Current Pharmaceutical Biotechnology

Food Science is a modern, multidimensional, rapidly developing scientific field which is continuously and drastically promoting significant and innovative scientific advances that strongly reinforce human public health and quality of life. In the last few decades, there is plenty of substantial evidence that several bioactive food components may exert beneficial effects against diverse chronic diseases by preventive and/or therapeutic mechanisms of action [1-3]. Notably, it should be noted that more than 60% of the currently available drugs in medicine have been directly or indirectly derived by naturally occurring sources such as foods, plants and herbs [1-3]. In this aspect, Food Science cooperatively utilizes modern methodological techniques and cutting edge technologies based on diverse basic sciences such as molecular biology, biotechnology, biochemistry, physiology and epidemiology. In view of the above considerations, the purpose of this special issue is to highlight recent advances in the multidimensional field of Food Science that collectively promote human public health and quality of life. At the beginning of this special issue, Troumbis et al. have described in depth and critically scrutinized the essential scientific field of “Nutritional Culturomics”, a specific focus area of culturomics epistemology developing digital humanities and computational linguistics approaches to search for macro-patterns of public interest in food, nutrition and diet choice as a major component of cultural evolution [4]. In this critical review study, a series of indicative examples have systematically been presented regarding these “Nutritional Culturomics” epistemology components [4]. After that, a substantial research study by Rigopoulos et al. has focused on the optimization of silver nanoparticle synthesis by banana peel extract [5]. This study has highlighted the potential of an eco-friendly method to synthesize nanoparticles and its promising optimization through statistical experimental design [5]. A second research study has evaluated the in vitro antioxidant, antithrombotic, antiatherogenic and antidiabetic activities of Urtica dioica, Sideritis euboea and Cistus creticus, investigating pasta fortification with the most bioactive one, supporting substantial evidence for the potential health benefits that could be derived from consuming pasta fortified with herbal extracts [6]. Owning to the increase in the world population, as well as the consumer's awareness on the health benefits of consumption of fruits, the demand for both fresh and processed fruits has been increased. In this aspect, Dimou et al. have highlighted on the current trends in addressing environmental issues caused by the production of high volumes of specific categories of fruit processing waste streams by investigating their potential usage as natural raw materials for the recovery of valuable bioactive compounds [7]. In parallel, Sarris et al. have assessed the ability of the screened strains to produce biomass, lipid, citric acid, mannitol, arabitol and erythritol, compounds presenting pharmaceutical and biotechnological interest, in glycerol-based nitrogenlimited media [8]. In a following review study by Petsas and Vagi, the bioremediation applications of pharmaceuticals and other organic contaminants using microbial strains were critically summarized [9]. More to the point, the recent advances in understanding the biodegradation of organic contaminants focusing on the processes, pathways, genes/enzymes and factors affecting the biodegradation have systematically been presented [9]. In another comprehensive review study, the anti-hyperlipidemic effects of plant extracts, vegetables, fruits and isolated compounds from plants included in Mediterranean diet region with anti-hyperlipidamic activity, as well as their mechanisms of action in modulating gene expression in metabolic and signaling pathways have critically been analyzed [10]. Moreover, Poulios et al. have critically analyzed and discussed the various technical approaches for the extraction and identification of sage bioactive components in order to point out the more appropriate approaches of them [11]. In conclusion, all the above studies cooperatively reinforce the multidimensional advancements of Food Science that significantly promote human public health and quality of life.

An established and validated HcAI definition to guide both daily clinical practice and infection surveillance is needed. HcAIs are defined as infections that occur during hospitalization or in a place of care and assistance, neither present clinically, nor in incubation, at the time of admission or including those which occur after discharge, despite being causally traceable by incubation time, etiologic agent and modality of transmission to the same hospitalization. In recent years, the number of HcAIs has increased; as a result of the increase in the age of the population, the greater number of examinations and invasive procedures are being carried out during hospitalization and, finally, the increasingly frequent development of phenomena of antibiotic -resistance. The incidence of a HcAI depends strongly on the type of hospital, the patient population studied, the definition of HcAI adopted and the detection systems used. It is therefore a phenomenon of broad relevance not only clinical, but also economic and social if only the costs, associated with the HcAI that the literature documents and reports as extremely high, are taken into account. For example, in the European Union, additional health costs and loss of productivity of at least 1.5 billion euros are estimated each year, due to infections caused by antimicrobial resistant bacteria. Moreover, a HcAI needs agreed-upon and uniform nomenclature to avoid potentially confusing terminology, such as “community onset,” “community associated,” “outpatient infections,” “infections among nonhospitalized patients,” “nonnosocomial,” and “infections in the first 48 hours of hospitalization” [1]. The Study on the Efficacy of Nosocomial Infection Control (SENIC), conducted on some USA hospitals between 1975 and 1976, is the only study that has estimated the rate of hospital infections at the national level. In this study, the rate of infected patient amounted to 5.2% while the rate of infections was observed to be 6.6%. Thereafter many prevalence studies have been conducted in the USA and in Europe so as to estimate the impact of HcAI. In 2002 in the USA, the HAI rate was set at 4.5%, which means that every day, 9.3 out of 1000 patients are at risk for HcAI which results in 1.7 million infected patients. The European Center for Disease Prevention and Control (ECDC) has estimated that around 4.544.100 HcAI episodes occur in Europe, with an estimated prevalence of 7.6% between 1995 and 2010, i.e. around 37.000 deaths in a year. It was estimated that more than 220.000 HcAI episodes occur in Canada every year which lead to 8.500-12.000 deaths every year. In the USA, there are many institutions and societies that act at the national level to control the HAI, to name but a few: CMS (Center for Medicare and Medicaid Services), CDC (Center for Disease Control), OSHA (Occupational Safety and Health Administrations), QIO (Quality Improvement Organization), etc. The CMS is an institution that deals with the governmental healthcare system and that, in recent years, started coordinating the HAI control. In 2007, it developed a program to improve the quality of assistance: the Plan to Implement a Medicare Hospital Value- Based Purchasing Program. This project involves the use of incentives for the high-performance actions in several domains such as patient safety, the treatment process, the outcomes, the patient experience, and the efficacy of coordinated treatments. Despite this, from the CMS 2008 inspections conducted on about 70% of the hospitals to evaluate the acknowledgement of the new guidelines, it came out that the HcAI were within the first 12 principal deficiencies. In 2008, the CMS in cooperation with the CDC has developed a new payment of benefits plan. Some indicators (the PoA indicators) have been identified so as to evaluate if a certain primary or secondary diagnosis was made at the time of admission. The activity of all these institutions implemented the construction of the 2009 Action Plan. This project represents a real attack, at all levels, to the HcAI and all the main organizations in the field of health took part in its preparation. The activity of the Action Plan was articulated in 5 working groups and had seven main goals to achieve in five years, each goal had its indicator. This special issue has the primary aim of evaluating the risks of acquiring a HcAI. As its secondary objectives, the special issue aims at evaluating if the introduction of the preventive actions, therapies and new measures of clinical risk management in the HcAI control has efficacy in reducing the HcAI prevalence. The papers collected in this special issue aim at identifying the epidemiology of HcAI, the main related risk factors and the possible use of antibiotic-therapies or the ongoing related-measures to prevent and/or to treat the related adverse events. Over the years, inappropriate use and abuse of antibiotic drugs around the world have led to the selection of multi-resistant pathogenic microorganisms making infections a major health problem due to relative increases in costs, prolongation of hospitalizations, as well as morbidity and mortality risk. This is one of the themes dealt in the paper by Orsi et al.; they present a retrospective matched cohort study conducted through the analysis of hospital admissions at Sant’Andrea Teaching Hospital in Rome from April to December 2015. The healthcare facility has 450 beds, 13,729 annual admissions, 6,264 Day Hospital hospitalizations and 1,076,469 outpatient accesses, showing an annual HAI prevalence of 6.34%. The present study demonstrates once again that HAIs caused by multidrug-resistant organisms are associated with higher mortality, longer hospital stays, and increased costs. Economic assessment may provide valuable information for implementing health policies and prevention of healthcare-associated infections due to alert organisms [2]. CRBSIs are defined as a bloodstream infection originated from an intravenous catheter. Intravascular device use is frequently associated with local and systemic infectious complications, such as insertion site infection, septic thrombophlebitis, endocarditis, bacteriemia, sepsis, metastatic infections (pulmonary abscess, cerebral abscess, pancreatic abscess, osteomyelitis, arthritis, endophthalmitis) and intravascular catheter-related bloodstream infections (CRBSIs). Caroleo et al. analyzed this important topic describing four cases of O. anthropi CRSBIs occurred almost simultaneously in Oncology Unit, the goal of this paper is to establish the role of the root cause analysis and clinical risk management in adverse events’ prevention and in healthcare quality implementation. The experience presented by these authors demonstrated that clinical audit and root cause analysis process, by determining the infection source, led to adopt prevention measures: a) in order to avoid the catheters contamination, a single-dose of flush sterilization solution has been used; b) both hand hygiene accuracy and information regarding guidelines-based CRBSIs prevention and surveillance strategies among healthcare workers have been implemented [3]. The Bambino Gesù Hospital’s (OPBG) experience about the improvement of HcAI control could lead to a reduction in expenditure related to prolonged hospitalization, outcomes and compensation for claims. In fact, according to several international studies, health-care associated infections have a notable impact both in social and economic terms. The aim of the study carried out in a pediatric hospital was to evaluate the effectiveness of the introduction of the mortality review committee on the improvement of the assistance provided at the OPBG in the period examined, especially related to preventable deaths that follow HAIs. Since 2010, as shown in the present study and in other works that evaluated HAI prevalence, in the OPBG, there was a very low rate of mortality due to infections associated with health-care. In fact, possible areas of intervention were identified that could potentially lead to an improvement in the quality of care provided. These improvements involved the prevention and management of healthcare-related infections [4]. Quality of care and related analysis of litigation of a high-income hospital such as the Umberto I general hospital in Rome is the aim of the paper by La Russa et al. [5]. The Umberto I general hospital counts on 1,200 beds for a total of 38,000 annual hospitalizations, 27,000 Day Hospital admissions and 2,303,046 outpatient accesses. In particular, the authors carried out a study on HAI claims with the aim of outlining a methodological approach to the litigation management and characterizing the economic impact of infections on health facilities resources. The proposed approach is based on an integrated evaluation of HAI claims by determining the risk of loss and technical estimates. The first task was to create a scoring system based on objective parameters evaluable from the medico-legal point of view, the Advanced Loss Eventuality Assessment (ALEA). For the determination of the technical estimates, it instead adopted a systematic procedure based on common evaluation systems of personal impairment in order to quantify the claim reserves on current liabilities for claims reported but not yet settled [5]. Prevention and surveillance programs showed to be helpful tools for infections control, having allowed to increase patients’ safety and healthcare system quality. Quality of medical care is defined as the capacity of the healthcare system to achieve several medical and non-medical goals. In this regard, several studies suggested a key role of quality medical records in determining medical care process, risk management and preventing liability. The problem of the HcAI has been largely debated in the last years. Albano et al., presented a number of cases in which surgical site infections (SSIs) were analyzed. SSIs are frequent complications that occur in 2-5% of patients who undergo surgery. More than 60% of SSIs have been estimated to be preventable by using evidence-based guidelines. Guidelines-based medical records filling was demonstrated to reduce HAIs-related litigation, improve patient medical care appraisal, therefore HS quality. The most frequent type of infections, SSIs and isolate meticillin-resistant Staphylococcus Aureus (MRSA), are more likely to be seen as preventable, and, in a judicial trial, medical records are the only elements able to demonstrate standard care adhesion for infection control [6]. Di Paolo et al. discussed the forensic perspectives in approaching HcAIs, ranging from legal responsibilities of the healthcare professional and the duty of care they have incumbent upon them in ensuring prevention of HcAIs, to the role of forensic pathologists in assessing the cause of death in cases of HcAIs fatalities and, finally, ethical issues such as the emerging role of patients and families’empowerment and autonomy in prevention and control of HcAIs. Authors concluded that HcAI are a major problem for patient safety in every health-care facility and system around the world and their control and prevention represent a challenging priority for health care institutions and workers committed to making health care safer. The burden of HcAI implies longer hospital stay, increased morbidities, additional financial burden, high costs for patients and their families, and excess deaths. Clinicians are at the forefront in the war against HcAIs, however, also forensic pathologists have a remarkable role [7]. Finally, Albolino et al. presented the Italian law that establishes that health professionals should comply, as far as possible and within the bounds of each specific case, with the recommendations included in the guidelines drafted by public and private healthcare organizations and institutions, as well as scientific societies and technical-scientific associations registered on the list compiled and regulated by Ministerial decree and updated every two years. In the absence of recommendations, healthcare professionals should follow good clinical practice. According to the 2011 definition provided by the Institute of Medicine (IOM), clinical guidelines are “Statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options”. The definition of good clinical practice (GCP) is more complicated. In Italy, a Ministerial Decree refers to “an international ethical and scientific quality standard for designing, recording and reporting trials that involve the participation of human subjects”. The European Union Network for Patient and Quality of Care is drawing up a project to define and implement patient safety procedures, in conjunction with the Italian National Agency for Regional Health Services (AGENAS) as associated partner and National Contact Point. Patient safety practices have been defined as “those that reduce the risk of adverse events related to exposure to medical care across a range of diagnoses or conditions”. Patient safety practices are transversal to clinical pathologies, the literature indicates the list of the ones strongly recommended as evidence-based, thus these are clearly indicated to be applied in the framework of the new Italian law. In conclusion, the law delineates a global patient care system, pointing to the opportunities for engagement and partnering of the healthcare system with health institutions, professional health associations, health training institutions, health-associated civil society groups, and citizens [8]. In this special issue, researchers discussed clinical, pharmacological, economic and juridical aspects of relevance for advancing in these particular topics. HcAIs represent a major public health problem, widespread in patients of all ages. Of every hundred hospitalized patients, seven in developed and ten in developing countries can acquire one of the HAIs Studies dedicated to advanced techniques will provide systematic reviews of new horizons opened in HcAIs, to understand and explain clinical events of social-economic relevance.

The Mental Health is stressed in the definition of Health given by World Health Organization´s (WHO): "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" [1]. According to WHO, there are more than 450 million people worldwide suffering from different mental disorders including schizophrenia, depression, intellectual disabilities and drug abuse disorders [2]. Although they have a vast range of symptoms, combination of abnormal thoughts, emotions, behavior and relationships with others is generally observed. Around 20% of the world's children and adolescents have mental disorders or problems and more than 350 million people across the world, of all ages and from all communities, suffer from depression [3]. Regarding dementia, is a syndrome in which there is a deterioration of cognitive function beyond the expected from normal ageing, it affects around 47 million people worldwide, with nearly 60% living in low- and middle-income countries. Dementia is caused by a variety of diseases and injuries, such as Alzheimer's disease or stroke (WHO, 2018). Most of mental disorders can be successfully treated by conventional therapies but the discrimination and stigma of patients with psychiatric disorders perpetuates and demands for more attention from all the mental health professionals in order to change attitudes and enhance the efficiency of services and therapies. It is consensual that an equilibrated diet is a key factor for the healthy status of an individual, not only physically but also in what concerns to mental health. Several studies have been dedicated to the relationship between diet and mental disorders [4-10] Jacka et al., 2011; Allen et al., 2014; Tampubolan and Hanandite, 2014; Morris, 2016; Jebena et al., 2016). In a study carried out by Jacka et al. [6], people with better quality diets were less likely to be depressed, whereas a higher intake of processed and unhealthy foods was associated with increased anxiety. Moreover, it has also been observed strong evidence for preventive effects on dementia of vitamin E, B vitamins, and n-3 fatty acids and deleterious effects of saturated fat in this syndrome [9]. This thematic issue is focused in the existing body of evidence which supports that food or particular food components can enhance mental health or protect from psychiatric disorders. In this line, this thematic issue is composed of important contributions on this topic. Due to the interest and diversity of the received papers, we have separated in two parts (PART 1 and PART 2), wherein each one will describe the diverse scope between the food and the human health Thus, the first paper of this thematic issue entitled “Food Components with Potential to be Used in the Therapeutic Approach of Mental Diseases”. This review compiles the main evidences from scientific studies on the most promising food components, as part of diet or dietary supplements, that constitute a valid alternative or a complement of the traditional drug treatments. These food components include vitamins, fatty acids, bioactive peptides, probiotics, carotenoids, polyphenols, saponins and creatine. Results of in vitro and in vivo animal studies, of randomized and placebo control trials, and systematic reviews have been addressed. The most recent advances were discussed, namely regarding mechanisms of action of the compounds responsible for their biological activities (e.g. anti-oxidative properties, neuronal protection and anti-inflammatory). Authors concluded that is required more research to prove the therapeutic potential of the food components based on scientific evidence and intervention studies to demonstrate the improvement of neuronal and cognitive impairments. The second review of the thematic issue entitles “Food with Influence in the Sexual and Reproductive Health”. This paper focuses in two prevalent conditions in general population, infertility and sexual dysfunction. These conditions have multifactorial etiology and affect both men and women. Data on the factors that most influence both female and male sexual and reproductive function were discussed. These factors include general nutritional status, specific foods (e.g. dairy food), nutrients and other food components and dietary supplements. It was concluded that the food insufficiency was associated with increased sexual risk behaviours more relevant in women, while in men, obesity showed a negative influence in male fertility. Moreover, the consumption of trans-fatty acids, high glycemic index food, high carbohydrate diet and high animal protein intake was associated with low fertility while consumption of vegetable proteins, antioxidants, omega-3 and omega-6 fatty acids and low glycemic index food was associated with improvement of fertility. According to the authors further studies are required to clarify the association between food/food components and sexual and reproductive Health, to be able to improve the treatment of patients with sexual and/or reproductive dysfunctions. The third review (“Does diet affect the symptoms of ADHD?”) of this thematic issue is dedicated to one common psychiatric diagnosis in childhood and adolescence, Attention Deficit Hyperactivity Disorder (ADHD). Although the conventional treatment is psychopharmacological, it originates several undesirable side effects. Therefore, the aim of this review paper is to compile information on dietary patterns of individuals with ADHD diagnosis, current treatments recommended in individuals with this diagnosis and dietary factors possibly implicated in the etiology and treatment of this disorder. Authors reported that there is still lack of evidence on the role of omega-3 PUFAs and vitamin supplementation in the effective therapeutic approach of this disorder. In this line, data on elimination diets were unclear as to the benefits provided to individuals with ADHD. One of the results indicated that children with ADHD are less likely to engage in healthy lifestyle behaviors than non-ADHD children. Authors mentioned that the effects of unhealthy diet patterns in ADHD individuals are not yet fully understood, however children with ADHD may benefit from a healthy lifestyle. Finally, in the fourth review paper (“Dietary Patterns: A New Therapeutic Approach for Depression?”), the relationship between the most common mental disorder, depression, and dietary patterns is addressed. Studies published between 2010 and 2018 and focusing on the impact of dietary patterns in depression and depressive symptoms were discussed. The goal is to evaluate if there is enough evidence on the dietary cost-effective intervention in depression. This is a subject of high importance due to the large-scale impact of this mental disorder. The paper concluded that, although etiological pathways are unknown, there is a well-established association between dietary patterns and depression. In fact, it was reported that healthier dietary patterns, can play a significant role in the prevention and adjunctive therapy of depression and depressive symptoms. The consumption of fruits, vegetables, lean meats, nuts and whole grains, and with low intake of processed and sugary foods was inversely associated with depression and depressive symptoms. Although it is difficult to infer causality because most of the studies were of cross-sectional design, a randomized controlled trial presented similar results. Authors highlight the need of large scale randomized clinical trials to confirm the association between lower risk of depression and depressive symptoms and high-quality dietary patterns.