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Dietary Guidelines in some countries recommend avoiding commercially processed baby food, while others encourage the consultation of ingredients and nutritional information. Therefore, the objective of this study was to systematically analyze different baby foods obtained from commercial market and "homemade" produced, in order to verify whether comercial products have low nutritional and unsafety attributes. The samples were analyzed for chemical composition, physicochemical aspects, texture, microbiological and mycotoxin contamination, and pesticide residues. Results showed that, in general, commercial samples have a higher energy density and better ratio of macronutrients. The sodium, pH, and texture of both products were in accordance with the recommendations. None of the baby foods evaluated were contaminated with yeast and molds, total coliforms, or Escherichia coli; however, Salmonella sp. was confirmed in one homemade sample. Pesticide residues were detected in all analyzed baby food samples; however, at lower levels than the limit of quantification. Ochratoxin A was detected in one homemade baby food sample (5.76 µg /kg). Considering the samples evaluated, commercial baby food samples appeared to be safer in relation to microbiological, pesticide residue standards, and mycotoxin contamination. Therefore, it could be concluded that the quality of commercial and homemade baby foods still needs to be improved, as well as more studies related to a critical analyses of both types of processes used.

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Los antimicrobianos parenterales son esenciales en el tratamiento de infecciones intrahospitalarias, sin embargo, es importante considerar la carga de sodio y volumen que pueden aportar, especialmente, en pacientes con restricción sódica. En el presente estudio se identificaron los antimicrobianos parenterales usados en uno de los hospitales más grandes del Perú. Se revisó la cantidad de sodio intrínseco y se calculó la cantidad de sodio total por día de tratamiento según el régimen frecuentemente usado en adultos. Como resultado, se encontró que 22% de las terapias antimicrobianas superaban el requerimiento de sodio diario, lo que podría ser perjudicial para pacientes con insuficiencia cardiaca, enfermedad renal crónica, con cirrosis hepática, entre otros.

Parenteral antibiotics are essential in the treatment of nosocomial infections; however, their sodium load and volume should be considered as an extra source, especially, in patients with sodium restriction. In this study, we identified the parental antibiotics used in one of the largest hospitals in Peru. We reviewed the amount of intrinsic sodium and we calculated the sodium load per day of treatment according to the commonly used regimen in adults. As a result, we found that 22% of the antibiotic treatment regimens exceed the daily sodium requirement, which could be harmful for patients with heart failure, chronic kidney disease, liver cirrhosis, among others.

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ABSTRACT Objective To describe the prevalence of inadequate mineral intake and associated factors with calcium, iron, zinc, magnesium, phosphorus, and sodium intakes in individuals aged 15-24.9 years. Methods We analyzed 476 individuals from the Brazilian Study of Nutrition and Health, stratified into two age groups (adolescents aged 15-18.9 years and young adults aged 19-24.9 years). Mineral intake was obtained from two 24-hour Dietary Recalls. The values of the Estimated Average Requirement and the Tolerable Upper Intake Levels were considered to calculate the prevalence of inadequacy. Multiple logistic regression was used to determine associated factors with mineral intake. Results Calcium and magnesium had the highest prevalence of inadequacy (>83%) in both sexes and age groups. Sodium intake was above Tolerable Upper Intake Levels for the majority of the population studied (>68%). The intake of all minerals was different between the sexes for the two age groups (p<0.01), and it was not different between age groups (p>0.05). The associated factors with mineral intake were sex (calcium, iron, phosphorus, and sodium), age group (calcium, magnesium, phosphorus, and sodium), and physical activity (calcium, iron, and magnesium), followed by socioeconomic level (zinc and sodium) and body weight status (iron and sodium). Conclusion The expressive portion of the studied population is at nutritional risk for calcium, magnesium, and sodium. Such data can contribute to the national public policy revision that is related to micronutrient intake and the adoption of healthier habits by adolescents and young adults.

RESUMO Objetivo Descrever as prevalências de inadequação e fatores associados à ingestão de cálcio, ferro, zinco, magnésio, fósforo e sódio em indivíduos dos 15 aos 24,9 anos. Métodos Foram analisados 476 indivíduos do Estudo Brasileiro de Nutrição e Saúde, estratificados em dois grupos etários (adolescentes de 15-18,9 anos e adultos jovens de 19-24,9 anos). A ingestão de minerais foi obtida por meio de dois recordatórios de 24hs. Os valores de Requerimento Médio Estimado e do Limite Superior Tolerável de Ingestão foram considerados para calcular as prevalências de inadequação. Regressão logística múltipla foi utilizada para determinar os fatores associados à ingestão de minerais. Resultados Cálcio e magnésio tiveram elevadas prevalências de inadequação (>83%) em pacientes de ambos os sexos e grupos etários. A ingestão de sódio foi acima Limite Superior Tolerável de Ingestão para a maioria da população estudada (>68%). O consumo de todos os minerais foi diferente entre os sexos para os dois grupos etários (p<0,01) e não foi diferente entre os grupos etários (p>0,05). Os fatores associados à ingestão dos minerais foram sexo (cálcio, ferro, fósforo e sódio), grupo etário (cálcio, magnésio, fósforo e sódio) e atividade física (cálcio, ferro e magnésio), seguidos por nível socioeconômico (zinco e sódio) e estado de peso corporal (ferro e sódio). Conclusão Expressiva parcela da população estudada encontra-se em risco nutricional para cálcio, magnésio e sódio. Esses dados podem contribuir para a revisão de políticas públicas nacionais que se relacionam à ingestão de micronutrientes e à adoção de hábitos mais saudáveis pelos adolescentes e adultos jovens.

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BACKGROUND: Although metformin is generally universally recommended as a first-line pharmacologic therapy for most people living with type 2 diabetes, second-line and third-line choices can require a tailored approach to achieve optimal blood glucose and glycated hemoglobin levels. OBJECTIVE: To examine national trends in second- and third-line antihyperglycemic medications following metformin monotherapy, comparing 2015 and 2019. METHODS: This retrospective cohort analysis of deidentified pharmacy claims from a large national pharmacy benefits manager from January 1, 2015, to December 31, 2015, and again in January 1, 2019, to December 31, 2019, included adults (aged ≥ 18 years) continuously enrolled in commercial or Medicare insurance plans who filled an index metformin prescription in either year. Proportions of patients by second-line and third-line antihyperglycemic class were calculated. RESULTS: Second-line use of sulfonylureas (-10.1%; P < 0.001), combination drugs (-3.0%; P < 0.001), and dipeptidyl peptidase-4 inhibitors (-2.0%; P = 0.031) significantly declined, whereas second-line use of sodium-glucose cotransporter 2 inhibitors (SGLT2is) (+4.9%; P < 0.001) and glucagon-like peptide-1 receptor agonists (GLP-1Ras) (+10.0%; P < 0.001) significantly increased. Similarly, third-line use of sulfonylureas declined (-5.5%; P = 0.005), whereas third-line use of SGLT2is (+3.4%; P = 0.005) and GLP-1RAs (+8.3%; P < 0.001) increased. Similar trends between 2015 and 2019 were found in commercial and Medicare subgroups. Among all groups in 2015 compared with 2019, sulfonylureas were the most prescribed second-line class and insulins the most common third-line class. Although SGLT2i and GLP-1RA together represented more than one-third of second-line and third-line prescriptions for commercially insured patients in 2019 (34.3% and 35.0%, respectively), these classes were less frequently prescribed in the Medicare subgroup (18% and 25.6%, respectively). CONCLUSIONS: This report provides updated second-line and third-line antihyperglycemic medication prescribing trends in the United States, which suggests that evidence-based guidelines are being used in practice to prevent complications and individualize diabetes care. DISCLOSURES: Ms Swart and Drs Peasah and Good are employed by UPMC Health Plan. Dr Neilson was employed by UPMC Health Plan at the time of the study. Drs Munshi and Henderson were employed by Evernorth at the time of the study.

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Sodium availability and food sources in 2018−2019 were estimated and trends analyzed for 15 years (2004−2019) in Costa Rica. Food purchase records from the National Household Income and Expenditure Survey (ENIGH) 2018−2019 were converted to energy and sodium using food composition tables measuring "apparent consumption". Foods were classified by sodium content. ENIGH is a probabilistic, stratified, two-stage and replicated national survey, carried out regularly by the national statistics institution. Results from the 2004−2005 and 2012−2013 ENIGHs came from previous analysis. Differences between periods were determined through descriptive and inferential statistics. The available sodium adjusted to 2000 kcal/person/day was 3.40, 3.86, and 3.84 g/person/day (g/p/d) for periods 2004−2005, 2013−2014, and 2018−2019, respectively. In this last period, this was 3.94 urban and 3.60 g/p/d rural (p < 0.05), with a non-linear increase with income. During 2004−2019 sodium from salt and salt-based condiments increased from 69.5 to 75.5%; the contribution of common salt increased, from 60.2 to 64.8% and condiments without added salt from 9.3 to 10.7%. From 2012−2013 to 2018−2019, processed and ultra-processed foods with added sodium intake increased from 14.2 to 16.9% and decreased in prepared meals (7.2 to 2.8%). Costa Rica has been successful in reducing salt/sodium available for consumption; after a 12% increase of salt consumption between 2004−2005 and 2012−2013, to a level almost twice as high as recommended, it has stabilized in the last period.

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The objective was to assess adherence to voluntary agreements for sodium reduction firmed between the food industries and the Ministry of Health in Brazil and to compare their targets with the limit proposed in the Pan American Health Organization (PAHO) nutritional profile model. We used data from 1.553 foods from 32 categories included in the agreements and sold in the largest Brazilian supermarket chains in 2017. The frequency of products with sodium equal or below the cut-offs proposed by the voluntary agreements and by PAHO was calculated. Classification concordance according to the two was evaluated with Cohen's kappa coefficient (k). Our results showed that 77.7% of products were adequate according to the voluntary agreements, and only 35.9% of them, according to the PAHO model. We identified a weak degree of concordance between both criteria in classifying a product as adequate about sodium content (k = 0.199). In conclusion, the voluntary agreements for sodium reduction are limited in their scope and rigor. The adoption of measures oriented for all products, with more restrictive and mandatory targets, should be considered in the country.

O objetivo do trabalho foi avaliar a adesão aos acordos voluntários de redução de sódio firmados entre indústrias de alimentos e o Ministério da Saúde e comparar as metas adotadas com o limite de sódio proposto no modelo de perfil nutricional da Organização Pan-Americana da Saúde (OPAS). Utilizaram-se informações de 1.553 alimentos de 32 categorias incluídas nos acordos e comercializados nas maiores redes de supermercados brasileiras em 2017. Foram calculadas as proporções de produtos com quantidade de sódio igual ou abaixo do limite proposto pelos acordos e pela OPAS. A concordância de classificação dos itens segundo os dois critérios foi avaliada com o coeficiente kappa de Cohen (k). Nossos resultados mostraram que 77,7% dos alimentos analisados estavam adequados segundo os acordos de redução de sódio, porém apenas 35,9%, segundo o modelo da OPAS. A concordância entre os dois critérios ao classificar um produto como adequado em relação ao conteúdo de sódio foi fraca (k = 0,199). Conclui-se que os acordos voluntários de redução de sódio são limitados em relação à abrangência e ao rigor das metas estabelecidas. A adoção de medidas voltadas a todos os produtos disponíveis, com metas mais restritivas e obrigatórias, deveria ser considerada no país.

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The use of mineral clays as alternative adsorbent has received attention due to their physicochemical characteristics, superficial negative charge, abundance of vermiculite (especially in Brazil), low cost, and chemical composition, which allows the material modification to increase the adsorptive capacity. This manuscript evaluated the use of expanded vermiculite (EV) and sodium-modified vermiculite (VNa) in the adsorption and ion exchange of Cd2+ ions. The sodification was successfully carried out making the ion exchange capacity greater in the modified clay, confirmed by EDX, cation exchange capacity (CEC), DRX, and FTIR analysis. The CEC was 210 and 233 mEq/100 g for the EV and VNa, respectively, with 97.8% exchangeable ion (Na+) in the VNa. FTIR spectra showed small variations in the groups related to ion exchange and XRD analysis indicated changes in the distance of the layers with loss of crystallinity after clay modification, which was recovered after cadmium adsorption. The kinetics became faster with an equilibrium time of 10 min for VNa and 45 min for EV. Cd2+ removal by vermiculite above 99% was achieved. Pseudo-second order model best described the kinetics, in which the resistance to mass transfer in external film is the limiting step of the process and, once this resistance is overcome, the ion exchange happens quickly. Despite the decrease in surface area after sodification, the adsorptive capacity increased 158% in the sodified adsorbent, from 0.107 mmol/g for EV to 0.276 mmol/g for VNa, under the evaluated conditions.

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Resumo O objetivo do trabalho foi avaliar a adesão aos acordos voluntários de redução de sódio firmados entre indústrias de alimentos e o Ministério da Saúde e comparar as metas adotadas com o limite de sódio proposto no modelo de perfil nutricional da Organização Pan-Americana da Saúde (OPAS). Utilizaram-se informações de 1.553 alimentos de 32 categorias incluídas nos acordos e comercializados nas maiores redes de supermercados brasileiras em 2017. Foram calculadas as proporções de produtos com quantidade de sódio igual ou abaixo do limite proposto pelos acordos e pela OPAS. A concordância de classificação dos itens segundo os dois critérios foi avaliada com o coeficiente kappa de Cohen (k). Nossos resultados mostraram que 77,7% dos alimentos analisados estavam adequados segundo os acordos de redução de sódio, porém apenas 35,9%, segundo o modelo da OPAS. A concordância entre os dois critérios ao classificar um produto como adequado em relação ao conteúdo de sódio foi fraca (k = 0,199). Conclui-se que os acordos voluntários de redução de sódio são limitados em relação à abrangência e ao rigor das metas estabelecidas. A adoção de medidas voltadas a todos os produtos disponíveis, com metas mais restritivas e obrigatórias, deveria ser considerada no país.

Abstract The objective was to assess adherence to voluntary agreements for sodium reduction firmed between the food industries and the Ministry of Health in Brazil and to compare their targets with the limit proposed in the Pan American Health Organization (PAHO) nutritional profile model. We used data from 1.553 foods from 32 categories included in the agreements and sold in the largest Brazilian supermarket chains in 2017. The frequency of products with sodium equal or below the cut-offs proposed by the voluntary agreements and by PAHO was calculated. Classification concordance according to the two was evaluated with Cohen's kappa coefficient (k). Our results showed that 77.7% of products were adequate according to the voluntary agreements, and only 35.9% of them, according to the PAHO model. We identified a weak degree of concordance between both criteria in classifying a product as adequate about sodium content (k = 0.199). In conclusion, the voluntary agreements for sodium reduction are limited in their scope and rigor. The adoption of measures oriented for all products, with more restrictive and mandatory targets, should be considered in the country.

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RESUMEN: El intervalo Postmortem (IPM) es un importante desafío por resolver en la patología forense, y consiste en poder determinar el tiempo transcurrido desde la muerte hasta el momento de la autopsia. Dada la poca confiabilidad de algunos métodos por la gran influencia de factores externos y propios del cadáver, la bioquímica forense ha recibido considerable atención por sus niveles de seguridad. La ciudad de Quito se ubica en la cordillera de Los Andes a 2850 msnm, sin embargo, en la literatura no existen reportes de medición de estos parámetros a una altura como ésta. El objetivo fue establecer una correlación entre sodio (Na+), cloro (Cl-) y potasio (K+) del humor vítreo del cuerpo vítreo y el IPM a la altura de la ciudad de Quito. Para el estudio se utilizaron 128 muestras de cuerpo vítreo provenientes de 16 autopsias practicadas en la Unidad de Medicina Legal Zona 9, en IPM de 6, 12, 24, 48, 72, 96, 120 y 144 horas. Para la obtención del humor vítreo se siguió el método convencional, se dividió para las 8 alícuotas y se llevó a congelación -20 °C hasta el momento de su análisis. La cuantificación de la concentración de electrolitos Na+, Cl- y Potasio+ se realizó mediante analizador ISE de Roche Cobas (Roche Diagnostics) C501, calibrado para uroanálisis, y no fue necesaria la dilución. Durante la calibración y cada tres muestras, se midió un estándar interno para corregir los efectos de la desviación sistemática en la calibración. El enfoque estadístico se basó en un análisis de correlación lineal, utilizando el coeficiente de correlación de Spearman. La correlación entre las horas postmortem y las concentraciones de los diferentes electrolitos, fueron estadísticamente significativas. Se pudo corroborar una correlación lineal significativa entre el IPM y el aumento del K+ en el HV.

SUMMARY: The postmortem interval (PMI) is an important challenge to be solved in forensic pathology, and it consists of being able to determine the time elapsed from death to the moment of autopsy. Given the unreliability of some methods due to the great influence of external factors and those specific to the corpse, forensic biochemistry has received considerable attention for its levels of safety. The city of Quito is located in the Andes mountain range at 2850 meters above sea level, however, in the literature there are no reports of measurement of these parameters at a height like this. The objective was to establish a correlation between sodium (Na+), chlorine (Cl-) and potassium (K+) of the vitreous humor and the MPI at a height of 2,850 masl. For the study, 128 samples of vitreous humor were used from 16 autopsies performed in the Zone 9 Legal Medicine Unit, in IPM of 6, 12, 24, 48, 72, 96, 120 and 144 hours. To obtain the vitreous humor, the conventional method was followed, it was divided for the 8 aliquots and it was frozen at -20 ° C until the moment of its analysis. The quantification of the concentration of electrolytes Na+, Cl- and K+ was carried out using an ISE analyzer from Roche Cobas (Roche Diagnostics) C501, calibrated for urinalysis, and no dilution was necessary. During calibration and every third sample, an internal standard was measured to correct for the effects of systematic deviation on the calibration. The statistical approach was based on a linear correlation analysis, using the Spearman correlation coefficient. The correlation between the postmortem hours and the concentrations of the different electrolytes were statistically significant. A significant linear correlation between the PMI and the increase in K+ in vitreous humor could be corroborated.

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Basic mechanisms are known to promote salt tolerance in plants: a delay in Na+ uptake or rapid Na+ remobilization from leaf tissue. We measured dynamics of the Na+/K+ ratio and components of carbon metabolism during the first 72 h after saline stress (200 mM NaCl) began in Cenostigma pyramidale, a woody species, under controlled conditions. Saline stress at two times: one plant group at the beginning of the morning and the other in the evening. Stressed plants had three times more Na+ in leaves than did control plants in the first 24 h. However, in the next few hours, despite new applications of saline solution, the Na+/K+ ratio continued to decline. Several samples, including night treatments, provided evidence that this species uses Na+ recirculation mechanisms to endure salt stress. Effects of salt on the traits evaluated differed depending on the time when stress began. Between the two saline treatments, in the first 24 h after saline stress, gas exchange decreased more strongly in morning-stressed plants, when large amounts of Na+ reached the leaf and K+ left this organ. Nevertheless, when stress was applied in the evening, leaf Na+ remobilization was faster, and the soluble sugar/starch ratio remained greater than did the control. Our data suggested that time of the beginning of salt stress could change the level of damage. Morning-stressed plants synthesized greater amounts of proline, H2O2, and malondialdehyde than did night-stressed plants. We recommend that details regarding the time of stress be taken into consideration in physiological studies.

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