Micronutrients Deficiency in Patients Receiving Parenteral Nutrition: Effect of Multivitamin Supply Shortage

Background: Total parenteral nutrition (TPN) is a life-saving therapy for patients with chronic intestinal failure. TPN typically consists of macronutrients (amino acids, dextrose, and lipids) as well as micronutrients (multi-vitamins [MVI] and trace elements) to meet fluid, calorie, and micronutrient needs. With the early years of PN administration, multiple deficiencies were noted leading to guidelines regarding need for daily use of essential trace element and MVI preparation for parenteral use. Unfortunately, during the last few years we have seen multiple shortages of PN related supplies including the most recent shortage of parenteral MVI preparation. Major organizations such as ASPEN have developed recommendations regarding management of shortages, however their clinical impact has not been fully evaluated. The current study evaluated the impact of MVI shortage on change in clinical practice and the prevalence of deficiency. Method(s): A retrospective review of electronic medical records for patients who received TPN during time of shortage in IV multivitamins supply due to COVID-19 crisis between January 2021 and June 2021. In our program, the shortage affected one TPN supplier. We included patients who received their TPN from affected supplier and who were tested for micronutrients including Vitamins A, B12, C, and D in the 6 months preceding the shortage in supply (period 1) as well as during the shortage period (period 2). Period 1 was defined as from July 1, 2020, to December 31, 2020, and period 2 was defined as from January 1, 2021, to June 30, 2021. In addition to baseline clinical characteristics, we captured changes in studied micronutrients. Result(s): Current retrospective analysis of a prospectively maintained database noted 21 patients (mean age of 63.3 +/- 13.8, 62% female) were impacted by MVI shortage during study period (Table 1). Most common primary diagnosis was Crohn's disease (33.3%) followed by enterocutaneous fistula (19%), and gastrointestinal dysmotility (14.3%). In 19/21 (90%) patients, MVI was administered 3 days per week in PN. In the remaining two patients who had short bowel,MVI was continued 7 days per week. Additionally, 19/21 (90%) patients also were supplemented orally with Vitamin D (17/21), Vitamin B12 (5/21), MVI (3/21), Vitamin C (1/21). There was a decline in average Vitamin C levels between the two study periods (Table 2) with a trend towards a decline in average 25-hydroxy vitamin D levels, while mean vitamin A and B12 levels did not change significantly. There was a significant increase in Vitamin D and C deficiencies, while no increase in deficiencies in Vitamin E, A, and B12 levels was noted (Figure 1). Conclusion(s): Unfortunately, shortages of key PN related supplies have become commonplace in the last few years. The most recent shortage affected MVI supplies. Our group managed the shortage through a combination of reduction of parenteral MVI administration to 3 days per week along with additional supplementation of specific micronutrients orally. Although with this strategy, there was an increase in Vitamin D and C levels falling below reference range, no significant deficiencies were noted. (Table Presented).

Isolation and Characterization of Protein Complexes of Overexpressed Human Serum Amyloid A from Cytokines-Induced Hepg2 Cells

Serum Amyloid A (SAA) is an apolipoprotein found in the serum of many vertebrate species and is associated with the acute-phase reaction in the body with expression levels reaching up to a 1000-fold increase. The loss of its alpha-helix conformation during its expression peak is directly linked to secondary amyloidosis. Recent studies have been suggested to play a role in cholesterol and HDL metabolism, retinol transport and tumor pathogenesis. Moreover, high SAA concentration in blood have been correlated with severe symptoms or death in patients with COVID-19. However, how this protein is involved in so many diseases is uncertain or not completely understood. Therefore, the purpose of this research is to determine which protein-protein interactions with SAA occur in human cells, and to predict its biochemical role based on new discovered complexes. Two major isoforms overexpressed during an acutephase reaction, human SAA1 and SAA2, are the focus of this study. Both are primarily produced in hepatocytes. HepG2 cells were cultured and induced with interleukin-1b, interleukin-6, LPS and retinol. Protein complexes associated with SAA will be isolated through a co-Immunoprecipitation technique, resolved by SDS-PAGE, and characterized by mass spectrometry. Our hypothesis focus on those protein complexes with SAA to explain how this protein lead other undiscovered metabolic pathways involved in both cellular and survival regulation. Special thanks to The Science and Technology Competency & Education Core (Stce) for Undergraduate and Graduate Junior Research Associates Working Program from the Puerto Rico IDeA Network Biomedical Research Excellence for funding part of this research.Copyright © 2023 The American Society for Biochemistry and Molecular Biology, Inc.

Achieving a sustainable food supply, for good health and planetary health, a focus on the international context

Globally, diet quality is poor, with populations failing to adhere to national dietary guidelines.(1) Such failure has been consistently linked with poorer health outcomes.(2) Examples of malnutrition include both under- and over-nutrition, with overweight and obesity now a significant health problem worldwide.(3) Other commonly occurring examples of malnutrition are micronutrient deficiencies with iron, vitamin A and iodine deficiencies being the most frequently occurring globally. These nutritional challenges have been influenced by recent global world events, including the COVID-19 pandemic, the war in Ukraine and the related economic uncertainties;with all of these events influencing food supply and food security. Diet and health status is socio-economically patterned, and such inequalities are likely to have been enhanced as a result of these recent events. In addition to the impact of diet on health outcomes it is increasingly recognised that what we eat, and the resulting food system, has significant environmental or planetary health impacts, and research activity is growing in terms of understanding the detail of these impacts, what changes are required to reduce these impacts and also how the impact of climate change on our food supply can be mitigated. Given the complexity of the interactions between climate change, other world events, food and health, and the different actors and drivers that influence these, a systems thinking approach to capture such complexity is essential.(4) Such an approach will help address the challenges set by the UN 2030 Agenda for Sustainable Development in the form of the Sustainable Development Goals, which are a call to action to end poverty and inequality, protect the planet, and ensure that all people enjoy health, justice and prosperity.(5) Progress against SDGs has been challenging with an ultimate target of 2030. While the scientific uncertainties regarding diet and public and planetary health need to be addressed, equal attention needs to be paid to the structures and systems, as there is a need for multi-level, coherent and sustained structural interventions and policies across the full food system/supply chain to effect behavior change. Such systems-level change must always keep nutritional status, including impact on micronutrient status, in mind. However, benefits to both population and environmental health could be expected from achieving dietary behaviour change towards more sustainable diets.

Screening of Natural Antivirals Against the COVID-19 Pandemic-A Compilation of Updates

Coronavirus disease 2019 (COVID-19), named by WHO, is a real public health disaster of the third millennium. This highly contagious viral disease has infected the world population and is now a global pandemic. This acute respiratory distress syndrome (ARDS) has severe complica-tions like pneumonitis, respiratory failure, shock, multiorgan failure, and death. Well-defined FDA-approved synthetic is not yet available. Case management strategies like lockdown, use of masks and sanitizers, social distancing, and repurposing of antiviral drugs were initially undertaken to cope with this pandemic. Different broad-spectrum antiviral drugs are being repurposed as one of the treatment modalities. The global vaccination programme with the newly launched COVID-19 vac-cines, Covishield, covaxin, sputnik V, etc., is an ongoing process. Simultaneously, significant research is being carried out in search of natural antivirals and evaluating the potency of food bioac-tives to aid naturistic protection against the coronavirus. This mini-review has compiled the latest updates on the screening and evidence-based mechanistic evaluation of phytochemicals and food bioactives as non-pharmacological adjuvant aid in COVID pandemics.Copyright © 2023 Bentham Science Publishers.

Study of the Relationships between COVID-19, Associated Diseases, and Vitamins

Background: Some vitamins play a beneficial role in the immune system and certain diseases may be associated with an increase in the number of COVID-19 cases and mortality. Objective(s): In this work, we aim to verify a possible relationship between vitamin A, vitamin D, sunlight, and COVID-19 cases and mortality. We also aim to study the relationship between chronic diseases and COVID-19 in the world. Method(s): We consulted online databases (Johns Hopkins, World Life Expectancy, NASA, and World Health Organization) and used SPSS (v23) for statistical analysis. Result(s): We found that countries with the highest number of cases and deaths by COVID-19 are the countries with the highest death rates from different types of cancer and multiple sclerosis. Besides, the relationship between cancer death rate and COVID-19 is not biased by the life expectancy. We also found that the low solar incidence and low vitamins A and D levels can be related to the number of cases and deaths by COVID-19. Conclusion(s): Our findings suggest a relationship between different cancer types and multiple sclerosis death rates and COVID-19. We also recommend that vitamins D and A may play a protective role in COVID-19 infection.Copyright © 2021 Bentham Science Publishers.

RNA INTERFERENCE IS THE BASIS OF HUMAN ANTIVIRAL DEFENSE.

Comparative analysis of antiviral protective mechanisms in protozoa and RNA interference of multicellular organisms has revealed their similarity, also providing a clue to understanding the adaptive immunity. In this article, we present the latest evidence on the importance of RNA-guided gene regulation in human antiviral defense. The role of neutralizing antibodies and interferon system in viral invasion is considered. The new concept has been introduced, i.e., antiviral protection of any living organism is based on the intracellular RNA-guided mechanisms. Simple and effective defense against viruses is that spacer segment of the viral DNA is inserted into the cellular chromosomes. Upon re-infection, the RNA transcript of the spacer directs nuclease enzymes against the foreign genome. This is a really adaptive immune defense that any cell potentially possesses. In humans, the interferon system provides an additional tool for early suppression of viral infections which shifts the cells to the alert regimen, thus preventing further spread of infection. The main task of the human central immune system is to maintain integrity and combat foreign organisms. Accordingly, a suitable index of acquired antiviral immunity should be a presence of specific spacer markers in DNA samples from reconvalescent persons, rather than detection of neutralizing antibodies, B and T memory cells. This article is addressed primarily to general medical community, and its practical conclusions are as follows: 1. Presence or absence of specific antibodies to SARS-CoV-2 is not a prognostic sign of the disease. Detection of specific antibodies in blood simply reflects the fact that the person has contacted with the viral agent. Absence of antibodies does not mean a lack of such contact, and the persons with high titers of specific antibodies are not protected from re-infection with SARS-CoV-2. 2. PCR testing: The PCR results may remain "false positive" in those subjects who have had COVID-19, if the genetic material is taken from the site of initial virus contraction (mainly, nasopharynx). In our opinion, negative PCR tests for COVID-19 in blood plasma and urine will be a more correct index for the absence of the disease, even with positive PCR tests from the nasopharyngeal samples. 3. It is necessary to draw attention of general practitioners to potential usage of retinol in prevention and treatment of COVID-19, given the importance of RLR receptors in recognition of viral RNAs and positive experience of vitamin A administration in measles, another dangerous viral disease. Copyright © 2022, SPb RAACI.

RNA INTERFERENCE IS THE BASIS OF HUMAN ANTIVIRAL DEFENSE

Comparative analysis of antiviral protective mechanisms in protozoa and RNA interference of multicellular organisms has revealed their similarity, also providing a clue to understanding the adaptive immunity. In this article, we present the latest evidence on the importance of RNA-guided gene regulation in human antiviral defense. The role of neutralizing antibodies and interferon system in viral invasion is considered. The new concept has been introduced, i.e., antiviral protection of any living organism is based on the intracellular RNA-guided mechanisms. Simple and effective defense against viruses is that spacer segment of the viral DNA is inserted into the cellular chromosomes. Upon re-infection, the RNA transcript of the spacer directs nuclease enzymes against the foreign genome. This is a really adaptive immune defense that any cell potentially possesses. In humans, the interferon system provides an additional tool for early suppression of viral infections which shifts the cells to the alert regimen, thus preventing further spread of infection. The main task of the human central immune system is to maintain integrity and combat foreign organisms. Accordingly, a suitable index of acquired antiviral immunity should be a presence of specific spacer markers in DNA samples from reconvalescent persons, rather than detection of neutralizing antibodies, B and T memory cells. This article is addressed primarily to general medical community, and its practical conclusions are as follows: 1. Presence or absence of specific antibodies to SARS-CoV-2 is not a prognostic sign of the disease. Detection of specific antibodies in blood simply reflects the fact that the person has contacted with the viral agent. Absence of antibodies does not mean a lack of such contact, and the persons with high titers of specific antibodies are not protected from re-infection with SARS-CoV-2. 2. PCR testing: The PCR results may remain "false positive” in those subjects who have had COVID-19, if the genetic material is taken from the site of initial virus contraction (mainly, nasopharynx). In our opinion, negative PCR tests for COVID-19 in blood plasma and urine will be a more correct index for the absence of the disease, even with positive PCR tests from the nasopharyngeal samples. 3. It is necessary to draw attention of general practitioners to potential usage of retinol in prevention and treatment of COVID-19, given the importance of RLR receptors in recognition of viral RNAs and positive experience of vitamin A administration in measles, another dangerous viral disease. © 2022, SPb RAACI.

O Impacto Da Pandemia De Covid-19 No Atendimento Do Paciente Com Leucemia

Objetivo: Analisar comparativamente as caracteristicas relativas aos gastos destinados a saude para tratamento de pacientes internados por Leucemias antes, durante e apos a pandemia de COVID-19 no Piaui. Materiais e Metodos: O estudo ecologico, de carater descritivo e retrospectivo. Os dados utilizados foram obtidos mediante o Departamento de Informatica do Sistema Unico de Saude (DATASUS), em que foi analisado o perfil de internacoes ocasionadas por leucemias, os gastos empreendidos com esses pacientes, o tempo medio de permanencia, a quantidade total de internacoes e o numero de obitos no periodo de janeiro de 2019 a maio de 2022. Os dados foram agrupados no Microsoft Excel, realizada analise estatistica descritiva, frequencia absoluta e relativa. Resultados: Durante a pandemia, houve reducao de 14,6% no numero de internacoes (779 em 2019 e 665 em 2020) e de 35,5% no valor total gasto com pacientes portadores de Leucemia no estado do Piaui (R$ 2.287.368,42 em 2019 e R$ 1.476.495,97 em 2020). A tendencia foi seguida nos anos de 2021 e 2022 (R$ 1.367.601,50 em 2021 e R$ 611.316,64 ate maio 2022). A media de permanencia em 2019 foi de 8,6 dias, enquanto no periodo de pandemico e pos-pandemico reduziu para 8 dias. O numero de obitos tambem obteve queda de 34,3% quando comparado ao ano anterior da pandemia de COVID-19 (67 obitos em 2019 e 44 obitos em 2020). Discussao: As leucemias compoem um grupo heterogeneo de neoplasias hematologicas resultantes da transformacao total ou parcial das celulas blasticas. Essa doenca tem o carater de alta prevalencia e taxa de mortalidade consideravel, tornando-se imprescindivel tomar estrategias a fim de assegurar a deteccao precoce, que e obtido com a associacao do diagnostico precoce com o rastreamento, segundo a organizacao mundial de saude. O diagnostico precoce acontece quando se tem profissionais bem treinados e uma populacao bem-informada acerca dos sinais e sintomas das leucemias e com acesso garantido as unidades de saude, enquanto o rastreio e uma busca ativa entre um grupo especifico de pessoas que tem maiores chances de virem a desenvolver. Durante a pandemia essa deteccao precoce foi prejudicada e, contrariando as estatisticas, os numeros de novos casos diminuiu, consequencia do foco das campanhas e da deteccao precoce ter sido direcionado ao COVID-19, sugerindo tambem subnotificacoes, os numeros de internacoes caiu, consequencia da falta de leitos, que eram destinados aos pacientes com sindromes respiratorias no periodo de 2020. A queda nos gastos tambem e consequencia da propria diminuicao das internacoes, mas tambem das verbas para saude publica terem sido mais direcionadas para dar suporte ao tratamento dos pacientes com COVID-19. Isso pode ser inferido atraves da analise de custo medio por paciente. Por fim, a queda do numero de obitos tambem foi alta, mas se manteve inalterada entre 2020 e 2021, o que sugere falta de autopsia e ate subnotificacao e notificacoes erroneas, tendo em vista que pacientes leucemicos sao mais propensos a infeccoes, como a propria COVID. Infere-se que os pacientes leucemicos do Piaui tenham ido a obito e notificados como por COVID ou procurado assistencia em maiores polos de saude em outros estados. Conclusao: Apos a analise comparativa dos dados coletados, pode-se concluir que houve uma diminuicao significativa, tanto na quantidade e tempo medio de internacoes e na mortalidade, quanto nos gastos para cuidar desses pacientes. Copyright © 2022

A 51-YEAR-OLD MAN WITH WEIGHT LOSS AND CARDIOGENIC SHOCK

CASE: A 51-year-old man without significant past medical history presented to our hospital with dyspnea on exertion. SARS-CoV-2 was detected on routine occupational screening 2 months prior to admission. He subsequently reported a 100lb weight loss, during which time he experienced dysgeusia and ate primarily cereal, sandwiches, and potatoes and consumed nearly no fruits or vegetables. Three weeks prior to admission he developed postprandial nausea and vomiting and anorexia. A week later he developed progressive epigastric pain, lower extremity edema, and dyspnea while walking around the college campus where he worked as a security guard, and sought medical attention. He did not have fever, chills, night sweats, cough, orthopnea, paroxysmal nocturnal dyspnea, rash, or diarrhea. He had not seen a doctor in 20 years and took no medications. He did not drink alcohol, smoke cigarettes, or use illicit substances. Vital signs were T 36.6°F HR 104 BP 149/111 RR 20 and SpO2 97%. Physical examination revealed a cachectic man with bitemporal wasting, sunken orbits, poor dentition, and severe periodontal disease. JVP was 14cm of H2O at 45°. An S3 was present. The abdomen was tender to palpation in the mid epigastrium. The extremities were cool with 3+ pitting edema. Pancreatitis was diagnosed after discovery of markedly elevated lipase levels and peripancreatic fat stranding on abdominal CT. TTE showed biventricular systolic dysfunction with LVEF 15%. He developed cardiogenic shock complicated by oliguric renal failure, congestive hepatopathy and obtundation, requiring ICU transfer for diuresis and inotropic support. Further workup revealed deficiencies of thiamine, zinc, and vitamins A, C, and D. A regadenoson myocardial perfusion PET/CT showed no flow-limiting coronary artery disease, and workup for inflammatory, infectious, and toxic-metabolic causes of heart failure was unrevealing. While COVID myocarditis and multisystem inflammatory syndrome in adults (MIS-A) were considered, ultimately, a diagnosis of wet beriberi was made. After 5 months of aggressive nutritional supplementation via percutaneous gastrostomy tube and initiation of guideline-directed medical therapy, LVEF improved to 53% and weight increased by 35lbs. IMPACT/DISCUSSION: Wet beriberi is a potentially underrecognized cause of dilated cardiomyopathy in resource-rich areas. Within 3 months, thiamine deficiency can cause high-output heart failure due to impaired myocardial energy metabolism and dysautonomia. Risk factors include alcohol use disorder, prolonged vomiting, and history of bariatric surgery. CONCLUSION: The laboratory evaluation of non-ischemic dilated cardiomyopathy should include measurement of serum thiamine, carnitine, and selenium levels in select patients, alongside iron studies, ANA, screening for HIV, Chagas disease, and viral myocarditis, and genetic testing in patients with a suggestive family history. Empiric thiamine repletion should be considered in all critically ill patients with evidence of malnutrition.

THE ABILITIES OF VITAMIN AND MINERAL SUPPLEMENTS DURING THE COVID-19 PANDEMIC

The insufficient provision of micronutrients (vitamins A, D, E, C, and B-group, the minerals zinc, iron, selenium, magnesium, copper, and phosphorus) weakens the immune response, which can increase the risk of infection, contribute to disease severity and COVID-19 complications. The population of Russia, both adults and children, has deficiencies of multiple micronutrients (vitamins D, B-group, calcium, magnesium, zinc, and iodine), their simultaneous deficiency is experienced by about one third of the surveyed population. The micronutrients in the body are interconnected to form metabolic networks. A lack of one or more vitamins can disrupt the conversion of other vitamins to their biologically active forms, causing a functional vitamin deficiency. The percentage of vitamins and minerals in the diet of the population is a modifiable risk factor for infectious diseases. This implies replenishing the insufficient dietary intake of micronutrients not only to cover the needs of the body, but also to achieve their optimal provision. We are not dealing with therapy with and use of vitamins in pharmacological dosages. The intake of multivitamins provides protection against COVID-19, a decrease in the severity of the disease, a reduction in the manifestations of post-COVID sequels, and an increase in the efficiency of vaccination. Optimization of the vitamin status in all population groups through the intake of vitamin and mineral supplements (VMS) containing a complete set of vitamins and immunotropic elements is an underestimated important preventive factor in protecting from viral infections. Conclusion: The relevance of taking VMS in pregnancy and lactation during the pandemic is becoming even more important. During the pandemic, the use of VMS by pregnant and lactating women will not only improve their own micronutrient status and subsequently optimize the percentage of vitamins and minerals in breast milk, and thus the micronutrient status of the baby, but will also contribute to the body's resistance to disease.

Vitamin C Deficiency in Blood Samples of COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) is the most notable pandemic of the modern era. A relationship between ascorbate (vitamin C) and COVID-19 severity is well known, whereas the role of other vitamins is less understood. The present study compared the blood levels of four vitamins in a cohort of COVID-19 patients with different severities and uninfected individuals. Serum concentrations of ascorbate, calcidiol, retinol, and α-tocopherol were measured in a cohort of 74 COVID-19 patients and 8 uninfected volunteers. The blood levels were statistically compared and additional co-morbidity factors were considered. COVID-19 patients had significantly lower plasma ascorbate levels than the controls (p-value < 0.001), and further stratification revealed that the controls had higher levels than fatal, critical, and severe COVID-19 cases (p-values < 0.001). However, no such trend was observed for calcidiol, retinol, or α-tocopherol (p-value ≥ 0.093). Survival analysis showed that plasma ascorbate below 11.4 µM was associated with a lengthy hospitalization and a high risk of death. The results indicated that COVID-19 cases had depleted blood ascorbate associated with poor medical conditions, confirming the role of this vitamin in the outcome of COVID-19 infection.

Microbial Dysbiosis and Epithelial Dysfunction in Vitamin A-Deficient Lungs

Once believed to be sterile, recent studies now show microbes inhabiting healthy lungs that are dysregulated in patients with chronic obstructive pulmonary disease (COPD), asthma, tuberculosis (TB), and SARS-CoV-2 infection. Other studies have shown an increase in pulmonary disease and recurrent respiratory infections in malnourished patients. According to the World Health Organization, vitamin A deficiency (VAD) is now a major public health issue in low-income communities and many developing countries. While VAD has been shown to alter gene expression and tissue morphology in humans and mice, research suggests the lung microbiome plays an intimate role in the metabolic regulation, pathogen inhibition, and inflammatory responses in the lung. Whether dysbiosis is a cause or consequence of chronic respiratory conditions, or whether retinoic acid (RA) - the bioactive metabolite of Vitamin A - is essential for lung microbiome homeostasis, remains unknown. Therefore, we hypothesize that dietary VAD leads to epithelial remodeling which promotes microbial dysbiosis;the dysbiosis then perpetuates epithelial remodeling via host-microbe interactions. Our preliminary results show anatomical/pathological changes to the epithelium in VAD adult mouse lungs compared to controls (VAS). Using our Nkx2- 1creERT2/dnRAR Rosa26 tdTomato transgenic mouse model that selectively induces VAD in the adult lung epithelium following tamoxifen injections, our data supports the hypothesis that host epithelial aberration associated with dietary VAD is induced locally in the lung and not via distal or systemic mechanisms. Our data also indicates the onset of dysbiosis in adult mouse lungs as early as three weeks post-diet modulation as observed through changes in microbial composition in VAD mice compared to controls. Finally, our bulk RNAseq analysis of host and microbial gene signatures has uncovered mechanisms associated with microbial metabolic functions, ciliopathy, host cellular polarity, and immune response to infection, that are dysregulated in the absence of vitamin A. Further, we have also identified altered transcriptional activity of microbes that are traditionally symbiotic or pathobiotic under normal homeostasis. This work indicates the presence of specific host-microbe interactions that are essential for lung homeostasis and protection against lung infection and disease that are dysregulated or lost in the absence of dietary vitamin A.

Sea grapes Kombucha Tea Improves Liver-Superoxide dismutase (SOD) Serum in Mice Fed on Cholesterol- and Fat-enriched Diet: A Novel Probiotic Ready-to-drink Rich in Ascorbic Acid

Background/Objectives: Sea grapes (Caulerpa racemosa) are rich in macro-micronutrients, such as protein, minerals, folic acid, ascorbic acid (Vitamin C), vitamin A, vitamin B1, and fiber.(1) Kombucha tea is a synbiotic fermented beverage that has many health benefits which fermentation process increases antioxidant levels in food products.(2) This study aims to evaluate the benefits of sea grapes kombucha tea, which include the amounts of vitamin C and its effect on Liver-Superoxide dismutase (SOD) serum in mice fed on cholesterol- and fat-enriched diet (CFED). Methods: The Kombucha tea in this study used the formulation of the previous study.(3) Vitamin C amounts were tested using the Titration-Iodometry method. Furthermore, 40 albino male (Mus musculus) mice weighing between 20-30 g were divided into four groups of ten each;group A as normal control (standard dry pellet diet), group B were fed CFED only, and C and D were fed CFED which given 150 and 300 mg/kgBW sea grapes kombucha tea (p.o.) for 4 weeks. This protocol has been registered at https://preclinicaltrials.eu (International Register of Preclinical Trials Protocols) PCTE0000258 and approved by the Ethics Committee RSUP Prof. Dr. RD. Kandou 100/EC/ KEPK-KANDOU/VI/2021. Statistical analysis in this study used The One-Way Anova SPSS 26.0. Results: Ascorbic acid amounts in this study kombucha tea was 1.45 ± 3.82 mg.mL-1. There was a significant difference in SOD levels between groups (p < 0.0001). SOD levels in group A, B, C, and D respectively 16.90 ± 2.82 U/mL;8.79 ± 0.67 U/mL;63.75 ± 4.55 U/mL and 80.27 ± 4.13 U/mL. Dosage of 300 mg/kgBW has significantly increased SOD activity (p < 0.0001) compared to 150 mg/kgBW. Discussion / Conclusion: The sea grapes kombucha tea has the potential to be a ready-to-drink beverage to meet daily vitamin C needs and increase SOD-Liver (Intracellular antioxidant). This study showed in line with previous study that consumption of ascorbic acid significantly increased the SOD activity in type-2 diabetes patients.(4) SOD plays a very important role as a defense against oxidative stress in the body.(5) Sea grapes kombucha tea has the potential to be an anti-inflammatory functional food and as a good immunomodulatory agent, especially during the COVID-19 pandemic.

Retinol Depletion in COVID-19.

Background and aims: COVID-19 has been a devastating pandemic. There are indications that vitamin A is depleted during infections. Vitamin A is important in development and immune homeostasis. It has been used successfully in measles, RSV and AIDS infections. In this study, we aimed to measure the serum retinol levels in severe COVID-19 patients to assess the importance of vitamin A in the COVID-19 pathogenesis. Methods: The serum retinol level was measured in two groups of patients: the COVID-19 group, which consisted of 27 severe COVID-19 patients hospitalized in the intensive care unit with respiratory failure, and the control group, which consisted of 23 patients without COVID-19 symptoms. Results: The mean serum retinol levels were 0.37 mg/L in the COVID-19 group and 0.52 mg/L in the control group. The difference between the serum retinol levels in the two groups was statistically significant. There was no significant difference in retinol levels between different ages and genders within the COVID-19 group. Comorbidity did not affect serum retinol levels. Conclusion: The serum retinol level was significantly lower in patients with severe COVID-19, and this difference was independent of age or underlying comorbidity. Our data show that retinol and retinoic acid signaling might be important in immunopathogenesis of COVID-19.

Significantly Reduced Retinol Binding Protein 4 (RBP4) Levels in Critically Ill COVID-19 Patients.

The SARS-CoV-2 virus is the causative agent of the COVID-19 pandemic. The disease causes respiratory failure in some individuals accompanied by marked hyperinflammation. Vitamin A (syn. retinol) can exist in the body in the storage form as retinyl ester, or in the transcriptionally active form as retinoic acid. The main function of retinol binding protein 4 (RBP4), synthesized in the liver, is to transport hydrophobic vitamin A to various tissues. Vitamin A has an important role in the innate and acquired immune system. In particular, it is involved in the repair of lung tissue after infections. In viral respiratory diseases such as influenza pneumonia, vitamin A supplementation has been shown to reduce mortality in animal models. In critically ill COVID-19 patients, a significant decrease in plasma vitamin A levels and an association with increased mortality have been observed. However, there is no evidence on RBP4 in relation to COVID-19. This prospective, multicenter, observational, cross-sectional study examined RBP4 (enzyme-linked immunosorbent assay) and vitamin A plasma levels (high-performance liquid chromatography) in COVID-19 patients, including 59 hospitalized patients. Of these, 19 developed critical illness (ARDS/ECMO), 20 developed severe illness (oxygenation disorder), and 20 developed moderate illness (no oxygenation disorder). Twenty age-matched convalescent patients following SARS-CoV-2 infection, were used as a control group. Reduced RBP4 plasma levels significantly correlated with impaired liver function and elevated inflammatory markers (CRP, lymphocytopenia). RBP4 levels were decreased in hospitalized patients with critical illness compared to nonpatients (p < 0.01). In comparison, significantly lower vitamin A levels were detected in hospitalized patients regardless of disease severity. Overall, we conclude that RBP4 plasma levels are significantly reduced in critically ill COVID-19 patients during acute inflammation, and vitamin A levels are significantly reduced in patients with moderate/severe/critical illness during the acute phase of illness.

General overview on SARS-CoV-2 and potential role of natural compounds as antiviral drugs targeting SARS-CoV-2 proteins. (Special issue.)

Purpose: The novel coronavirus disease namely COVID-19 is a viral disease induced by severe acute respiratory syndrome coronavirus (SARS-CoV-2). The cases were first reported in Wuhan, China, by the end of 2019 and subsequently spread worldwide. The virus can be transferred through direct or indirect contact and leads to several manifestations;the most common are fever, dry cough, pneumonia, and acute respiratory distress syndrome (ARDS). COVID-19 has caused massive human and economic losses, posing an ongoing threat. Understanding the current situation and developing a treatment which can be both safe and effective has become essential. In this regard, natural products could be an important resource in the development of treatment for COVID-19, as they have contributed to the treatment of other viruses in the past. This review aims to understand the cellular machinery of SARS-CoV-2 and to identify its drug targets.

Boosting the immune system with functional compounds during the COVID-19 pandemic: a review

Background: More than 1 year has passed since the outbreak of the COVID-19 pandemic. Nutrition and its role in boosting the immune system have been a hot topic during the previous year in the light of the COVID-19 pandemic. An effective medicine for COVID-19 has not been introduced and public vaccination has not gained an acceptable speed in the world;therefore, preventive measures, protocols adherence, and a robust immune system are crucial. The aim of this study was to evaluate the role of food in boosting the immune system during the Covid-19 pandemic.

Herbal plants: an alternative therapy to combat immunity disorders & COVID-19

COVID-19, a worldwide epidemic, is afflicting the whole planet. Vaccines have been developed;however, they will not be able to eliminate the COVID-19 virus. As a result, the only approach to address the problem is to the disease is to have a robust immune system. A well-balanced diet can help enhance immunity, which is necessary for preventing and treating viral illnesses. Vitamins A, C, and D and minerals like Selenium and Zinc found in fruits, herbs, and vegetables have been demonstrated to have beneficial immunity-enhancing effects in viral respiratory infections. In this publication, we have attempted to describe the advantages of medicinal herbs, vitamins, minerals, nutraceuticals, and probiotics in combating the new Coronavirus. The dietary concept based on existing evidence might help inhibit and regulate COVID-19.

Vitamin A and viral infection in critical care

Vitamin A is fat-soluble compounds of retinoid derivate, consisting of retinol, retinal, and retinyl esters. Vitamin A also affects cell growth and differentiation, playing a critical role in the normal formation and function of the heart, lungs, kidneys, and other organs. According to the role of vitamin A in enhancing immune function, it is known as an anti-inflammatory agent. Also, vitamin A supplementation by reducing morbidity and mortality in different infectious diseases, such as measles, diarrheal disease, measles-related pneumonia, human immunodeficiency virus infection, and malaria considered as a crucial factor against infection. So vitamin A deficiency can be life-threatening, because of impairing the response to infection and significant risk of development of severe respiratory infections in infants and young children. In this paper, we have discussed the effects of vitamin A in modulating immune responses in viral infections and the direct effects of this vitamin on viral replication by comparing its role during different types of viral infections.