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

Mejora de las habilidades de sutura después de entrenamiento. Presentación de un modelo de simulación y de evaluación.

Introduction. Acquiring surgical skills through simulation is a growing need nowadays. Every day more, patient safety is valued, and therefore it isunacceptable that surgeons without previous training attend patients. Our objective is to develop a low-cost simulation system, and a score, which allowsevaluating the acquisition of knowledge. Methods. 6 first-year ophthalmology residents were chosen to perform two recorded sessions, where they performed different suture techniques. Between them, the residents were allowed to complete a 4-session training. After completing the training, the initial and final sessions were evaluated by 3 blind expert surgeons. Mann–Whitney tests wereused to compare scores. And the agreement between the three evaluators was checked using the Fleiss´ kappa concordance test. Results. The concordance inthe evaluation between the three examiners was substantial, κ= 0,71 (IC 95%, 0,33 a 0,82), p &lt; .0005. Residents improved their median performance scores after completion of training (6,52 vs 7,81) however, no significant differences were found due to the small number of participants. Conclusion. We developed a low-cost, portable training system with acquisition of skills in a group of residents.We have also developed an evaluation scale that allows to objectively assessprogression.Introducción. Adquirir habilidades quirúrgicas a través de la simulación es una necesidad creciente en la actualidad. Cada día se valora más la seguridad delpaciente, y por ello es inaceptable que cirujanos sin la formación adecuada previa atiendan a los pacientes. Nuestro objetivo es desarrollar un sistema de simulación de bajo coste, y una escala de medida, que permita evaluar la adquisición de conocimientos. Métodos. Se eligieron 12 residentes de primer año de oftalmología para realizar dos sesiones grabadas, donde realizaron diferentes técnicas de sutura.Entre ellas, a los residentes se les permitió completar un entrenamiento de 4 sesiones. Después de completar el entrenamiento, las sesiones inicial y final fueron evaluadas por 3 cirujanos expertos. Se utilizó la prueba de Mann-Whitney para comparar puntuaciones. Y se comprobó la concordancia entre los tres evaluadores mediante la prueba de concordancia kappa de Fleiss. Resultados. La concordancia en la evaluación entre los tres examinadores fue sustancial, κ= 0,71 (IC 95%, 0,33 a0,82), p &lt; .0005. Los residentes mejoraron su desempeño promedio después de completar el entrenamiento (6,52 vs 7,81); sin embargo, no se encontraron diferencias significativas debido al pequeño número de participantes. Conclusión.Desarrollamos un sistema de entrenamiento portátil de bajo coste para la adquisición de habilidades quirúrgicas en un grupo de residentes. Asimismo,hemos desarrollado una escala de evaluación que permite evaluar objetivamente la progresión

Improvement of suturing skills after training. Presentation of a simulation and evaluation model.

Introducción. Adquirir habilidades quirúrgicas a través de la simulación es una necesidad creciente en la actualidad. Cada día se valora más la seguridad del paciente, y por ello es inaceptable que cirujanos sin la formación adecuada previa atiendan a los pacientes. Nuestro objetivo es desarrollar un sistema de simulación de bajo coste, y una escala de medida, que permita evaluar la adquisición de conocimientos. Métodos. Se eligieron 12 residentes de primeraño de oftalmología para realizar dos sesiones grabadas, donde realizaron diferentes técnicas de sutura. Entre ellas, a los residentes se les permitió completar un entrenamiento de 4 sesiones. Después de completar el entrenamiento, las sesiones inicial y final fueron evaluadas por 3cirujanos expertos. Se utilizó la prueba de Mann-Whitney para comparar puntuaciones. Y se comprobó la concordancia entre los tres evaluadores mediante la prueba de concordancia kappade Fleiss. Resultados. La concordancia en la evaluación entre los tres examinadores fue sustancial,κ= 0,71 (IC 95%, 0,33 a 0,82), p < .0005. Los residentes mejoraron su desempeño promedio despuésde completar el entrenamiento (6,52 vs 7,81); sin embargo, no se encontraron diferencias significativas debido al pequeño número de participantes. Conclusión. Desarrollamos un sistema de entrenamiento portátil de bajo coste para la adquisición de habilidades quirúrgicas en un grupo de residentes. Asimismo, hemos desarrollado una escala de evaluación que permite evaluar objetivamente la progresión.Introduction. Acquiring surgical skills through simulation is a growing need nowadays.Every day more, patient safety is valued, and therefore it is unacceptable that surgeons withoutprevious training attend patients. Our objective is to develop a low-cost simulation system, and ascore, which allows evaluating the acquisition of knowledge. Methods. 6 first-year ophthalmologyresidents were chosen to perform two recorded sessions, where they performed different suturetechniques. Between them, the residents were allowed to complete a 4-session training. Aftercompleting the training, the initial and final sessions were evaluated by 3 blind expert surgeons.Mann–Whitney tests were used to compare scores. And the agreement between the threeevaluators was checked using the Fleiss ́ kappa concordance test. Results. The concordance in theevaluation between the three examiners was substantial, κ= 0,71 (IC 95%, 0,33 a 0,82), p < .0005.Residents improved their median performance scores after completion of training (6,52 vs 7,81)however, no significant differences were found due to the small number of participants.Conclusion. We developed a low-cost, portable training system with acquisition of skills in agroup of residents. We have also developed an evaluation scale that allows to objectively assessprogression

Repeatability of choriocapillaris flow voids by optical coherence tomography angiography in central serous chorioretinopathy.

PurposeTo assess the repeatability of flow signal voids (FSV) measurements of the choriocapillaris (CC) and choroid (CH) in central serous chorioretinopathy (CSCR) by Swept-Source optical coherence tomography angiography (SS-OCTA).MethodsCross-sectional study including 104 eyes of 52 patients with unilateral CSCR. Two consecutive macular 6x6 mm SS-OCTA scans (Plex Elite 9000; Zeiss, Dublin, CA) were obtained from the affected eyes with persistent subretinal fluid (SRF) (CSCR group) and the fellow unaffected eyes (control group). FSV area and the number of contours measurements were analyzed using three slabs: inner CC, outer CC and CH. The repeatability of the measurements was assessed with intraclass correlation coefficients (ICC) and coefficients of variation (CV).ResultsIn the CSCR group, ICCs for the FSV area in the three slabs were all ≥0.859, observing higher values for the outer CC and the CH (0.959 and 0.964) than for the inner CC (0.859). Similar ICC values were obtained for the FSV area in control eyes, observing the highest values for the outer CC (0.949), followed by the CH (0.932) and inner CC (0.844). Regarding the FSV number of contours measurements, ICCs were higher for the outer CC and CH (0.949 and 0.932) than for inner CC (0.844). CV for the FSV area was 4.7%, 3.8% and 8.6% in the CSCR eyes and 4.8%, 3.9% and 9.3% in the control group for the inner CC, outer CC and CH respectively.ConclusionSS-OCTA offers good repeatability to quantify macular FSV in CSCR eyes and fellow eyes

Recovery course of persistent posterior subretinal fluid after successful repair of rhegmatogenous retinal detachment

Purpose To investigate best corrected visual acuity (BCVA), subretinal fluid (SRF) absorption time or ellipsoid zone (EZ) restoration time and various variables in patients with persistent SRF after successful primary repair of rhegmatogenous retinal detachment (RRD). Methods This retrospective multicenter study allowed independent analysis of the healing pattern by two observers based on composite of serial cross-sectional macular optical coherence tomography (OCT) scans. Univariate and multivariate analyses were implemented. Results One hundred and three cases had persistent SRF after pars plana vitrectomy, scleral buckling, or pneumatic retinopexy. By univariate analysis, SRF resolution time correlated positively with the number of retinal breaks ( p < 0.001) and with increased myopia ( p = 0.011). Using multivariate analysis, final BCVA (log MAR) correlated positively with age, duration of RRD, initial BCVA (OR = 3.28; [95%CI = 1.44–7.47]; p = 0.015), and SRF resolution time (OR = 0.46 [95%CI 0.21–1.05]; p = 0.049). EZ restoration time was longer with increasing number of retinal tears (OR = 0.67; [95%CI 0.29–1.52]; p = 0.030), worse final BCVA, and presence of macula-off RRD (OR = 0.26; [95%CI 0.08–0.88]; p = 0.056). SRF resolution time correlated marginally with prone position. Conclusions Residual posterior SRF is more common in eyes with multiple breaks or in myopic eyes. Final BCVA is better in younger subjects and in eyes with shorter duration of RRD. Persistent SRF is a self-limited disorder with a mean resolution of 11.2 months with good visual prognosis improving from a mean baseline logMAR of 1.08 to 0.25 at one year