Appropriateness of direct oral anticoagulant prescribing in older subjects with atrial fibrillation discharged from acute medical wards.

AIMS: Knowledge on the prescriptive practice of direct oral anticoagulants (DOACs) in older subjects with atrial fibrillation (AF) hospitalized in acute medical wards is limited. This study aimed to evaluate the prevalence and appropriateness of DOAC prescriptions in hospitalized older subjects with AF, discharged from acute medical wards. METHODS: We analysed a cohort of 609 subjects with AF, aged ≥65 years (mean age 85 years) enrolled from 39 geriatric and nephrology wards in Italy. DOAC prescriptive appropriateness was evaluated according to the summary of product characteristics (smPC), 2019 Beers and STOPP criteria, and drug-drug interactions (DDIs). RESULTS: At hospital discharge, 33% of patients with AF were prescribed with DOAC, 26% with vitamin-K antagonist, while 41% did not receive any anticoagulant. Among subjects on DOAC therapy, 31% presented a violation of the smPC criteria (mainly underdosage-17%), while 48% and 18% presented a Beers/STOPP inappropriate prescription, or a DDI, respectively. Older age, lower body mass index (BMI), cancer and higher estimated glomerular filtration rate (eGFR) were independently associated with DOAC underdosage or missed prescription (age: adjusted odds ratio [aOR] 1.06, 95% confidence interval [95% CI] 1.00-1.12 for underdosage; eGFR: aOR 1.04, 95% CI 1.02-1.07 for underdosage; BMI: aOR 0.95, 95% CI 0.91-0.99 for missed prescription; cancer: aOR 1.93, 95% CI 1.19-3.13 for missed prescription). CONCLUSIONS: This study showed a suboptimal DOAC prescriptive practice in older in-patients, with frequent missed prescription and DOAC underdosage. Contrary to current recommendations, physicians appear overly concerned by bleeding risk in real-life older and frailer subjects. Strategies should be developed to promote appropriate DOAC prescription in the hospital setting.

Effects of Genotype, Storage Temperature and Time on Quality and Compositional Traits of Cherry Tomato.

The experiment addressed the effects of two storage temperatures, namely 10 (T10) and 20 °C (T20), on main quality and functional traits of three cherry tomato cultivars ('Eletta', 'Sugarland' and 'Ottymo'), after 0 (S0), 7 (S7) and 14 (S14) days of storage. At T10 both fruit weight and firmness were better retained during storage. At S14, T10 promoted fruit Chroma and overall fruit color deviation (ΔE*ab). Total polyphenols content (TPC) of fruits peaked at S7 (4660 mg GAE kg-1 DW) then declined at S14 (by 16%), with the highest values recorded at T10. Lycopene showed a similar trend, but with a higher average concentration recorded at T20 (488 mg kg-1 DW). ß-carotene content peaked at S14, irrespective of the storage temperature. At S14, the concentrations of phytoene and phytofluene were higher at T20 (48.3 and 40.9 mg kg-1 DW, respectively), but the opposite was found at S7. 'Sugarland' and 'Ottymo' showed the highest ΔE*ab along storage, with the former cultivar proving the highest TPC and lycopene content, whereas 'Eletta' did so for phytoene and phytofluene. Our results suggest that unravelling the possible functional interactions among these three carotenoids would allow for a better orientation of breeding programs, targeting the phytochemical evolution of tomatoes during refrigerated storage.

Characterization of Prickly Pear Peel Flour as a Bioactive and Functional Ingredient in Bread Preparation.

The aim of the present research was to evaluate the addition of prickly pear peel flour (PPPF) to bread dough as a source of nutrient and bioactive compounds. The PPPF's physical, chemical and nutritional composition was evaluated, as well as its content of bioactive compounds betalains, and flavonoids. The characterization evidenced high fiber and carbohydrate contents and an elevated amount of polyphenols and betalain compounds. The PPPF was then added at different concentrations (5, 10, 15, 20, 50%, w/w) to bread formulations as a potential functional ingredient. All concentrations, except 50% PPPF, evidenced good leavening dough properties and were then tested for baking. In relation to the content of added PPPF, the amount of betalains, representing bioactive compounds, remained high even after the baking process, suggesting a protective matrix effect. Among the different formulations, those containing PPPF at 10% showed the highest values in terms of the leavening dough capacity and bread specific volume and received the best sensory evaluation score.

Antioxidant and Antimicrobial Properties of Semi-Processed Frozen Prickly Pear Juice as Affected by Cultivar and Harvest Time.

Consumer interest toward natural ingredients is creating a growing trend in the food industry and research for the development of natural products such as colorants, antimicrobials and antioxidants. Semi-processed frozen prickly pear (Opuntia ficus-indica (L.) Mill.) juices (PPJs), obtained from three cultivars with white, red and yellow pulp, with different harvest times ("Agostani" and "Bastardoni"), were characterized for betalains, total phenolics, flavonoids, carotenoids, antioxidant capacity (by 2,2-diphenyl-1-picryl-hydrazyl-hydrate (DPPH)) and antimicrobial potential against foodborne pathogenic bacteria. Through chemical assays, PPJs showed high contents of total polyphenols, flavonoids and betalains and marked antioxidant capacity. PPJs from the first harvest ("Agostani") revealed the significantly highest amount of polyphenols in white cultivar and of betacyanin and betaxanthin in yellow and red cultivars; antioxidant capacity was significantly higher in "Agostani" PPJs than in "Bastardoni" ones. Regarding antimicrobial potential, all PPJs revealed good antibacterial activity, particularly against Salmonella enterica as evidenced by the widest inhibition haloes. These results encourage the suitability of the first flowering prickly pear fruits, with low market value as fresh fruit but with high nutritional features, to be processed as semi-finished product. In particular, its use as ingredient in foods with high risk of Salmonella contamination may act as a natural preservative.

Influence of ripeness and drying process on the polyphenols and tocopherols of Pistacia vera L.

This paper highlights, for the first time, the changes in the phenolics fraction (anthocyanins, flavonoids and stilbenes) and tocopherols of unpeeled Pistacia vera L. var. bianca with ripening, and the effect of the sun-drying process. The total polyphenol levels in pistachios, measured as mg of Gallic Acid Equivalent (GAE), were: 201 +/- 10.1, 349 +/- 18.3 and 184.7 +/- 6.2 mg GAE/100 g DM in unripe, ripe and dried ripe samples, respectively. Most phenolics in ripe pistachios were found to be anthocyanins. They increased with ripening, while the sun drying process caused a susbtantial loss. Flavonoids found in all pistachio samples were daidzein, genistein, daidzin, quercetin, eriodictyol, luteolin, genistin and naringenin, which decreased both with ripening and drying. Before the drying process both unripe and ripe pistachios showed a higher content of trans-resveratrol than dried ripe samples. gamma-Tocopherol was the major vitamin E isomer found in pistachios. The total content (of alpha- and gamma-tocopherols) decreased, both during ripening and during the drying process. These results suggested that unpeeled pistachios can be considered an important source of phenolics, particularly of anthocyanins. Moreover, in order to preserve these healthy characteristics, new and more efficient drying processes should be adopted.