Proton Pump Inhibitors: Rational Use and Use-Reduction - The Windsor Workshop.

BACKGROUND: Despite deprescribing initiatives to curb overutilization of proton pump inhibitors (PPIs), achieving meaningful reductions in PPI use is proving a challenge. SUMMARY: An international group of primary care doctors and gastroenterologists examined the literature surrounding PPI use and use-reduction to clarify: (i) what constitutes rational PPI prescribing; (ii) when and in whom PPI use-reduction should be attempted; and (iii) what strategies to use when attempting PPI use-reduction. KEY MESSAGES: Before starting a PPI for reflux-like symptoms, patients should be educated on potential causes and alternative approaches including dietary and lifestyle modification, weight loss, and relaxation strategies. When commencing a PPI, patients should understand the reason for treatment, planned duration, and review date. PPI use at hospital discharge should not be continued without a recognized indication for long-term treatment. Long-term PPI therapy should be reviewed at least annually. PPI use-reduction should be based on the lack of a rational indication for long-term PPI use, not concern for PPI-associated adverse events. PPI use-reduction strategies involving switching to on-demand PPI or dose tapering, with rescue therapy for rebound symptoms, are more likely to succeed than abrupt cessation.

Introducing Colorectal Cancer Screening in Romania - Preliminary Results from the Regional Pilot Programs (ROCCAS).

BACKGROUND AND AIMS: Colorectal cancer (CRC) is the third cause of cancer-related death worldwide. Screening programs can reduce CRC mortality rates by up to 60%. In line with the European Union recommendations, Romania started the first four regional pilot screening programs in 2020 (the ROCCAS II projects). This study reports the interim screening performance indicators. METHODS: People aged 50 to 74 years were invited to the screening program. General practitioners (GPs) evaluated CRC risk based on a survey. High-risk or symptomatic individuals were referred directly to colonoscopy. The average risk participants received a fecal immunochemical test (FIT). Positive cases were invited to colonoscopy. Three regions were screened using the OC-SENSOR® (South-Muntenia, Bucharest-Ilfov, South-East) and one region (South-West) used the FOB GOLD®. The data was collected in the ROCCAS screening electronic registry. The following FIT parameters were evaluated: rates of return, invalidity, positivity, and colonoscopy acceptance rate according to age group, gender, region of provenience, and vulnerability status. RESULTS: We included all cases screened between January 1, 2022 and September 30, 2023. In total, 168,958 people received the FIT test within the projects. The global FIT return rate was 90%. Factors associated with a higher return rate were female gender (90.77% vs 88.83%, p<0.0001), vulnerable status (91.23% vs 88.83%; p<0.00001), and rural residence (91.84% vs 88.42%, p<0.00001). The overall positivity rate was 5.75%. It was higher in males (7.64% vs 4.57% in females, p<0.00001) and progressively increased with the age group. The total invalid FIT rate was 5.87%, significantly lower for OC-SENSOR® (2.24%) than for the FOB GOLD® (13.6%). The overall acceptability rate for colonoscopy was 51.3%. CONCLUSIONS: According to our preliminary data, GP's participation in the pilot programs ensured adequate adherence to screening through FIT. The rate for FIT return and positivity were acceptable for both tests, while the invalid rate was much higher in FOB GOLD® compared to the OC-SENSOR®. Moreover, colonoscopy acceptance needs to be improved. Our preliminary analysis revealed the screening performance indicators meet the EU recommendations and fulfill the premises for national-level expansion of the program starting in 2024.

Management advice for patients with reflux-like symptoms: an evidence-based consensus.

Patients with reflux-like symptoms (heartburn and regurgitation) are often not well advised on implementing individualised strategies to help control their symptoms using dietary changes, lifestyle modifications, behavioural changes or fast-acting rescue therapies. One reason for this may be the lack of emphasis in management guidelines owing to 'low-quality' evidence and a paucity of interventional studies. Thus, a panel of 11 gastroenterologists and primary care doctors used the Delphi method to develop consolidated advice for patients based on expert consensus. A steering committee selected topics for literature searches using the PubMed database, and a modified Delphi process including two online meetings and two rounds of voting was conducted to generate consensus statements based on prespecified criteria (67% voting 'strongly agree' or 'agree with minor reservation'). After expert discussion and two rounds of voting, 21 consensus statements were generated, and assigned strength of evidence and Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) rating. Eleven statements achieved the strongest (100%) agreement: five are related to diet and include identification and avoidance of dietary triggers, limiting alcohol, coffee and carbonated beverages, and advising patients troubled by postprandial symptoms not to overeat; the remaining six statements concern advice around smoking cessation, weight loss, raising the head-of-the-bed, avoiding recumbency after meals, stress reduction and alginate use. The aim of developing the consensus statements is that they may serve as a foundation for tools and advice that can routinely help patients with reflux-like symptoms better understand the causes of their symptoms and manage their individual risk factors and triggers.

Nannochloris sp. Microalgae Strain for Treatment of Dairy Wastewaters.

This paper focuses on a process for dairy wastewater treatment by mixotrophic cultivation of microalgae Nannochloris sp., using cheese whey obtained as a side flow from cheese production as an organic carbon source. The microalgae samples were prepared by adding to the standard growth medium increasing amounts of cheese whey, calculated to ensure a lactose concentration between 0 and 10 g/L. The samples were incubated at a constant temperature of 28 °C and 175 rpm stirring speed for a total time of seven days. Two LED (Light Emitting Diode) illumination schemes were applied in order to assess the effect of this parameter on microalgae development and bioactive compound accumulation: continuous illumination (light stress) versus alternative cycles of 12 h light-12 h dark (day-night cycle). The growth medium was analyzed before and after microalgae cultivation in order to determine the reduction of carbon, nitrogen, and phosphorus. The results obtained for this process, after a seven-day cultivation period, were as follows: reduction of 99-100% of lactose from the growth medium, up to 96% reduction in chemical oxygen demand, up to 91% reduction in nitrogen content, and up to 70% reduction in phosphorus content.

Ultrasound-Assisted Extraction of Blackberry Seed Oil: Optimization and Oil Characterization.

Ultrasound-assisted extraction (UAE) was applied to extract oil from blackberry (BB) seeds. The effect of UAE conditions on oil recovery and quality was investigated. Favorable experimental conditions (ultrasound intensity (UI), extraction temperature, and time) were investigated using response surface methodology (RSM). A Box-Behnken design was used to predict optimized conditions for BB seed oil extraction. These conditions were as follows: 13.77 W/cm2 UI, 45 °C extraction temperature, and 15 min extraction time. The experimental value obtained for extraction efficiency under optimal conditions was 87 ± 0.34%, in good agreement with the optimized predicted value. UAE does not affect the oil composition and confers higher antioxidant values in BB seed oil in comparison with Soxhlet extraction.

The Influence of Ultrasound on the Growth of Nannochloris sp. in Modified Growth Medium.

The influence of ultrasound irradiation on the algal biomass productivity as well as its oil content and fatty acids profile, grown in a modified Zarrouk medium, i.e., deproteinized whey waste solution, was investigated. The algal samples (Nannochloris sp. 424-1 microalgae) were grown for 7 days in a thermostated incubator at 28 °C, shaken under continuous light. During this period, the algal biomass was subjected to induced stress by ultrasonic irradiation at different powers and sonication time. The obtained results demonstrate that ultrasound stressing of algae biomass has a positive effect on both the quantity of biomass and the oil obtained, also causing a shift in fatty acid composition by increasing the proportion of C16 and C18 polyunsaturated fatty acids. A low dosage level of exposure to the ultrasound led to algal biomass increase as well as lipid accumulation. For both types of irradiation modes which were investigated, daily and only initial irradiation, the beneficial effect of the ultrasound decreases as the exposure time increases and the excessive sonication becomes detrimental to microalgae growth.

Perspectives on hypertension's prevalence, treatment and control in a high cardiovascular risk East European country: data from the SEPHAR III survey.

OBJECTIVES: To estimate the trend in arterial hypertension's prevalence, awareness, treatment, and control in Romania, starting from the latest national survey Study for the Evaluation of Prevalence of Hypertension and Cardiovascular Risk in Romania III that has a crucial importance for the development of prevention strategies at national level. METHODS: A representative sample of 1970 Romanian adults (mean age 48.38 years, age range 18-80 years, 52.5% women, 72.58% response rate), was enrolled. During the two study visits, three blood pressure (BP) measurements were performed at 1-min interval. Hypertension was defined as study SBP at least 140 mmHg and/or study DBP at least 90 mmHg at both study visits or previously diagnosed hypertension, regardless of BP values. BP control was defined as SBP less than 140 mmHg and DBP less than 90 mmHg in hypertensive patients. RESULTS: General hypertension prevalence is 45.1% (19.1% newly diagnosed hypertension, 80.9% awareness of hypertension), increasing with age, regardless of sex and area of residence. Although the majority (72.2%) of hypertensive patients were treated (51.9% with two or more drugs), only 30.8% of them had controlled BP values. Following the evolution from the last 11 years, it is expected that in 2020 the prevalence of hypertension to be up to 44%, the awareness up to 96.2%, treatment of hypertension up to 83.7%, and BP control up to 36.6%. CONCLUSION: Hypertension's prevalence in Romania is on the rise despite the increase in awareness, treatment, and control. Possible explanations of this trend might be the increasing incidence of unhealthy lifestyle and diet, including high salt intake, and a general increase in the prevalence of obesity, diabetes mellitus, and dyslipidemia.