Chinese guideline for diagnosis and management of drug-induced liver injury (2023 version) / 中华肝脏病杂志

Drug-induced liver injury (DILI) is an important adverse drug reaction that can lead to acute liver failure or even death in severe cases. Currently, the diagnosis of DILI still follows the strategy of exclusion. Therefore, a detailed history taking and a thorough and careful exclusion of other potential causes of liver injury is the key to correct diagnosis. This guideline was developed based on evidence-based medicine provided by the latest research advances and aims to provide professional guidance to clinicians on how to identify suspected DILI timely and standardize the diagnosis and management in clinical practice. Based on the clinical settings in China, the guideline also specifically focused on DILI in chronic liver disease, drug-induced viral hepatitis reactivation, common causing agents of DILI (herbal and dietary supplements, anti-tuberculosis drugs, anti-neoplastic drugs), and signal and assessment of DILI in clinical trials.

Interpretation on Consensus on drug-induced liver injury by CIOMS Working Group:liver injury attributed to herbal and dietary supplements / 中国中药杂志

With the increase in the medical level, the improvement of adverse drug reaction(ADR) monitoring systems, and the enhancement of public awareness of safe medication, drug safety incidents have been frequently reported. Drug-induced liver injury(DILI), especially liver injury attributed to herbal and dietary supplements(HDS), has globally attracted high attention, bringing great threats and severe challenges to the people for drug safety management such as clinical medication and medical supervision. Consensus on drug-induced liver injury had been published by the Council for International Organizations of Medical Sciences(CIOMS) in 2020. In this consensus, liver injury attributed to HDS was included in a special chapter for the first time. The hot topics, including the definition of HDS-induced liver injury, epidemiological history, potential risk factors, collection of related risk signals, causality assessment, risk prevention, control and management were discussed from a global perspective. Based on the previous works, some experts from China were invited by CIOMS to undertake the compilation of this chapter. Meanwhile, a new causality assessment in DILI based on the integrated evidence chain(iEC) method was widely recognized by experts in China and abroad, and was recommended by this consensus. This paper briefly introduced the main contents, background, and characteristics of the Consensus on drug-induced liver injury. Significantly, a brief interpretation was illustrated to analyze the special highlights of Chapter 8, "Liver injury attributed to HDS", so as to provide practical references for the medical staff and the researchers who worked on either Chinese or Western medicine in China.

Efficacy of intermittent iron supplementation in children with mild iron-deficiency anemia / 中国当代儿科杂志

OBJECTIVES@#To study the efficacy of intermittent iron supplementation in children with mild iron-deficiency anemia.@*METHODS@#A total of 147 children with mild iron-deficiency anemia were enrolled in this prospective study. They were divided into an intermittent iron supplementation group (n=83) and a conventional iron supplementation group (n=64). The levels of hemoglobin were measured before treatment and after 1 and 3 months of treatment. The treat response rate and the incidence rate of adverse drug reactions were compared between the two groups.@*RESULTS@#Both groups had a significant increase in the level of hemoglobin after iron supplementation (P<0.05). After 1 month of treatment, the conventional iron supplementation group had a significantly higher treatment response rate than the intermittent iron supplementation group (61% vs 42%, P<0.05). After 3 months of treatment, there was no significant difference in the treatment response between the two groups (86% vs 78%, P>0.05). The incidence rate of adverse drug reactions in the conventional iron supplementation group was significantly higher than that in the intermittent iron supplementation group (25% vs 8%, P<0.05).@*CONCLUSIONS@#For children with mild iron-deficiency anemia, although intermittent iron supplementation is inferior to conventional iron supplementation in the short-term efficacy, there is no significant difference in the long-term efficacy between the two methods, and compared with conventional iron supplementation, intermittent iron supplementation can reduce the incidence of adverse drug reactions, alleviate family financial burdens, and improve treatment compliance of children, thus holding promise for clinical application.

Espirulina como producto natural con potencialidades para su empleo en pacientes con diabetes mellitus / Spirulina as a natural product with potentials for its use in patients with diabetes mellitus

Introducción: La Spirulina platensis es una cianobacteria planctónica filamentosa, que contiene un espectro natural de mezclas de pigmentos de caroteno, xantofila y ficocianina, con actividad antioxidante y la posibilidad de inducir un mejor control de la glucemia en las personas con diabetes mellitus. Objetivo: Describir los efectos del uso del producto logrado a partir de la bacteria Spirulina platensis en el paciente con diabetes mellitus. Método: Se utilizaron como buscadores de información científica a PubMed, SciELO, Google y Google Académico. Las palabras claves utilizadas fueron: espirulina, Spirulina platensis, Arthrospira platensis, diabetes mellitus y control metabólico. Se evaluaron artículos de revisión, de investigación y páginas web que, en general, tenían menos de 10 años de publicados en idioma español, portugués e inglés, cuyos títulos estaban relacionados con el tema de estudio. Se obtuvieron 70 referencias bibliográficas, de las cuales 49 se citaron en el presente artículo. Conclusiones: La espirulina tiene varios efectos benéficos que permiten su uso como coadyuvante en la prevención y tratamiento de la diabetes mellitus. Es un nutriente con bondades nutraceúticas y funcionales, con potente actividad antioxidante, que incide en un mejor control glucémico y puede ser útil en el manejo de las posibles complicaciones y comorbilidades que acompañan a la diabetes mellitus. Su uso conlleva la posibilidad de algunas reacciones adversas, sobre todo de tipo digestivas, aunque no son frecuentes si se emplean las dosis recomendadas; en general, es considerada un producto seguro(AU)

Introduction: Spirulina platensis is a plankton filamentous cyanobacteria that has a natural spectrum of carotene, xanthophyll and phycocyanin pigments´mix, with antioxidant activity and the possibility of inducing a better control of glycemia in patients with diabetes mellitus. Objective: Describe the effects of the use in patients with diabetes mellitus of a product made from Spirulina platensis bacteria. Method: There were used as scientific information searchers: PubMed, SciELO, Google and Google Scholar. The keywords used were: Spirulina, Spirulina platensis, Arthrospira platensis, diabetes mellitus and metabolic control. There were assessed review articles, research articles and web pages, that in general had less than 10 years of being published in Spanish, Portuguese or English language, and whose titles were related with the studied topic. 70 bibliographic references were collected, and 49 of them were quoted in this article. Conclusions: Spirulina has different beneficial effects that allow its use as coadjuvant agent in the prevention and treatment of diabetes mellitus. It is a nutrient with functional and nutraceutical mildness, with a powerful antioxidant activity which has incidence in a better glycemic control and can be useful in the management of possible complications and comorbidities that accompany diabetes mellitus. Its use entails the possible adverse reactions, mainly digestive ones; although they are not frequent if the recommended doses are used. In general terms, it is considered a safe product(AU)

Excessive prenatal supplementation of iodine and fetal goiter: report of two cases using three-dimensional ultrasound and magnetic resonance imaging / Suplementação pré-natal excessiva de iodo e bócio fetal: Relato de dois casos utilizando ultrassonografia tridimensional e ressonância magnética

Abstract Fetal thyroid complications in pregnancy are uncommon, and are commonly related to the passage of substances through the placenta. The excessive iodine intake during the pregnancy is a well-known mechanism of fetal thyroid enlargement or goiter, and invasive procedures have been proposed for the treatment of fetal thyroid pathologies. In the present report, we demonstrate two cases from different centers of prenatal diagnosis of fetal thyroid enlargement and/or goiter in three fetuses (one pair of twins, wherein both fetuses were affected, and one singleton pregnancy). The anamnesis revealed the ingestion of iodine by the patients, prescribed from inadequate vitamin supplementation. In both cases, the cessation of iodine supplement intake resulted in a marked reduction of the volume of the fetal thyroid glands, demonstrating that conservative treatmentmay be an option in those cases. Also, clinicians must be aware that patients may be exposed to harmful dosages or substances during pregnancy.

Resumo As complicações fetais da tireoide na gravidez são incomuns e são comumente relacionadas à passagem de substâncias pela placenta. A ingestão excessiva de iodo durante a gravidez é um mecanismo bem conhecido de aumento da tireoide ou bócio fetal, e procedimentos invasivos foram propostos para o tratamento de patologias da tireoide fetal. No presente relato de caso, demonstramos dois casos de diferentes centros de diagnóstico pré-natal de aumento da tireoide fetal e/ou bócio em três fetos (um par de gêmeos, em que ambos os fetos foram afetados, e uma gravidez única). A anamnese revelou a ingestão de iodo pelos pacientes prescrita por suplementação inadequada de vitaminas. Nos dois casos, a interrupção da ingestão de suplemento de iodo resultou em uma redução acentuada do volume das glândulas tireoides fetais, demonstrando que o tratamento conservador pode ser uma opção nestes casos. Além disso, os médicos devem estar cientes de que as pacientes podem ser expostas a doses ou substâncias nocivas durante a gravidez.

Suplementos alimentares e práticas corporais: a emergência da análise antropológica para a intervenção profissional em saúde / Dietary supplements and body practices: the emergence of anthropological analysis for professional health intervention

Na seara de estudos do campo das Ciências Humanas e Sociais em Alimentação, o presente manuscrito problematiza os usos de suplementos alimentares como uma construção socio-cultural no contexto das práticas corporais. Do mesmo modo que o ato de "comer" pode ser compreendido especificamente a partir de determinados grupos sociais em dado tempo histórico, este ensaio discute a relevância do campo antropológico para análise das condi-ções materiais e simbólicas do "tomar" suplementos alimentares por praticantes da cultura fit. Assim, com base em uma revisão narrativa, objetiva-se analisar e discutir a emergência da análise antropológica para a compreensão das relações entre práticas corporais e suple-mentos alimentares, especialmente para a intervenção profissional em saúde. Em termos gerais, optou-se por delinear quatro eixos argumentativos no sentido de sustentar o poten-cial teórico-metodológico da Antropologia para a sensibilização do ofício laboral em saúde no que diz respeito a esses produtos. Em síntese, foi possível considerar que a ingestão dessas substâncias pelos sujeitos revela experiências e vivências sociais que podem ser mo-duladas, articuladas, interpretadas e incorporadas à prescrição ou à orientação nos consul-tórios ou nos espaços de práticas corporais. Conclui-se que, diante do aumento do mercado consumidor desses produtos, há a necessidade de defender uma intervenção profissional dialógica, afetiva, sensível, integral, crítica, reflexiva, emancipada e, sobretudo, humana sobre o processo de suplementação.

In the field of studies of the Humanities and Social Sciences on Food, this manuscript problematizes the uses of dietary supplements as a sociocultural construction in the con-text of body practices. In the same way that the behavior of "eating" can be understood specifically from particular social groups in a given historical time, this essay discusses the relevance of the anthropological field for the analysis of the material and symbolic conditions of "taking" dietary supplements by practitioners of the fit culture. Thus, ba-sed on a narrative review, this manuscript aimed to analyze and discuss the emergence of the anthropological analysis to understand the relationships between body practices and dietary supplements, especially for professional health intervention. In general terms, this manuscript selected four arguments to support the theoretical and methodological poten-tial of Anthropology for the health work profession regarding these products. In summary, this text considered that these substances intake reveals social experiences and practices that can be modulated, articulated, interpreted, and incorporated into the prescription or guidance in clinics or in the spaces of body practices. The study concludes that, due to the increase in the consumer market for these products, there is a need to defend a dialogical, affective, sensitive, integral, critical, reflective, emancipated professional intervention and, above all, human intervention on the supplementation process.

Calcium supplementation and cardiovascular disease in postmenopausal women: a study in South Brazil / Suplementação de cálcio e doença cardiovascular em mulheres na pós-menopausa: um estudo no Sul do Brasil

Objective: To evaluate the link between calcium supplementa- tion and cardiovascular disease in postmenopausal women (aged 55 years or older). Methods: A standardized questionnaire was employed to collect data about calcium supplements, eart di- sease, and demographic of women attended at Primary Care in the South Region of Brazil. Generalized linear regression models were performed to evaluate the association and adjust for poten- tial confounders. Results: Overall, 1,057 women completed the questionnaire. Information about calcium supplementation was present in 1,035 questionnaires. The mean ± standard deviation of the age of participants was 67.2±7.6 years. The frequency of calcium supplementation was 18.6%. There was no association between heart failure, stroke, and ischemic heart disease and cal- cium supplementation (prevalence ratio; 95% confidence interval of 0.3; -0.9-0.4, -0.2; -0.8-0.4 and -0.5; -1.0-0.02, respectively. Con- clusions: Our study did not find an association of higher risk of cardiovascular disease in women using calcium supplementation at Primary Care in South Brazil.

Objetivo: Avaliar a ligação entre a suplementação de cálcio e doença cardiovascular em mulheres na pós-menopausa (com 55 anos ou mais). Métodos: Um questionário padronizado foi em- pregado para coletar dados sobre suplementos de cálcio, doenças cardíacas e demográficos de mulheres que frequentavam a Aten- ção Primária na Região Sul do Brasil. Modelos de regressão linear generalizada foram realizados para avaliar a associação e ajustar os potenciais fatores de confusão. Resultados: No total, 1.057 mulheres responderam ao questionário. As informações sobre su- plementação de cálcio estavam presentes em 1.035 questionários. A média ± desvio-padrão da idade dos participantes foi de 67,2 ± 7,6 anos. A frequência de suplementação de cálcio foi de 18,6%. Não houve associação entre insuficiência cardíaca, acidente vas- cular cerebral e doença cardíaca isquêmica e suplementação de cálcio (razão de prevalência; intervalo de confiança de 95% de -0,3; -0,9-0,4, -0,2; -0,8-0,4 e -0,5; -1,0-0,02, respectivamente). Con- clusão: Nosso estudo não encontrou associação de maior risco de doença cardiovascular em mulheres em uso de suplementação de cálcio na Atenção Primária no Sul do Brasil.

Gut microbiota and the use of probiotics in constipation in children and adolescents: systematic review / Microbiota intestinal e emprego dos probióticos na constipação intestinal em crianças e adolescentes: revisão sistemática

ABSTRACT Objective: To perform a systematic review of literature data on gut microbiota and the efficacy of probiotics for the treatment of constipation in children and adolescents. Data source: The research was performed in the PubMed, the Scientific Electronic Library Online (SciELO) and the Latin American and Caribbean Health Sciences Literature (LILACS) databases in English, Portuguese and Spanish. All original articles that mentioned the evaluation of the gut microbiota or the use of probiotics in children with constipation in their title and abstract were selected. Data synthesis: 559 articles were found, 47 of which were selected for reading. From these, 12 articles were included; they studied children and adolescents divided into two categories: a gut microbiota evaluation (n=4) and an evaluation of the use of probiotics in constipation therapy (n=8). The four papers that analyzed fecal microbiota used different laboratory methodologies. No typical pattern of gut microbiota was found. Regarding treatment, eight clinical trials with heterogeneous methodologies were found. Fifteen strains of probiotics were evaluated and only one was analyzed in more than one article. Irregular beneficial effects of probiotics have been demonstrated in some manifestations of constipation (bowel frequency or consistency of stool or abdominal pain or pain during a bowel movement or flatulence). In one clinical trial, a complete control of constipation without the use of laxatives was obtained. Conclusions: There is no specific pattern of fecal microbiota abnormalities in constipation. Despite the probiotics' positive effects on certain characteristics of the intestinal habitat, there is still no evidence to recommend it in the treatment of constipation in pediatrics.

RESUMO Objetivo: Realizar revisão sistemática dos dados da literatura sobre a microbiota intestinal e a eficácia dos probióticos para o tratamento da constipação intestinal em crianças e adolescentes. Fonte de dados: Foi realizada busca nas bases de dados PubMed, Scientific Electronic Library Online (SciELO) e Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), em inglês, português e espanhol. Foram selecionados, pelo título e pelo resumo, todos os artigos originais que avaliaram a microbiota intestinal ou o emprego de probióticos em crianças com constipação intestinal. Síntese dos dados: Foram encontrados 559 artigos, dos quais 47 foram selecionados para leitura. Destes, foram incluídos 12 artigos que estudaram crianças e adolescentes distribuídos em duas categorias: avaliação da microbiota intestinal (n=4) e avaliação do emprego dos probióticos na terapêutica da constipação intestinal (n=8). Os quatro artigos que analisaram a microbiota fecal utilizaram metodologias laboratoriais diferentes. Não foi observado um padrão típico de microbiota intestinal. Quanto ao tratamento, foram encontrados oito ensaios clínicos com metodologias heterogêneas. Foram avaliadas 15 cepas de probióticos e apenas uma foi avaliada em mais de um artigo. Foram evidenciados efeitos benéficos não uniformes dos probióticos em algumas manifestações da constipação intestinal (frequência evacuatória, consistência das fezes, dor abdominal, dor ao evacuar ou flatulência). Em apenas um ensaio clínico foi obtido completo controle da constipação intestinal sem o emprego concomitante de laxantes. Conclusões: Não existe um padrão específico de anormalidades da microbiota fecal na constipação intestinal. Apesar dos efeitos positivos dos probióticos em determinadas características do hábito intestinal, ainda não existem evidências que permitam sua recomendação no tratamento da constipação intestinal em pediatria.

Evaluating the effects of vanadyl sulfate on biomarkers of oxidative stress and inflammation in renal tissue of rats with diabetes type 2

Vanadyl sulfate (VS) is an ingredient in some food supplements and experimental drugs. This study was designed to assay the effects of VS on biomarkers of oxidative stress and inflammation in renal tissue of rats with diabetes type 2. 30 male Wistar rats were divided into three equal groups as follow: non-diabetics, non-treated diabetics and VS-treated diabetics. Diabetes type 2 has been induced through high fat diet and fructose in the animals. Diabetic rats were treated with 25 mg/kgBW of VS in water for 12 weeks. At the end of study, glucose and insulin were measured using commercially available kits in serum and biomarkers of oxidative stress and inflammation in renal homogenates of animals were measured by related methods. Compared to controls, glucose and insulin were increased significantly in non-treated diabetic rats (p-value <0.05) that showed the induction of diabetes type 2 in rats. The results showed that in VS-treated diabetic rats compared to the non-treated diabetic group, vanadyl sulfate significantly reduced the glucose and insulin secretion and changed renal inflammatory and oxidative markers, except protein carbonyl so that we couldn't find any significant changes. Our study showed that vanadyl supplementation had positive effects on oxidative stress and inflammation biomarkers in kidney of diabetic rats

Sports supplement induces dental structure corrosion: an in vitro pilot study / El suplemento deportivo induce corrosión en la estructura dental: un estudio piloto in vitro

Dietary supplements are being consumed with an increasingly high frequency among sports practitioners, whether at professional and/or amateur level. The supplements contain some nutritional properties in their composition, so they can dissolute the hydroxyapatite crystals of the enamel and favor the process of dental corrosion. The objective was to measure the corrosive power of protein-based supplementation (Whey Protein), under conditions that resemble the use of the supplement by the athletes, increasing the ecological validity of the study. The teeth of the test group (TG) were placed in contact with the Whey protein solution and then exposed to artificial saliva. And the teeth of the control group (CG) were exposed only to artificial saliva. The analysis occurred in natural healthy molar teeth, so that each tooth of the TG was immersed in 50 mL of supplement for 1.5 minutes and then placed in contact with the artificial saliva for 30 seconds. The same procedure was performed 5 times a day for 30, 60, 90, 120, 150 and 180 days. Each group, in its time (TG0 to TG180), underwent analysis of superficial roughness with the aid of optical profilometer (Talysurf CCI®, 3D model). The control group (CG) did not change its superficial roughness. Half of the teeth of the test group (TG) suffered loss of enamel surface. The values, in micrometers, of surface loss of the TG samples were 1.21; 2.1; 2.0; 1.04; 0.97; 0.8; 0.53; 1.14; 1.9; 2.0; 1.66; 1.80. The dietary supplement (Whey protein®) may be a potential cause of the dental corrosion process, considering the demineralization of hydroxyapatite that occurs along with the surface enamel loss.

Los suplementos dietéticos se consumen con una frecuencia cada vez más alta entre los practicantes de deportes, sea a nivel profesional y / o aficionado. Los suplementos contienen algunas propiedades nutricionales en su composición, por lo que pueden disolver los cristales de hidroxiapatita del esmalte y favorecer el proceso de corrosión dental. El objetivo fue medir el poder corrosivo de la suplementación a base de proteínas (proteína de suero), en condiciones que se asemejan al uso del suplemento por parte de los atletas, aumentando la validez ecológica del estudio. Los dientes del grupo de prueba (TG) se pusieron en contacto con la solución de proteína de suero y luego se expusieron a saliva artificial. Y los dientes del grupo de control (CG) estuvieron expuestos solo a saliva artificial. El análisis se realizó en dientes molares sanos naturales, cada diente del TG se sumergió en 50 ml de suplemento durante 1,5 minutos y luego se puso en contacto con la saliva artificial durante 30 segundos. El mismo procedimiento se realizó 5 veces al día durante 30, 60, 90, 120, 150 y 180 días. Cada grupo, en su momento (TG0 a TG180), se sometió a un análisis de rugosidad superficial con la ayuda de un perfilómetro óptico (Talysurf CCI®, modelo 3D). El grupo de control (CG) no cambió su rugosidad superficial. La mitad de los dientes del grupo de prueba (TG) sufrieron pérdida de la superficie del esmalte. Los valores, en micrómetros, de pérdida de superficie de las muestras de TG fueron 1.21; 2.1; 2,0; 1.04; 0,97; 0.8; 0,53; 1.14; 1.9; 2,0; 1,66; 1.80. El suplemento dietético (Whey protein®) puede ser una causa potencial del proceso de corrosión dental, considerando la desmineralización de la hidroxiapatita que ocurre junto con la pérdida de esmalte superficial.

Análise bioeconômica do farelo de arroz na recria de bezerras de corte em azevém / Bioeconomics analyses of rice brain use for reaning of beef heifers on Italian ryegrass pasture

Objetivou-se avaliar a economicidade, o desempenho produtivo e o desenvolvimento das estruturas corporais relacionadas ao trato reprodutivo de bezerras de corte mantidas exclusivamente em pastagem de azevém (Lolium multiflorum Lam.) ou em pastagem de azevém recebendo 0,5 e 1,0% do peso corporal (PC) de farelo de arroz integral (FAI) como suplemento. O método de pastejo foi o rotativo, e o intervalo entre pastejos foi estabelecido considerando-se a soma térmica necessária para a emissão de 1,5 folha de azevém (187,5ºC). O delineamento experimental foi o inteiramente ao acaso, com medidas repetidas no tempo. O ganho médio diário das bezerras não diferiu entre os sistemas alimentares. A taxa de lotação e o ganho de peso por área foram maiores quando as bezerras receberam 1,0% do PC de farelo de arroz integral. A maior margem bruta foi observada quando as bezerras receberam 0,5% de FAI. O custo variável obtido para os diferentes sistemas alimentares apresentou comportamento crescente em função dos níveis de FAI, superando o uso exclusivo do azevém em 49,4% e 81,8%. O peso corporal final, o escore de condição corporal e o escore do trato reprodutivo não diferiram entre os sistemas alimentares. Considerando-se um animal adulto com peso corporal médio de 450kg, as bezerras ao início do experimento apresentaram 34% do peso corporal adulto e peso corporal final médio de 56% do peso adulto. A utilização de níveis de farelo de arroz integral (FAI) na recria de bezerras de corte sob pastejo rotativo em azevém não modifica o ganho médio diário e o escore do trato reprodutivo. O fornecimento de 1% de FAI mostrou efeito substitutivo, proporcionando um incremento de 31,2% na taxa de lotação e de 38,3% no ganho por área. O sistema alimentar AZ0,5 permitiu uma maior margem bruta; já o retorno financeiro direto foi positivo em todos os sistemas alimentares, com melhor retorno calculado para o uso exclusivo do azevém.(AU)

The experiment was carried out with the objective of evaluating the gross margin, the productive and reproductive performance of beef heifers kept exclusively on ryegrass pasture (Lolium multiflorum Lam.) or ryegrass receiving 0.5 and 1.0% of body weight (BW) of whole rice bran as supplement. The grazing method was the rotational and the interval between grazings was set by the thermal sum required for the appearing of 1.5 ryegrass leaf (187.5ºC). The experimental design was completely randomized with repeated measures. Heifers average daily gain did not differ between the feeding systems. The stocking rate and weight gain per area were higher when heifers received 1.0% BW of whole rice bran. The higher gross margin was observed when heifers received 0.5% BW. The variable cost obtained for the different feeding systems showed increasing behavior depending on the WRB levels, surpassing the exclusive use of ryegrass in 49.4% and 81.8%. The final body weight, body condition score and reproductive tract score did not differ between the feeding systems. Considering an adult animal with an average body weight of 450kg, the heifers at the beginning of the experiment showed 34% of mature body weight and final average body weight of 56% of adult weight. The use of rice bran levels (FAZ) in the rearing of beef heifers under rotational grazing on ryegrass does not change the average daily gain and the reproductive tract score. The supply of 1% FAI showed substitutive effect, providing an increase in capacity of 31,2% and 38.3% rate of the gain per area. The food system AZ0,5 allowed a higher gross margin, as the economic return was positive in all food systems, with better return calculated for the exclusive use of ryegrass.(AU)

Efectos en la función renal de la suplementación de creatina con fines deportivos / Effects of creatine supplementation on renal function

Creatine supplements may transitorily rise serum creatinine levels and mimic a kidney disease. If its use is associated with a high protein diet, the resulting increase in blood urea nitrogen will increase the confusion. Since clinical laboratories usually inform the estimated glomerular filtration rate based on serum creatinine, its elevation may lead to over diagnose a chronic renal failure, with the inherent personal and public health consequences. Creatine supplements are safe and do not cause renal disease. Reports of kidney damage associated with its use are scanty. However, creatine supplements should not be used in people with chronic renal disease or using potentially nephrotoxic medications.

A suplementação de pacientes com diabetes mellitus tipo 2 com castanha-do-brasil, pode alterar o estado nutricional relativo ao selênio, o grau de inflamação e a microbiota intestinal? / Can supplementation of patients with type 2 diabetes mellitus with brazil nuts affect the nutritional status of selenium, the degree of inflammation and the intestinal microbiota?

O diabetes mellitus tipo 2 está intimamente ligado a formação de espécies reativas de oxigênio, as quais aumentam os produtos de glicação avançada e consequentemente a inflamação e o desenvolvimento das complicações associadas a doença. Nesse contexto, destaca-se o papel do microbioma intestinal, visto que esta pode ser capaz de modificar fatores ligados ao sistema imune e sua modulação pode ser uma boa alternativa para melhora do quadro inflamatório e complicações da doença. A castanha-do-brasil, fonte de selênio, além de outros nutrientes, poderia atuar no sistema de defesa antioxidante e anti-inflamatório, além de influenciar a microbiota intestinal, resultando benefícios aos pacientes. Portanto, este estudo teve como objetivo avaliar estes efeitos da suplementação de indivíduos com diabetes mellitus tipo 2, com uma nóz de castanha-do-brasil (Bertholletia excelsa H.B.K.) por dia, durante 60 dias. Para tanto, foi delineado um ensaio clínico, longitudinal, com 29 pacientes voluntários com diabetes mellitus tipo 2, atendidos no Ambulatório de Endocrinologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os participantes foram avaliados antes e após a intervenção, e realizaram uma coleta de fezes (caracterização da microbiota intestinal e concentração de selênio) e uma coleta de sangue (análises de status de selênio, marcadores inflamatórios, glicêmicos e lipídicos, e da permeabilidade intestinal), a avaliação da ingestão alimentar foi por meio de Registro Alimentar de 3 dias Inicialmente, determinou-se a composição centesimal e a concentração de selênio da castanha-do-brasil utilizada. A análise bioinformática foi conduzida usando o Quantitative Insight into Microbial Ecology (QIIME, versão 1.9.0). A análise estatística foi realizada com os softwares Statistical Package for the Social Sciences, versão 23.0, e R versão 1.1.463. A concentração de selênio na castanha in natura foi de 79,8µg/g. A idade média dos participantes foi 54,9±3,6 anos. A ingestão de castanha-do-brasil foi capaz de melhorar significativamente os parâmetros: concentrações de selênio no plasma (Δ 95,82, p<0,001), nos eritrócitos (Δ 163,16, p<0,001) e nas fezes (Δ 166,31 p<0,001), assim como na selenoproteína P (Δ 5,36 p<0,026) e atividade da enzima glutationa peroxidase (Δ 30,61 p<0,040) e redução da hemoglobina glicada (Δ -0,8, p=0,001). No entanto, não houve alteração do perfil lipídico, inflamatório, ingestão alimentar e marcadores antropométricos. Apesar de não verificarmos mudança na composição global da microbiota intestinal, a diversidade interpessoal (ß diversidade) variou conforme a concentração de selenoproteína P (p=0,03) e porcentagem de hemoglobina glicada (p=0,04). A suplementação com castanha-do-brasil melhorou o perfil glicêmico e o status de selênio. Apesar de não ser observada influência na composição global da microbiota, a segregação observada indica certa resistência da microbiota frente a intervenção com a castanha

Type 2 diabetes mellitus is closely linked to the formation of reactive oxygen species, such as those that increase advanced glycation products (AGEs) and, consequently, inflammation and the development of complications associated with this disease. In this context, the study of the intestinal microbiome is of extreme importance, since it may be able to alter the factors related to the immune system and its modulation may be a good alternative for the improvement of the clinical and inflammatory status. Brazil nut is rich in selenium, in addition to other nutrients, which could act in the anti-inflammatory and antioxidant defense system and influence intestinal microbiota composition. Therefore, this study had the objective of determining the supplementation with type 2 diabetes mellitus. This longitudinal clinical trial was designed with 29 patients with type 2 diabetes mellitus, attended at the Endocrinology Outpatient Clinic of the Hospital das Clínicas, Faculdade de Medicina of the University of São Paulo. The intervention with Brazil nuts lasted 60 days and the participants were evaluated before and after by a collection of feces (intestinal microbiota characterization and selenium concentration) and blood collection (analyzes of selenium status, inflammatory markers, glycemic and lipid levels, and intestinal permeability), and dietary intake by means of a 3-day Food Registry. Initially, the centesimal composition and the selenium concentration of the nut were determined used. Bioinformatic analysis was conducted using the Quantitative Insight into Microbial Ecology (QIIME, version 1.9.0). Statistical analysis was performed with the software Statistical Package for the Social Sciences, version 23.0, and R version 1.1.463. The concentration of selenium in the nut in natura was 79.8 µg / g. The mean age of the participants was 54.9 ± 3.6 years, the mean time of diagnosis of the disease was 11.7 ± 6.9 years. The Brazil nut intake was able to significantly improve the parameters: plasma selenium concentrations (Δ 95,82, p<0,001), nem da circunferência da cintura (Δ-1 p=0,217) and GPX (Δ30.61 p <0.040) and reduction in HbA1c (Δ -0.8, p = 0.001). However, there were no changes in the lipid profile, inflammation, food intake and anthropometric markers. Although we did not verify a change in the global composition of the intestinal microbiota, the interpersonal diversity (ß diversity) varied according to the concentration of SELENOP (p = 0.03) and HbA1c percentage (p = 0.04). We conclude that brazil nut supplementation improved the glycemic profile and the status of selenium. Although no influence was observed on the overall composition of the microbiota, the observed segregation indicates some resistance of the microbiota to the intervention with the chestnut

Evaluation of growth performance and gastro-intestinal parameters on the response of weaned piglets to dietary organic acids

ABSTRACT Two experiments (E) were carried out to evaluate the effects of fumaric acid and an acidifier blend [composed by calcium formate, calcium lactate and medium-chain fatty acids (capric and caprylic)] in piglet diets containing colistin (40 ppm) or halquinol (120 ppm) on performance, diarrhea incidence (E1), organs relative weight, pH values, intestinal morphometry and microbiota (E2). In E1, 192 and E2, 24 piglets weaned at 21-day-old were randomly assigned to blocks with 2x2 factorial arrangement of treatments [absence or presence of fumaric acid x absence or presence of acidifier blend], six replicates of eight (E1) and one piglet per pen (E2). For E1, the treatments were control (CD): no acidifier product + 40 ppm of colistin, FA: fumaric acid in absence of acidifier blend, AB: acidifier blend in absence of fumaric acid and, AF+AB: presence of fumaric acid and acidifier blend. For E2, the pre-starter I diet were used and the same treatments as E1 evaluated. No treatment effects (P>0.05) were observed on performance, diarrhea incidence (E1), gut pH values and duodenum morphometry of piglets (E2). However, the addition of AB increased (P<0.05) large intestine relative weight and, FA addition decreased (P<0.05) pancreas relative weight, jejunum villi height and, total coliform and E. coli counts in cecum. The inclusion of FA and AB in diets containing colistin or halquinol did not improve performance, although FA exerted an inhibitory effect on cecum microbiota.

Stability of antioxidant vitamins in commercial vitamin supplements

The stability of vitamins A, E, and C was determined in 12 brands of vitamin supplements over a 12-month storage period. The variations in concentrations of these vitamins across three different batches of five brands were measured. Vitamins A and E was determined by HPLC method, and vitamin C was measured by using potentiometric titration. All samples for stability studies were maintained at room temperature and protected from light. Measurements were carried out in the first semester of the expiration date and then every six months up to 12 months of storage. After this period, only one sample showed no significant decrease in vitamin A and E concentrations in relation to the concentrations measured at the beginning of the study. The concentration of vitamin C showed no significant decrease in 50% of the samples after 6 months of storage, although after 12 months, 92% had significant losses in concentration. The analysis of the different batches showed significant variations in the vitamin levels, which do not seem to be significant for inspection purposes considering the tolerance outlined in the legislation. Over-fortification of vitamin supplements during manufacture seems to be required, but the additional amount of supplementation will depend on each sample.

Hepatotoxicity by herbs: a practical review of a neglected disease / Hepatotoxicidad por hierbas: una revisión práctica de una enfermedad subestimada

Herbs are commonly used worldwide for the treatment of various diseases, constituting a multi-billion dollar market. Unfortunately, hepatotoxicity induced by herbs is also common. The true incidence and prevalence are not known. There is need for more strict regulations andexperimental and pre-clinical studies regarding its efficacy and safety. There is no gold standard for the diagnosis of herbs-induced liver injury (HILI) and it constitutes a diagnostic challenge for the clinician, whereestablishing causality could be cumbersome. Clinical presentation varies from asymptomatic cases with mildly abnormal liver tests to fulminant liver failure requiring liver transplantation. In this review, we will discuss the epidemiology, clinical manifestations, challenges and diagnostic approach of HILI and will also present some exemplary cases from the University of Miami, Division of Hepatology.

Las hierbas y productos derivados son comúnmente usados alrededor del mundo para el tratamiento de varias enfermedades, constituyendo un mercado multibillonario. Desafortunadamente, hepatotoxidad inducida por estos productos también es común. Existe la necesidad de regulaciones más estrictas, y de estudios experimentales y pre-clínicos acerca de su eficacia y seguridad. No existe un gold-standard para el diagnóstico de injuria hepática inducida por hierbas (HILI), constituyendo un reto diagnóstico para el clínico, donde el establecer una relación de causalidad puede resultar muy difícil. La presentación clínica puede variar desde casos asintomáticos con enzimas hepáticas levemente elevadas hasta casos de falla hepática fulminante requiriendo transplante hepático. En esta revisión, discutiremos brevemente la epidemiologia, manifestaciones clínicas, retos y aproximación diagnostica de la injuria hepática inducida por hierbas y finalmente mostraremos algunos casos ejemplares extraídos de nuestro archivo en la División de Hepatología de la Universidad de Miami.

Calcium intake: good for the bones but bad for the heart? An analysis of clinical studies

ABSTRACT The proper dietary calcium intake and calcium supplementation, when indicated, are important factors in the acquisition of peak bone mass during youth and in the prevention of fractures in old age. In addition to its deposition in bone, calcium confers an increase in its resistance and exhibits important activities in different enzymatic pathways in the body (e.g., neural, hormonal, muscle-related and blood clotting pathways). Thus, calcium supplementation can directly or indirectly affect important functions in the body, such as the control of blood pressure, plasma glucose, body weight, lipid profile and endothelial function. Since one publication reported increased cardiovascular risk due to calcium supplementation, many researchers have studied whether this risk actually exists; the results are conflicting, and the involved mechanisms are uncertain. However, studies that have evaluated the influence of the consumption of foods rich in calcium have reported no increase in the cardiovascular risk, which suggests that nutritional intake should be prioritized as a method for supplementation and that the use of calcium supplements should be reserved for patients who truly need supplementation and are unable to achieve the recommended daily nutritional intake of calcium.

Drug-Induced Liver Injury: Pattern Recognition and Future Directions

Drug-induced liver injury (DILI) remains a significant clinical challenge and is the leading cause of acute liver failure in most countries. An aging population that uses more medications, a constant influx of newly developed drugs and a growing risk from unfamiliar herbal and dietary supplements will make DILI an increasing part of clinical practice. Currently, the most effective strategy for disease management is rapid identification, withholding the inciting agents, supportive care and having a firm understanding of the expected natural history. There are resources available to aid the clinician, including a new online "textbook" as well as causality assessment tools, but a heightened awareness of risk and the disease's varying phenotypes and good history-taking remain cornerstones to diagnosis. Looking ahead, growing registries of cases, pharmacoepidemiology studies and translational research into the mechanisms of injury may produce better diagnostic tools, markers for risk and disease, and prevention and therapeutics.

A critical analysis of the hepatotoxicity cases described in the literature related to Herbalife (r) products

Abstract The aim of this study was to assess the hepatotoxicity cases described in the literature, attributed to the consumption of Herbalife(r) products, and to determine whether a causal relationship exists between the reported cases of liver injury and the use of these products. A literature search was performed on the PubMed, LILACS and PAHO databases. Seven publications reporting a total of 53 cases of hepatotoxicity linked to the use of Herbalife(r) products were retrieved. All of the studies lacked sufficient information to some degree, whether related to patients' history, concomitant use of medication and/or other compounds (including alcohol), observations on interrupted use (dechallenge), results found with markers, viral serology and autoantibodies or observations concerning re-exposure to the products. In addition to these items, the lack of clear information on the type of products evaluated and their respective composition is an important factor to be considered. Furthermore, data quality was also questionable due to the presence of confounding factors, absence of proper exclusion of alternative explanations, and the use of questionable methods for attributing causality. Hence, an association between hepatotoxicity and consumption of these products cannot be proven based on the data collected and rigorous scientific analysis.

resumo Este estudo teve como objetivo avaliar os casos de hepatotoxicidade descritos em literatura, atribuídos ao consumo de produtos Herbalife(r), e verificar se é possível ou não estabelecer uma relação de causalidade entre eles. Realizou-se levantamento bibliográfico nas bases de dados PubMed, LILACS e PAHO e foram encontrados 7 manuscritos reportando 53 casos de hepatotoxicidade, relacionados ao uso de produtos Herbalife. Observou-se que todos trazem, de alguma forma, quantidade insuficiente de informações em relação ao histórico dos pacientes, ao uso concomitante de medicamentos e/ou outros compostos (incluindo álcool), às observações após a interrupção do uso (dechallenge), aos resultados referentes a marcadores e sorologia virais e autoanticorpos e às observações quanto à reexposição aos produtos. Some-se a estes fatos a falta de identificação clara e comprovada do tipo de produto envolvido, assim como sua composição. Além disso, a qualidade dos dados também é questionável devido à presença de variáveis de confundimento, ausência de exclusão adequada de explicações alternativas e ao uso de métodos discutíveis de atribuição de causalidade. Desta forma, a associação entre hepatotoxicidade e o consumo destes produtos não pode ser comprovada, após observar o conjunto dos dados coletados, utilizando-se rigor técnico-cientifico.