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

Determinants of management outcome in open tibia fractures in ile-ife

Background:Fracture of a normal tibia shaft constitutes a major trauma mostly sustained by young adults during high-energy injuries. Its superficial location and the subcutaneous characteristics of its anteromedial aspect easily causes open fracture. The objectives of this study were to determine the pattern of presentation, and determinants of management outcome in open fractures of the tibia. Methods: This is a prospective hospital based study. A total of 89 patients aged 4 to 80 years with open fractures of the tibia with or without fibula involvement were studied. All the patients received anti tetanus prophylaxis and intravenous antibiotics as well as wound irrigation, debridement and skeletal stabilisation. Results: Students and traders accounted for the majority of the cases (57.3%). Most of the open tibia fractures 69 (77.5%) had above knee Plaster of Paris cast. The majority of the cases were Gustilo and Anderson type II 32 (36.0%) cases and type I 22(24.7%) cases. There was Correlation between the presence of wound infection and (i) Gustilo and Anderson grading (F -.352, P .001); (ii) Injury to Debridement time in hours (F -.304, P .004); (iii) Osteomyelitis (F .397, P .001); (iv) Delayed union (F .253, P .017); and (v) Union time in weeks (F -.350, P .001). There was also correlation between the following: (i) Injury to Debridement time in hours and the distance from the accident scene to the hospital (F .464, P .001); (ii) The fracture pattern and the union time in weeks (F .353, P .001); and (iii) The presence of osteomyelities and delayed union (F .382, P .001). The commonest complications observed were wound infection 35(39.3%) patients and delayed union 30(33.7%) patients. Conclusion: This study shows that the higher the Gustilo and Anderson grading of the open fractures of the tibia, the more severe the wound and bone infection that occurred. The interval between injury time and wound débridement time affected the treatment outcome

Predictive factors for primary amputation in trauma patients in a Nigerian University Teaching Hospital

Background: The decision to attempt salvage or to amputate a severely injured limb is among the most difficult decision that the orthopaedist must face.Objective: To determine possible predictive factors that could become guides in taking decision for primary amputation as a first line treatment for trauma patients.Design: A prospective study of post-traumatic primary limb amputations.Setting: The Obafemi Awolowo University Teaching Hospital Ile-Ife, Nigeria from January, 2000 to December, 2004.Subjects: Sixty six trauma patients admitted through the Accident and Emergency Unit from January 2000 to December 2004.Results: Sixty six traumatised patient limbs were primarily amputated during the study period.The male: female ratio was 3.7:1 and means age was 28.6 years ±16.6(range: 4-7lyears). 80.3% of the patients were below forty years. All the patients had a single limb amputation. The mean MESS score was 9.4 ± 1.3 (range: 7.0-12.0). The main predictive factors in trauma at the emergency unit for primary amputation include age, sex , occupation, limb ischaemia, gangrene, severe open fracture, source or nature of injury, presence of shock, delay in hospital presentation, and MESS.Conclusion: Immediate amputation is often viewed by the patient and family as a result of the injury. Conversely, a delayed amputation may be viewed as a failure of treatment. Identified predictive factors for primary amputation will reduce trauma associated morbidity and mortality