The Cost of Atrial Fibrillation: A Systematic Review.

OBJECTIVES: Atrial fibrillation (AF) is the most common cardiac arrhythmia, with an increasing incidence and prevalence because of progressively aging populations. Costs related to AF are both direct and indirect. This systematic review aims to identify the main cost drivers of the illness, assess the potential economic impact resulting from changes in care strategies, and propose interventions where they are most needed. METHODS: A systematic literature search of the PubMed and Scopus databases was performed to identify analytical observational studies defining the cost of illness in cases of AF. The search strategy was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 recommendations. RESULTS: Of the 944 articles retrieved, 24 met the inclusion criteria. These studies were conducted in several countries. All studies calculated the direct medical costs, whereas 8 of 24 studies assessed indirect costs. The median annual direct medical cost per patient, considering all studies, was €9409 (13 333 US dollars in purchasing power parities), with a very large variability due to the heterogeneity of different analyses. Hospitalization costs are generally the main cost drivers. Comorbidities and complications, such as stroke, considerably increase the average annual direct medical cost of AF. CONCLUSIONS: In most of the analyzed studies, inpatient care cost represents the main component of the mean direct medical cost per patient. Stroke and heart failure are responsible for a large share of the total costs; therefore, implementing guidelines to manage comorbidities in AF is a necessary step to improve health and mitigate healthcare costs.

Production of bioactive and aroma volatile compounds of Lawsonia inermis L. cultivated under different growth conditions.

The present study aimed to investigate the influence of different growing conditions on the amount of leaf pigments (chlorophylls, carotenoids), bioactive metabolites, such as polyphenols, flavonoids, lawsone and volatile organic compounds (VOCs) of Lawsonia inermis L. (henna) plants. Young henna plants were cultivated for two months in a growth chamber (GC) and in open-air conditions during summer under the Mediterranean climate (OF), and leaves were analysed to evaluate their adaptive responses. The different growth conditions modified the carbon allocation priorities, increasing antioxidant metabolites (e.g. phenolic and flavonoid compounds) while decreasing lawsone in GC conditions. Quali-quantitative changes were observed for VOCs. This study revealed that GC conditions permit an alternative use of Lawsonia cultivation, because of the increase in the endogenous content of bioactive secondary metabolites with many potential biological activities.

Detrimental effects detected in exfoliated buccal cells from anesthesiology medical residents occupationally exposed to inhalation anesthetics: An observational study.

Operating room professionals are scarcely aware of their individual occupational exposure to waste anesthetic gases (WAGs). Medical residents spend several hours per day in operating rooms and consequently experience occupational exposure to WAGs. Considering that no studies have yet evaluated the potential toxicity in medical residents exposed to WAGs using the buccal micronucleus cytome (BMCyt) assay, this pioneering study aimed to compare the BMCyt assay markers, including DNA damage, cell proliferation, and cell death in the exfoliated buccal cells of surgery and anesthesiology residents occupationally exposed to WAGs. The study enrolled a total of 60 physicians, including internal medicine residents (unexposed group), and residents from surgery and anesthesiology programs who were occupationally exposed to sevoflurane, isoflurane and nitrous oxide. WAGs were measured, and the mean values were higher than the international recommendation. The anesthesiology residents (high exposure) showed statistically significant lower frequencies of basal cells, and statistically significant higher frequencies of micronuclei, karyorrhexis, pyknosis, and differentiated cells than did the unexposed group; karyolysis frequencies were significantly higher in anesthesiology residents than were those in the unexposed group or in surgical residents (low exposure). The findings suggest a genetic risk for young professionals exposed to WAGs at the beginning of their careers. Thus, exposure to high WAGs concentrations leads to impairment of the buccal cell proliferative potential, genomic instability and cell death, especially in anesthesiology residents, demonstrating an early impact on their health.