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

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century

Global, regional, and national incidence of six major immune-mediated inflammatory diseases : findings from the global burden of disease study 2019

DATA SHARING STATEMENT : Data used for the analyses are publicly available from the Institute of Health Metrics and Evaluation (http://www.healthdata.org/; http:// ghdx.healthdata.org/gbd-results-tool).BACKGROUND : The causes for immune-mediated inflammatory diseases (IMIDs) are diverse and the incidence trends of IMIDs from specific causes are rarely studied. The study aims to investigate the pattern and trend of IMIDs from 1990 to 2019. METHODS : We collected detailed information on six major causes of IMIDs, including asthma, inflammatory bowel disease, multiple sclerosis, rheumatoid arthritis, psoriasis, and atopic dermatitis, between 1990 and 2019, derived from the Global Burden of Disease study in 2019. The average annual percent change (AAPC) in number of incidents and age standardized incidence rate (ASR) on IMIDs, by sex, age, region, and causes, were calculated to quantify the temporal trends. FINDINGS : In 2019, rheumatoid arthritis, atopic dermatitis, asthma, multiple sclerosis, psoriasis, inflammatory bowel disease accounted 1.59%, 36.17%, 54.71%, 0.09%, 6.84%, 0.60% of overall new IMIDs cases, respectively. The ASR of IMIDs showed substantial regional and global variation with the highest in High SDI region, High-income North America, and United States of America. Throughout human lifespan, the age distribution of incident cases from six IMIDs was quite different. Globally, incident cases of IMIDs increased with an AAPC of 0.68 and the ASR decreased with an AAPC of −0.34 from 1990 to 2019. The incident cases increased across six IMIDs, the ASR of rheumatoid arthritis increased (0.21, 95% CI 0.18, 0.25), while the ASR of asthma (AAPC = −0.41), inflammatory bowel disease (AAPC = −0.72), multiple sclerosis (AAPC = −0.26), psoriasis (AAPC = −0.77), and atopic dermatitis (AAPC = −0.15) decreased. The ASR of overall and six individual IMID increased with SDI at regional and global level. Countries with higher ASR in 1990 experienced a more rapid decrease in ASR. INTERPRETATION : The incidence patterns of IMIDs varied considerably across the world. Innovative prevention and integrative management strategy are urgently needed to mitigate the increasing ASR of rheumatoid arthritis and upsurging new cases of other five IMIDs, respectively.The Global Burden of Disease Study is funded by the Bill and Melinda Gates Foundation. Support from Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital; Shaqra University; the School of Pharmacy, University of Botswana; the Indian Council of Medical Research (ICMR); an Australian National Health and Medical Research Council (NHMRC) Investigator Fellowship; the Italian Center of Precision Medicine and Chronic Inflammation in Milan; the Department of Environmental Health Engineering of Isfahan University of Medical Sciences, Isfahan, Iran; National Health and Medical Research Council (NHMRC), Australia; Jazan University, Saudi Arabia; the Clinician Scientist Program of the Clinician Scientist Academy (UMEA) of the University Hospital Essen; AIMST University, Malaysia; the Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India; a Kornhauser Research Fellowship at The University of Sydney; the National Research, Development and Innovation Office Hungary; Taipei Medical University; CREATE Hope Scientific Fellowship from Lung Foundation Australia; the National Institute for Health and Care Research Manchester Biomedical Research Centre and an NIHR Clinical Lectureship in Respiratory Medicine; Kasturba Medical College, Mangalore and Manipal Academy of Higher Education, Manipal; Author Gate Publications; the Cleveland Clinic Foundation and Nassau University Medical center; the Italian Ministry of Health (RRC); King Abdulaziz University (DSR), Jeddah, and King Abdulaziz City for Science & Technology (KACSAT), Saudi Arabia, Science & Technology Development Fund (STDF), and US-Egypt Science & Technology joint Fund: The Academy of Scientific Research and Technology (ASRT), Egypt; partially supported by the Centre of Studies in Geography and Spatial Planning; the International Center of Medical Sciences Research (ICMSR), Islamabad Pakistan; Ain Shams University and the Egyptian Fulbright Mission Program; the Belgian American Educational Foundation; Health Data Research UK; the Spanish Ministry of Science and Innovation, Institute of Health Carlos III, CIBERSAM, and INCLIVA; the Clinical Research Development Unit, Imam Reza Hospital, Mashhad University of Medical Sciences; Shaqra University; Saveetha Institute of Medical and Technical Sciences and SRM Institute of Science and Technology; University of Agriculture, Faisalabad-Pakistan; the Chinese University of Hong Kong Research Committee Postdoctoral Fellowship Scheme; the institutional support of the Department of Microbiology and Immunology, Faculty of Pharmacy, Zagazig University, Egypt; the European (EU) and Developing Countries Clinical Trials Partnership, the EU Horizon 2020 Framework Programme, UK-National Institute for Health and Care Research, the Mahathir Science Award Foundation and EU-EDCTP.http://www.thelancet.comam2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

Endodontic Advances and Evidence-Based Clinical Guidelines

Endodontic Advances and Evidence-Based Clinical Guidelines provides a comprehensive and up-to-date description of recent research findings and their impact on clinical practice. Using an innovative approach to the field, the book enables readers to translate the current body of knowledge on endodontic diseases and treatment into guidelines for enhancing patient care. Divided into four parts, the book first addresses new research findings and advances in technology, techniques, materials, and clinical management. In addition, it provides revised clinical guidelines for a variety of areas within the specialty, such as endodontic diagnosis, treatment planning, management of endodontic emergencies, regenerative endodontic procedures, three-dimensional imaging, and the use of systemic antibiotics. Each chapter contains numerous high-quality illustrations and clinical cases highlighting current research directions, key concepts, and new trends in clinical techniques and education. Endodontic Advances and Evidence-Based Clinical Guidelines: Presents the latest understanding of current literature, evidence, and clinical practice Examines new trends, treatments, and advanced diagnostic techniques in the field Covers a wide range of topics, including management of root canals, repair of perforation defects, removal of root filling materials, and alternatives to root canal treatment Endodontic Advances and Evidence-Based Clinical Guidelines is an invaluable resource for undergraduate and postgraduate dental students, general dental practitioners, endodontic specialists, researchers in the field of endodontics, and clinicians, researchers, and educators in other fields of dentistr

Immediate operation versus percutaneous drainage for treatment of appendicular absces

Aim: This study aims to compare the outcomes, morbidity and hospital stay in patients who underwent emergency surgery, and those who underwent percutaneous drainage for treatment of appendicular abscess. Patients and methods: From April 2013 to October 2014, we recruited 40 patients with appendicular abscesses for this study. These patients were randomized into two groups: group 1 (20 patients) for emergency surgery and group 2 (20 patients) for percutaneous drainage. Preoperative data, hospital stay, functional recovery and postoperative complications were analyzed. Results: Functional recovery was 2.2 ± 1 days in group 1 and 1 ± 0 day in group 2. Hospital stay in group 1 was 7.7 ± 3.5 days and in group 2 was 4 ± 1 days. Postoperative complications in group 1 were noted in 8 (40%) patients. No complications were recorded in group 2. Conclusions: Appendicular abscesses may be safely and effectively treated by US-guided percutaneous drainage with high technical and clinical success rates, low incidence of complications and shorter hospital stay

Tooth, root, and canal anatomy

Knowledge of root and canal morphology is a prerequisite for successful endodontic treatment. The external and internal morphological features of roots are variable and complex. Current advancements in non-destructive digital image systems, such as cone-beam computed tomography (CBCT) and micro-computed tomography (micro-CT), allow detailed qualitative and quantitative analyses of root and canal morphology. This growing body of knowledge has paved the way for revising several historical concepts and introducing new perspectives for more accurate descriptions of root and canal morphology in teaching, research, and clinical practice. This chapter aims to provide an update on the application of a new system for classifying root and canal morphology, accessory canals, and anomalies, to discuss anatomy of the root apex and apical foramen, and to present the growing body of knowledge on root and canal morphology in all tooth types

Enhancement of anti-corrosion and mechanical properties of alkyd-based protective paints for steel petroleum structures incorporating natural limonite pigment

In the present approach, natural limonite iron oxide samples from Baharyia Oasis areas have been collected and ground to the micro-sized scale to be used as pigment for upholding the corrosion resistance behavior and mechanical performance properties of protective paints for steel petroleum structures. The assessment procedure includes measuring of specific gravity, moisture content, oil absorption, particle size distribution, particle shape, pH value, soluble in water, hardness, powder color and chemical composition by XRF analysis of limonite pigment particles. X-ray diffraction (XRD) analysis was implemented to assure the phase identification of the crystalline limonite pigment particles. Dynamic light scattering (DLS) measurements were accomplished to measure the particle size distribution and Zeta-potential of these particles in suspension. Amorphous and lamellar morphology of limonite particles was manifested by scanning electron microscopy (SEM) micrographs. EDX investigation was employed to give a semi-quantitative analysis and the chemical composition of limonite pigment. Different alkyd-based coating formulations were modified using various uniformly dispersing amounts of the processed limonite pigment particles as bi-functional modifier. The anti-corrosion performance properties of the considered limonite modified coating formulations against unmodified blank coating were studied by accelerated corrosion experiment (salt spray chamber) after 500 h exposure in 5% NaCl solution. The obtained results revealed a significant improvement in the rust grade, blistering size, color tolerance and adhesion performance of limonite modified coated steel films compared to unmodified conventional coating. To confirm the previous concept, weight loss method was performed. The mechanical performance properties for these films were investigated by adhesion cross-cut, bend and impact coating tests to confirm their application efficiency. From the recorded data it was found that, the adhesion properties, elongation character and resistance to rapid deformation of these coatings increased significantly to the steel surface with increasing the limonite pigment (%) by weight in the coating formulation. The results obtained compared with the ASTM and paint handbooks and found satisfactory for producing color paint pigment

Technology enhanced education

Dental education has evolved through the years, and various advanced technologies are being incorporated into the curriculum to improve the quality of teaching and learning. The use of electronic devices and software programs continues to be at the forefront of e-learning modules, including in the field of Endodontology. This chapter aims to discuss current advances in dental education and applications of e-learning in Dentistry. Advances and applications of e-learning tools and virtual reality combined with more recent improvements in knowledge and clinical practice in the field of Endodontology will also be discussed