The “Hygiene Package”: Analysis of Fraud Rates in Italy in the Period before and after Its Entry into Force

In violation of EU legislation, fraudulent activities in agri-food chains seek to make economic profits at the expense of consumers. Food frauds (FFs) often constitute a public health risk as well as a risk to animal and plant health, animal welfare and the environment. To analyze FFs in Italy during 1997–2020 with the aim of gaining observational insights into the effectiveness of the legislation in force and consequently of inspection activities, FFs were determined from official food inspections carried out by the Central Inspectorate of Quality Protection and Fraud Repression of Agri-food Products in 1997–2020. Inspected sectors were wine, oils and fats, milk and dairy products, fruit and vegetables, meat, eggs, honey, feeds and supplements, and seeds. Data show that the inspection activities have significantly improved in terms of sampling and fraud detection. However, a higher incidence of fraud involving the meat sector was observed. The obtained results demonstrate that there has not been a clear change of direction after the so-called “hygiene package” (food hygiene rules in the EU) came into force. Thus, more effective measures are needed to manage risk as well as new analytical solutions to increase the deterrence against meat adulteration and the rapid detection of fraud.

CT-Guided Direct Current Cardioversion for Atrial Arrhythmias During the COVID-19 Pandemic (preprint)

ABSTRACT Objective To assess left atrial appendage (LAA) thrombus detection using a novel cardiac computed tomography (CT) protocol specifically prior to direct current cardioversion (DCCV). Background Transesophageal echocardiography (TEE) is the gold standard in evaluating the LAA prior to DCCV for atrial fibrillation (AF) or flutter (AFL). The COVID-19 pandemic has restricted availability of TEE and anesthesia support. Methods Prospective cohort of consecutive patients with uncontrolled AF/AFL referred for DCCV from March 2020 to March 2021 were enrolled. CT evaluation of LAA was performed with an initial arterial and subsequent 30-second delayed acquisition to exclude thrombus prior to DCCV. Primary end points were to assess safety and outcomes. Results A total of 161 patients were included; mean age 69.8 ± 11.1 years; mean CHA 2 DS 2 -VASc 3.4 ± 1.7; and HAS-BLED 1.8 ± 0.9. Median follow-up 175 (105-267) days with zero cardiac-related deaths, and no episodes of TIA or embolic stroke. There was no statistically significant change in mean glomerular filtration rate (GFR) in the study population between the pre- and post-GFR measurements (73.9 ± 21.0 vs 72.7 ± 20.3; p=0.104). Overall mean total dose length product (DLP) was 1042.8 ± 447.5 mGy*cm. Modifying the CT protocol to a narrower 8-cm axial coverage had a statistically significant decrease in total DLP (from 1130.6 ± 464.1 mGy*cm to 802.1 ± 286.4 mGy*cm; P<0.0001). Conclusion Cardiac CT is both a safe and feasible alternative imaging to TEE for patients prior to DCCV. Perspectives Competency in Medical Knowledge Cardiac CT is a powerful tool for the evaluation of left atrial appendage and detection of thrombus prior to direct current cardioversion. Translational Outlook Our protocol was implemented with the restrictions during COVID-19 in mind, yet CT can be a viable tool beyond the pandemic; future randomized clinical trials can bridge the gap between CT and TEE in the setting of cardioversion and help elucidate its safety profile further.