Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Testing a potential mantle geohygrometer; the effect of dissolved water on the intracrystalline partitioning of Al in orthopyroxene

The presence of water in the Earth's mantle has wide ranging implications and a detailed picture of the spatial and temporal distribution of water in the mantle is needed to be able to understand fundamental global-scale processes. However the interpretation of measured water concentrations in nominally anhydrous minerals (NAMs) from xenoliths or magmatic phenocrysts is complicated by fast diffusion of H and hence the probability of hydration or dehydration during ascent. Rauch and Keppler [1]M. Rauch, H. Keppler, Water solubility in orthopyroxene, Contrib. Mineral. Petrol. 143 (2002) 525-536 have proposed that the partitioning of Al between octahedral and tetrahedral sites in orthopyroxene has the potential to be used as a more reliable mantle geohygrometer than direct measurements of water concentrations in xenolith minerals. In the present study, we have tested the theoretical basis for this geohygrometer by experimentally producing aluminous orthopyroxene samples and measuring the intracrystalline partitioning of Al using very high-field 27Al magic angle spinning nuclear magnetic resonance. In both dry and hydrous orthopyroxene, aluminium is shown to be incorporated by a Tschermak's substitution (one tetrahedral and one octahedral Al), thus the incorporation mechanism of Al in orthopyroxene is not a valid basis for a geohygrometer. However, the effect of OH on the local environment of Al has been observed, and quantification of all the different types of Al in the hydrous samples suggests that OH is incorporated by protonation of O21 and O22 sites. The results suggest that NMR studies on nuclei other than 1H offer new possibilities for studying the interaction of water with mantle minerals. © 2005 Elsevier B.V. All rights reserved

Seroconvertion to hepatitis B vaccine after weight reduction in obese non-responder Soroconversão à vacina contra hepatite B após redução de peso em obeso não respondedor

Decreased responses to hepatitis B vaccine have been associated with some host conditions including obesity. Susceptible non-responders to a primary three-dose vaccine series should be revaccinated. Those who maintain a non-responder condition after revaccination with three vaccine doses are unlikely to develop protection using more doses. This is a description of an obese woman who received six doses of hepatitis B vaccine and persisted as a non-responder. She was submitted to a vertical banded gastroplasty Roux-en-Y gastric bypass Capellas's technique. After weight reduction, she received three additional doses of vaccine and seroconverted. Further studies should help clarify the need to evaluate antibody levels and eventually revaccinate the increasing population of individuals who undergo weight reduction.<br>A diminuição da resposta à vacinação contra hepatite B já foi relacionada a algumas condições clínicas, inclusive à obesidade. Indivíduos que não responderam à série de três doses devem ser revacinados. Caso continuem não-respondedores após duas séries de vacina, não há indicação de doses adicionais. Esta é a descrição de mulher obesa que não havia soroconvertido após ter recebido seis doses de vacina contra hepatite B. Ela foi submetida à gastroplastia em Y de Roux, pela técnica de Capella. Após a redução de peso, a paciente recebeu mais três doses de vacina contra hepatite B e soroconverteu. Novos estudos poderão indicar a necessidade de avaliação de níveis de anticorpos contra antígenos vacinais e eventualmente revacinar esta população cada vez maior de pacientes que se submetem à cirurgia para redução de peso