Diversity, distribution and conservation of the terrestrial reptiles of Oman (Sauropsida, Squamata)

All authors: Salvador Carranza , Meritxell Xipell, Pedro Tarroso, Andrew Gardner, Edwin Nicholas Arnold, Michael D. Robinson, Marc Simó-Riudalbas, Raquel Vasconcelos, Philip de Pous, Fèlix Amat, Jiří Šmíd, Roberto Sindaco, Margarita Metallinou †, Johannes Els, Juan Manuel Pleguezuelos, Luis Machado, David Donaire, Gabriel Martínez, Joan Garcia-Porta, Tomáš Mazuch, Thomas Wilms, Jürgen Gebhart, Javier Aznar, Javier Gallego, Bernd-Michael Zwanzig, Daniel Fernández-Guiberteau, Theodore Papenfuss, Saleh Al Saadi, Ali Alghafri, Sultan Khalifa, Hamed Al Farqani, Salim Bait Bilal, Iman Sulaiman Alazri, Aziza Saud Al Adhoobi, Zeyana Salim Al Omairi, Mohammed Al Shariani, Ali Al Kiyumi, Thuraya Al Sariri, Ahmed Said Al Shukaili, Suleiman Nasser Al Akhzami.In the present work, we use an exceptional database including 5,359 records of 101 species of Oman’s terrestrial reptiles together with spatial tools to infer the spatial patterns of species richness and endemicity, to infer the habitat preference of each species and to better define conservation priorities, with especial focus on the effectiveness of the protected areas in preserving this unique arid fauna. Our results indicate that the sampling effort is not only remarkable from a taxonomic point of view, with multiple observations for most species, but also for the spatial coverage achieved. The observations are distributed almost continuously across the two-dimensional climatic space of Oman defined by the mean annual temperature and the total annual precipitation and across the Principal Component Analysis (PCA) of the multivariate climatic space and are well represented within 17 out of the 20 climatic clusters grouping 10% of the explained climatic variance defined by PC1 and PC2. Species richness is highest in the Hajar and Dhofar Mountains, two of the most biodiverse areas of the Arabian Peninsula, and endemic species richness is greatest in the Jebel Akhdar, the highest part of the Hajar Mountains. Oman’s 22 protected areas cover only 3.91% of the country, including within their limits 63.37% of terrestrial reptiles and 50% of all endemics. Our analyses show that large areas of the climatic space of Oman lie outside protected areas and that seven of the 20 climatic clusters are not protected at all. The results of the gap analysis indicate that most of the species are below the conservation target of 17% or even the less restrictive 12% of their total area within a protected area in order to be considered adequately protected. Therefore, an evaluation of the coverage of the current network of protected areas and the identification of priority protected areas for reptiles using reserve design algorithms are urgently needed. Our study also shows that more than half of the species are still pending of a definitive evaluation by the International Union for Conservation of Nature (IUCN).This work was funded by grants CGL2012-36970, CGL2015-70390-P from the Ministerio de Economía y Competitividad, Spain (cofunded by FEDER) to SC, the project Field study for the conservation of reptiles in Oman, Ministry of Environment and Climate Affairs, Oman (Ref: 22412027) to SC and grant 2014-SGR-1532 from the Secretaria d'Universitats i Recerca del Departament d'Economia i Coneixement de la Generalitat de Catalunya to SC. MSR is funded by a FPI grant from the Ministerio de Economía y Competitividad, Spain (BES-2013-064248); RV, PT and LM were funded by Fundação para a Ciência e Tecnologia (FCT) through post-doc grants (SFRH/BPD/79913/2011) to RV, (SFRH/BPD/93473/2013) to PT and PhD grant (SFRH/BD/89820/2012) to LM, financed by Programa Operacional Potencial Humano (POPH) – Quadro de Referência Estrategico Nacional (QREN) from the European Social Fund and Portuguese Ministerio da Educação e Ciência

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

Tiempo de llegada hospitalaria y pronóstico funcional después de un infarto cerebral: resultados del estudio PREMIER

Resumen: Introducción: La información sobre el tiempo de llegada hospitalaria después de un infarto cerebral (IC) se ha originado en países con unidades especializadas en ictus. Existe poca información en naciones emergentes. Nos propusimos identificar los factores que influyen en el tiempo de llegada hospitalaria a 1, 3 y 6 h y su relación con el pronóstico funcional después del ictus. Métodos: Se analizó la información de pacientes con IC incluidos en el estudio Primer Registro Mexicano de Isquemia Cerebral (PREMIER) que tuvieran tiempo definido desde el inicio de los síntomas hasta la llegada hospitalaria. El desenlace funcional se evaluó mediante la escala modificada de Rankin a los 30 días, 3, 6 y 12 meses. Resultados: De 1.096 pacientes con IC, 61 (6%) llegaron en < 1 h, 250 (23%) en < 3 h y 464 (42%) en < 6 h. Favorecieron la llegada temprana en < 1 h: el antecedente familiar de cardiopatía isquémica y ser migrañoso; en < 3 h: edad 40-69 años, antecedente familiar de hipertensión, antecedente personal de dislipidemia y cardiopatía isquémica, así como la atención en hospital privado; en < 6 h: antecedente familiar de hipertensión, ser migrañoso, ictus previo, cardiopatía isquémica y atención en hospital privado. La llegada hospitalaria tardía se asoció a ictus lacunar y alcoholismo. Solo el 2,4% recibió trombólisis. Independientemente de la trombólisis, la llegada en < 3 h se asoció a menor mortalidad a los 3 y 6 meses, además de menos complicaciones intrahospitalarias. Conclusiones: Una proporción importante de pacientes tuvo un tiempo de llegada hospitalaria temprana; sin embargo, menos del 3% recibió trombólisis. Aunque muchos factores se asociaron a la llegada temprana, es prioritario identificar las barreras intrahospitalarias que obstaculizan la trombólisis. Abstract: Introduction: Information regarding hospital arrival times after acute ischaemic stroke (AIS) has mainly been gathered from countries with specialised stroke units. Little data from emerging nations is available. We aim to identify factors associated with achieving hospital arrival times of less than 1, 3, and 6 hours, and analyse how arrival times are related to functional outcomes after AIS. Methods: We analysed data from patients with AIS included in the PREMIER study (Primer Registro Mexicano de Isquemia Cerebral) which defined time from symptom onset to hospital arrival. The functional prognosis at 30 days and at 3, 6, and 12 months was evaluated using the modified Rankin Scale. Results: Among 1096 patients with AIS, 61 (6%) arrived in <1 hour, 250 (23%) in <3 hours, and 464 (42%) in <6 hours. The factors associated with very early (<1 hour) arrival were family history of ischemic heart disease and personal history of migraines; in <3 hours: age 40-69 years, family history of hypertension, personal history of dyslipidaemia and ischaemic heart disease, and care in a private hospital; in <6 hours: migraine, previous stroke, ischaemic heart disease, care in a private hospital, and family history of hypertension. Delayed hospital arrival was associated with lacunar stroke and alcoholism. Only 2.4% of patients underwent thrombolysis. Regardless of whether or not thrombolysis was performed, arrival time in <3 hours was associated with lower mortality at 3 and 6 months, and with fewer in-hospital complications. Conclusions: A high percentage of patients had short hospital arrival times; however, less than 3% underwent thrombolysis. Although many factors were associated with early hospital arrival, it is a priority to identify in-hospital barriers to performing thrombolysis. Palabras clave: Desenlace, Ictus, Infarto cerebral, Mortalidad, Pronóstico, Keywords: Outcome, Stroke, Cerebral infarction, Mortality, Prognosi

Hospital arrival time and functional outcome after acute ischaemic stroke: Results from the PREMIER study

Introduction: Information regarding hospital arrival times after acute ischaemic stroke (AIS) has mainly been gathered from countries with specialised stroke units. Little data from emerging nations are available. We aim to identify factors associated with achieving hospital arrival times of less than 1, 3, and 6 hours, and analyse how arrival times are related to functional outcomes after AIS. Methods: We analysed data from patients with AIS included in the PREMIER study (Primer Registro Mexicano de Isquemia Cerebral) which defined time from symptom onset to hospital arrival. The functional prognosis at 30 days and at 3, 6, and 12 months was evaluated using the modified Rankin Scale. Results: Among 1096 patients with AIS, 61 (6%) arrived in <1 hour, 250 (23%) in <3 hours, and 464 (42%) in <6 hours. The factors associated with very early (<1 h) arrival were family history of ischaemic heart disease and personal history of migraines; in <3 hours: age 40 to 69 years, family history of hypertension, personal history of dyslipidaemia and ischaemic heart disease, and care in a private hospital; in <6 hours: migraine, previous stroke, ischaemic heart disease, care in a private hospital, and family history of hypertension. Delayed hospital arrival was associated with lacunar stroke and alcoholism. Only 2.4% of patients underwent thrombolysis. Regardless of whether or not thrombolysis was performed, arrival time in <3 hours was associated with lower mortality at 3 and 6 months, and with fewer in-hospital complications. Conclusions: A high percentage of patients had short hospital arrival times; however, less than 3% underwent thrombolysis. Although many factors were associated with early hospital arrival, it is a priority to identify in-hospital barriers to performing thrombolysis. Resumen: Introducción: La información sobre el tiempo de llegada hospitalaria después de un infarto cerebral (IC) se ha originado en países con unidades especializadas en ictus. Existe poca información en naciones emergentes. Nos propusimos identificar los factores que influyen en el tiempo de llegada hospitalaria a 1, 3 y 6 h y su relación con el pronóstico funcional después del ictus. Métodos: Se analizó la información de pacientes con IC incluidos en el estudio Primer Registro Mexicano de Isquemia Cerebral (PREMIER) que tuvieran tiempo definido desde el inicio de los síntomas hasta la llegada hospitalaria. El desenlace funcional se evaluó mediante la escala modificada de Rankin a los 30 días, 3, 6 y 12 meses. Resultados: De 1.096 pacientes con IC, 61 (6%) llegaron en < 1 h, 250 (23%) en < 3 h y 464 (42%) en < 6 h. Favorecieron la llegada temprana en < 1 h: el antecedente familiar de cardiopatía isquémica y ser migrañoso; en < 3 h: edad 40-69 años, antecedente familiar de hipertensión, antecedente personal de dislipidemia y cardiopatía isquémica, así como la atención en hospital privado; en < 6 h: antecedente familiar de hipertensión, ser migrañoso, ictus previo, cardiopatía isquémica y atención en hospital privado. La llegada hospitalaria tardía se asoció a ictus lacunar y alcoholismo. Solo el 2,4% recibió trombólisis. Independientemente de la trombólisis, la llegada en < 3 h se asoció a menor mortalidad a los 3 y 6 meses, además de menos complicaciones intrahospitalarias. Conclusiones: Una proporción importante de pacientes tuvo un tiempo de llegada hospitalaria temprana; sin embargo, menos del 3% recibió trombólisis. Aunque muchos factores se asociaron a la llegada temprana, es prioritario identificar las barreras intrahospitalarias que obstaculizan la trombólisis. Keywords: Outcome, Stroke, Cerebral infarction, Mortality, Prognosis, Palabras clave: Desenlace, Ictus, Infarto cerebral, Mortalidad, Pronóstic

Atherothrombotic disease, traditional risk factors, and 4-year mortality in a Latin American population: the REACH registry

Sérgio Salles Xavier. Instituto Nacional de Infectologia Evandro Chagas. Documento produzido em parceria ou por autor vinculado à Fiocruz, mas não consta a informação no documento.REACH Investigators by Country: Chile: Acevedo M, Araya F, Barrientos N, Blanchi V, Chavez E, Corbalan R, Diaz R, Dighero H, Garayar B, Garjardo L, ´Garrido B, Gutierrez V, Hoppe A, Kauffmann R, Kramer A, Kunstmann S, Manriquez L, Srur EM, Tapia J, Varleta PE, Villar RA. Panama: Arango AC, Arauz J, Benzadon A, Cabrera JR, Cantisano L, Castillo B, Chavez EH, Chen CH, Diaz E, Dina RE, Espinosa H, Hernandez D, Hernandez J, Lopez R, Madrid JL, Medine FP, Minchola JA, Mini M, Molina G, Motta J, Moya J, Ortiz ME, Parajeles A, Ramos CA, Rodriguez E, Saravia GL, Sprok JM, Tortos-Guzman J, Urrutia V, Veras D, Vercauteren JP, Villa-Garcin P, Vinocour M. Brazil: Albuquerque D, Atai de Jr L, Atie J, Avezum A, Bandeira F, Bodanese L, Brasileiro A, Carvalho AC, Dutra O, Esporcatte R, Esteves JP, Eugenio AM, Feitosa G, Fernandes J, Halpern A, Knobel M, Lopes C, Lyra R, Machado N, Maciel L, Marino R, Massaro A, Matos A, Mesquita E, Moreira M, Nagato YN, Nicolau JC, Nogueira PR, Pazin-Filho A, Pires MT, Rocha A, Rocha R, Saraiva JF, Schmid H, Serro J, Tambascia M, Xavier SS, Yamamoto F, Yoshida WB, Zanella MT. Mexico: Abundes A, Aguayo G, Alcocer MA, Alegr´ıa MA, Alexanderson G, Alpizar M, Amaya LE, Arauz A, Astorga A, Azpiri JR, Barinagarrementeria F, Benavides MA, Bernal E, Briseno HM, Caluo C, Cant ˜ u-Brito C, Cedillo FR, Colorado ´H, Cortes J, Cossio J, De los R´ıos MO, De Zatarain R, D´ıaz C, Eng L, Esparragoza J, Espinosa L, Espinoza C, Fernandez P, Garc´ıa E, Garc´ıa R, Garza A, Gaxiola E, Gonzalez FJ, Guerrero F, Herududez I, Kostine A, Leiva JL, Llamas-Lopez L, Lopez B, L ´ opez J, L ´ opez M, Marcos A, Najar S, Nettel J, Ortiz F, Peralta R, Perez JC, Ranero A, Rangel-Guerra R, Rodr´ıguez J, Rodr´ıguez L, Rojas JA, Romero A, Rubio G, Ruiz JL, Sagastegui A, Talamas O, Tapia M, Toriz JL, Uribe A, Vazquez J, Velasco JA, Velasco EC, Velasco-Sanchez RG, Villarreal J.Submitted by Repositório Arca ([email protected]) on 2019-04-24T16:56:17Z No. of bitstreams: 1 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-10-15T14:46:18Z (GMT) No. of bitstreams: 2 ve_Cantu-Brito_Carlos_etal_INI_2012.pdf: 274833 bytes, checksum: d72c0b6da13433fa50bf9e204cb83cde (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2019-10-15T14:46:18Z (GMT). No. of bitstreams: 2 ve_Cantu-Brito_Carlos_etal_INI_2012.pdf: 274833 bytes, checksum: d72c0b6da13433fa50bf9e204cb83cde (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2012Salvador Zubirán National Institute of Medical Sciences and Nutrition. Department of Neurology and Psychiatry Mexico City, Mexico.Salvador Zubirán National Institute of Medical Sciences and Nutrition. Department of Neurology and Psychiatry Mexico City, Mexico.Fray Antonio Alcalde Public Hospital. Department of Neurology. Guadalajara, Jalisco, Mexico.Jardines Specialty Hospital. Department of Cardiology. Zapopan, Jalisco, Mexico.State University of Rio de Janeiro. Hospital Pedro Ernesto. Department of Cardiology. Rio de Janeiro, RJ, Brasil.Pontifical Catholic University of Chile. Department of Cardiovascular Diseases. Santiago de Chile, Chile.Scientific Department. Clinical Research Department. Sanofi, Mexico.VA Boston Healthcare System. Brigham and Women’s Hospital. Department of Cardiology. Boston, MA, USA / Harvard Medical School. Boston, MA, USA.Bichat-Claude Bernard Hospital. Paris, France / University Hospital North Paris Val de Seine. Paris, France / Paris Diderot University. Paris, France.Background: Atherothrombosis is becoming the leading cause of chronic morbidity in developing countries. This epidemiological transition will represent an unbearable socioeconomic burden in the near future. We investigated factors associated with 4-year all-cause mortality in a Latin American population at high risk. Hypothesis: Largely modifiable risk factors as well as polyvascular disease are the main predictors of 4-year all-cause and cardiovascular mortality in this Latin American cohort. Methods: We analyzed 1816 Latin American stable outpatients (62.3% men, mean age 67 years) with symptomatic atherothrombosis (87.1%) or with multiple risk factors only (12.9%), in the Reduction of Atherothrombosis for Continued Health registry. Results: Of patients with symptomatic atherothrombosis, 57.3% had coronary artery disease, 32% cerebrovascular disease, and 11.7% peripheral artery disease at baseline (9.1% polyvascular). The main risk factors were hypertension (76%), hypercholesterolemia (60%), and smoking (52.3%) in patients with established atherothrombosis; and hypertension (89.7%), diabetes (80.8%), and hypercholesterolemia (73.9%) in those with risk factors only. Four-year all-cause mortality steeply increased with none (6.8%), 1 (9.2%), 2 (15.5%), and 3 (29.2%) symptomatic arterial disease locations. In patients with only 1 location, cardiovascular mortality was significantly higher with peripheral artery disease (11.3%) than with cerebrovascular disease (6%) or coronary artery disease (5.1%). Significant baseline predictors of 4-year all-cause mortality were congestive heartfailure (hazard ratio [HR]: 3.81), body mass index<20 (HR: 2.32), hypertension (HR: 1.84), polyvascular disease (HR: 1.69), and age ≥65 years (HR: 1.47), whereas statin use (HR: 0.49) and body mass index ≥30 (HR: 0.58) were associated with a reduced risk. Conclusions: Hypertension was the main modifiable risk factor for atherothrombosis and all-cause mortality in this Latin American cohort. Nearly one-third of the population with 3 symptomatic vascular-disease locations died at 4-year follow-up

Add-on Pyridostigmine Enhances CD4+ T-Cell Recovery in HIV-1-Infected Immunological Non-Responders: A Proof-of-Concept Study

BackgroundIn human immunodeficiency virus (HIV)-infection, persistent T-cell activation leads to rapid turnover and increased cell death, leading to immune exhaustion and increased susceptibility to opportunistic infections. Stimulation of the vagus nerve increases acetylcholine (ACh) release and modulates inflammation in chronic inflammatory conditions, a neural mechanism known as the cholinergic anti-inflammatory pathway (CAP). Pyridostigmine (PDG), an ACh-esterase inhibitor, increases the half-life of endogenous ACh, therefore mimicking the CAP. We have previously observed that PDG reduces ex vivo activation and proliferation of T-cells obtained from people living with HIV.MethodsWe conducted a 16-week proof-of-concept open trial using PDG as add-on therapy in seven HIV-infected patients with discordant immune response receiving combined antiretroviral therapy, to determine whether PDG would promote an increase in total CD4+ T-cells. The trial was approved by the Institutional Research and Ethics Board and registered in ClinicalTrials.gov (NCT00518154).ResultsSeven patients were enrolled after signing informed consent forms. We observed that addition of PDG induced a significant increase in total CD4+ T-cells (baseline = 153.1 ± 43.1 vs. week-12 = 211.9 ± 61.1 cells/µL; p = 0.02). Post hoc analysis showed that in response to PDG, four patients (57%) significantly increased CD4+ T-cell counts (responders = 257.8 ± 26.6 vs. non-responders = 150.6 ± 18.0 cells/µL; p = 0.002), and the effect persisted for at least 1 year after discontinuation of PDG.ConclusionOur data indicate that in patients with HIV, add-on PDG results in a significant and persistent increase in circulating CD4+ T-cells