Incidence, Patterns, and Associations Between Dual-Antiplatelet Therapy Cessation and Risk for Adverse Events Among Patients With and Without Diabetes Mellitus Receiving Drug-Eluting Stents: Results From the PARIS Registry.

OBJECTIVES: The aim of this study was to examine the frequency and clinical impact of different cessation patterns of dual-antiplatelet therapy (DAPT) after percutaneous coronary intervention with drug-eluting stents among patients with and those without diabetes mellitus (DM). BACKGROUND: Early DAPT suspension after percutaneous coronary intervention increases the risk for major adverse cardiac events. However, temporal variability in risk and relation to DAPT cessation patterns among patients with DM remain unclear. METHODS: Using data from the PARIS (Patterns of Non-Adherence to Anti-Platelet Regimens in Stented Patients) registry, 1,430 patients with DM (34%) and 2,777 without DM (66%) treated with drug-eluting stents were identified. DAPT cessation modes were classified as temporary interruption (<14 days), disruption because of bleeding or poor compliance, and physician-recommended discontinuation. RESULTS: During 2-year follow-up, DM was associated with an increased risk for thrombotic events but a similar risk for bleeding. The cumulative incidence of DAPT cessation was significantly lower in patients with versus those without DM (50.1% vs. 55.4%; p < 0.01), driven largely by less frequent physician-guided discontinuation beyond 1 year. In contrast, 2-year rates of interruption and disruption were similar between groups. When DAPT was interrupted or discontinued under physician guidance, the risk for major adverse cardiac events was unchanged compared with patients with DM on uninterrupted DAPT. Conversely, when DAPT was disrupted, the risk for major adverse cardiac events increased compared with uninterrupted DAPT, regardless of diabetic status, with no evidence of statistical interaction. CONCLUSIONS: DAPT cessation patterns vary according to diabetic status, with less frequent physician-guided discontinuation among patients with DM. The presence of DM does not emerge as a modifier of cardiovascular risk after DAPT cessation

Dual-Antiplatelet Therapy Cessation and Cardiovascular Risk in Relation to Age: Analysis From the PARIS Registry.

OBJECTIVES: The aim of this study was to examine the association between dual-antiplatelet therapy (DAPT) cessation and cardiovascular risk after percutaneous coronary intervention in relation to age. BACKGROUND: Examination of outcomes by age after percutaneous coronary intervention is relevant given the aging population. METHODS: Two-year clinical outcomes, incidence, and effect of DAPT cessation on outcomes were compared by ages ≤55, 56 to 74, and ≥75 years from the PARIS (Patterns of Non-Adherence to Antiplatelet Regimens in Stented Patients) registry. DAPT cessation included physician-recommended discontinuation, interruption for surgery, and disruption (from noncompliance or bleeding). Clinical endpoints were major adverse cardiac events (MACE) (a composite of cardiac death, definite or probable stent thrombosis, spontaneous myocardial infarction, or clinically indicated target lesion revascularization), a secondary restrictive definition of MACE (MACE2) excluding target lesion revascularization, and bleeding. RESULTS: A total of 1,192 patients (24%) were ≤55 years, 2,869 (57%) were 56 to 74 years, and 957 (19%) were ≥75 years of age. Patients ≥75 years of age had higher DAPT cessation rates and increased risk for MACE2, death, cardiac death, and bleeding compared with younger patients. Discontinuation and interruption were not associated with increased cardiovascular risk across age groups, whereas disruption was associated with increased risk for MACE and MACE2 in younger patients but not in patients ≥75 years of age (p for trend <0.05). CONCLUSIONS: Nonadherence and outcomes vary by age, with patients ≥75 years having the highest DAPT cessation rates. We observed no association between outcomes and DAPT cessation in patients ≥75 years, whereas discontinuation was associated with lower MACE rates and disruption with increased MACE rates in patients <75 years

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

Inequality and Economic Growth: A Dynamic Analysis

Este estudio explora la relación entre desigualdad y crecimiento económico, utilizando mediciones anuales del Índice de Gini y tasa de crecimiento del producto per cápita para 38 países entre los años 1980 y 2010. Utilizando una metodología de análisis de clústeres, basada en el estudio de la dinámica de regímenes y la introducción de secuencias simbólicas se segmenta la muestra en grupos de países con similar desempeño con respecto a las variables bajo análisis. Durante el periodo considerado se obtienen dos grupos de países: un grupo de alta desigualdad y medio-alto crecimiento económico, y un segundo grupo de baja desigualdad y crecimiento. Adicionalmente, considerando la relación entre crecimiento económico y desigualdad de ingreso en un contexto de datos de panel se especifica un modelo para cada grupo, mostrando que la relación entre las variables depende de las dinámicas de los países. En particular el trabajo muestra que en los países con mayores ingresos per cápita se observa una relación positiva entre desigualdad y crecimiento económico, mientras que para las economías emergentes la relación depende del modelo consideradoThis study explores the relationship between inequality and economic growth, using annual measurements of the Gini Index and per capita GDP growth rate for 38 countries during the period 1980 - 2010. The study introduces a cluster analysis based the concept of dynamical regimes and the introduction of symbolic sequences to segment the sample into homogeneous groups of countries with similar performance with respect to the variables under analysis. During the considered period, two groups of countries are obtained: a group of high inequality and medium-high economic growth, and a second group of low inequality and low growth. Additionally, considering the relationship between economic growth and income inequality in a panel data context, a model is specified for each group, showing that the relationship between the variables depends on the dynamics of the countries. In particular, the study shows that in countries with higher per capita income there is a positive relationship between inequality and economic growth, while for emerging economies the relationship depends on the considered mode

Lepidobatrachus asper Budgett,1899 (Amphibia: Anura: Ceratophryidae): new country record, distribution map and natural history notes

Lepidobatrachus asper is a large to medium frog known from the Chaco lowlands of Paraguay and Argentina. We provide the first species record for the Brazilian Chaco, which extends the species geographical distribution ca. 73 km northeast from Puerto Casado, Alto Paraguay Departament, Paraguay. We also provide a distribution map and information about the species habitat conditions and diet. The Brazilian Chaco is still poorly surveyed, and the rapid environmental degradation can lead to local extinctions of certain species

Isolation and characterization of microsatellites markers for two South American frogs (Leptodactylus bufonius and L. chaquensis) using next generation sequencing

Leptodactylus bufonius (Vizcacheras' white-lipped frog) and L. chaquensis (Cei's white-lipped frog) are pond-breeding frogs that inhabit the Chaco and surrounding savanna-like formations in South America. Throughout the Chacoan plain, the combined impacts of livestock and forestry practices have led to a highly fragmented landscape and an impoverished ecological system, threatening local species. We cloned and characterized new microsatellite markers for both species. These markers will be useful for behavioral and conservation genetic studies of populations throughout this threatened habitat.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Lepidobatrachus asper Budgett,1899 (Amphibia: Anura: Ceratophryidae): New country record, distribution map and natural history notes

Lepidobatrachus asper is a large to medium frog known from the Chaco lowlands of Paraguay and Argentina. We provide the first species record for the Brazilian Chaco, which extends the species geographical distribution ca. 73 km northeast from Puerto Casado, Alto Paraguay Departament, Paraguay. We also provide a distribution map and information about the species habitat conditions and diet. The Brazilian Chaco is still poorly surveyed, and the rapid environmental degradation can lead to local extinctions of certain species. © 2013 Check List and Authors