered metalloprotein was then evaluated based on physiochemical properties, allergenicity, toxicity, and surface accessibility. Cloning and expression analysis was performed to further investigate its potential as a therapeutic agent.

RESULTS

The metalloprotein chosen for side chain insertion, cytochrome C oxidase, showed promising results. It was computed as a probable non-allergen and exhibited no toxic domains, indicating its non-toxic nature. Additionally, it demonstrated a strong binding affinity with the huntingtin protein, with a binding energy of -1,253.3 Kcal/mol.

CONCLUSIONS

Metal-based proteins, when engineered with additional neurogenerative amino acids, hold potential as drug candidates for treating neurodegenerative diseases such as Huntington's disease. The successful development of these engineered metalloproteins could offer therapeutic advantages. Further testing, both in vitro and in vivo, is necessary to evaluate their efficacy and validate their potential activity as novel drugs for the treatment of neurodegenerative diseases.

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

Background

Non-dominant right coronary artery (RCA) occlusion is uncommon and usually affects a small area of the myocardium. Rarely, it can complicate fatal outcomes such as shock, cardiac arrest, bradyarrhythmia, or tachyarrhythmia.

Case summary

A 50-year-old man with no significant medical history presented with ventricular fibrillation (VF) cardiac arrest. He required prolonged cardiopulmonary resuscitation and multiple defibrillation shocks to achieve return of spontaneous circulation. ST elevation was noted on inferior leads. Due to refractory VF, extracorporeal membrane oxygenation (ECMO) was initiated followed by coronary angiography which demonstrated 100% acute occlusion of proximal RCA (small non-dominant), 90% stenosis of ramus intermedius (RI), and 80% stenosis of obtuse marginal (OM) arteries. Left ventricular ejection fraction was 35%. Percutaneous coronary intervention (PCI) of the RCA was performed with drug eluting stent. He had excellent clinical recovery without any neurological deficits. The ECMO was weaned off and decannulated within three days. Guideline directed medical therapy was administered. He remained hemodynamically stable and underwent staged PCI of RI and OM to achieve complete revascularization.

Discussion

Non-dominant RCA lesions are usually considered benign. However, when acute RCA occlusion results in cardiac arrest as seen in our patient, prompt revascularization is necessary. Treatment of cardiogenic shock with appropriate pharmacological and mechanical therapies is important, such as ECMO in our patient.

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

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

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

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

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

Introduction

Micronutrients such as minerals and vitamins are required in a minute quantity but play a pivotal role in the functioning of the body. Therefore, deficiency in one of them can lead to lethal health conditions. Iron deficiency anaemia is one of the most common micronutrient deficiencies across the world and is affecting women and children.

Methods

The present study aimed to investigate the anti-anaemic effect of fortified jamun leather on anaemia biomarkers and haematology in anaemic female Sprague Dawley rats. A total of 40 Sprague Dawley rats were used in 4 groups. Iron deficiency anaemia was induced by oral administration of the Asunra drug. The treatments were fed at two dosage levels i.e., 40 and 60% iron-fortified leather. All animals were treated for 60 days and the parameters including biochemical, and histopathology of the kidney and liver were examined.

Results

The experiment's findings showed that the group fed with iron-fortified leather (G₃) succeeded significantly (P < 0.05) in restoring the serum iron (98.68 ± 2.88 μg/dL), haemoglobin (12.41 ± 0.32 g/dL), ferritin (24.54 ± 1.98 ng/mL) and haematocrit levels (39.30 ± 1.66%) at the end of the 60 days period. Additionally, the treated group's mean values for transferrin and total iron binding capacity were lower than those of the anaemic rats, indicating an improvement in iron levels. The microscopic analysis revealed that treatments had no toxic effects on the kidney and liver tissues, except in the diseased group, which had necrosis and irregular cell structure.

Conclusion

Conclusively, iron-fortified jamun leather helped improve iron deficiency biomarkers and imparted a non-toxic effect on tissues in rats.

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

Background

Cardiogenic shock (CS) associated with severe mitral regurgitation (MR) forebodes a high risk of morbidity and mortality. Transcatheter edge-to-edge repair (TEER) is a rapidly evolving technique for severe MR in haemodynamically stable patients. However, the safety and efficacy of TEER for severe MR in CS are not well established.

Case summary

An 83-year-old male presented with dyspnoea and was hospitalized for heart failure. Chest X-ray revealed pulmonary oedema. Transthoracic echocardiography showed severely depressed ejection fraction (EF) with severe secondary MR. Right heart catheterization confirmed a low cardiac index. Diuretics and inotropes were administered. Due to persistent hypotension, we could not wean inotropes. The patient was deemed high risk for surgery by the heart team, and a decision was made to proceed with TEER with MitraClip. Under transoesophageal echocardiography and fluoroscopic guidance, two MitraClips were deployed sequentially. The MR grade was reduced to two mild jets subsequently. The patient was weaned off inotropes and eventually discharged. At the 30-day follow-up, he was participating in physical activities such as golf.

Discussion

Cardiogenic shock complicated by severe MR carries high mortality. With severe MR, the forward stroke volume is lower than the stated EF leading to poor organ perfusion. Inotropes and/or mechanical circulatory support devices are paramount for initial stabilization; however, they do not treat underlying MR. Transcatheter edge-to-edge repair with MitraClip has been shown to improve survival in CS patients with severe MR in observational studies. However, prospective trials are lacking. Our case demonstrates the utility of MitraClip to treat severe secondary MR refractory to medical therapy in a CS patient. The heart team must evaluate risks and benefits of this therapy in CS patients.

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

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

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

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

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

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

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

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

Abstract 199: Use Of Hybrid Veno-venous-pulmonary Artery ECMO In A Patient With Respiratory Failure Secondary To COVID-19

Background: Extracorporeal membrane oxygenation (ECMO) is a form of cardio-pulmonary life support used for patients with respiratory and/or cardiac failure. Hybrid ECMO is a sophisticated circuit to match the exact hemodynamic demands in patients who are refractory to traditional ECMO settings.

Case: A 43-year-old male presented with dyspnea for four days. On physical examination, he exhibited increased work of breathing and decreased breath sounds bilaterally. Pulse oximetry was 70% on room air, minimally improved to 75% on maximum high flow nasal cannula. He was found to be COVID-19 positive and demonstrated diffuse bilateral lung consolidation on CT chest consistent with severe acute respiratory distress syndrome. Patient was intubated but continued to show poor oxygenation with P/F ratio of 71 (Normal: >400). Veno-Venous (VV) ECMO was started with cannulations into the right femoral vein (RFV) and right internal jugular vein (RIJV); this resulted in an initial improvement of partial pressure of oxygen (pO2) in arterial blood gas. However, within a few days, pO2 started to decrease with visual evidence of recirculation of oxygenated blood into the venous drainage line. A transthoracic echocardiography revealed severe pulmonary artery (PA) hypertension secondary to respiratory failure with PA pressure of 116mmHg (Normal: 18-25mmHg). This prompted a revision of the ECMO circuit to offload the right ventricle. Revised circuit included a cannula in the RFV for venous drainage and oxygenated venous return through two pathways: cannula in the RIJV (approximately 1 liter return), and a third cannula inserted through the left subclavian vein terminating into the main PA (approximately 4 liters return). Hereon, patient was able to maintain adequate pO2 for the remainder of his hospital stay until he was transferred to a lung transplant center.

Conclusion: Our case illustrates the clinical sophistication of hybrid VV-PA ECMO - especially in patients with PA hypertension and impending right-sided heart failure. As respiratory failure secondary to COVID-19 becomes more prevalent, hybrid ECMO may provide a practical solution to protect the right heart in the journey to lung transplant.

Abstract 198: Cardiovascular Outcomes, Behavioral Risk Factors, And Health Insurance In Transgender Population In The United States Of America: Analysis From The 2020 Behavioral Risk Factor Surveillance Survey

Background: There is paucity of clinical data regarding the health and cardiovascular (CV) outcomes of transgender (TG) population. Our aim was to determine the association of CV outcomes (and behavioral risk factors) with being TG in the USA.

Methods: We utilized Centers for Disease Control's Behavioral Risk Factor Surveillance Survey (BRFSS) 2020 to determine responders who identified as TG. Non-TG (Cis gender) were also identified and used as controls. Behavioral risk factors such as history of smoking, lack of exercise, and heavy alcohol consumption (adult men having >14 drinks/week and adult women having >7 drinks/week) were measured. CV outcomes such as stroke, myocardial infarction (MI) and stable angina (SA) were noted. Lack of health insurance and college education were also analyzed. Data was studied in STATA 15 and multivariate logistic regression was used to estimate adjusted odds ratios (AOR) reported with p-value (significance=<0.05).

Results: There were 401,958 individuals in this survey. 1017 (0.25%) and 235887 (58.7%) were TG and cis genders respectively. There was a significant association of being TG and reporting stroke (AOR 1.87, [1.71-1.92], p=0.002) and MI (AOR 1.45, [1.39-1.55], p=0.003) compared to Cis genders. Association of TG population with reporting SA was statistically insignificant (p=0.66). TG group was also more likely to not have exercised in the past 30 days (AOR 2.71, [2.51-2.89], p=0.009). Heavy alcohol consumption in past 30 days was significantly higher in TG group (AOR 1.36, [1.21-1.44], P=0.002) compared to Cis genders. There was no significant association of smoking noted (p=0.5). TG population had higher odds of reporting depression (AOR 1.53, [1.50-1.61], p<0.001) compared to Cis genders. They were also more likely to not have health insurance (AOR 0.44, [0.36-0.71], p<0.002), and lack college education (AOR 0.53, [0.50-0.81], p<0.003).

Conclusion: Transgender population reports higher rates of cardiovascular diseases (stroke and MI), depressive disorder and heavy alcohol consumption. They are also more likely to not exercise, lack basic health insurance and college education contributing to worse clinical outcomes.

Sjogren syndrome presenting as atrioventricular block in an adult

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

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

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

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

Background

The presence of bifascicular block on electrocardiography suggests that otherwise-unexplained syncope may be due to complete heart block. European Society of Cardiology (ESC) recommends investigating it with electrophysiology study (EPS). PPM is indicated if high-degree atrioventricular block is inducible. Long term rhythm monitoring with implantable loop recorder (ILR) is recommended if EPS is negative. We evaluated adherence to these guidelines.

Methods

This is a single-center retrospective audit of adult patients with bifascicular block hospitalized for unexplained syncope between January 2018 and August 2019 under general medicine service. Patients with an alternative explanation for syncope were excluded. Guideline adherence was assessed by formal cardiology consult and whether EPS followed by ILR and/or PPM were offered.

Results

65 out of 580 adult patients (11.2%) admitted to general medicine service for syncope had a bifascicular block; 29 (5%) were identified to have bifascicular block and unexplained syncope. Median age was 77 ±10 years; 9 (31%) were female, and 6 (20.7%) patients had at least one prior hospital visit for syncope at our academic medical center. Cardiology was consulted on 17 (58.6%) patients. Two patients were evaluated by EPS (1 refused) followed by ILR. Overall, 3 out of 29 patients (10.3%) received guideline-directed evaluation during the hospitalization based on ESC guidelines. None of the patients received empiric PPM during the index hospitalization.

Conclusion

Among patients admitted to the general medicine service with unexplained syncope and bifascicular block, a minority (10.3%) underwent guideline-directed evaluation per ESC recommendations. Cardiology was consulted in 58.6% of cases.

Clinical predictors of symptom improvement failure in gastroparesis

Background

Methods

Results

Conclusions

An Intricate Review on Nutritional and Analytical Profiling of Coconut, Flaxseed, Olive, and Sunflower Oil Blends

Vegetable oils (VOs), being our major dietary fat source, play a vital role in nourishment. Different VOs have highly contrasting fatty acid (FA) profiles and hence possess varying levels of health protectiveness. Consumption of a single VO cannot meet the recommended allowances of various FA either from saturated FA (SFA), monounsaturated FA (MUFA), polyunsaturated FA (PUFA), Ω-3 PUFAs, and medium-chain triglycerides (MCTs). Coconut oil (CO), flaxseed oil (FO), olive oil (OO), and sunflower oil (SFO) are among the top listed contrast VOs that are highly appreciated based on their rich contents of SFAs, Ω-3 PUFAs, MUFAs, and Ω-6 PUFA, respectively. Besides being protective against various disease biomarkers, these contrasting VOs are still inappropriate when consumed alone in 100% of daily fat recommendations. This review compiles the available data on blending of such contrasting VOs into single tailored blended oil (BO) with suitable FA composition to meet the recommended levels of SFA, MUFA, PUFA, MCTs, and Ω-3 to Ω-6 PUFA ratios which could ultimately serve as a cost-effective dietary intervention towards the health protectiveness and improvement of the whole population in general. The blending of any two or more VOs from CO, FO, OO, and SFO in the form of binary, ternary, or another type of blending was found to be very conclusive towards balancing FA composition; enhancing physiochemical and stability properties; and promising the therapeutic protectiveness of the resultant BOs.

An overview of chia seed (Salvia hispanica L.) bioactive peptides' derivation and utilization as an emerging nutraceutical food

Chia (S. hispanica L.) is an annual herbaceous plant that has gained popularity for its seeds of high-quality vegetative proteins, richest contents of omega-3 polyunsaturated fatty acids (Ω-3 PUFA), soluble dietary fiber, and great gelling ability, as well as its high contents of bioactive peptides of antioxidative and nutraceutical potential for many other clinical biomarkers. Such health protective bioactive peptides should be utilized for supplementation in the food and nutrition industries. This review was therefore designed to align the researches done on chia bioactive peptide's derivation, processing, consumption and to identify their antioxidative and nutraceutical potential for various disease biomarkers. The evidence gathered is fairly compelling for the health-promising nutraceutical and clinical potential of chia seed bioactive peptides as antioxidants, dipeptidyl peptidase-IV inhibitors (DPP4), angiotensin-converting enzyme (ACE) inhibitors, and anti-inflammatory drugs. Their assimilation into everyday diets has the potential to open new doors in health departments and food sectors.

Nutritional and lifestyle changes required for minimizing the recovery period in home quarantined COVID-19 patients of Punjab, Pakistan

The COVID-19 pandemic has introduced a new battle in human history for a safe and fearless life. Therefore, this cross-sectional survey was conducted (Punjab, Pakistan) on healthy recovered, home quarantined COVID-19 patients to draw conclusive health support guidelines in the fight against this pandemic. COVID-19 recovered patients (n = 80) of age ≥14 years were randomly selected during the period November 2020 to February 2021. A nutrition and lifestyle changes questionnaire, containing ten sections and seventy questions, was completed through the telephone/WhatsApp. Data were transferred into an Excel spreadsheet and statistically analyzed by applying chi-square, correlation, and a t test of independent values using SPSS-16 software. The patients had an age range of 14 to 80 years, of which 52 (65%) were male and 28 (35%) were female, and 32 (40%) had a normal BMI. The patients had a peak COVID-19 recovery period of 2 weeks, and a mean recovery period of 2.8 ± 1.4 weeks. Certain variables, including gender (males), age (>40 years), sleep (≤5 hr), less/no physical activity, obesity, diabetes mellitus, and autoimmune diseases, were significantly associated with delayed recovery. Poor nutritional outcomes, including lower intakes of water, legumes, nuts, meat, and milk/yogurt; and higher consumption of fast/fried/junk/spicy foods and cold water/drinks, were also significantly associated with a longer recovery period. The results were similar for not taking daily doses of multivitamins, and vitamins C, D, E, and zinc. This study identified that staying physically active, maintaining sensible body weight, having a sleep of 7 hr, consuming more foods of plant origin especially plant-based proteins from nuts and legumes, taking supplemental doses of multivitamins, vitamin D, E, and zinc, along with drinking ≥2 L of water daily can provide a significant role in early and safe recovery from COVID-19.

Cereal processing waste, an environmental impact and value addition perspectives: A comprehensive treatise

This review is to describe various methods used for the treatment of cereal processing wastes and their efficiency to reduce environmental issues. Physico-chemical and biological methods have great potential for the treatment of cereal industrial waste. These methods can be used alone or in combination with effective treatment. Physico-chemical treatments are mostly employed for the pretreatment of cereal processing wastes that helps in reduced sludge formation during biological treatments. Biological treatments are mostly used owing to their high efficiency in removing pollutants, and less expensive than physico-chemical treatments. However, these treatments consume more time as compared to physico-chemical treatments. These treatments also proved to be efficient for a high rate of cereal waste conversion into value-added products. Thus, cereal industrial waste can result in value-added products such as biohydrogen, bioethanol, butanol, biogas and biocoal as biofuels, industrial valued enzymes, biomass, biofertilizer, proteins, organic acids, polysaccharides and few others.

Stabilization and attributive amelioration of sugarcane juice by naturally derived preservatives using aonla and moringa extract

Sugarcane juice (SCJ) is a cheap, popular, and very nutritious beverage served at roadside stalls in many countries during harvesting season. The juice is normally consumed immediately after extraction as fermentation sets within a few hours of extraction. Preserving the raw sugarcane juice is always challenging because it spoils within a few hours of extraction due to fermentation. Therefore, the bottling, distribution, and marketing of sugarcane are difficult tasks. The present study was designed to investigate the effect of naturally derived preservatives using aonla extract (AE) and moringa extract (ME) in different proportions (0%, 3%, 5%, and 7%) for the preservation of SCJ during 21 days of the storage period at 4 ± 2°C temperature. The effect of extracts and storage time were analyzed on physicochemical parameters, bioactive compounds, enzymatic, microbiological, and sensory analyses of SCJ. A significant improvement in pH of 5% AE (5.30 ± 0.06) and 5% ME (5.36 ± 0.02) was observed at 21 days as compared to control (5.89 ± 0.02). The total phenolic contents in 7% ME were also observed to be retained (4.4 ± 0.02 mg GAE/mL) at 21 days as compared to control (2.65 ± 0.03 mg GAE/mL). Other physicochemical and phytochemical analyses including titratable acidity, total soluble solids, total flavonoids, ascorbic acid, 2,2-Diphenyl-2-picrylhydrazyl (DPPH), and ferric reducing antioxidant power assay (FRAP) also indicated that SCJ treated with ME was significantly stable (p < .05) regarding quality parameters, nutritional and sensory attributes at different storage intervals. These findings may be practical for the large-scale production, storage, and marketing of SCJ products.

Geographical Differences in Cardiovascular Comorbidities and Outcomes of COVID-19 Hospitalized Patients in the USA

Introduction

Cardiovascular comorbidities may predispose to adverse outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19). However, across the USA, the burden of cardiovascular comorbidities varies significantly. Whether clinical outcomes of hospitalized patients with COVID-19 differ between regions has not yet been studied systematically. Here, we report differences in underlying cardiovascular comorbidities and clinical outcomes of patients hospitalized with COVID-19 in Texas and in New York state.

Methods

We established a multicenter retrospective registry including patients hospitalized with COVID-19 between March 15 and July 12, 2020. Demographic and clinical data were manually retrieved from electronic medical records. We focused on the following outcomes: mortality, need for pharmacologic circulatory support, need for mechanical ventilation, and need for hemodialysis. Univariate and multivariate logistic regression analyses were performed.

Results

Patients in the Texas cohort (n = 296) were younger (57 vs. 63 years, p value <0.001), they had a higher BMI (30.3 kg/m² vs. 28.5 kg/m², p = 0.015), and they had higher rates of diabetes mellitus (41 vs. 30%; p = 0.014). In contrast, patients in the New York state cohort (n = 218) had higher rates of coronary artery disease (19 vs. 10%, p = 0.005) and atrial fibrillation (11 vs. 5%, p = 0.012). Pharmacologic circulatory support, mechanical ventilation, and hemodialysis were more frequent in the Texas cohort (21 vs. 13%, p = 0.020; 30 vs. 12%, p < 0.001; and 11 vs. 5%, p = 0.009, respectively). In-hospital mortality was similar between the 2 cohorts (16 vs. 18%, p = 0.469). After adjusting for differences in underlying comorbidities, only the use of mechanical ventilation remained significantly higher in the participating Texas hospitals (odds ratios [95% CI]: 3.88 [1.23, 12.24]). Median time to pharmacologic circulatory support was 8 days (interquartile range: 2, 13.8) in the Texas cohort compared to 1 day (0, 3) in the New York state cohort, while median time to in-hospital mortality was 16 days (10, 25.5) and 7 days (4, 14), respectively (both p < 0.001). In-hospital mortality was higher in the late versus the early study phase in the New York state cohort (24 vs. 14%, p = 0.050), while it was similar between the 2 phases in the Texas cohort (16 vs. 15%, p = 0.741).

Conclusions

Geographical differences, including practice pattern variations and the impact of disease burden on provision of health care, are important for the evaluation of COVID-19 outcomes. Unadjusted data may cause bias affecting future regulatory policies and proper allocation of resources.

Characterization of peanut seed oil of selected varieties and its application in the cereal-based product

Peanut (Arachis hypogaea) is an important oilseed crop of the world. Peanut seed oil (PSO) contains linolenic acid, oleic acid, also a good source of omega-6 fatty acids and omega-3 fatty acids. It contains an abundant amount of vitamin E which also act as an antioxidant. The research work was carried out to estimate the suitability of utilization of peanut oil from different available peanut varieties, i.e., Bari 2001, Bari 2011 in cereal-based products. The main objective of the study is the characterization of peanut seed oil acquired from Bari 2001 and 2011 variety, and explored its application in cookies and shelf life of the product. The purpose of the study is to determine the oil contents and characterization, its application in cookies and shelf life of the product. The data thus collected was analyzed by applying standard statistical procedures. Peroxide, saponification, and free fatty acids in Bari 2001 and Bari 2011 were 1.51 ± 0.09 meq O₂/kg and 1.47 ± 0.07 meq O₂/kg, 195.81 ± 2.47 mgKOH/g and 191.60 ± 2.66 mgKOH/g and 0.96 ± 0.07% and 0.91 ± 0.04% respectively. Cookies were prepared by incorporating PSO oil (Bari 2011) at concentrations of 5% (FC₁), 10% (FC₂), 15% (FC₃), 20% (FC₄), 25% (FC₅) and along with control (FC₀). Storage study (60 days) assessed the quality, sensory evaluation and oxidative stability of products in order of most suitable to least accepted as FC₃ > FC₄ > FC₅ > FC₁ > FC₂ > FC_0. The cookies produced by 15% replacement peanut seed oil resulted in an acceptable product.

Cysteine and homocysteine as biomarker of various diseases

Cysteine and homocysteine (Hcy), both sulfur-containing amino acids (AAs), produced from methionine another sulfur-containing amino acid, which is converted to Hcy and further converted to cysteine. This article aims to highlight the link between cysteine and Hcy, and their mechanisms, important functions, play in the body and their role as a biomarker for various types of diseases. So that using cysteine and Hcy as a biomarker, we can prevent and diagnose many diseases. This review concluded that hyperhomocysteinemia (elevated levels of homocysteine) is considered as toxic for cells and is associated with different health problems. Hyperhomocysteinemia and low levels of cysteine associated with various diseases like cardiovascular diseases (CVD), ischemic stroke, neurological disorders, diabetes, cancer like lung and colorectal cancer, renal dysfunction-linked conditions, and vitiligo.

Functional food and nutra-pharmaceutical perspectives of date (Phoenix dactylifera L.) fruit

Date palm counts among the oldest fruit crops of the world and is mainly cultivated for its highly nutritious fruits consumed as a staple food in many countries, especially in the Gulf region. Dates are enriched with numerous therapeutic bioactives and functional compounds such as phenolics, flavonols, carotenoids, minerals, and vitamins that not only provide an appreciable amount of energy required for the human body but also act as an effective therapeutic agent against several diseases. This review aimed to provide a deep insight into the nutritional as well as phytochemicals profile of date fruit and its seeds in order to explore their biological (anti-cancer, anti-diabetic, cardio-protective, anti-inflammatory properties), functional food, and nutra-pharmaceutical attributes. PRACTICAL APPLICATIONS: This review provides updated information regarding the date fruits and seeds phytochemicals composition together with highlighting dates potential as a natural therapeutic agent against several diseases. The study also urges the importance of consuming dates as a great package to live a healthy life due to the functional food and nutraceutical properties of this valuable fruit. The study also provides information first time as recommending dates to cope with the hidden hunger or micronutrient deficiency faced by the third world inhabitants. Hence, the review may further help the industry and researchers to explore the potential of dates for future medicinal and nutra-pharmaceutical applications.

Is our initial evaluation of patients admitted for syncope guideline-directed and cost-effective?

Introduction

Recent American College of Cardiology and European Society of Cardiology guidelines for syncope evaluation help distinguish high-cardiac risk patients from those with low-risk orthostatic and neurogenic syncope. Inpatient evaluation is recommended if at least one high-risk feature is present.

Objective

To assess guideline adherence and its impact on hospitalization in patients who presented with syncope before and after the introduction of guideline-based syncope protocol in the emergency department (ED).

Methods

All adult patients admitted to general medicine from the ED with the primary diagnosis of syncope in the months of October 2016 and October 2018 (before and after the introduction of syncope protocol in 2017). Electronic charts were retrospectively reviewed for high-risk cardiac features and orthostatic blood pressure measurement.

Results

Sixty patients were admitted for syncope in October 2016 (n = 32) and October 2018 (n = 28), out of which 33 (55%) were female and 47 (78.3%) were over age 50. Forty-five patients had at least one high-risk feature. Excluding one patient with an alternate diagnosis at discharge, 14 out of 60 patients (23.3%) admitted for syncope did not have any high-risk feature. Orthostatic blood pressure was measured in 3 patients (5%) in the ED and 27 patients (45%) later in the hospitalization. Six out of eight patients with implanted cardioverter-defibrillator or pacemaker had their devices interrogated. After the introduction of syncope protocol, there was an improvement in the proportion of high-risk patients admitted [68.7% (22/32) in October 2016 vs. 82.1% (23/28) in October 2018].

Conclusion

Utilizing syncope protocol in the ED may improve guideline adherence, direct appropriate disposition, and reduce healthcare expenses.