Advanced COPD patients under home mechanical ventilation and/or long term oxygen therapy: italian health care costs.

Introduction. Little information is available on health care costs for patients with very severe chronic obstructive pulmonary disease The aim of the current work was to evaluate Italian health care costs in these patients. Patients and Methods. Prospective 1-year analysis were assessed in three subgroups of patients; non-invasively ventilated (n=30); invasively-ventilated (n=12) and on long-term oxygen therapy (n= 41). Acute costs for care were a sum of fees for doctor\u2019s consultations, admissions to hospital (ward and intensive care unit) and emergency drugs. Chronic costs were the sum of costs for pharmacotherapy and home ventilation and/or oxygen care. Results. Mean cost/day/patient was 96\ub1112 \u20ac (range 9-526 \u20ac), with acute costs accounting for 72% and chronic costs for 28% of the total cost burden, with no significant differences in costs associated with the three subgroups. Acute costs had a non-normally distribution (range 0 to 510 \u20ac) with cost for hospitalization being the highest cost burden with greater than 30 % of acute care costs were attributed to only a small segment of patients. Chronic care costs were also unevenly distributed among the various groups (ANOVA p=0.006), with home oxygen supply being the highest cost burden. Conclusions. The current Health Care System is in urgent need for a reassessment of the high cost burden associated with hospitalizations and home oxygen supply

Advanced COPD patients under Home Mechanical Ventilation and/or Long Term Oxygen Therapy: Italian Healthcare Costs

Background and Aim. Little information is available on healthcare costs for patients with very severe chronic obstructive pulmonary disease. The aim of the current work was to evaluate Italian healthcare costs in these patients. Methods. Prospective 1-year analysis was assessed in three subgroups of patients; non-invasively ventilated (n=30); invasively-ventilated (n=12) and on longterm oxygen therapy (n=41). Acute costs for care were a sum of fees for doctor’s consultations, admissions to hospital (ward and intensive care units) and emergency drugs. Chronic costs were the sum of costs for pharmacotherapy and home ventilation and/or oxygen care. Results. Mean cost/day/patient was 96±112€ (range 9-526€), with acute costs accounting for 72% and chronic costs for 28% of the total cost burden, with no significant differences in costs associated with the three subgroups. Acute costs had a non-normal distribution (range 0 to 510€) being cost for hospitalisation the highest cost burden with more than 30% of acute care costs attributed to only a small segment of patients. Chronic care costs were also unevenly distributed among the various groups (ANOVA p=0.006), being home oxygen supply the highest cost burden. Conclusions. The current Health Care System is in urgent need for a reassessment of the high cost burden associated with hospitalisations and home oxygen supply

Effects of EPHX1 and CYP3A4 polymorphisms on carbamazepine metabolism in epileptic patients

BACKGROUND: The aim of this study was to investigate the effect of two genetic polymorphisms in the coding regions (exon 3 and exon 4) of the EPHX1 gene, ie, 337T>C and 416A>G, respectively, on the metabolism of carbamazepine (CBZ) 10,11-epoxide (the active metabolite of CBZ) by evaluating the variation in serum CBZ 10,11-epoxide levels 4 hours after administration of the drug. Moreover, we reported the genotype frequencies of the CYP3A4*22 (rs 35599367, C>T) variant and its influence on the metabolism of CBZ. METHODS: The analysis was performed in 50 patients receiving CBZ as monotherapy. DNA was extracted from leukocytes using a commercially available kit. Serum CBZ 10,11-epoxide levels were measured by high-performance liquid chromatography. Allelic discrimination was performed using polymerase chain reaction-restriction fragment length polymorphism. Statistical analysis of the difference in mean values for CBZ 10,11-epoxide levels according to genotype was performed using the Student's t-test with Statistical Package for the Social Sciences version 13 software. RESULTS: Fourteen percent of the study group were CC, 42% were CT, and 44% were TT for the EPHX1 337T>C variant. No GG homozygote was identified for the EPHX1 416A>G variant; 64% were AA and 36% were AG. When we compared serum CBZ 10,11-epoxide levels 4 hours after drug administration, we found no statistically significant difference between the 337 CC, CT, and TT genotypes. Similarly, no difference in serum CBZ 10,11-epoxide levels was found between 416A>G AA and AG. Genotype frequencies for the CYP3A4*22 (rs 35599367 C>T) allelic variant were 94% for CC and 6% for CT, with no statistically significant difference in serum CBZ 10,11-epoxide levels between these genotypes 4 hours after administration of the drug (2.6±1.3 μg/μL and 2.5±1.2 μg/μL, respectively). CONCLUSION: Although there is some evidence of involvement of these polymorphisms in enzyme activity in vitro, we found no interference with CBZ metabolism in vivo

Frequency of left ventricular hypertrophy in non-valvular atrial fibrillation

Left ventricular hypertrophy (LVH) is significantly related to adverse clinical outcomes in patients at high risk of cardiovascular events. In patients with atrial fibrillation (AF), data on LVH, that is, prevalence and determinants, are inconsistent mainly because of different definitions and heterogeneity of study populations. We determined echocardiographic-based LVH prevalence and clinical factors independently associated with its development in a prospective cohort of patients with non-valvular (NV) AF. From the "Atrial Fibrillation Registry for Ankle-brachial Index Prevalence Assessment: Collaborative Italian Study" (ARAPACIS) population, 1,184 patients with NVAF (mean age 72 \ub1 11 years; 56% men) with complete data to define LVH were selected. ARAPACIS is a multicenter, observational, prospective, longitudinal on-going study designed to estimate prevalence of peripheral artery disease in patients with NVAF. We found a high prevalence of LVH (52%) in patients with NVAF. Compared to those without LVH, patients with AF with LVH were older and had a higher prevalence of hypertension, diabetes, and previous myocardial infarction (MI). A higher prevalence of ankle-brachial index 640.90 was seen in patients with LVH (22 vs 17%, p = 0.0392). Patients with LVH were at significantly higher thromboembolic risk, with CHA2DS2-VASc 652 seen in 93% of LVH and in 73% of patients without LVH (p <0.05). Women with LVH had a higher prevalence of concentric hypertrophy than men (46% vs 29%, p = 0.0003). Logistic regression analysis demonstrated that female gender (odds ratio [OR] 2.80, p <0.0001), age (OR 1.03 per year, p <0.001), hypertension (OR 2.30, p <0.001), diabetes (OR 1.62, p = 0.004), and previous MI (OR 1.96, p = 0.001) were independently associated with LVH. In conclusion, patients with NVAF have a high prevalence of LVH, which is related to female gender, older age, hypertension, and previous MI. These patients are at high thromboembolic risk and deserve a holistic approach to cardiovascular prevention

High Level Meeting on National Drought Policy: Summary and Major Outcomes

Drought is widely recognized as a slow creeping natural hazard that occurs as a consequence of the natural climatic variability. In recent years, concern has grown world-wide that droughts may be increasing in frequency and severity given the changing climatic conditions. Responses to droughts in most parts of the world are generally reactive in terms of crisis management and are known to be untimely, poorly coordinated and disintegrated. Without a coordinated, national drought policy, nations will continue to respond to drought in a reactive, crisis management mode. In order to address the issue of national drought policy, the World Meteorological Organization (WMO), the Secretariat of the United Nations Convention to Combat Desertification (UNCCD) and the Food and Agriculture Organization of the United Nations (FAO), in collaboration with a number of partners, organized the High-level Meeting on National Drought Policy (HMNDP) in Geneva, Switzerland, from 11 to 15 March 2013. The goal of HMNDP was to provide practical insight into useful, science-based actions to address key drought issues and various strategies to cope with drought. During HMNDP, detailed discussions were held during a scientific segment over 3.5 days, leading to the adoption of a HMNDP Declaration in a High Level Segment, calling on all the governments around the world to develop and implement national drought policies. The major outcomes of the scientific and high level segments are presented

Polimorfismo del gene ACE:gene della longevit\ue0 o fattore di rischio nella patologia ipertensiva

Negli ultimi decenni l\u2019allungamento della vita media ha stimolato un particolare interesse nello studio dei processi dell\u2019invecchiamento e nella ricerca di possibili geni coinvolti nella longevit\ue0. In particolare i centenari dimostrano di avere una prevalenza minore di malattie cardiovascolari e dei fattori di rischio ad essa correlati. L\u2019enzima di conversione dell\u2019angiotensina (ACE), presente in tutte le cellule endoteliali, gioca un ruolo essenziale nel mantenimento dell\u2019omeostasi del flusso vascolare, regolando sia la produzione del vasocostrittore angiotensina II sia inattivando la bradichinina. In particolare alcuni studi hanno riportato una possibile correlazione tra il polimorfismo Inserzione/Delezione (I/D) localizzato all\u2019interno dell\u2019introne 16 del gene ACE e la patologia ipertensiva nonch\ue9 un suo possibile ruolo nella longevit\ue0. Lo studio \ue8 stato condotto su 200 soggetti di et\ue0 >90 anni provenienti dalla Regione Sardegna, 123 pazienti ipertesi (24-76 anni) e 112 soggetti normotesi (30-65 anni). Il polimorfismo (I/D) \ue8 stato tipizzato mediante PCR; gli amplificati di 490bp (allele I) e di 190bp (allele D) sono stati visualizzati su gel di agarosio al 2%. I nostri risultati mostrano una frequenza del genotipo D/D maggiore nei soggetti ipertesi rispetto ai soggetti normotesi (49% vs 36%, P = 0.027) e maggiore nel gruppo dei centenari sia rispetto ai soggetti ipertesi che normotesi ( 52% vs 49%, P = 0.016; 52% vs 36% , P < 0.01 ) . Sebbene il ruolo del gene ACE nel processo della longevit\ue0 e nella patogenesi delle malattie cardiovascolari rimanga controverso, il nostro studio suggerisce una possibile associazione tra longevit\ue0 e varianti alleliche di geni coinvolti nella patogenesi dell\u2019ipertensione