Human Milk: Benefits, Composition and Evolution

Breastfeeding provides all the energy that the child needs in the form of nutrients in the first months of life. The components cover the nutritional needs in all stages, including colostrum and final or mature milk. It must also be taken into account that the composition of milk varies from one woman to another, between both breasts, between feedings and in the different stages in the same mother. It can be said that variation is an active mechanism to perfectly adjust to the nutritional and immunological needs of each child. Components of breast milk can exert beneficial non-nutritional functions. Breast milk also has bioactive factors, which affect biological processes and, therefore, have an impact on health. In the nutrition of premature babies, parenteral nutrition is carried out first, which later becomes enteral through different strategies, such as early minimal enteral nutrition. Despite this, they still present postnatal growth restrictions, which is associated with adverse neurocognitive outcomes. Breast milk achieves multiple benefits in both preterm and term births. Digestion and absorption in the stomach and intestines follow circadian rhythms in mammals, and these rhythms are regulated by rhythmically expressed clock genes in the intestine, as well as by daily food intake.

Biobased Hyperbranched Poly(ester)s of Precise Structure for the Release of Therapeutics

Hyperbrached poly(ester)s derived from naturally-occurring biomonomers may serve as excellent platforms for the sustained-release of therapeutics. Those generated from glycerol are particularly attractive. Traditionally, the difference in reactivity of the hydroxyl groups of glycerol has precluded the formation of well-defined polymers at high monomer conversion without gelation. Using the Martin-Smith model to select appropriate monomer ratios (ratios of functional groups), polymerization may be carried out to high conversion while avoiding gelation and with the assurance of a single type of endgroup. Various agents may be attached via esterification, amide formation or other process. Sustained release of the active agent may be readily achieved by enzyme-catalyzed hydrolysis.

Systemic soluble Programmed Death-Ligand 1 levels in sarcoidosis subjects does not vary with disease progression

Interaction of programmed cell death 1 (PD-1) receptor and its ligand 1 (PD-L1) is well studied in the field of fibrotic lung diseases, supporting its use as a biomarker of progression of interstitial lung disease. Anti PD-L1 therapy has shown effectiveness in improvement of many malignancies and murine models of autoimmune fibrotic lung diseases. Higher PD-1 expression on T cells and PD-L1 expression on human lung fibroblasts are known to contribute towards severity in sarcoidosis and idiopathic pulmonary fibrosis (IPF), respectively. The focus of this investigation was to determine if soluble form of PD-L1 (sPD-L1) serves as predictive biomarker of disease severity in interstitial lung disease (ILD), such as scleroderma, sarcoidosis and IPF. Comparison of local environments, such as bronchoalveolar lavage, revealed significantly higher sPD-L1 levels compared to systemic environments, such as peripheral blood (p=0.001, paired two-tailed Student’s t test). Investigation of serum samples of healthy control, IPF, scleroderma and sarcoidosis patients reveal significantly higher levels in sarcoidosis and IPF patients, compared to patients with scleroderma (p=0.001; p=0.02, one-way ANOVA with Tukey’s respectively). Comparison of serum levels between sarcoidosis patients and healthy controls revealed no significant differences (p=0.09, unpaired two-tailed t test). In addition, comparison of physiologic parameters, such as percent predicated Forced Vital Capacity (FVC) and sPD-L1 levels in sarcoidosis and IPF patients revealed no correlation. These observations suggest that sPD-L1 will not serve as a biomarker of sarcoidosis disease severity. Additional investigation of sPD-L1 in local environments is warranted.

Ethics or Bioethics for the Medical Profession?

The events that have occurred as a result of the Covid-19 pandemic have brought to the fore the figure of the doctor, as a main actor, in this complex and uncertain scenario. Many of the medical actions carried out have required strength, reflection, wisdom and prudence, all of them essential virtues according to the classical philosophical tradition, and that the ETHOS of the medical profession and the doctor translate, with this it is necessary to emphasize that it is the traditional medical ethics, the basis of this undeniable commitment to humanity, and that Bioethics, born 60 years ago, has been invested with an unthinkable condition, by its creator VR Potter, who proposed that the main objective should be scientific development -Technical but with ecological responsibility, beyond its supposed guiding function of current medicine. Which are the motivations for choosing the School of Medicine? What does it mean to be a good professional? How to respond to an increasingly demanding society? In light of the development of new technologies and communication systems, which today are universally accessible. It seems that the answer to these questions lies in a higher education based on ancestral ethical principles, which have been professed by generations of doctors, in traditional clinical practice and in practicing general medicine to achieve the specific medical training process, thus achieving efficiently meet the primary health demands of society. Therefore, Bioethics must be understood as an incipient discipline whose objective is to warn about the care of ecosystems, necessary for the survival of the human being, different from medical ethics.

Coevolution study of tau and a-synuclein suggests a connection between their normal interaction in neurons and the Parkinson's disease-associated mutation A53T

Alpha-synuclein lies at the center of Parkinson’s disease etiology, and polymorphisms in the gene for the microtubule-associated protein tau are risk factors for getting the disease. Tau and a-synuclein interact in vitro, and a-synuclein can also compete with tau binding to microtubules. To test whether these interactions might be part of their natural biological functions, a correlated mutation analysis was performed between tau and a-synuclein, looking for evidence of coevolution. For comparison, analyses were also performed between tau and b- and g-synuclein. In addition, analyses were performed between tau and the synuclein proteins and the neuronal tubulin proteins. Potential correlated mutations were detected between tau and a-synuclein, one involving an a-synuclein residue known to interact with tau in vitro, Asn122, and others involving the Parkinson’s disease-associated mutation A53T. No significant correlated mutations were seen between tau and b- and g-synuclein. Tau showed potential correlated mutations with the neuron-specific bIII-tubulin protein, encoded by the TUBB3 gene. No convincing correlated mutations were seen between the synuclein and tubulin proteins, with the possible exception of b-synuclein with bIVa-tubulin, encoded by the TUBB4A gene. While the correlated mutations between tau and a-synuclein suggest the two proteins have coevolved, additional study will be needed to confirm that their interaction is part of their normal biological function in cells.

The belated implementation of a long-awaited health system in Cyprus and the role of interest groups

It is really a paradox that 60 years were required to establish a modern health system in Cyprus, despite the expressed positive attitude οf all political parties and most governments. This article investigates the planning and implementation of the National Health System (NHS) and its delay determinants, by employing qualitative research of published sources, audio material and 33 interviews with elite key informants. A major anti-reform alliance, consisting of private doctors, private hospitals and health insurance companies was identified, further supported by doctors of the “old” public system, whose benefits were threatened. Delay contributions additionally arose from media and patient groups, whilst the pharmaceutical sector imposed insignificant influence. Τhe prevailing political, economic and social environment, along with aspects of the proposed reform, fueled this anti-reform movement. However, climate in favour of the NHS implementation gradually developed, attributed to the power balance shift supportingthe Minister of Health and the government, mobilization of important actors/stakeholders, including the Federation of Patients' Organizations of Cyprus and the Media, and significant decrease in the influence of reform-resistant groups. The new dynamics created a supportive environment leading to the NHS launch on June 1st, 2019; thus Cyprus has ceased to be the last state of the European Union (EU) without a universal health coverage system. The process of introducing this new system in Cyprus is a prime example of resource and power redistribution amongst different interest groups and of the catalysts required to exit the orbit of an extremely “path-dependent” system, potentially inspiring future reformers.

History of Trypanosomosis in the One-Humped Camel and Development of its Treatment and Cure, with Special Reference to Sudan

Sudan has one of the largest populations of domestic animals in Africa. One-humped camel (Camelus dromedarius) numbers were estimated at 4.5 million in 2009. Once used extensively for military transport they are still used in the transport role by spatially mobile pastoralist households and are a major source of milk and meat for these people. Trypanosomosis, due to Trypanosoma evansi, generally known as ‘surra’ but as ‘gufar’ in Sudan was first identified in camels in the country in 1902 and is the main cause of disease although T. vivax infections have recently been discovered in parts of Sudan. This protozoan disease is the most important health problem in camels, causing high morbidity and huge production losses. The causal organism, unlike most other trypanosomes, is not transmitted cyclically with tsetse (genus Glossina) flies as the vector but mechanically by biting flies mainly family Tabanidae but also by others of the Muscidae. Identification of the parasite in camel blood was initially by simple microscopic techniques but biotechnology and molecular methods now enable infection to be diagnosed at an earlier stage and with more accuracy. Prophylactic and curative treatments of trypanosomosis are notoriously complicated and uncertain with the situation in camels being exacerbated because of its peculiar physiology. Many trypanocides have been developed over time but the parasite often develops resistance to these drugs. Some drugs are successful, for some time, as both prophylactics and cures but are often accompanied by undesirable side effects. Other drugs used on conventional domestic stock are ineffective in camels or have lower efficacy. Research on diagnosis and treatment of trypanosomosis is continuing but the disease continues to cause production losses to the detriment of national and household incomes and food security.

Time-course of adaptations for electroretinography and pupillography

Cones are primarily involved in photopic vision and light adaptation. Rods are responsible for scotopic vision and dark adaptation. The typical time-courses of light and dark adaptations have been known for century. However, information regarding the minimal adaptation time for electroretinography (ERG) and pupillography would be helpful for practical applications and clinical efficiency. Therefore, we investigated the relationship between adaptation time and the parameters of ERG and pupillography. Forty-six eyes of 23 healthy women (mean age, 21.7 years) were enrolled. ERG and pupillography were tested for right and left eyes, respectively. ERG with a skin electrode was used to determine amplitude (µV) and implicit time (msec) by the records of rod-, flash-, cone-, and flicker-responses with white light (0.01–30 cd·s/m2). Infrared pupillography was used to record the pupillary response to 1-sec stimulation of red light (100 cd/m2). Cone- and flicker- (rod-, flash-, and pupil) responses were recorded after light (dark) adaptation at 1, 5, 10, 15, and 20 min. Amplitude was significantly different between 1 min and ≥5 or ≥10 min after adaptation in b-wave of cone- or rod-response, respectively. Implicit time differed significantly between 1 min and ≥5 min after adaptation with b-wave of cone- and rod-response. There were significant differences between 1 min and ≥10 or ≥5 min after dark adaptation in parameter of minimum pupil diameter or constriction rate, respectively. Consequently, light-adapted ERGs can be recorded, even in 5 min of light adaptation time without special light condition, whereas dark-adapted ERGs and pupillary response results can be obtained in 10 min or longer of dark adaptation time in complete darkness.

A Comparison of Neuropathy Quality of Life Tools: Norfolk QOL-DN, PN-QOL-97, and NeuroQOL-28

Aims To explore the effectiveness of the Norfolk QOL-DN (QOL-DN), PN-QOL-97, and NeuroQOL-28 as tools for early detection of diabetic peripheral neuropathy in overweight, obese, and inactive (OOI), prediabetes (PD), and type 2 diabetes (T2D) individuals. Methods Thirty-four adults were divided by A1C [(10 OOI, 13 PD, and 11 T2D] and the sural nerves were tested bilaterally via NC-Stat DPN Check, conducting a sural nerve conduction study (NCS). Participants were individually timed, filling out questionnaires (QOL-DN, NeuroQOL-28, and PN-QOL-97) at a self-selected pace. Data were analyzed and compared to NCS findings to determine the best instrument for early neuropathy detection, usability in screening settings, and application for individuals with OOI, PD, and T2D. Results Abnormal NCS results were obtained from 27 individuals, of which 25 were bilateral and symmetrical. Confirmed DSPN criteria were met for 24, and 1 case met criteria for subclinical neuropathy. Normal NCS findings, reported symptoms, and reduced bilateral sensation were found in 7 cases. The QOL-DN and NeuroQOL-28 significantly predict neuropathy criteria in OOI, PD, and T2D subjects. Analyses revealed the QOL-DN as the quickest for completion (M=5.17; SD=1.83), followed by the NeuroQOL-28 (M=5.58; SD=3.56), and the PN-QOL-97 (M=13.23; SD=3.606). Conclusions The QOL-DN and NeuroQOL-28 are valid early screening measures for DPN detection. Time completion studies revealed that the QOL-DN and NeuroQOL-28 may be used as excellent short screening measures, completed in approximately 6 minutes or less, with reasonable scoring for both. The NeuroQOL-28 is a better fit for immediate feedback, time constraints, or limited staff. Future investigations should evaluate these tools for detection in DPN-prone individuals and in subclinical populations screenings.

A Pilot Study of At-Home Virtual Reality for Chronic Pain Patients

Chronic pain disorders are a common and expensive health problem worldwide. Available treatments for these disorders have been decreasing and new treatments are needed. Virtual reality (VR) has been used for acute and procedural pain for years but systems are only now becoming available for use with chronic pain. In this study patients with a chronic pain disorder were given the option of using either take-home virtual reality equipment for one month or take-home biofeedback equipment for one month. In the VR condition patients were oriented to the “PainCare” app but could access any free content from the internet as well. Qualitative data was gathered on 23 VR patients and 12 biofeedback patients. Pre-post measures of depression, catastrophizing and function were obtained from 17 VR patients and 8 biofeedback patients. Data found that there was a statistically significant decrease in depression and catastrophizing in the VR group but no such decrease was found in the biofeedback group. No significant increase in function was found in either group though the VR group trended in that direction. One hundred percent (100%) of the patients who tried VR reported that they thought it had helped them overall at least a little. Patient ratings of the VR equipment were more favorable than the biofeedback equipment. This non-randomized small sample study suggests that at-home VR use can be used successfully with patients to decrease the important treatment variables of depression and catastrophizing, and perhaps become a significant contribution to the treatment of chronic pain disorders.