B-Type Natriuretic Peptide-A Paradox in the Diagnosis of Acute Heart Failure with Preserved Ejection Fraction in Obese Patients.

BACKGROUND AND OBJECTIVES: B-type natriuretic peptide (BNP) represents a clinical tool for the diagnosis and prognostic evaluation of acute and chronic heart failure patients. The purpose of this retrospective study was to evaluate BNP values in obese and non-obese patients with acute heart failure with preserved ejection fraction. MATERIALS AND METHODS: In this study, we enrolled 240 patients who presented to the emergency department complaining of acute shortness of breath and fatigue. The patients were divided into two groups according to their body mass index (BMI) values. The BMI was calculated as weight (kilograms) divided by height (square meters). The BNP testing was carried out in the emergency department. RESULTS: Group I included patients with a BMI of <30 kg/m2 and group II included patients with a BMI of ≥30 kg/m2. The average age of the patients was 60.05 ± 5.02 years. The patients in group II were significantly younger compared with those included in group I. Group II included a higher number of women compared to group I. Group I had fewer patients classified within New York Heart Association (NYHA) functional classes III and IV compared with group II. Echocardiography revealed an ejection fraction of ≥50% in all participants. Lower BNP levels were observed in patients from group II (median = 56, IQR = 53-67) in comparison to group I (median = 108.5, IQR = 106-112) (p < 0.001). CONCLUSIONS: Obesity and heart failure are continuously rising worldwide. In this retrospective study, we have highlighted the necessity to lower the threshold of BNP levels in obese patients with acute heart failure and preserved ejection fraction.

Optimizing Atrial Fibrillation Care: Comparative Assessment of Anticoagulant Therapies and Risk Factors.

BACKGROUND AND OBJECTIVES: Atrial fibrillation (AF) is a common arrhythmia associated with various risk factors and significant morbidity and mortality. MATERIALS AND METHODS: This article presents findings from a study involving 345 patients with permanent AF. This study examined demographics, risk factors, associated pathologies, complications, and anticoagulant therapy over the course of a year. RESULTS: The results showed a slight predominance of AF in males (55%), with the highest incidence in individuals aged 75 and older (49%). Common risk factors included arterial hypertension (54%), dyslipidemia, diabetes mellitus type 2 (19.13%), and obesity (15.65%). Comorbidities such as congestive heart failure (35.6%), mitral valve regurgitation (60%), and dilated cardiomyopathy (32%) were prevalent among the patients. Major complications included congestive heart failure (32%), stroke (17%), and myocardial infarction (5%). Thromboembolic and bleeding risk assessment using CHA2DS2-VASc and HAS-BLED scores demonstrated a high thromboembolic risk in all patients. The majority of patients were receiving novel oral anticoagulants (NOACs) before admission (73%), while NOACs were also the most prescribed antithrombotic therapy at discharge (61%). CONCLUSIONS: This study highlights the importance of risk factor management and appropriate anticoagulant therapy in patients with AF, to reduce complications and improve outcomes. The results support the importance of tailored therapeutic schemes, for optimal care of patients with AF.

Characterization of the Chemical Composition and Biological Activities of Bog Bilberry (Vaccinium uliginosum L.) Leaf Extracts Obtained via Various Extraction Techniques.

This investigation aimed to assess the chemical composition and biological activities of bog bilberry (Vaccinium uliginosum L.) leaves. Hydroethanolic extracts were obtained using four extraction techniques: one conventional (CE) and three alternative methods; ultrasound (UAE), microwave (MAE) and high-pressure (HPE) extractions. Spectrophotometric analysis was conducted to determine their chemical content, including the total phenolic content (TPC) and total flavonoid content (TFC). Furthermore, their antioxidative and antimicrobial properties were evaluated. HPLC (high performance liquid chromatography) analysis identified and quantified 17 phenolic compounds, with chlorogenic acid being the predominant compound, with the lowest level (37.36 ± 0.06 mg/g) for the bog bilberry leaf extract obtained by CE and the highest levels (e.g., HPE = 44.47 ± 0.08 mg/g) for the bog bilberry leaf extracts obtained by the alternative methods. Extracts obtained by HPE, UAE and MAE presented TPC values (135.75 ± 2.86 mg GAE/g; 130.52 ± 1.99 mg GAE/g; 119.23 ± 1.79 mg GAE/g) higher than those obtained by the CE method (113.07 ± 0.98 mg GAE/g). Regarding the TFC values, similar to TPC, the highest levels were registered in the extracts obtained by alternative methods (HPE = 43.16 ± 0.12 mg QE/g; MAE = 39.79 ± 0.41 mg QE/g and UAE = 33.89 ± 0.35 mg QE/g), while the CE extract registered the lowest level, 31.47 ± 0.28 mg QE/g. In the case of DPPH (1,1-diphenyl-2-picrylhydrazyl) antioxidant activity, the extracts from HPE, UAE and MAE exhibited the strongest radical scavenging capacities of 71.14%, 63.13% and 60.84%, respectively, whereas the CE extract registered only 55.37%. According to Microbiology Reader LogPhase 600 (BioTek), a common MIC value of 8.88 mg/mL was registered for all types of extracts against Staphylococcus aureus (Gram-positive bacteria) and Salmonella enterica (Gram-negative bacteria). Moreover, the alternative extraction methods (UAE, HPE) effectively inhibited the growth of Candida parapsilosis, in comparison to the lack of inhibition from the CE method. This study provides valuable insights into bog bilberry leaf extracts, reporting a comprehensive evaluation of their chemical composition and associated biological activities, with alternative extraction methods presenting greater potential for the recovery of phenolic compounds with increased biological activities than the conventional method.

Research on Consumer Perception Regarding Traditional Food Products of Romania.

Traditional Romanian food products are an integral part of local culture and spirituality. These food traditions have been formed over the centuries and represent a particularly important part ofthe development of a circular economy in rural areas. In order to contribute to the development of this sector of activity we conducted a study on consumer perception of traditional Romanian food products. The purpose of this work was to identify the structure of the studies and the future directions of research related to the image of traditional food products through the bibliometric study, as well as the identification of consumer trends, of these products through a survey based on the questionnaire. The results obtained indicate that traditional Romanian food products are consumed by the majority of respondents participating in the survey and that this sector ofactivity has continuity in its development and presents a clear interest among citizens.

Health, Economic, and Social Impacts of Substandard and Falsified Medicines in Low- and Middle-Income Countries: A Systematic Review of Methodological Approaches.

Little is known about the adverse health, economic, and social impacts of substandard and falsified medicines (SFMs). This systematic review aimed to identify the methods used in studies to measure the impact of SFMs in low- and middle-income countries (LMICs), summarize their findings, and identify gaps in the reviewed literature. A search of eight databases for published papers, and a manual search of references in the relevant literature were conducted using synonyms of SFMs and LMICs. Studies in the English language that estimated the health, social, or economic impacts of SFMs in LMICs published before June 17, 2022 were considered eligible. Search results generated 1,078 articles, and 11 studies were included after screening and quality assessment. All included studies focused on countries in sub-Saharan Africa. Six studies used the Substandard and Falsified Antimalarials Research Impact model to estimate the impact of SFMs. This model is an important contribution. However, it is technically challenging and data demanding, which poses challenges to its adoption by national academics and policymakers alike. The included studies estimate that substandard and falsified antimalarial medicines can account from 10% to ∼40% of total annual malaria costs, and SFMs affect rural and poor populations disproportionately. Evidence on the impact of SFMs is limited in general and nonexistent regarding social outcomes. Further research needs to focus on practical methods that can serve local authorities without major investments in terms of technical capacity and data collection.

Plant-Based Dairy Alternatives-A Future Direction to the Milky Way.

One significant food group that is part of our daily diet is the dairy group, and both research and industry are actively involved to meet the increasing requirement for plant-based dairy alternatives (PBDAs). The production tendency of PBDAs is growing with a predictable rate of over 18.5% in 2023 from 7.4% at the moment. A multitude of sources can be used for development such as cereals, pseudocereals, legumes, nuts, and seeds to obtain food products such as vegetal milk, cheese, cream, yogurt, butter, and different sweets, such as ice cream, which have nearly similar nutritional profiles to those of animal-origin products. Increased interest in PBDAs is manifested in groups with special dietary needs (e.g., lactose intolerant individuals, pregnant women, newborns, and the elderly) or with pathologies such as metabolic syndromes, dermatological diseases, and arthritis. In spite of the vast range of production perspectives, certain industrial challenges arise during development, such as processing and preservation technologies. This paper aims at providing an overview of the currently available PBDAs based on recent studies selected from the electronic databases PubMed, Web of Science Core Collection, and Scopus. We found 148 publications regarding PBDAs in correlation with their nutritional and technological aspects, together with the implications in terms of health. Therefore, this review focuses on the relationship between plant-based alternatives for dairy products and the human diet, from the raw material to the final products, including the industrial processes and health-related concerns.

Vaccinium Species (Ericaceae): Phytochemistry and Biological Properties of Medicinal Plants.

The Vaccinium L. (Ericaceae) genus consists of a globally widespread and diverse genus of around 4250 species, of which the most valuable is the Vaccinioidae subfamily. The current review focuses on the distribution, history, bioactive compounds, and health-related effects of three species: cranberry, blueberry, and huckleberry. Several studies highlight that the consumption of Vaccinium spp. presents numerous beneficial health-related outcomes, including antioxidant, antimicrobial, anti-inflammatory, and protective effects against diabetes, obesity, cancer, neurodegenerative diseases and cardiovascular disorders. These plants' prevalence and commercial value have enhanced in the past several years; thus, the generated by-products have also increased. Consequently, the identified phenolic compounds found in the discarded leaves of these plants are also presented, and their impact on health and economic value is discussed. The main bioactive compounds identified in this genus belong to anthocyanins (cyanidin, malvidin, and delphinidin), flavonoids (quercetin, isoquercetin, and astragalin), phenolic acids (gallic, p-Coumaric, cinnamic, syringic, ferulic, and caffeic acids), and iridoids.

Collective-Documentary of a National Health Care Tragedy.

This Arts and Medicine feature reviews the 2019 movie Collective, which documents corruption underlying poor patient outcomes in the Romanian national health system and provides an update on the people and reform efforts featured in the film.

Prevalence of Cardiovascular Comorbidities in Patients with Rheumatoid Arthritis.

Background and Objectives: The risk of developing cardiovascular diseases (CVD) in patients suffering from rheumatoid arthritis (RA) is two times higher compared to the general population. The objective of this retrospective study was to determine which cardiovascular complications can appear in men vs. women with rheumatoid arthritis. Early diagnosis and initiation of therapeutic measures to reduce the progression rate of rheumatoid arthritis, while also maintaining an active lifestyle, are the most important problems in young patients. Materials and Methods: We included a number of 200 patients, divided into two groups according to gender (124 women and 76 men) with rheumatoid arthritis, presenting various stages of disease concomitant with cardiovascular complications. We assessed traditional and non-traditional risk factors, as well as electrocardiographic and echocardiographic findings in both groups. Results: All patients presented an atherogenic coefficient over two, indicating a significant risk of atherogenesis. Men had elevated levels of total cholesterol compared with women (≥200 mg/dL; 77.6%-men vs. 25.8%-women, p < 0.001). The participants presented cardiac arrhythmias, especially in the active stage of RA. Women had an increased risk of atrial fibrillation by 2.308 times compared to men (p = 0.020). One of the most important complications found in young women was pulmonary arterial hypertension (p = 0.007). Conclusions: In daily clinical practice, the screening of RA is carried out in sufficiently. This disease is often undiagnosed, and the risk factors remain unassessed. As a result, RA patients continue to present an increased risk of developing CVD.

Natural Polyphenol Recovery from Apple-, Cereal-, and Tomato-Processing By-Products and Related Health-Promoting Properties.

Polyphenols of plant origin are a broad family of secondary metabolites that range from basic phenolic acids to more complex compounds such as stilbenes, flavonoids, and tannins, all of which have several phenol units in their structure. Considerable health benefits, such as having prebiotic potential and cardio-protective and weight control effects, have been linked to diets based on polyphenol-enriched foods and plant-based products, indicating the potential role of these substances in the prevention or treatment of numerous pathologies. The most representative phenolic compounds in apple pomace are phloridzin, chlorogenic acid, and epicatechin, with major health implications in diabetes, cancer, and cardiovascular and neurocognitive diseases. The cereal byproducts are rich in flavonoids (cyanidin 3-glucoside) and phenolic acids (ferulic acid), all with significant results in reducing the incidence of noncommunicable diseases. Quercetin, naringenin, and rutin are the predominant phenolic molecules in tomato by-products, having important antioxidant and antimicrobial activities. The present understanding of the functionality of polyphenols in health outcomes, specifically, noncommunicable illnesses, is summarized in this review, focusing on the applicability of this evidence in three extensive agrifood industries (apple, cereal, and tomato processing). Moreover, the reintegration of by-products into the food chain via functional food products and personalized nutrition (e.g., 3D food printing) is detailed, supporting a novel direction to be explored within the circular economy concept.

Biofunctional soy-based sourdough for improved rheological properties during storage.

Frozen dough storage, along with its thawing process, negatively affects the quality of the final product. Thus, fermentation with selected cultures and the enrichment of wheat-based dough using a specific soy powder could optimize the viscoelastic quality of frozen dough and increase its nutritional characteristics. Based on these aspects, the present study's objective was to examine the effects of soy powder addition to wheat flour with single cultures of Fructilactobacillus florum DSM 22689 or Saccharomyces cerevisiae and coculture with these two microorganisms for 72 h of fermentation. Additionally, the fermentation process was monitored, and viscoelastic behavior and physical-chemical analyses of the fermented sourdough before and after frozen storage were assessed, as soy protein has been proposed to hinder water migration throughout frozen storage. As observed, soy powder, an essential functional ingredient, had a favorable impact on the water-starch-gluten system, and enhanced the viscoelastic behavior before and after 4 weeks of frozen storage.

Development of Pectin and Poly(vinyl alcohol)-Based Active Packaging Enriched with Itaconic Acid and Apple Pomace-Derived Antioxidants.

The production of active and biodegradable packaging materials is an emerging and efficient alternative to plastic packaging materials. By combining poly(vinyl alcohol) (PVA), pectin, and itaconic acid (IA), biodegradable and water-soluble packaging materials can be obtained that can also increase the shelf-life and quality of foodstuff. In the present study, the generated film-forming solutions were enriched with organic or phenolic extracts from apple by-products (apple pomace). These extracts possess an efficient antioxidant activity of 9.70 ± 0.08, and 78.61 ± 0.24 µM Trolox/100 g fresh weight, respectively. Furthermore, the lyophilization of these by-products increased the extract's organic and phenolic content and the antioxidant activity to 67.45 ± 0.28 and 166.69 ± 0.47 µM Trolox/100 g fresh weight, respectively. These extracts influence the physical-chemical properties of the biofilm solutions by facilitating the polymerization process and thus positively influencing their viscosity. The resulting biofilms presented low water vapor permeability and reduced solubility in water. Adding IA and organic/phenolic compounds facilitates the resistance against intrinsic and extrinsic factors; therefore, they might be applicable in the food industry.

Polysaccharide-Based Edible Gels as Functional Ingredients: Characterization, Applicability, and Human Health Benefits.

Nowadays, edible materials such as polysaccharides have gained attention due to their valuable attributes, especially gelling property. Polysaccharide-based edible gels (PEGs) can be classified as (i) hydrogels, (ii) oleogels and bigels, (iii) and aerogels, cryogels and xerogels, respectively. PEGs have different characteristics and benefits depending on the functional groups of polysaccharide chains (e.g., carboxylic, sulphonic, amino, methoxyl) and on the preparation method. However, PEGs are found in the incipient phase of research and most studies are related to their preparation, characterization, sustainable raw materials, and applicability. Furthermore, all these aspects are treated separately for each class of PEG, without offering an overview of those already obtained PEGs. The novelty of this manuscript is to offer an overview of the classification, definition, formulation, and characterization of PEGs. Furthermore, the applicability of PEGs in the food sector (e.g., food packaging, improving food profile agent, delivery systems) and in the medical/pharmaceutical sector is also critically discussed. Ultimately, the correlation between PEG consumption and polysaccharides properties for human health (e.g., intestinal microecology, "bridge effect" in obesity, gut microbiota) are critically discussed for the first time. Bigels may be valuable for use as ink for 3D food printing in personalized diets for human health treatment. PEGs have a significant role in developing smart materials as both ingredients and coatings and methods, and techniques for exploring PEGs are essential. PEGs as carriers of bioactive compounds have a demonstrated effect on obesity. All the physical, chemical, and biological interactions among PEGs and other organic and inorganic structures should be investigated.

Microencapsulation and Bioaccessibility of Phenolic Compounds of Vaccinium Leaf Extracts.

In recent years, Vaccinium spp. (bilberry-VMT, lingonberry-VVIT, and blueberry-VCS) have sparked particular interest for their prospective health benefits. The latest investigations have place them as important alternative sources of nutraceuticals as their leaves are the main by-products of berry harvesting. The present study is aimed at investigating the bioaccessibility of phenolic compounds from leaves of the Vaccinium species, both as microencapsulated powder and aqueous extracts, following exposure to in vitro simulated digestion. Moreover, the impact of maltodextrin and glucose microencapsulation carriers on the extracts' phenolic content was assessed. Prior to encapsulation, the viscosity of the emulsions was shown at a shear stress of 50 s-1 dilatant and a Newtonian behaviour above this value with a final viscosity between 1.024 and 1.049 mPa·s. The final microencapsulation yield for the samples ranged between 79 and 81%. Although the microencapsulated forms presented a targeted release at the intestinal level, the phenolic content decreased after gastrointestinal digestion. The bioaccessibility of the microencapsulated extracts showed higher values than their non-encapsulated counterparts, with the highest value of 45.43% in the VVIT sample, followed by VCS with 41.07%. However, the non-encapsulated VCS sample presented high bioaccessibility after in vitro digestion (38.65%). As concluded, further in vivo research should be conducted on the leaves of the Vaccinium species.

The Use of Cost-Effectiveness Thresholds for Evaluating Health Interventions in Low- and Middle-Income Countries From 2015 to 2020: A Review.

OBJECTIVES: Evidence-informed priority setting, in particular cost-effectiveness analysis (CEA), can help target resources better to achieve universal health coverage. Central to the application of CEA is the use of a cost-effectiveness threshold. We add to the literature by looking at what thresholds have been used in published CEA and the proportion of interventions found to be cost-effective, by type of threshold. METHODS: We identified CEA studies in low- and middle-income countries from the Global Health Cost-Effectiveness Analysis Registry that were published between January 1, 2015, and January 6, 2020. We extracted data on the country of focus, type of interventions under consideration, funder, threshold used, and recommendations. RESULTS: A total of 230 studies with a total 713 interventions were included in this review; 1 to 3× gross domestic product (GDP) per capita was the most common type of threshold used in judging cost-effectiveness (84.3%). Approximately a third of studies (34.2%) using 1 to 3× GDP per capita applied a threshold at 3× GDP per capita. We have found that no study used locally developed thresholds. We found that 79.3% of interventions received a recommendation as "cost-effective" and that 85.9% of studies had at least 1 intervention that was considered cost-effective. The use of 1 to 3× GDP per capita led to a higher proportion of study interventions being judged as cost-effective compared with other types of thresholds. CONCLUSIONS: Despite the wide concerns about the use of 1 to 3× GDP per capita, this threshold is still widely used in the literature. Using this threshold leads to more interventions being recommended as "cost-effective." This study further explore alternatives to the 1 to 3× GDP as a decision rule.

Integration of Solid State and Submerged Fermentations for the Valorization of Organic Municipal Solid Waste.

Solid state fermentation (SsF) is recognized as a suitable process for the production of enzymes using organic residues as substrates. However, only a few studies have integrated an evaluation of the feasibility of applying enzymes produced by SsF into subsequent hydrolyses followed by the production of target compounds, e.g., lactic acid (LA), through submerged-liquid fermentations (SmF). In this study, wheat bran (WB) was used as the substrate for the production of enzymes via SsF by Aspergillus awamori DSM No. 63272. Following optimization, cellulase and glucoamylase activities were 73.63 ± 5.47 FPU/gds and 107.10 ± 2.63 U/gdb after 7 days and 5 days of fermentation, respectively. Enzymes were then used for the hydrolysis of the organic fraction of municipal solid waste (OFMSW). During hydrolysis, glucose increased considerably with a final value of 19.77 ± 1.56 g/L. Subsequently, hydrolysates were fermented in SmF by Bacillus coagulans A166 increasing the LA concentration by 15.59 g/L. The data reported in this study provides an example of how SsF and SmF technologies can be combined for the valorization of WB and OFMSW.

Economic impact of avoidable cancer deaths caused by diagnostic delay during the COVID-19 pandemic: A national population-based modelling study in England, UK.

INTRODUCTION: Delays in cancer diagnosis arose from the commencement of non-pharmaceutical interventions (NPI) introduced in the UK in March 2020 in response to the COVID-19 pandemic. Our earlier work predicted this will lead to approximately 3620 avoidable deaths for four major tumour types (breast, bowel, lung, and oesophageal cancer) in the next 5 years. Here, using national population-based modelling, we estimate the health and economic losses resulting from these avoidable cancer deaths. We also compare these with the impact of an equivalent number of COVID-19 deaths to understand the welfare consequences of the different health conditions. METHODS: We estimate health losses using quality-adjusted life years (QALYs) and lost economic productivity using the human capital (HC) approach. The analysis uses linked English National Health Service (NHS) cancer registration and hospital administrative datasets for patients aged 15-84 years, diagnosed with breast, colorectal, and oesophageal cancer between 1st Jan to 31st Dec 2010, with follow-up data until 31st Dec 2014, and diagnosed with lung cancer between 1st Jan to 31st Dec 31 2012, with follow-up data until 31st Dec 2015. Productivity losses are based on the estimation of excess additional deaths due to cancer at 1, 3 and 5 years for the four cancer types, which were derived from a previous analysis using this dataset. A total of 500 random samples drawn from the total number of COVID-19 deaths reported by the Office for National Statistics, stratified by gender, were used to estimate productivity losses for an equivalent number of deaths (n = 3620) due to SARS-CoV-2 infection. RESULTS: We collected data for 32,583 patients with breast cancer, 24,975 with colorectal cancer, 6744 with oesophageal cancer, and 29,305 with lung cancer. We estimate that across the four site-specific cancers combined in England alone, additional excess cancer deaths would amount to a loss of 32,700 QALYs (95% CI 31,300-34,100) and productivity losses of £103.8million GBP (73.2-132.2) in the next five years. For breast cancer, we estimate a loss of 4100 QALYS (3900-4400) and productivity losses of £23.2 m (18.2-28.6); for colorectal cancer, 15,000 QALYS (14,100-16,000) lost and productivity losses of £35.7 m (22.4-48.7); for lung cancer 10,900 QALYS (9,900-11,700) lost and productivity losses of £38.3 m (14.0-59.9) for lung cancer; and for oesophageal cancer, 2700 QALYS (2300-3,100) lost and productivity losses of £6.6 m (-6 to -17.6). In comparison, the equivalent number of COVID-19 deaths caused approximately 21,450 QALYs lost, as well as productivity losses amounting to £76.4 m (73.5-79.2). CONCLUSION: Premature cancer deaths resulting from diagnostic delays during the first wave of the COVID-19 pandemic in the UK will result in significant economic losses. On a per-capita basis, this impact is, in fact, greater than that of deaths directly attributable to COVID-19. These results emphasise the importance of robust evaluation of the trade-offs of the wider health, welfare and economic effects of NPI to support both resource allocation and the prioritisation of time-critical health services directly impacted in a pandemic, such as cancer care.