The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Sero-epidemiological survey of anaplasma marginale, Babesia bovis, and Babesia bigemina in cattle from lower Shabelle region, Somalia

Orientador: Prof. Dr. Rafael F. C. VieiraCoorientador: Prof. Dr. Abdalla M. IbrahimDissertação (mestrado) - Universidade Federal do Paraná, Setor de Setor de Ciências Agrárias, Programa de Pós-Graduação em Ciências Veterinárias. Defesa : Curitiba, 27/07/2022Inclui referênciasResumo: Fundo: A anaplasmose, causada por Anaplasma marginale, e a babesiose bovina, causada por Babesia bovis e Babesia bigemina, são doenças transmitidas por carrapatos que representam importantes ameaças à pecuária. Ambas as doenças são causas importantes de graves perdas econômicas na pecuária em todo o mundo, inclusive na África Subsaariana. Na Somália, o status dessas doenças é desconhecido. Portanto, os objetivos do presente estudo foram i) determinar a ocorrência de anticorpos contra A. marginale, B. bovis e B. bigemina em bovinos, ii) identificar espécies de carrapatos parasitando os animais, e iii) determinar fatores associados a exposição em fazendas dos distritos de Awdhegle, Wanla Weyn e Afgoye na região inferior de Shabelle, Somália Métodos: Foram avaliadas 127 amostras de soro e 66 carrapatos de bovinos. Um questionário epidemiológico foi aplicado a cada proprietário da fazenda abordando local de amostragem, idade, sexo, condição corporal e presença de carrapatos. O volume globular (PCV) foi medido pelo método de microhematócrito. Amostras de soro bovino foram rastreadas usando ELISA comercial para a detecção de anti-A. marginale (baseado em MSP5), anti-B. bovis (BV60 recombinante) e anti-B. bigemina (antígenos brutos) e carrapatos foram identificados com base na técnica morfológica e molecular. Resultados: A soropositividade geral para A. marginale, B. bovis e B. bigemina foi de 108/127 (85%; IC 95%: 77,6 - 90,8%), 93/127 (73,2%, IC 95%: 64,7 - 80,7% ) e 94/127 (74%, IC 95 %: 65,5 - 81,4%), respectivamente. Um total de 15/127 (11,8%, IC 95%: 6,8 - 18,7%), 1/127 (0,08%, IC 95%: 0,02 - 4,3) e 1/127 (0,08%, IC 95%: 0,02 - 4,3%) bovinos foram apenas soropositivos para A. marginale, B. bovis e B. bigemina, respectivamente. Um total de 93/127 (73,2%; IC 95%: 64,7-80,7%) bovinos foram soropositivos para pelo menos as espécies Anaplasma e/ou Babesia. Fatores de risco como idade, condição corporal e localização foram analisados, porém apenas a localização dos animais (p<0,05) foi significativamente associada à soropositividade para Anaplasma marginale, B. bovis e B. bigemina e condição corporal (p< 0,05) foram significativamente associados apenas com B. bigemina. Trinta dos 127 (23,6%; IC 95%: 16,54 - 31,9%) bovinos estavam infestados por 66 (37 M, 26 F e três ninfas) carrapatos no momento da amostragem: Rhipicephalus pulchellus (43/66; 65,15%, 19M, 24F), Amblyomma gemma (12/66; 18,18%, 12M), Amblyomma lepidum (6/66; 9,09%, 5M e 1F), Hyalomma marginatum (1/66; 1,51%, 1F) e Hyalmomma rufipes (1 /66; 1,51%, 1M). Duas ninfas foram identificadas como R. pulchellus e Rhipicephalus pravus. A concentração média de PCV para bovinos foi de 0,26 L/L, com 54/123 (43,9%, IC 95%:34,9 - 53,1%) bovinos anêmicos. Não foi encontrada associação entre PCV e soropositividade para A. marginale (P = 0,10) e Babesia spp (P = 0,80). Conclusão: O presente estudo mostrou uma alta soropositividade para A. marginale, B. bovis e B. bigemina em bovinos da Somália. Considerando a alta soropositividade, nossos dados destacam a necessidade de novas investigações utilizando técnicas moleculares.Abstract: Background: Anaplasmosis, caused by Anaplasma marginale, and bovine babesiosis, caused by Babesia bovis and Babesia bigemina, are tick-borne diseases that represent important threats to the livestock industry. Both diseases are important causes of severe economic losses in cattle farming worldwide, including in Sub-Saharan Africa. In Somalia, the status of these diseases is unknown. Therefore, the aims of the present study were i) to determine the occurrence of antibodies against A. marginale, B. bovis and B. bigemina in cattle, ii) to identify tick species parasitizing the animals, and iii) to determine factors associated with exposure in farms from Awdhegle, Wanla Weyn, and Afgoye districts in the lower Shabelle region, Somalia. Methods: A total of 127 serum samples and 66 ticks collected from cattle were evaluated. An epidemiological questionnaire was applied to each farm owner addressing sampling location, age, gender, body condition, and presence of ticks. The packed cell volume (PCV) was measured by the microhematocrit method. Cattle serum samples were screened using commercial ELISA for the detection of anti-A. marginale (MSP5-based), anti-B. bovis (recombinant BV60) and anti-B. bigemina (crude antigens) antibodies and ticks were identified based on morphological and molecular technique. Results: The overall seropositivity for A. marginale, B. bovis and B. bigemina was 108/127 (85%; 95% CI: 77.6 - 90.8%), 93/127 (73.2%, 95% CI: 64.7 - 80.7%) and 94/127 (74%, 95 % CI: 65.5 - 81.4%), respectively. A total of 15/127 (11.8%, 95% CI: 6.8 - 18.7%), 1/127 (0.08%, 95% CI: 0.02 - 4.3), and 1/127 (0.08%, 95% CI: 0.02 - 4.3%) cattle were solely seropositive for A. marginale, B. bovis, and B. bigemina, respectively. A total of 93/127 (73.2%; 95%CI: 64.7-80.7%) cattle were seropositive for at least Anaplasma and/or Babesia species. In regardless of associated risk factors like age, body condition, and location were analyzed, only location (p<0.05) was found to be significantly associated with seropositive for Anaplasma marginale, B. bovis, and B. bigemina and body condition (p<0.05) was found to be significantly associated only with B. bigemina. Thirty out of 127 (23.6%; 95% CI: 16.54 - 31.9%) cattle were infested by 66 (37 M, 26 F, and three nymphs) ticks at the time of sampling: Rhipicephalus pulchellus (43/66; 65.15%, 19M, 24F), Amblyomma gemma (12/66; 18.18%, 12M), Amblyomma lepidum (6/66; 9.09%, 5M and 1F), Hyalomma marginatum (1/66; 1.51%, 1F) and Hyalmomma rufipes (1/66; 1.51%, 1M). Two nymphs were identified as R. pulchellus and Rhipicephalus pravus. The mean PCV concentration for cattle was 0.26 L/L, with 54/123 (43.9%, 95% CI:34.9 - 53.1%) cattle anemic. Association between PCV and seropositivity to A. marginale (P = 0.10) and Babesia spp (P = 0.80) was not found. Conclusion: The present study showed a high seropositivity for A. marginale, B. bovis and B. bigemina in cattle from Somalia. Considering the high seropositivity, our data highlight the need for further investigations using molecular techniques

Assessment of drug-susceptible and multidrug-resistant tuberculosis (MDR-TB) in the Central Region of Somalia: A 3-year retrospective study.

BackgroundMultidrug-resistant tuberculosis (MDR-TB) remains a public health emergency and a threat globally. Although increasing MDR-TB cases have been recently reported in Somalia, limited information is known. This study aims to determine the prevalence of drug-susceptible and MDR-TB in suspected patients referred to the TB Department in Mudug Hospital, Galkayo, Somalia, and identify potential factors associated with MDR-TB.MethodsA 3-year hospital laboratory-based retrospective study was conducted by manually reviewing laboratory records of Mycobacterium tuberculosis specimens and GeneXpert MTB/RIF results from January 2019 to December 2021 at the reference mycobacteria laboratory department in Mudug Hospital.ResultsA total of 714 positive GeneXpert-MTB results were identified: 619 (86.7%) were drug susceptible (no Rifampin resistance [RR] detected) and 95 (13.3%) with RR detected or defined as MDR-TB. Most of the MDR-TB patients were males (71.6%, 68/95) and between the ages of 15 to 24 (31.6%, 30/95). Most isolates were collected in 2021 (43.2%, 41/95). Multivariate analyses show no significant difference between patients having MDR-TB and/or drug-susceptible TB for all variables.ConclusionThis study showed an alarming frequency of MDR-TB cases among M. tuberculosis-positive patients at a regional TB reference laboratory in central Somalia

Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair

Importance Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors.Objective To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR.Design, Setting, and Participants The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR.Exposure Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia.Main Outcomes and Measures The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients.Results In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72).Conclusions The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies