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

Fever of unknown origin - Hidden in the head

The original algorithmic approach, as outlined by de Kleijn and colleagues and practiced commonly, envisages performing computed tomography (CT) of chest, abdomen, and pelvis in patients with classical fever of unknown origin (FUO), in whom no potentially diagnostic clue exists. It further envisages performing positron emission tomography (PET) scan, if CT scan is unrevealing. Imaging of head and neck especially magnetic resonance imaging (MRI) has not been included in this algorithm, that leaves these important regions unexplored in most settings where PET scan is unavailable. MRI is a safe modality for evaluating central nervous system lesions and its role in FUO has not been adequately evaluated. We present three patients of FUO in whom the diagnosis of tuberculoma of brain as a cause of prolonged pyrexia got delayed because the MRI of head was not done initially, to comply with the approach of minimum diagnostic evaluation

Are We Ready to Reclassify Crohn’s Disease Using Molecular Classification?

Crohn’s disease (CD) is a type of inflammatory bowel disease. The number of IBD cases worldwide was estimated to be 4.9 million in 2019. CD exhibits heterogeneity in clinical presentation, anatomical involvement, disease behaviour, clinical course and response to treatment. The classical description of CD involves transmural inflammation with skip lesions anywhere along the entire gastrointestinal tract. The complexity and heterogeneity of Crohn’s disease is not currently reflected in the conventional classification system. Though the knowledge of Crohn’s pathophysiology remains far from understood, the established complex interplay of the omics—genomics, transcriptomics, proteomics, epigenomics, metagenomics, metabolomics, lipidomics and immunophenomics—provides numerous targets for potential molecular markers of disease. Advancing technology has enabled identification of small molecules within these omics, which can be extrapolated to differentiate types of Crohn’s disease. The multi-omic future of Crohn’s disease is promising, with potential for advancements in understanding of its pathogenesis and implementation of personalised medicine

Visceral basidiobolomycosis: An overlooked infection in immunocompetent children

Visceral basidiobolomycosis is an unusual fungal infection of viscera caused by saprophyte Basidiobolus ranarum. It is very rare in healthy children and poses a diagnostic challenge due to the non-specific clinical presentation and the absence of predisposing factors. We report a case of gastrointestinal basidiobolomycosis in a 4-year-old healthy girl who presented with a short history of abdominal pain, bleeding per rectum, fever, and weight loss. The diagnosis was based on high eosinophilic count, classical histopathology findings of fungal hyphae (the Splendore-Hoeppli phenomenon), and positive fungal culture from a tissue biopsy. Fungal infection was successfully eradicated with a combined approach of surgical resection of the infected tissue and a well-monitored course of antifungal therapy. The atypical clinical presentation, diagnostic techniques, and the role of surgery in the management of a rare and lethal fungal disease in an immunocompetent child are discussed

Enoki Mushroom (Flammulina velutipes (Curtis) Singer) Breeding

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“Excess gooD can be Dangerous”. A case series of iatrogenic symptomatic hypercalcemia due to hypervitaminosis D

Vitamin D is increasingly recognized to have several beneficial effects. Its toxicity, causing hypercalcemia, is considered as extremely rare. We report case series of 15 patients (most of them being elderly subjects) with iatrogenic symptomatic hypercalcemia in whom toxicity occurred due to empirical excessive administration of vitamin D by oral and parenteral rout

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Not AvailableA total of 35 strains of shiitake mushroom, Lentinula edodes, obtained from culture bank of ICAR-Directorate of Mushroom Research, Solan, were identified using ITS 5.8S rDNA sequences. Out of them, 30 were found to be true L. edodes. The accessions varied in their morphological characteristics and growth responses (radial growth and downward linear growth) at different temperature and substrates. The differences in growth responses were also used to assess genetic and physiological relatedness of the strains. The L. edodes strains showed high heterogeneity. The diversity studies amongst 30 strains were undertaken using ITS 5.8S rDNA sequences and short sequence repeat and inter-retroelement amplified polymorphism markers. A large genetic diversity amongst the test L. edodes strains was revealed by analysis of physiological requirements and genetics, which can be tapped for identifying the strains for different climates and substrates. Also, this huge genetic diversity can be used to breed better quality, stress tolerant and high yielding strains.Not Availabl

Bangladesh Journal of Botany

Not AvailableThe present experiment was conducted in order to prepare a suitable substrate composition using wheat straw and also to ascertain the effect of various levels of nitrogen supplementation on the yield and biological efficiency of Pleurotus mushroom. The strain DMRP-205 of Pleurotus djamor was used in the study. Among different treatment combinations, maximum biological efficiency of 75.11% was recorded in T2 with 0.5% of urea supplementation. It was also observed that, though the higher nitrogen supplementation does not increase the yield proportionately, it has significant effect on the spawn run period, cropping duration and colour intensity of the basidiocarp. The study necessitates the nitrogen supplementation at optimum levels (0.5%) to realize the maximum yield in P. djamor cultivation