Prevalence of comorbidities in patients with obstructive sleep apnea syndrome, overlap syndrome and obesity hypoventilation syndrome

Sleep-disordered breathing causes a burden to the sufferer, the health care system and the society. Most studies have focused on obstructive sleep apnea (OSA); however, the prevalence of comorbidities in patients affected by overlap syndrome (OS) and obesity hypoventilation syndrome (OHS) has not been carefully evaluated

Climate and landscape composition explain agronomic practices, pesticide use and grape yield in vineyards across Italy

Context Worldwide, organic farming is being promoted as one of the main alternatives to intensive conventional farming. However, the benefits of organic agriculture are still controversial and need to be tested across wide environmental gradients. Objective Here, we carried out an observational study to test how agronomic practices, pest management, environmental impact and yield of conventional and organic vineyards changed along wide climatic and landscape gradients across Italy. Methods We used a block design with 38 pairs of conventional and organic vineyards across Italy. Results and conclusions Most agronomic practices did not differ between conventional and organic vineyards. By contrast, landscape composition and climate were strong predictors of management in both systems. First, increasing semi-natural areas around the vineyards reduced pesticide pressure and related environmental impacts, but was also associated with lower yield. Second, irrespective of the farming system, a warm and dry climate was associated with reduced fungicide pressure. Conventional farming had a yield gain of 40% in cold and wet climate compared to organic but the yield gap disappeared in the warmest regions. Significance In both farming systems, we observed a large variability in management practices that was mainly explained by climate and landscape composition. This large variability should be considered when evaluating the benefits and drawbacks of different farming systems under contrasting environmental contexts

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

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure < 100 mmHg (n = 1127), estimated glomerular filtration rate < 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

Características de los pacientes mayores de 75 años en el Registro ARGEN-IAM-ST

Background: Older adults represent a growing population in clinical practice.Objectives: The aim of this study was to learn the clinical characteristics and outcome of older adults hospitalized with myocardialinfarction in Argentina.Methods: Patients included in the ARGEN-IAM-ST registry were analyzed depending on whether they were older or youngerthan 75 years of age.Results: Among the 1,714 patients included in the registry, 233 (13.6%) were aged 75 years or older. These patients hadgreater prevalence of female sex and hypertension and lower incidence of smoking habits, while the prevalence of diabetes,dyslipidemia, anterior myocardial infarction and time from onset of symptoms was similar. They were less likely to receivereperfusion therapy and progression to heart failure (31% vs. 14%; p <0.01), reinfarction (3.9 vs. 1.4%; p=0.009), minorbleeding (7.7% vs. 3.2%; p <0.002) and mortality (21.5% vs. 6.7%, p <0.001) were more common.Conclusions: Older adults with myocardial infarction have a more unfavorable outcome and mortality is three times greaterthan that of patients <75 years.Introducción: Los adultos mayores representan una población cada vez más numerosa en la práctica clínica.Objetivos: Conocer las características clínicas y evolución de los adultos mayores que se internan por infarto en Argentina.Material y métodos: Se analizaron los pacientes de acuerdo con la edad mayor o menor de 75 años incluidos en el registroARGEN-IAM-ST.Resultados: De 1714 pacientes ingresados, 233 (13,6%) tenían una edad ≥ 75 años. Se observó en estos una mayor prevalenciade sexo femenino, de hipertensión arterial, menor de tabaquismo y similar de diabetes, dislipidemia, infarto agudo de miocardiode localización anterior y tiempo de evolución al ingreso. Recibieron menos tratamiento de reperfusión y evolucionaronmás frecuentemente con insuficiencia cardíaca (el 31% vs. a 14%; p < 0,01), reinfarto (3,9 vs. 1,4%; p = 0,009), sangrado nomayor (7,7% vs. 3,2%, p < 0,002) y muerte (21,5% vs. 6,7%, p < 0,001).Conclusiones: Los adultos mayores con infarto tienen una evolución más tórpida y una mortalidad que triplica la de los pacientesmenores de 75 años

Pluralidade cultural: análise e reflexão

Be talked about cultural diversity in the historical and legal context, on Art. 26 of the Law of Guidelines and Bases of National Education (LDB), which must be accomplished in its entirety in the elementary and secondary education. In this context, both the Federal Constitution of 1988, and also in the LDB, the issue of cultural diversity is addressed in a generic and comprehensive manner. Dance promotes know ledge of various cultures, has a strong Power of integration that facilitates the Discovery of diversity. Natural environmental resources permit to produce practical classes where the physical qualities of the students are developed and the awakening of environmental awareness. Thus, it is shown the Eco Sports integrating man and nature. Presents the Physical Education for Special as an affordable reality for any professional of the area. The methodology is based on a qualitative and quantitative descriptive model, ex­post­facto type. Was used as a focus group, students of the 1st semester of the Physical Education of the University Castelo Branco (UCB). Compiled the results of research and discussion was compared with another article, to conclude that there is need to develop the professional future of physical education, empowering you to create a legacy of opportunities.Discorreu­se sobre a pluralidade cultural no contexto histórico e legal, sobre o Art. 26, da Lei de Diretrizes e Bases do Ensino Nacional (LDB), que precisa ser cumprido na sua íntegra, no ensino fundamental e médio. Nesse contexto, tanto a Constituição Federal de 1988, e também na LDB, a questão da diversidade cultural é tratada de maneira genérica e abrangente. A dança promove o conhecimento de várias culturas, tem um forte poder de integração que facilita a descoberta da diversidade. Recursos naturais ambientais permitem produzir aulas práticas onde sejam desenvolvidas as qualidades físicas dos educandos e o despertar de uma consciência ecológica. Dessa forma, mostram­se os Eco Esportes integrando o homem com a natureza. Apresenta­se a Educação Física para Especiais como uma realidade acessível a qualquer profissional da área. A Metodologia se baseia em um modelo descritivo qualitativo e quantitativo, tipo ex­post­facto. Utilizou­se como grupo focal, os alunos do 1º período do curso de Educação Física da Universidade Castelo Branco (UCB). Compilou­se os resultados da pesquisa e na discussão comparou­se com outro artigo, para concluir que há necessidade de se desenvolver o futuro profissional de educação física, capacitando­o a criar um legado de oportunidades

Cardiac myosin activation with omecamtiv mecarbil in systolic heart failure

BACKGROUND The selective cardiac myosin activator omecamtiv mecarbil has been shown to improve cardiac function in patients with heart failure with a reduced ejection fraction. Its effect on cardiovascular outcomes is unknown. METHODS We randomly assigned 8256 patients (inpatients and outpatients) with symptomatic chronic heart failure and an ejection fraction of 35% or less to receive omecamtiv mecarbil (using pharmacokinetic-guided doses of 25 mg, 37.5 mg, or 50 mg twice daily) or placebo, in addition to standard heart-failure therapy. The primary outcome was a composite of a first heart-failure event (hospitalization or urgent visit for heart failure) or death from cardiovascular causes. RESULTS During a median of 21.8 months, a primary-outcome event occurred in 1523 of 4120 patients (37.0%) in the omecamtiv mecarbil group and in 1607 of 4112 patients (39.1%) in the placebo group (hazard ratio, 0.92; 95% confidence interval [CI], 0.86 to 0.99; P = 0.03). A total of 808 patients (19.6%) and 798 patients (19.4%), respectively, died from cardiovascular causes (hazard ratio, 1.01; 95% CI, 0.92 to 1.11). There was no significant difference between groups in the change from baseline on the Kansas City Cardiomyopathy Questionnaire total symptom score. At week 24, the change from baseline for the median N-terminal pro-B-type natriuretic peptide level was 10% lower in the omecamtiv mecarbil group than in the placebo group; the median cardiac troponin I level was 4 ng per liter higher. The frequency of cardiac ischemic and ventricular arrhythmia events was similar in the two groups. CONCLUSIONS Among patients with heart failure and a reduced ejection, those who received omecamtiv mecarbil had a lower incidence of a composite of a heart-failure event or death from cardiovascular causes than those who received placebo. (Funded by Amgen and others; GALACTIC-HF ClinicalTrials.gov number, NCT02929329; EudraCT number, 2016 -002299-28.)

Correction to: Comparative effectiveness and safety of non-vitamin K antagonists for atrial fibrillation in clinical practice: GLORIA-AF Registry

International audienceIn this article, the name of the GLORIA-AF investigator Anastasios Kollias was given incorrectly as Athanasios Kollias in the Acknowledgements. The original article has been corrected