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

The potential peatland extent and carbon sink in Sweden, as related to the Peatland / Ice Age Hypothesis

Peatlands cover approximately 65,600 km2 (16 %) of the Swedish land area. The available areas suitable for peatland expansion are far from occupied after ca. 12,000 years of the present interglacial. We estimate the potential extent of peatland in Sweden, based on slope properties of possible areas excluding lakes and glaciofluvial deposits. We assume no human presence or anthropic effects, so the calculation is speculative. It may have been relevant for previous interglacials.We calculate the potential final area of peatlands in three scenarios where they cover all available land with different maximum slope angles (1−3 º) using a Digital Elevation Model (DEM). The three scenarios yield potential peatland areas of 95,663 km2 (21 % of total available area), 168,287 km2 (38 %) and 222,141 km2 (50 %). The relative increases from the present 65,600 km2 are 46, 157 and 239 % respectively.The slope scenarios give CO2 uptake rates of 8.9−10.8, 18.1−22.4 and 24.6−30.5 Mt yr−1. Under global warming conditions with isotherms moved northwards and to higher altitudes, following an increase of raised bog area, the CO2 uptake rates might increase to 12.2−13.8, 24.4−27.7 and 33.5−37.9 Mt yr−1; i.e. up to 4.3−4.9 vpb of atmospheric CO2. If we make the speculative extrapolation from Sweden to all high latitude peatlands, and assume that all suitable areas with slope angle ≤ 3 ° become occupied, the global peatland CO2 sink might approach 3.7 Gt yr−1 (about 2 vpm yr−1) and potentially cause a net radiative cooling approaching 5 W m−2

Effect of treatment on established osteoporosis in young women with amenorrhoea

Background and Objective - Amenorrhoea in women of reproductive age causes loss of bone mineral. This study assessed the effect of treatment of amenorrhoea on bone mineral density. Design - Serial measurements of bone mineral density were obtained in women receiving treatment for amenorrhoea. Patients - Eighty-five women aged 17-40 with a past or current history of amenorrhoea, from various causes, with median duration of 46.5 months (range 8 months-21 years). Measurements - Bone mineral density in the lumbar spine was measured by dual-energy X-ray absorptiometry. Results - Initial vertebral bone mineral density was low, mean 0.85 (SD 0.10) g/cm2. After an interval of 19.6 (SD 7.5) months on treatment there was a highly significant increase to 0.89 (SD 0.10) g/cm2 (P < 0.0005). This was equivalent to a gain in bone mass of 2.1% per year (95% confidence interval 1.5-2.8%). Improvement was seen in all diagnostic groups (except polycystic ovary syndrome) and with all types of therapy. We observed no difference in the response of previously untreated patients compared with those already on treatment, nor any change in response with increasing duration of treatment. No new fractures were reported during the study. Conclusions - Bone mineral density in young women with amenorrhoea is improved by appropriate treatment, but recovery is not substantial. Hence early diagnosis and therapy is essential to prevent bone loss

Prevalence and risk factors associated with bovine viral diarrhea virus infection in dairy herds in Jordan

A cross-sectional study was carried out to determine the seroprevalence and to identify risk factors associated with bovine viral diarrhea virus (BVDV) infection in 62 non-vaccinated dairy herds (671 cows) in Jordan between January and June 2007. Information regarding herd management was recorded through a personal interview with farmers. Antibodies against BVDV were detected using an indirect ELISA test. Chi-square analysis and multivariable logistic regression model were used to identify risk factors for BVDV seropositivity. The true prevalence of antibodies against BVDV in individual cows and cattle herds was 31.6% and 80.7%, respectively. The seroprevalence of BVDV in medium and large size herds was significantly higher than that in smaller herds. There was no significant difference in BVD seroprevalence between different age groups. Random-effects logistic regression model revealed two major factors associated with seropositivity to BVDV; exchange of visits between adjacent farm workers and not isolating newly purchased animals before addition to the herd. The seroprevalence of BVDV in cows located in the northern Jordanian governorates was significantly higher than that in other studied governorates. Results of this study indicated that BVDV is highly prevalent in Jordan and BVDV infection could be controlled by livestock-trade control, and applying strict biosecurity measures in the dairy farms.A. Q. Talafha, S. M. Hirche, M. M. Ababneh, A. M. Al-Majali and M. M. Ababne