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The hemoglobin/red blood cell distribution width (Hb/RDW) ratio has emerged as a potential biomarker for acute kidney injury (AKI), particularly in patients with cardiovascular conditions. This study investigated the relationship between Hb/RDW ratio and AKI incidence in critically ill patients diagnosed with sepsis and heart failure (HF). A retrospective study was conducted with 119 critically ill patients with sepsis and 83 patients with HF, analyzed according to the presence or absence of kidney injury. Multivariable logistic regression identified independent predictors of AKI. Outcomes between higher and lower Hb/RDW groups were compared. Patients who developed AKI showed higher C-reactive protein levels, elevated RDW (15.7 ± 2.2 vs. 14.9 ± 1.8; p = 0.01), and higher SAPS 3 scores, along with markedly lower Hb concentrations and Hb/RDW ratios (75.1 ± 1.6 vs. 85.5 ± 1.9; p < 0.001). In multivariable analysis, serum urea (OR 1.016; 95% CI 1.005-1.027 per mg/dL), SAPS 3, and Hb/RDW ratio (OR 0.977; 95% CI 0.959-0.996) were independently associated with AKI. Patients with a lower Hb/RDW ratio had higher frequencies of AKI, kidney-replacement therapy, red-cell transfusion, and mortality. During a 7-year follow-up, progression to dialysis-dependent stage V chronic kidney disease (CKD-V) occurred in 10.8% of HF patients and 2.5% of sepsis patients, indicating that a lower Hb/RDW ratio was also associated with worse long-term renal outcomes. The Hb/RDW ratio is independently associated with AKI and may also reflect long-term kidney prognosis, representing a cost-effective and readily available ICU marker to identify patients at risk for both acute and chronic renal deterioration in sepsis or HF.

To build a solid marketing and sales process, B2B companies invest in robust CRM and Marketing automation systems to help teams to identify and manage companies, contacts, interactions, sales opportunities and more. These systems offer several report types for different roles within the company, being the Marketing Attribution one of the most important to marketing leaders when analyzing what are the campaigns, channels and tactics that drive more revenue. This information is key when choosing which channels companies should allocate budget, but these tools can’t track all touchpoints in the buying journey, which can lead marketing leaders to make misleading decisions on where to invest their budgets. This research tested and analyzed an experiment applied in a prominent B2B company that added a layer of customer-level sourced data to what is tracked by the attribution tool,suggesting a hybrid attribution model that is able to identify hidden touch points and re-distribute the weights of credits attributed. To perform the study, an experimental research collected and analyzed data from a sample of 220 purchase paths, discovering that marketing attribution models widely adopted by companies can be significantly improved when granular user-level data is added to the view. It has significant managerial contributions as marketing leaders can do a better channel performance analysis and make more informed decisions when allocating investments.

IntroductionThe hemoglobin/red blood cell distribution width (Hb/RDW) ratio has emerged as a potential biomarker for acute kidney injury (AKI), particularly in patients with cardiovascular conditions. This study investigated the relationship between Hb/RDW ratio and AKI incidence in critically ill patients diagnosed with sepsis and heart failure (HF).MethodsA retrospective study was conducted with 119 critically ill patients with sepsis and 83 patients with HF, analyzed according to the presence or absence of kidney injury. Multivariable logistic regression identified independent predictors of AKI. Outcomes between higher and lower Hb/RDW groups were compared.ResultsPatients who developed AKI showed higher C-reactive protein levels, elevated RDW (15.7 ± 2.2 vs. 14.9 ± 1.8; p = 0.01), and higher SAPS 3 scores, along with markedly lower Hb concentrations and Hb/RDW ratios (75.1 ± 1.6 vs. 85.5 ± 1.9; p < 0.001). In multivariable analysis, serum urea (OR 1.016; 95% CI 1.005-1.027 per mg/dL), SAPS 3, and Hb/RDW ratio (OR 0.977; 95% CI 0.959-0.996) were independently associated with AKI. Patients with a lower Hb/RDW ratio had higher frequencies of AKI, kidney-replacement therapy, red-cell transfusion, and mortality. During a 7-year follow-up, progression to dialysis-dependent stage V chronic kidney disease (CKD-V) occurred in 10.8% of HF patients and 2.5% of sepsis patients, indicating that a lower Hb/RDW ratio was also associated with worse long-term renal outcomes.ConclusionThe Hb/RDW ratio is independently associated with AKI and may also reflect long-term kidney prognosis, representing a cost-effective and readily available ICU marker to identify patients at risk for both acute and chronic renal deterioration in sepsis or HF.

Essential oils are biosynthesized in the secondary metabolism of plants, and in their chemical composition, they can be identified different classes of compounds with potential antioxidant and biological applications. Over the years in the Amazon, several species of aromatic plants were discovered and used in traditional medicine. The literature has shown that essential oils extracted from amazon species have several biological activities, such as antioxidant, antibacterial, antifungal, cytotoxic, and antiprotozoal activities. These activities are related to the diversified chemical composition found in essential oils that, by synergism, favors its pharmacological action. In light of this vital importance, this study aimed at performing a review of the literature with particular emphasis on the chemical composition and biological activities in studies conducted with species collected in the Amazon, taking into consideration in particular the last 10 years of collection and research.

Biodegradable films based on starches from different botanical sources exhibited physicochemical and functional properties which were related with the starch characteristics. However, had inadequate mechanical properties and were hard and brittle. In this research, jackfruit seed starch plasticized with glycerol were developed and characterized. The starch and glycerol concentrations ranged from 2 to 6% w/w and 20 to 60 g/100 g starch, respectively. Bioplastics were obtained by the casting method and characterized in terms of color, mechanical properties, solubility, water vapor permeability (WVP), morphology and free energy of the hydrophobic interaction. Electronic micrographics showed the presence of some intact starch granules. The bioplastics were hydrophilic and those of 6% starch and 40% glycerol were the most hydrophilic (ΔGsastot = 41.35 mJ m−1). The solubility of the films presented a direct relationship with the starch concentration ranging from 16.42 to 23.26%. Increased opacity and color difference were observed with increasing starch concentration. The WVP ranged from 1.374 × 10−3 to 3.07 × 10−4 g m/day m2 which was positively related with the concentration of starch and glycerol. Tensile strength, percent elongation and Young’s Modulus indicated that the jackfruit starch and glycerol provided a film with good mechanical properties. The results replaced that jackfruit starch can be used to develop films, with low opacity, moderate WVP and relatively high mechanical stability, by using glycerol in the gelatinized starch dispersions.

The Zika virus (ZIKV) gained prominence as a significant global pathogen after the 2015–2016 outbreaks associated it with an increase in neurological complications in adults and congenital malformations. Different mechanisms have been proposed by which ZIKV may cross the blood–brain barrier and reach the central nervous system to cause neuroinflammation. Although ZIKV infection triggers a robust immune response, the virus has developed different strategies to escape it. Furthermore, although the virus is present in areas with cocirculation of other pathogenic agents, few studies have evaluated the cross-immune reactions and coinfection of ZIKV. Coinfections of ZIKV with other viruses, parasites, and bacteria are described. Such interactions can worsen infections and alter the immune response, imposing new therapeutic challenges and highlighting the need for more studies in the field. In this review, we discuss various aspects of ZIKV biology, focusing on the impacts of coinfections.

COVID-19 is associated with a prothrombotic state leading to adverse clinical outcomes. Whether therapeutic anticoagulation improves outcomes in patients hospitalised with COVID-19 is unknown. We aimed to compare the efficacy and safety of therapeutic versus prophylactic anticoagulation in this population. We did a pragmatic, open-label (with blinded adjudication), multicentre, randomised, controlled trial, at 31 sites in Brazil. Patients (aged ≥18 years) hospitalised with COVID-19 and elevated D-dimer concentration, and who had COVID-19 symptoms for up to 14 days before randomisation, were randomly assigned (1:1) to receive either therapeutic or prophylactic anticoagulation. Therapeutic anticoagulation was in-hospital oral rivaroxaban (20 mg or 15 mg daily) for stable patients, or initial subcutaneous enoxaparin (1 mg/kg twice per day) or intravenous unfractionated heparin (to achieve a 0·3–0·7 IU/mL anti-Xa concentration) for clinically unstable patients, followed by rivaroxaban to day 30. Prophylactic anticoagulation was standard in-hospital enoxaparin or unfractionated heparin. The primary efficacy outcome was a hierarchical analysis of time to death, duration of hospitalisation, or duration of supplemental oxygen to day 30, analysed with the win ratio method (a ratio >1 reflects a better outcome in the therapeutic anticoagulation group) in the intention-to-treat population. The primary safety outcome was major or clinically relevant non-major bleeding through 30 days. This study is registered with ClinicalTrials.gov (NCT04394377) and is completed. From June 24, 2020, to Feb 26, 2021, 3331 patients were screened and 615 were randomly allocated (311 [50%] to the therapeutic anticoagulation group and 304 [50%] to the prophylactic anticoagulation group). 576 (94%) were clinically stable and 39 (6%) clinically unstable. One patient, in the therapeutic group, was lost to follow-up because of withdrawal of consent and was not included in the primary analysis. The primary efficacy outcome was not different between patients assigned therapeutic or prophylactic anticoagulation, with 28 899 (34·8%) wins in the therapeutic group and 34 288 (41·3%) in the prophylactic group (win ratio 0·86 [95% CI 0·59–1·22], p=0·40). Consistent results were seen in clinically stable and clinically unstable patients. The primary safety outcome of major or clinically relevant non-major bleeding occurred in 26 (8%) patients assigned therapeutic anticoagulation and seven (2%) assigned prophylactic anticoagulation (relative risk 3·64 [95% CI 1·61–8·27], p=0·0010). Allergic reaction to the study medication occurred in two (1%) patients in the therapeutic anticoagulation group and three (1%) in the prophylactic anticoagulation group. In patients hospitalised with COVID-19 and elevated D-dimer concentration, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not improve clinical outcomes and increased bleeding compared with prophylactic anticoagulation. Therefore, use of therapeutic-dose rivaroxaban, and other direct oral anticoagulants, should be avoided in these patients in the absence of an evidence-based indication for oral anticoagulation. Coalition COVID-19 Brazil, Bayer SA.

The essential oil (EO) of Calycolpus goetheanus (Myrtaceae) specimens (A, B, and C) were obtained through hydrodistillation. The analysis of the chemical composition of the EOs was by gas chromatography coupled with mass spectrometry CG-MS, and gas chromatography coupled with a flame ionization detector CG-FID. The phytotoxic activity of those EOs was evaluated against two weed species from common pasture areas in the Amazon region: Mimosa pudica L. and Senna obtusifolia (L.) The antioxidant capacity of the EOs was determined by (DPPH•) and (ABTS•+). Using molecular docking, we evaluated the interaction mode of the major EO compounds with the molecular binding protein 4-hydroxyphenylpyruvate dioxygenase (HPPD). The EO of specimen A was characterized by β-eudesmol (22.83%), (E)-caryophyllene (14.61%), and γ-eudesmol (13.87%), while compounds 1,8-cineole (8.64%), (E)-caryophyllene (5.86%), δ-cadinene (5.78%), and palustrol (4.97%) characterize the chemical profile of specimen B’s EOs, and specimen C had α-cadinol (9.03%), δ-cadinene (8.01%), and (E)-caryophyllene (6.74%) as the majority. The phytotoxic potential of the EOs was observed in the receptor species M. pudica with percentages of inhibition of 30%, and 33.33% for specimens B and C, respectively. The EOs’ antioxidant in DPPH• was 0.79 ± 0.08 and 0.83 ± 0.02 mM for specimens A and B, respectively. In the TEAC, was 0.07 ± 0.02 mM for specimen A and 0.12 ± 0.06 mM for specimen B. In the results of the in silico study, we observed that the van der Waals and hydrophobic interactions of the alkyl and pi-alkyl types were the main interactions responsible for the formation of the receptor–ligand complex.

Moringa oleifera seeds contain a water-soluble lectin [water-soluble M. oleifera lectin (WSMoL)] that has shown coagulant activity. Magnesium ions are able to interfere with the ability of this lectin to bind carbohydrates. In this study, we performed structural characterization of WSMoL and analyzed its effect on the electrical resistance of a kaolin clay suspension in both presence and absence of monosaccharides ( N -acetylglucosamine, glucose, or fructose) and magnesium ions. The coagulant activity of WSMoL was monitored by measuring optical density and electrical resistance over a period of 60 min. Native WSMoL had a molecular mass of 60 kDa and exhibited anionic nature (pI 5.5). In sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS-PAGE), it appeared as three polypeptide bands of 30, 20, and 10 kDa. WSMoL reduced the optical density and electrical resistance of the kaolin suspension, which suggests that suspended particles are destabilized and that this is followed by formation of complexes. The coagulant activity of lectin decreased in the presence of Mg 2+ ions and carbohydrates at concentrations that also inhibited hemagglutinating activity. This was most likely due to conformational changes in lectin structure. Our findings suggest that the coagulant activity of WSMoL is enhanced by lowering of electrical resistance of the medium and is impaired by lectin–carbohydrate and lectin–Mg 2+ interactions.

To determine risk factors for the development of long coronavirus disease 2019 (COVID-19) in healthcare personnel (HCP). We conducted a case-control study among HCP who had confirmed symptomatic COVID-19 working in a Brazilian healthcare system between March 1, 2020, and July 15, 2022. Cases were defined as those having long COVID according to the Centers for Disease Control and Prevention definition. Controls were defined as HCP who had documented COVID-19 but did not develop long COVID. Multiple logistic regression was used to assess the association between exposure variables and long COVID during 180 days of follow-up. Of 7,051 HCP diagnosed with COVID-19, 1,933 (27.4%) who developed long COVID were compared to 5,118 (72.6%) who did not. The majority of those with long COVID (51.8%) had 3 or more symptoms. Factors associated with the development of long COVID were female sex (OR, 1.21; 95% CI, 1.05-1.39), age (OR, 1.01; 95% CI, 1.00-1.02), and 2 or more SARS-CoV-2 infections (OR, 1.27; 95% CI, 1.07-1.50). Those infected with the SARS-CoV-2 δ (delta) variant (OR, 0.30; 95% CI, 0.17-0.50) or the SARS-CoV-2 o (omicron) variant (OR, 0.49; 95% CI, 0.30-0.78), and those receiving 4 COVID-19 vaccine doses prior to infection (OR, 0.05; 95% CI, 0.01-0.19) were significantly less likely to develop long COVID. Long COVID can be prevalent among HCP. Acquiring >1 SARS-CoV-2 infection was a major risk factor for long COVID, while maintenance of immunity via vaccination was highly protective.