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Fatigue development in endurance sports has several causes; among these, dehydration can impair performance. Both water and electrolytes are lost during exercise, in particular, when exercising in hot environments. These losses must be replaced, with carbohydrate-electrolyte solutions, in different forms. This study aimed to evaluate the effects of different hydrating solutions on body fluid status. Nine male recreational cyclists performed three experimental trials on separate days: trials consisted of a two-hour endurance ride, with three different hydration solutions, consumed in a randomized order (water, water+powder, water+gel). Body weight was measured, and bioimpedance vector analysis was performed both before and after each trial. Changes from pre- to post-training in the impedance vector, phase angle, total body water and extracellular water were then compared between the three conditions, using MANOVA for repeated measures. A time × treatment effect was shown for the total body water (p=0.05) and impedance vector (p=0.032), with both the powder and gel differing from the water-only condition. Powder and gel solutions have been shown to be equally effective in limiting the negative effects of dehydration, preventing the loss of total body water. However, gels may represent a practical advantage for endurance athletes, especially those who take part in long-distance races.

Oxidative stress plays an important role in the aetiology and pathogenesis of many chronic diseases. Edible mushrooms, especially Pleurotus spp., are considered to be a natural source of potential antioxidants. This work investigated the influence of solvent nature on the extraction yield of Pleurotus pulmonarius, Pleurotus floridanus and Pleurotus sajor-caju and the influence of extract mixture concentrations on oxidative stress. Extracts from each mushroom species and mixtures (1w:1w:1w) were produced by macerating the powders (1w:5v) in different solvents: distilled water, ethanol, hexane, ethyl acetate and dichloromethane. The extraction yield was then determined and the antioxidant activity was evaluated for the extracts and formulations, with ascorbic acid used as a standard. Based on the best yield and antioxidant activity in vitro, the aqueous extract mixture was used for acute toxicity testing (at 2000 mg/kg BW), and its effects at 250 and 500 mg/kg BW over 14 days on oxidative stress induced in vivo by lead acetate (35 mg/kg BW every two days) were compared. Ascorbic acid was used as a reference. Oxidative stress markers were assessed in serum and homogenized tissue. We found that water had the best yield (66.32% for P. pulmonarius, 68.56% for P. floridanus and 65.40% for P. sajor-caju), followed by the ethanol, ethyl acetate, dichloromethane and hexane extracts. In addition, all extracts and formulations had significant ferric reducing antioxidant power at C = 1 mg/ml (62.59–546.67 mg AAE/g), good scavenging activity as assessed by the DPPH free radical assay at C = 25 mg/ml (63.08– 78.52%) and significant polyphenol content at C = 100 mg/ml (1.69–26.50 mg CE/g) with the best results seen with the aqueous extracts. The aqueous extract mixture showed no particular signs of toxicity. After lead exposure, significant increases were observed with respect to serum transaminase activity and creatinine and urea levels, but a decrease in total protein levels was found. In addition, a significant increase in malondialdehyde levels but a decrease in reduced glutathione levels and superoxide dismutase, catalase and total antioxidant capacity was noted in the serum, liver and kidneys. Treatment with the mixture brought about a significant amelioration in terms of antioxidant parameters, with the greatest effect seen with a dose of 500 mg/kg BW, as well as with the ascorbic acid used as a reference. The results here suggest that these mushrooms, due to their antioxidant potential, are beneficial for health and could be useful for the production of medicinal products and nutraceuticals.

Infectious diseases remain a major health challenge and are becoming increasingly difficult to manage due to the spread of antibiotic resistance. A novel approach is to exploit human milk oligosaccharides (HMOs), which are now known to reduce the prevalence of infectious diseases among breastfed infants. HMOs have bacteriostatic or bactericidal activity against a wide range of important pathogens, such as Streptococcus agalactiae (group B Streptococcus), Streptococcus pneumoniae, Campylobacter jejuni, Clostridioides difficile, Entamoeba histolytica and Candida albicans. Furthermore, HMOs can act synergistically with antibiotics, reducing the minimum inhibitory concentration for certain antibiotics by up to 32-fold. This could extend the therapeutic window of some antibiotics and also reduce the doses required to treat infectious diseases. Given the risk posed by the emergence of antibiotic-resistant pathogens, it would be advantageous to further exploit this synergism between antibiotics and HMOs.

Nutraceuticals are garnering increased interest among people throughout the world at the present time. Although the consumption of functional foods has taken place since the Ayurvedic era, the term ‘nutraceutical’ has only been coined recently. With the growing nutraceutical market and its impact on population health, regulation of these food products is warranted. There are different regulatory requirements for nutraceuticals throughout the world. In Nepal, nutraceuticals are regulated by the Dietary Supplement Guideline published by the Ministry of Agriculture and Livestock Development. This Guideline aims to protect the health of the consumer and uphold service to the customer by controlling and assuring the stated composition and purity of the nutritional supplementary food, along with defining quality standards, as stated in the preamble of the Guideline. Functional foods are subdivided into six different classes; these are controlled in terms of production, sale, export and import within the territory of Nepal by this Guideline. Even though there are strict laws, unnecessary prescription of nutraceuticals for financial benefit and the sale of unauthorized herbal formulations and nutraceuticals by street vendors are still common practices. We believe the Nepalese authorities should make a greater effort to halt such practices.

On March 11th 2020, the World Health Organisation (WHO) declared COVID-19 the first pandemic due to a coronavirus. Clinical severity can vary significantly; some patients are asymptomatic, others develop mild infections of the upper respiratory tract, while others develop severe pneumonia and acute respiratory distress syndrome (ARDS). Risk factors are elderly age, a high sequential organ failure assessment (SOFA) score and chronic comorbidities. The knowledge of these factors is very important but they do not explain the disparity between the sexes or the deaths of young patients who did not have any health problems before the diagnosis of SARS-CoV-2 infection. Among the various factors that could help explain these dynamics, it is of great interest to investigate the potential contribution of the soluble androgen receptor (AR) and of the adipose organ, with particular reference to the actions of leptin. If what was proposed in this analysis were confirmed by surveys, it would be possible to consider acting at the level of these molecular objectives, with different synthesized or extracted molecules including bicalutamide and magnolol for AR, and curcumin, silibinin and other molecules for leptin. Further studies are needed to validate this suggestion. These studies could help to find new treatments and provide useful information for a better assessment of the risk of serious SARS-CoV-2-related disease, taking into account the susceptibility and characteristics of the host.

Withania somnifera (WS) is a traditional Ayurvedic herb. In addition to Ayurveda texts, the modern medical literature reports many potential health benefits of WS, including its possible use as a supplement as an ergogenic aid. Only recently, the efficacy of WS as an adjuvant to resistance training programmes was assessed. Most of the studies investigating this research area have mainly considered untrained subjects. In this regard, the aim of this study was to evaluate the impact of eight weeks of WS supplementation on strength training adaptations in trained individuals. Sixteen trained male individuals (25.7 ± 3.0 years; 74.7 ± 6.9 kg; 178.9 ± 4.5 cm; 23.3 ± 1.1 BMI), with at least four years of resistance training experience, participated in the study. Individuals continued with their resistance–strength training programmes, while diets and supplementation strategies remained unchanged. Eight of the 16 subjects (treated group) were supplemented with WS (500 mg/d WS powder extract, withanolides 2.5%) for a period of eight weeks, while the other eight subjects (control group) were not supplemented. To evaluate strength, one-repetition maximum tests (1RMs) were performed in four selected exercises at the beginning (T1), in the middle (T2) and at the end (T3) of the study. Compared to the untreated group, treated individuals showed a significant increase in total maximal strength (the sum of 1RM results) (p=0.05); however, no significant differences emerged from any single exercise maximal strength comparisons. These preliminary data suggest that, in these experimental conditions, eight weeks of supplementation with WS does not appear to contribute significantly to the induction of strength training adaptations in trained individuals.

The present study attempted to develop a simple protocol for the transformation of vitamin-rich microgreens of Vigna radiata into microcapsules with a longer shelf life. The microencapsulation method adopted was the coupling ionotropic gelation method followed by lyophilization. The microcapsules thus produced were characterized based on weight, swelling index, vitamin content and also, the range and magnitude of in vitro dissolution in simulated gastric and intestinal fluids (SGF: pH 1.2; SIF: pH 6.8, 7.4). The results showed that the microcapsules undergo high water loss during hydrogel to xerogel conversion (96.525%) and have a high swelling index (5.76) in SGF. The release rate of the enclosed vitamins was found to be very low in gastric conditions (SGF) but high in intestinal conditions (SIF). The timecourse of vitamin release (over 1–6 hours) was found to be linear and probably diffusion-controlled. Hence, microcapsules developed through this technology can be potentially used as natural and biodegradable dietary supplements that can replace and thereby reduce the health risk associated with artificial supplements.

A period of intense or prolonged muscle activity can cause a decline in performance, which can range from muscle weakness to muscle damage and soreness. Muscle fatigue can be largely reversible in minutes or hours. It is generally viewed to be the result of insufficient energy and a lack of availability of key metabolites that enable contracting muscles to meet increased energy demand. However, muscle recovery can fail to take effect quickly, and this can be associated with structural changes and damage within the muscle, inducing a cascade of events leading to immediate or delayed soreness. In previous research, SEPIFIT TM Protect, a combination of natural red wine polyphenols, zinc and vitamin E, showed in vitro efficacy with respect to lactate, interleukin-6 and creatine kinase, which are markers of muscle damage and fatigue. We have therefore conducted a pilot clinical study to evaluate the effects of this active complex in healthy men undertaking regular and stable physical activity and who were subjected to a pain induction protocol. The results showed that the consumption of 135 mg of the complex per day for 12 days was effective in reducing creatine kinase release and maintaining muscular power capacity after the pain induction protocol. It also induced a better perception of performance, physical condition and muscle soreness. SEPIFIT TM Protect can thus be considered an interesting complex to contribute to muscle recovery during physical exertion.

Unbalanced diets with a high protein load, illness, abuse of drugs and ageing are some of the many elements predisposing to alter tissue pH balance. This, poorly compensated for by buffer systems acting to maintain the acid-base balance, can be a harbinger of: 1) calcium phosphate removal from the bones with osteopenia and, later, osteoporosis; 2) symptomatic aggravation of various pre-existing conditions typically characterized by the presence of pain (arthritis, headache, myalgia and so on); 3) the genesis of new diseases. The scientific literature clearly reports that the administration of citrates, or carbonates, support physiological pH tissue balance and alkalizes urinary pH. In addition, this effect, could reduce the risk of osteopenia and the perception of pain. Non-allopathic medicine describes a situation that is even more severe, secondary to that described above. Wit the progression of impaired balance, the body, probably in an attempt to limit the damage to skeleton structures, could bring about the storage of excess acid in the extracellular matrix by preventing its further elimination in urine, which would then be paradoxically alkaline. The aim of our study was to demonstrate that, even in this case, the administration of citrates can normalize urinary pH, making it acidic. This urinary normalization would be the result of the release of stored acid from connective tissue. This release would also lead to balance tissue pH and this would be monitored through observing the typical symptoms of patients with osteoarthritis, myalgia, headache and migraine, the incidence of which should be significantly reduced.

The gastrointestinal (GI) microbiota plays a key role in health and disease. It also has a longdistance effect influencing the brain through the gut–brain axis. The establishment of an effective GI microbiota is associated with human milk oligosaccharides (HMOs). In animal studies there is evidence that HMOs can influence brain activity and cognitive development. This further suggests that management of the GI microbiota by dietary means could impact upon a wide range of diseases. Autism, which is the familiar name for autism spectrum disorder (ASD), comprises a group of heterogeneous neurodevelopmental disorders characterized by social deficits, repetitive and stereotypical behaviours, insistence on routines and communication impairments. GI abnormalities are a characteristic of a substantial number of children with ASD. These children possess a lower overall abundance of beneficial taxa, such as Bifidobacteria and Akkermansia, in the GI microbiota. Many children with ASD have higher counts of potentially pathogenic Clostridia than normally developing children. The underlying pathophysiology of ASD remains unknown although sub-optimal breast-feeding practices are associated with ASD. HMOs selectively promote the growth of Bifidobacteria in the GI tract, which is associated with numerous beneficial health outcomes. There are two potential benefits of HMOs in alleviating autism. Firstly, supplying HMOs to infants though breast-feeding can help establish a functional GI microbiota and thus avoid GI dysbiosis which is commonly related to the onset of autism. Secondly, administration of HMOs may alleviate the symptoms of autism through an effect on the gut–brain axis.

Monascus purpureus (MTCC 1090) was obtained from the IMTECH Culture Collection Centre, Chandigarh, India. Extracellular and intracellular polyketide pigment was produced by solidstate fermentation using red rice production and pigments were extracted with methanol solvent. Maximum pigment production was found with intracellular extraction and the total yield of pigment was 41 U/g followed by 33 U/g for extracellular production by substrate fermentation. Crude pigments were separated by column chromatography and an antibacterial study revealed that the yellow pigment was most effective against all test pathogens and the red pigment was found to be a potent antioxidant. The greatest antagonistic activity was almost 91% against Trichophyton rubrum followed by 88% against Microsporum canis.

Teething discomfort is a widespread disorder affecting a very high percentage of infants. It creates anxiety in parents, who look for help in paediatric clinics. The use of hyaluronic acid gels has been shown in the last 20 years to be an effective tool, generally devoid of side effects, in reducing oral mucosal inflammation in adults. Recently, such results have also been confirmed in infants affected by teething. From our routine practice results, we have retrospectively reported the efficacy and the safety profile of Bonjela® Soothing Teething Gel, a teething gel capable of addressing in a significant way this infant complaint, which improves all of the clinical outcomes used in these types of study to describe the clinical condition of infants.

Oral mucosal ulcers are quite common in an otherwise healthy population, and can determine a real worsening of the quality of life. Conventional therapy is not appropriate since ulcers often recur and, even if not needed, therapy lasting not less than 2–3 weeks carries a high risk of serious side effects. The use of hyaluronic acid applied as an adhesive gel over the lesions seems to have potential in terms of efficacy and the avoidance of side effects. Of course, hyaluronic acid-based formulations show different effects and tolerability. In our study, we retrospectively report the results obtained using a medical device, Bloxaphte®, applied for 14 days to counteract ulcers in adults. Our data clearly demonstrate the healing capability and safety profile of the product in reducing the number and size of the ulcers within the first week of daily application.

Furanoeudesma-1,3-diene, curzerene and lindestrene are thought to be the active principles underlying the analgesic action of myrrh (Commiphora molmol) extract. Recently, a very highly standardized dry extract from myrrh has been developed (RodeMyr®) and formulated in a single active nutritional supplement (Mirra+®), notified to the Italian Health Authorities in 2018. We have therefore used such a finished product to evaluate the analgesic action of myrrh in subjects affected by chronic pain. The results of the study have shown that the use of 100 mg of dry myrrh extract, administered twice a day, is effective in reducing pain perception and functio laesa both as a sole and an add-on therapy. Tolerability, compliance and side effect evaluation demonstrated the safety profile of the extract and its usefulness in treating patients with chronic pain.

In an attempt to better characterize the strain M247, a strain of Lactobacillus crispatus isolated in 1989 from the faeces of a healthy newborn baby, we have further investigated its antibiotic resistance profile, evaluating also antibiotics not recommended by the EFSA, and analyzing in addition its viability in the presence of a high concentration of boric acid, a molecule commonly use to eradicate antimycotic-resistant fungi from the vagina. At the same time, we have evaluated the ability of M247 to adhere to vaginal epithelial cells to get a better understanding of its vaginal colonizing properties. According to the obtained results, M247 appears to be insensitive to metronidazole, sulfamethoxazole and boric acid. Such resistance is not transferrable due to the total absence of mobile elements inside its genome. Moreover, the M247 strain has been shown to adhere by more than 70% to vaginal epithelial cells, thereby providing a mechanistic explanation of its vaginal colonizing capabilities observed both after local and oral use.

The oral administration of Streptococcus salivarius K12 represents a valid solution for the prevention of pharyngitis or pharyngotonsillitis, of bacterial or viral origin, and/or acute otitis media. In particular, this could be an interesting alternative to antibiotic prophylaxis in patients with relapse or disease recurrence. In this regard, the studies published in the scientific literature are limited, and thus, it was of interest to provide a meta-analysis in order to analyze in more detail the results obtained in this research field. For the meta-analysis, clinical studies were selected, as identified through PubMed, which examined the relationship between the use of formulations based on Streptococcus salivarius K12 and the number of cases or episodes of pharyngitis or pharyngotonsillitis, of bacterial or viral origin, and acute otitis media in children and adults. The effect size (ES) was calculated according to Cohen using the fixed effects model (fixed effects). Seven studies met the predefined inclusion criteria and they were included in the meta-analysis. ES values equal to -1.40 [-1.67; -1.13] and -1.01 [-1.19; -0.83] were obtained for the effect of Streptococcus salivarius K12 on the prevention of pharyngitis and acute otitis media, respectively. Both values were translated into a "big effect" according to Cohen's scale. Treatment based on this strain is effective for both the prevention of pharyngitis and acute otitis media. In addition, it is further revealed that the strain is more effective in the prevention of pharyngitis. It is desirable that further clinical investigation continues to expand and update the meta-analysis work and to recommend the use of the strain as a useful prophylactic tool to reduce the events of pharyngotonsillitis and acute otitis media.

Jackfruit belongs to the family Moraceae and is used as a novel source of starch. In the native stage, starch granules are generally insoluble at room temperature, extremely resistant to enzymatic hydrolysis and display an inability to endure processing conditions related to pH, temperature, shear rate and freeze–thawing. Modification can be carried out using chemical, physical or enzymatic methods, or a combination of these. To solve this problem, modification of starches is usually conducted to alter pasting, gelatinization and retrogradation behavior. Modified starches have been recognized as a multifunctional excipient in various industries. This review covers a wide array of topics relating to starch, including: methods of modification; the impact of modification on morphology, crystallinity, viscosity and functionality; and the application of modified starch.

This study evaluated the oral administration of a new supplement containing a combination of bioactive agents (hyaluronic acid, glucosamine sulfate, chondroitin sulfate, alpha-lipoic acid, methylsulfonylmethane and vitamins A, C and E). The objective of the study was to demonstrate that the oral administration of this product combats vulvovaginal atrophy in young women. This observational study recruited 32 women of fertile age with vaginal dryness, post-coital cystitis and/or dyspareunia (painful intercourse). Patients were evaluated using the VHI scale and the FSFI at baseline and at each follow-up. All patients took one tablet of the supplement twice daily (morning and evening) for two months. After two months, 28 patients (87%) showed an improvement in symptoms and reported complete remission. At the first follow-up at three months, that is, one month after stopping treatment, no substantial changes were reported. At the second follow-up at four months, that is, two months after stopping treatment, vaginal dryness had recurred, and patients were asked to re-start the therapy. We can conclude that this product is highly effective in young women suffering from vaginal dryness and sexual dysfunction caused by oxidative stress.

The development of contemporary knowledge in the field of oral microbiology and probiotics was commenced by Elie Metchnikoff's report on Lactobacillus bulgaricus in 1907. Since then, multiple indications for the use of probiotics have been established, following the WHO definition: "probiotics are live microorganisms, which when applied in adequate amount may benefit the host health status". In accordance with a general classification, several types of bacteria and fungi have been distinguished and, moreover, their mechanisms of action run parallel in both the gut and oral cavity. The possible use of probiotics in dentistry is a relatively new idea. Until now, three species prevailed in available research: Bifidobacterium, Lactobacillus rhamnosus GG and Lactobacillus reuteri. Current research focuses on the application of probiotics and the natural displacement of cariogenic bacteria within the oral cavity, and the subsequent alteration of health status in both adults and children. Carioblis BLIS M18 probiotic, which contains freeze-dried cultures of Streptococcus salivarius M18, was introduced to the market as a supplement indicated for patients with a high caries rate. The aim of this study was to investigate the influence of the BLIS M18 strain on oral cavity microflora and estimate possible health outcomes.

Nutritional status assessment of the individual is a key aspect in the monitoring of health status. In this context, body composition evaluation results are of fundamental importance. Several body composition techniques can be used depending on the information needed and the examined categories, and all the techniques are characterized by advantages and disadvantages. In this regard, this study aims to evaluate and compare the most commonly used techniques to evaluate body fat mass percentages in different situations. Fifty subjects took part in the study. Anthropometric data were collected and the percentage of fat mass was estimated using three different techniques: circumference, skinfold and ultrasound. Correlation strength among techniques was evaluated and the level of agreement among techniques was determined. Inferential analysis was performed and the percentage error of each technique for each individual was calculated. Correlation analysis revealed a stronger coefficient between skinfold and ultrasounds than between skinfold and circumferences (respectively, r=0.932 and r=0.686). Delta fat mass percentages were similar, approximately 5%, both when considering skinfold–ultrasound and skinfold–circumference. Stratifying the population by gender, it was observed that the correlation is worse in women than in men. In the case of stratification by BMI, in the ‘Obese’ grouping, the correlation coefficient was small, independent of the technique. Comparing these techniques has highlighted some critical features of single methods, especially considering specific target populations. This highlights the importance of the use of coupled techniques or the inadequacy of one with respect to another for particular categories.

Enterococcus is a genus of lactic acid bacteria which normally colonize the intestines of mammals including humans [1]. Enterococci are among the first bacterial colonizers after birth and are able to proliferate in both the large and the small intestine. Enterococcus faecium and Enterococcus faecalis are the most common species of enterococcus found in human feces. However, enterococci can also cause serious infection including sepsis, pneumonia, ophthalmitis, nephritis and osteomyelitis, mainly as complications of various chronic conditions associated with intestinal dysbiosis such as cancer, AIDS or chronic renal failure [2]. Most clinical strains of enterococci belong to the two species E. faecium and E. faecalis, with vancomycin-resistant enterococcal strains (VRE) being the most common cause of lethal infection. Several virulence genes have been discovered in enterococci, allowing the identification of potentially hazardous strains [3]. At the same time, enterococci have a long history, being used as starters for making fermented food products from meat, milk or vegetables [4]. Many enterococcal strains (SF68, M74, LX, etc.) from that group of probiotic strains have been used for a long time as clinically effective probiotics. The current paper summarizes the probiotic effects of one Enterococcus faecium strain—E. faecium L3. This strain was originally isolated from starter culture used in the Russian food industry. The strain was fully characterized microbiologically and genetically and tested for the absence of virulence genes, safety in laboratory animals and it immunomodulatory features. E. faecium L3 has been used in Russia in several probiotic products such as Laminolakt and Bakfir for the last 20 years. The benefits of the strain have been shown in several randomized clinical studies, including some where it was used for the treatment of gastrointestinal diseases such as chronic gastritis, gastric ulcers, irritable bowel syndrome, pancreatitis and chronic hepatitis [5– 7]. In addition to other clinical effects such as anti-cancer properties, a significant cholesterol-lowering activity was also shown [8].

Infectious diseases remain a major health challenge and are becoming increasingly difficult to manage due to the spread of antibiotic resistance. A novel approach is to exploit human milk oligosaccharides (HMOs), which are now known to reduce the prevalence of infectious diseases among breastfed infants. HMOs have bacteriostatic or bactericidal activity against a wide range of important pathogens, such as Streptococcus agalactiae (group B Streptococcus), Streptococcus pneumoniae, Campylobacter jejuni, Clostridioides difficile, Entamoeba histolytica and Candida albicans. Furthermore, HMOs can act synergistically with antibiotics, reducing the minimum inhibitory concentration for certain antibiotics by up to 32-fold. This could extend the therapeutic window of some antibiotics and also reduce the doses required to treat infectious diseases. Given the risk posed by the emergence of antibiotic-resistant pathogens, it would be advantageous to further exploit this synergism between antibiotics and HMOs.