US drug approvals rise in 2020 over previous year

Several medicines were approved as first treatments, including Gilead Sciences' Veklury (remdesivir) for patients with COVID-19 who require hospitalization (4);Amivas' artesunate for injection for severe malaria (5);Horizon Therapeutics Ireland DAC's Tepezza (teprotumumab-trbw), an antibody drug conjugate (ADC) for treating thyroid eye disease (6);and Ultragenyx Pharmaceutical's Dojolvi (triheptanoin) and Alnylam Pharmaceuticals' Oxlumo (lumasiran), both first treatments for metabolic disorders-Dojolvi for treating paediatric and adult patients with molecularly confirmed long-chain fatty acid oxidation disorders (7) and Oxlumo (lumasiran) for treating the rare genetic disorder, primary hyperoxaluria type 1 (8). Blueprint Medicines Corporation) for treating unresectable or metastatic gastrointestinal stromal tumours harboring a platelet-derived growth factor receptor alpha exon 18 mutation (9);Koselugo (selumetinib, AstraZeneca Pharmaceuticals), for neurofibromatosis type 1 (10);Pemazyre (pemigatinib, Incyte Corporation), for certain types of previously treated, advanced bile duct cancer (cholangiocarcinoma) (11);Tabrecta (capmatinib, Novartis) for non-small cell lung cancer that has spread to other parts of the body and whose tumours have mutations that lead to MET exon 14 skipping (12);and Retevmo (selpercatinib, Loxo Oncology, a subsidiary of Eli Lilly and Company) for treating three types of tumours with alterations of the "rearranged during transfection" gene (13). Gilead, "U.S. FDA Approves Kite's Tecartus, the First and Only CAR T Treatment for Relapsed or Refractory Mantle Cell Lymphoma," Press Release, 24 July 2020.

Omega-3 fatty acids supplements for dry eye - Are they effective or ineffective?

Purpose: To evaluate effectiveness of omega-3 fatty acid supplements in relieving dry eye symptoms and signs in symptomatic visual display terminal users (VDT). Methods: A randomized controlled study was done; eyes of 470 VDT users were randomized to receive four capsules twice daily for 6 months (O3FAgroup), each containing 180 mg of eicosapentaenoic acid and 120 mg docosahexaenoic acid. The O3FA group was compared with another group (n = 480) who received four capsules of a placebo (olive oil) twice daily. Patients were evaluated at baseline, 1, 3, and 6 months, respectively. The primary outcome was improvement in omega-3 index (a measure of EPA and DHA ratio in RBC membrane). Secondary outcomes were improvement dry eye symptoms, Nelson grade on conjunctival impression cytology, Schirmer test values, tear film breakup time (TBUT), and tear film osmolarity. Means of groups (pre-treatment, 1, 3, and 6-months) were compared with repeated measure analysis of variance. Results: At baseline, 81% patients had low omega-3 index. In the O3FA group, a significant increase in omega-3 index, improvement in symptoms, reduction in tear film osmolarity, and increase in Schirmer, TBUT, and goblet cell density was observed. These changes were not significant in the placebo group. Improvement in test parameters was significantly (P < 0.001) better in patients with low omega3 index (<4%) subgroup. Conclusion: Dietary omega-3 fatty acids are effective for dry eye in VDT users; omega-3 index appears to be the predictor to identify potential dry eye patients who are likely to benefit from oral omega-3 dietary intervention.

Purchase Behavior According to the Development of Sustainable Pistachio (Pistacia vera L.) Rice Cake: For Korean Consumers

In recent years, the rice cake market has grown considerably in terms of research and development of products suitable for consumer needs and beneficial to health at the same time. Since the outbreak of COVID-19, the number of consumers consuming antioxidant-rich foods and immunity-boosting foods to improve health and promote healthy eating habits has increased. Pistachio rice cakes have been tested and found to be high in polyphenols, which have good antioxidant activity and strengthen the immune system. Therefore, research was conducted on pistachio rice cakes to develop safe, health functional, and sustainable food. In order to maximize the sales potential of pistachio rice cakes, a survey was conducted among Korean adults to investigate perception of pistachio, pistachio rice cake purchasing behavior, and popularization plans. Pearson's correlation analysis was performed to examine the correlation between pistachio perception, pistachio rice cake purchasing behavior, and pistachio rice cake popularization measures, and they were found to have a close relationship. In addition, as a result of multiple regression analysis, perception and purchasing behavior of pistachio rice cake products were found to have a significant positive (+) effect on rice cake technology development, development of brand specializing in rice cakes, and cultivation of traditional rice cake experts. This study suggests that continuous research and development of food safety and sustainability of rice cakes are required, and it is expected to be utilized as basic data to form a research basis that can be a strategy for increasing sales in the rice cake industry.

Anxiolytic-like Effects and Quantitative EEG Profile of Palmitone Induces Responses Like Buspirone Rather Than Diazepam as Clinical Drugs.

Anxiety is a mental disorder with a growing worldwide incidence due to the SARS-CoV-2 virus pandemic. Pharmacological therapy includes drugs such as benzodiazepines (BDZs) or azapirones like buspirone (BUSP) or analogs, which unfortunately produce severe adverse effects or no immediate response, respectively. Medicinal plants or their bioactive metabolites are a shared global alternative to treat anxiety. Palmitone is one active compound isolated from Annona species due to its tranquilizing activity. However, its influence on neural activity and possible mechanism of action are unknown. In this study, an electroencephalographic (EEG) spectral power analysis was used to corroborate its depressant activity in comparison with the anxiolytic-like effects of reference drugs such as diazepam (DZP, 1 mg/kg) and BUSP (4 mg/kg) or 8-OH-DPAT (1 mg/kg), alone or in the presence of the GABAA (picrotoxin, PTX, 1 mg/kg) or serotonin 5-HT1A receptor antagonists (WAY100634, WAY, 1 mg/kg). The anxiolytic-like activity was assayed using the behavioral response of mice employing open-field, hole-board, and plus-maze tests. EEG activity was registered in both the frontal and parietal cortex, performing a 10 min baseline and 30 min recording after the treatments. As a result, anxiety-like behavior was significantly decreased in mice administered with palmitone, DZP, BUSP, or 8-OH-DPAT. The effect of palmitone was equivalent to that produced by 5-HT1A receptor agonists but 50% less effective than DZP. The presence of PTX and WAY prevented the anxiolytic-like response of DZP and 8-OH-DPAT, respectively. Whereas only the antagonist of the 5-HT1A receptor (WAY) inhibited the palmitone effects. Palmitone and BUSP exhibited similar changes in the relative power bands after the spectral power analysis. This response was different to the changes induced by DZP. In conclusion, brain electrical activity was associated with the anxiolytic-like effects of palmitone implying a serotoninergic rather than a GABAergic mechanism of action.

Benefits of supplementation with microbial omega-3 fatty acids on human health and the current market scenario for fish-free omega-3 fatty acid

Background Growing evidence points to a link between specific fatty acids ingested through the diet and human health. Chain length, saturation degree, and position of double bonds in fatty acids determine their effect in humans. Omega-3 and omega-6 fatty acids have been recognized for their contribution to the prevention and/or treatment of diabetes, cancer, visual impairment, cardiovascular diseases, as well as neurological and musculoskeletal disorders. Scope and approach Humans cannot synthesize these fatty acids in sufficient amounts and need to absorb them through the diet. Oleaginous microalgae constitute a promising, sustainable source of such fatty acids, as they can accumulate up to 85% of lipids on a cell dry weight basis. Key findings and conclusions The present review summarizes the potential of oleaginous microalgae as a convenient, economical, and sustainable source of polyunsaturated fatty acids, and explores their beneficial role in human health. The growing prevalence of cardiovascular diseases and changing dietary preferences are driving the increasing demand for microbial omega-3 fatty acids. Following the COVID-19 pandemic, the importance of a healthy immune system has further strengthened the market for omega-3 fatty acids.

COVID-19 and the Microbiome: The Gut-Lung Connection

The world is currently experiencing a major pandemic due to COVID-19, a disease caused by SARS-CoV-2 infection. This virus is highly transmissible and clinically presents with a wide range of manifestations. The microbiome has a profound effect on the development of host immunity and susceptibility to infection. In severe COVID-19 patients, alterations of the gut and lung microbiome were detected. Emerging evidence indicates bidirectional crosstalk through a gut-lung axis, in which microbial metabolites, such as short-chain fatty acids, play pivotal roles in human health. In this review we will discuss the gut and lung microbiome in health and during viral infection, with a focus on SARS-CoV-2 infection. © 2022 Elsevier Inc. All rights reserved.

Challenging Case in Clinical Practice: Multimodal Management of Concurrent Structural and Virally Exacerbated Trigeminal Neuralgia

Introduction: Trigeminal neuralgia (TN) is among the most painful disorders of the orofacial region. Although TN has many possible etiologies, such as nerve compression, recently published evidence suggests that TN, or its exacerbations, may be the result of viral infections in the head and neck. This case presents clinical findings from a TN patient experiencing virally-induced exacerbations treated with intravenous (IV) magnesium sulfate and oral anti-inflammatories who was previously non-responsive to first-line pharmaceuticals. Methods: AM is a 51-year-old cis-female with a four-year history of TN caused by vascular encroachment of the trigeminal nerve and exacerbated by episodes of viral sinusitis and COVID-19. AM presented to the National University of Natural Medicine clinic in May 2019 and again in April 2022. After screening for contraindications, she was started on an IV Myer's push with an elevated dose of magnesium sulfate and oral anti-inflammatories: curcumin and omega-3. Results: Since her second presentation to our clinic in April 2022, the patient has undergone 11 treatments and reports significant benefit in pain and quality of life. Despite the initial MRI revealing vascular encroachment on her trigeminal nerve she experienced benefit from her treatment regimen and denied a neurosurgical consultation and repeat MRI. Conclusion: This study contributes to a growing body of literature suggesting that cranial neuralgias may be exacerbated by orofacial or upper-respiratory viral infections and that TN specifically may be well managed with IV nutrient therapy and oral anti-inflammatories. Given the paucity of successful treatment strategies, exploring cost-effective treatments with low side effect profiles is a worthwhile approach to improving clinical outcomes in patients with TN.

A Review of the Impact of Maternal Prenatal Stress on Offspring Microbiota and Metabolites.

Maternal prenatal stress exposure affects the development of offspring. We searched for articles in the PubMed database and reviewed the evidence for how prenatal stress alters the composition of the microbiome, the production of microbial-derived metabolites, and regulates microbiome-induced behavioral changes in the offspring. The gut-brain signaling axis has gained considerable attention in recent years and provides insights into the microbial dysfunction in several metabolic disorders. Here, we reviewed evidence from human studies and animal models to discuss how maternal stress can modulate the offspring microbiome. We will discuss how probiotic supplementation has a profound effect on the stress response, the production of short chain fatty acids (SCFAs), and how psychobiotics are emerging as novel therapeutic targets. Finally, we highlight the potential molecular mechanisms by which the effects of stress are transmitted to the offspring and discuss how the mitigation of early-life stress as a risk factor can improve the birth outcomes.

Endotoxin Tolerance Acquisition and Altered Hepatic Fatty Acid Profile in Aged Mice.

(1) Background: Aging is linked to an altered immune response and metabolism. Inflammatory conditions, such as sepsis, COVID-19, and steatohepatitis are more prevalent in the elderly and steatosis is linked both to severe COVID-19 and sepsis. We hypothesized that aging is linked to a loss of endotoxin tolerance, which normally protects the host from excessive inflammation, and that this is accompanied by elevated levels of hepatic lipids. (2) Methods: An in vivo lipopolysaccharide (LPS) tolerance model in young and old mice was used and the cytokine serum levels were measured by ELISA. Cytokine and toll-like receptor gene expression was determined by qPCR in the lungs and the liver; hepatic fatty acid composition was assessed by GC-MS. (3) Results: The old mice showed a distinct potential for endotoxin tolerance as suggested by the serum cytokine levels and gene expression in the lung tissue. Endotoxin tolerance was less pronounced in the livers of the aged mice. However, the fatty acid composition strongly differed in the liver tissues of the young and old mice with a distinct change in the ratio of C18 to C16 fatty acids. (4) Conclusions: Endotoxin tolerance is maintained in advanced age, but changes in the metabolic tissue homeostasis may lead to an altered immune response in old individuals.

The Role of Diet and Specific Nutrients during the COVID-19 Pandemic: What Have We Learned over the Last Three Years?

Nutrients and diets have an important impact on our immune system and infection risk and a huge number of papers have been published dealing with various aspects of nutrition in relation to SARS-CoV-2 infection risk or COVID-19 severity. This narrative review aims to give an update on this association and tries to summarize some of the most important findings after three years of pandemic. The analysis of major studies and systematic reviews leads to the conclusion that a healthy plant-based diet reduces the risks for SARS-CoV-2 infection and especially COVID-19 severity. Regarding micronutrients, vitamin D is to the fore, but also zinc, vitamin C and, to some extent, selenium may play a role in COVID-19. Furthermore, omega-3-fatty acids with their anti-inflammatory effects also deserve attention. Therefore, a major aim of societal nutritional efforts in future should be to foster a high quality plant-based diet, which not only exerts beneficial effects on the immune system but also reduces the risk for non-communicable diseases such as type 2 diabetes or obesity which are also primary risk factors for worse COVID-19 outcomes. Another aim should be to focus on a good supply of critical immune-effective nutrients, such as vitamin D and zinc.

Associations of Dietary Intake with the Intestinal Microbiota and Short-Chain Fatty Acids Among Young Adults with Type 1 Diabetes and Overweight or Obesity.

BACKGROUND: Diet, a key component of type 1 diabetes (T1D) management, modulates the intestinal microbiota and its metabolically active byproducts-including SCFA-through fermentation of dietary carbohydrates such as fiber. However, the diet-microbiome relationship remains largely unexplored in longstanding T1D. OBJECTIVES: We evaluated whether increased carbohydrate intake, including fiber, is associated with increased SCFA-producing gut microbes, SCFA, and intestinal microbial diversity among young adults with longstanding T1D and overweight or obesity. METHODS: Young adult men and women with T1D for ≥1 y, aged 19-30 y, and BMI of 27.0-39.9 kg/m2 at baseline provided stool samples at baseline and 3, 6, and 9 mo of a randomized dietary weight loss trial. Diet was assessed by 1-2 24-h recalls. The abundance of SCFA-producing microbes was measured using 16S rRNA gene sequencing. GC-MS measured fecal SCFA (acetate, butyrate, propionate, and total) concentrations. Adjusted and Bonferroni-corrected generalized estimating equations modeled associations of dietary fiber (total, soluble, and pectins) and carbohydrate (available carbohydrate, and fructose) with microbiome-related outcomes. Primary analyses were restricted to data collected before COVID-19 interruptions. RESULTS: Fiber (total and soluble) and carbohydrates (available and fructose) were positively associated with total SCFA and acetate concentrations (n = 40 participants, 52 visits). Each 10 g/d of total and soluble fiber intake was associated with an additional 8.8 µmol/g (95% CI: 4.5, 12.8 µmol/g; P = 0.006) and 24.0 µmol/g (95% CI: 12.9, 35.1 µmol/g; P = 0.003) of fecal acetate, respectively. Available carbohydrate intake was positively associated with SCFA producers Roseburia and Ruminococcus gnavus. All diet variables except pectin were inversely associated with normalized abundance of Bacteroides and Alistipes. Fructose was inversely associated with Akkermansia abundance. CONCLUSIONS: In young adults with longstanding T1D, fiber and carbohydrate intake were associated positively with fecal SCFA but had variable associations with SCFA-producing gut microbes. Controlled feeding studies should determine whether gut microbes and SCFA can be directly manipulated in T1D.

Melatonin improved glucose homeostasis is associated with the reprogrammed gut microbiota and reduced fecal levels of short-chain fatty acids in db/db mice.

Accumulated evidence shows that melatonin possesses the potential to improve lipid metabolism by modifying gut microbiota and glucose metabolism via regulating the melatonin receptor signaling pathway. However, the contribution of melatonin consumption on glucose homeostasis by affecting gut microbiota has not been investigated in diabetes. In the current work, we investigated the effect of melatonin administration on gut microbiota and glucose homeostasis in db/db mice, a type 2 diabetes model with leptin receptor deficiency. Administration of melatonin through drinking water (at 0.25% and 0.50%) for 12 weeks decreased diabetic polydipsia and polyuria, increased insulin sensitivity and impeded glycemia. The accumulated fecal levels of total short-chain fatty acids (SCFAs) and acetic acid are positively correlated with diabetes-related parameters-homeostasis model assessment of insulin resistance (HOMA-IR) index and fasting blood glucose (FBG) level. The reprogramming of gut microbiota structure and abundance and the reduction of fecal levels of SCFAs, including acetic acid, butyric acid, isovaleric acid, caproic acid, and isobutyric acid, by melatonin may be beneficial for enhancing insulin sensitivity and lowering FBG, which were verified by the results of correlation analysis between acetic acid or total SCFAs and HOMA-IR and FBG. In addition, the melatonin downregulated hepatic genes, including fructose-1,6-bisphosphatase 1, forkhead box O1 alpha, thioredoxin-interacting protein, phosphoenolpyruvate carboxy-kinase (PEPCK), PEPCK1 and a glucose-6-phosphatase catalytic subunit, that responsible for gluconeogenesis support the result that melatonin improved glucose metabolism. Overall, results showed that the melatonin supplementation reduced fecal SCFAs level via reprogramming of gut microbiota, and the reduction of fecal SCFAs level is associated with improved glucose homeostasis in db/db mice.

Antiviral Potential of Coconut (Cocos nucifera L.) Oil and COVID-19

Background: COVID-19 caused by the novel SARS Coronavirus-2 (SARS-CoV-2) is causing serious problems in the global public health sphere. In the absence of a powerful antiviral treatment, the exploration of plant-based products with antiviral potential has gained interest. Scope and Approach: This commentary presents the prospects of utilizing coconut oil directly or its derivatives such as monolaurin in treating COVID-19 with a special emphasis on their biochemical characteristics features. The potential pitfalls therein and way forward are also highlighted. Key findings and conclusions: There are enough research-backed evidences to demonstrate the antiviral capabilities of coconut oil and monolaurin. The possibility of developing a medium-chain fatty acidbased nasal spray as a prophylactic or therapeutic is also discussed. Nevertheless, the potential impediments in devising suitable therapeutic models to treat SARS-CoV-2, are presented.Copyright © 2021 Bentham Science Publishers.

Content and economic evaluation of omega-3 fatty acid nutritional supplements

Marinederived omega3 fatty acids, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are abundant in seafood and fish oils. They are recommended for their many health benefits. There has been a large and sustained growth in sales of nutritional supplements containing omega3 fatty acids during the COVID-19 pandemic. In this study, a total of 54 omega3 fatty acids supplement products of various brands available in Turkey was analysed for their fatty acids content using gas chromatography. In 59.3 % of the products examined, EPA plus DHA content was found to be less than what was stated on the label. It was observed that 25.9 % could meet the daily EPA+DHA need with a capsule or a measure of consumption. Overall, 35.2 % of products were found satisfactory in terms of providing 80 % or more of the daily EPA+DHA requirement with a capsule or a measure of consumption and advantageous in terms of contents and price. The remaining 64.8 % of products could not provide 80 % of the daily EPA+DHA requirement with a single capsule. This study provided information on the accuracy of the declared contents of omega3 fatty acids supplements and evaluated the advantages for the consumers.

COVID-related alteration in the balance between pro-and anti/inflammatory bioactive lipids and cytokines

COVID-19 caused by SARS-CoV-2 is an inflammatory condition involving mainly lungs, vascular endothelium, liver, heart, and brain with significant disturbances in the innate and adaptive immune responses. SARS-CoV-2 virus enters the cells by binding to ACE2 receptor that is present in many tissues. Despite the availability of effective vaccine(s) against SARS-CoV-2 and its variants current pandemic continues to cause significant morbidity and mortality The emergence of several mutant variants of SARS-CoV-2 is a major concern especially about the efficacy of current vaccines against these variants and other variants that are likely to emerge in the future. In this context, the observation that essential fatty acids (EFAs) such as linoleic acid (LA) and their metabolites can inactivate SARS-CoV-2, regulate inflammatory events and immune responses, and suppress inappropriate excess production of proinflammatory interleukin-6 (IL-6) and tumor necrosis factor-a (TNF-a), and bradykinin and thus, restore homeostasis is noteworthy. Of all the EFAs, LA and arachidonic acid (AA) are the most effective to inactivate SARS-CoV-2 and other similar viruses and prevent unwarranted inflammation, enhance wound healing by augmenting the production of anti-inflammatory bioactive lipids and cytokines. Since an imbalance between pro- and anti-inflammatory cytokine(s) and other molecules involved in inflammation and wound healing have a significant role in other serious diseases such as sepsis, ARDS (acute respiratory distress syndrome), ischemia-reperfusion injury and severe pneumonia(s), it remains to be seen whether administration of LA and AA and other fatty acids can prevent and suppress these life-threatening diseases in addition to COVID-19.

Phospholipase D-Catalyzed Transphosphatidylation for the Synthesis of Rare Complex Phospholipid Species─Hemi-bis(monoacylglycero)phosphate and Bis(diacylglycero)phosphate

Progress in developing synthetic pathways for novel and complex phospholipid species, such as Hemi-bis(monoacylglycero)phosphates (Hemi-BMPs) and bis(diacylglycero)phosphates (BDPs), is essential for expanding the knowledge and availability of rare and uncommon phospholipid species. These structurally complex phospholipid species have recently gained more attention with promising applications, as active pharmaceutical ingredient carriers in multiple COVID-19 vaccines, or biomarkers for numerous lysosomal storage disorders and certain types of cancers. The presented work facilitates the production of a range of structurally diverse Hemi-BMP and BDP products intending to increase the availability and thereby the understanding of the underlying chemistry for these high-valuable compounds. The transphosphatidylation of phosphatidylcholine with a variety of structurally diverse monoacylglycerols and diacylglycerols is proceeded by phospholipase D (PLD) catalysis in a biphasic system. Optimization in regard to enzyme loading (5 U), substrate mole ratio (1:5 mol/mol), temperature (30 °C), and aqueous concentration of (18% v/v) afforded the highest conversion for the model transphosphatidylation of phosphatidylcholine with monoolein, yielding 87% in 2 h. The study additionally proposes a reaction mechanism based on molecular simulation, elegantly elaborating the structural constraints (substrate configuration and character of the fatty acid residues) for access to the active site of PLD accordingly for lower yield of BDPs. The successful system designed for the production of high-valuable Hemi-BMP and BDP-analogues demonstrated in this work promises to enhance the understanding of these complex phospholipids, leading to new scientific breakthroughs. © 2023 American Chemical Society.

Patients' diets in Latvian psycho-neurological hospitals

The role of nutrition in the treatment of diseases is known, and it can be a contributing and hindering factor which can shorten or prolong the time of treatment. Studies on mental health have shown that the inclusion of certain nutrient in increased amounts in patients' diet can have a positive effect on the treatment of depression, anxiety etc. The COVID-19 pandemic increases the risk of depression in general population, which means an increased number of patients in need of professional help. Therefore, the aim of the study was to evaluate the patients' diets in Latvian psycho-neurological hospitals, emphasizing the provision of certain nutrients which are essential for mental health. There were analyzed a one-week menu at three Latvian psycho-neurological hospitals. Provision of nutrients (minerals, vitamins, fatty acids) in patients' diets was calculated using Finish food composition database. Basic conditions for provision of patients' diet are determined by the regulation of the Cabinet of Ministers, indicating the daily variety of energy value, minimum and maximum amount of proteins, fats and carbohydrates. The obtained results regarding patients' diets were processed using MS Excel and SPSS Statistics 22. The required amount of nutrients per day can be achieved with a variety of foods which in turn can significantly affect the concentration of minerals and vitamins and profile of fatty acids in the diet. In general, the provision of minerals and vitamins in hospitals' diets was close to the recommendations of a healthy person, but it was not sufficient for psycho-neurological hospital patients. It would be desirable to raise their concentration by increasing the amount of vegetables and fruits in the diet. Analysis of fatty acid profile in patients' diets showed significant differences depending on whether fish or meat products were included. It would be advisable to increase the concentration of omega-3 fatty acids. In general, the nutrition provision for patients of psycho-neurological hospitals could be assessed as sufficient, but several aspects need to be improved. Vitamin D intake should be significantly increased as it didn't reach the generally recommended dose. Fruit should be included and the amount of vegetables should be increased to provide a recommendation of at least 400 g per day, which in turn will increase the intake of vitamins and minerals.

Anaerobic Co-Digestion of Agricultural Residues Produced in Southern and Northern Greece

In Greece biomass is often being disposed of uncontrollably, resulting in significant environmental impacts. The aim of this study is the single-stage anaerobic co-digestion assessment, valorizing Northern and Southern Greece mixtures, resulting from previous literature reviews, experimental designs, and biochemical methane potential (BMP) assays. Regarding the methane yield maximization, in Northern Greece, the most suitable mixture was 10% corn silage, 80% cattle manure, and 10% malt;while in Southern Greece it was 10% corn silage, 57% cattle manure, 23% orange peels, and 10% olive pomace for fall/winter season. The hydraulic retention time (HRT) was set at 20 d and an initial organic loading rate (OLR) of 2 g COD/(L·d) was applied, with a view to gradually increase it. However, volatile fatty acids accumulation was observed, which led to OLR reduction to 1.5 g COD/(L·d) for both experiments. The Northern Greece reactor operated successfully for OLR 1.5–5 g COD/(L·d), while further increase led to system failure. On the other hand, the reactor of the Southern Greece mixture operated successfully at OLR 1.5–2 g COD/(L·d), but further operation indicated inadequacy, probably due to inhibitor (such as limonene) accumulation. Mixtures consisting of corn silage, cattle manure, and malt can be successfully valorized at high OLR. However, further investigation for mixtures with orange peels is suggested due to the presence of inhibitors.

Omega 3 Fatty Acids' Effects on COVID-19

Recently, the novel coronavirus, which is called severe acute respiratory syndrome coronavirus 2, has been responsible for the highly rapid spread of COVID-19 disease, globally. Until now, 535 million people were affected and 6.3 million people died due to this outbreak throughout the World. Although the lethality of this disease is lower than the severe acute respiratory syndrome coronavirus and Middle East respiratory syndrome, severe complications of this disease are attributed to "cytokine storm” that is the reason for the severe lung damage. The cytokine storm causes systemic inflammation, acute respiratory distress syndrome, septic shock, stroke, multiple organ dysfunction, and death. As a result of these symptoms, there are pivotal studies about vaccination, drug, and medication to prevent severe complications and treat patients with COVID-19. Besides these studies, some research shows that nutrients are able to manage the cytokine storm such as many types of vitamins, trace elements, and omega 3 fatty acids. Omega 3 polyunsaturated fatty acids have specific roles in the inflammatory process. Omega 3 fatty acids have a role in the improvement of the inflammatory balance. They interact with viral infection in disparate stages such as viral entry and replication. This study highlights the roles of omega 3 polyunsaturated fatty acids in the prevention and treatment of the COVID-19. In addition, omega 3 fatty acids show anti-viral and anti-inflammatory effects on the severe acute respiratory syndrome coronavirus 2 and increase survival rates in patients infected with COVID-19.

Macronutrient and micronutrient requirements and therapeutic effects in critically ill patients with SARS-CoV-2: A narrative review.

BACKGROUND: COVID-19 can lead to critical illness and induce hypermetabolism, protein catabolism, and inflammation. These pathological processes may alter energy and protein requirements, and certain micronutrients may attenuate the associated detriments. This narrative review summarizes the macronutrient and micronutrient requirements and therapeutic effects in critically ill patients with SARS-CoV-2. METHODS: We searched four databases for randomized controlled trials (RCTs) and studies that measured macronutrient and micronutrient requirements, published from February 2020 to September 2022. RESULTS: Ten articles reported on energy and protein requirements, and five articles reported the therapeutic effects of ω-3 (n = 1), group B vitamins (n = 1), and vitamin C (n = 3). Patients' resting energy expenditure gradually increased with time, measuring approximately 20 kcal/kg body weight (BW), 25 kcal/kg BW, and 30 kcal/kg BW for the first, second, and third week onwards, respectively. Patients remained in negative nitrogen balances in the first week, and a protein intake of ≥1.5 g/kg BW may be necessary to achieve nitrogen equilibrium. Preliminary evidence suggests that ω-3 fatty acids may protect against renal and respiratory impairments. The therapeutic effects of group B vitamins and vitamin C cannot be ascertained, although intravenous vitamin C appears promising in reducing mortality and inflammation. CONCLUSION: There are no RCTs to guide the optimal dose of energy and protein in critically ill patients with SARS-CoV-2. Additional larger-scale, well-designed RCTs are needed to elucidate the therapeutic effects of ω-3, group B vitamins, and vitamin C.