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

Short Communication: The effect of dry period duration and dietary energy density on the rennet gelation properties of milk in early lactation

Peer-reviewedThis is the author’s version of a work that was accepted for publication in Journal of Dairy Science. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Dairy Science, 93(2), February 2010, DOI:10.3168/jds.2009-2651This study was carried out to examine the effects of decreasing dry period duration (DP) and altering the energy density of the diet during early lactation on the rheological characteristics of milk. Forty mature Holstein-Friesian cows were used in a completely randomized design with a 2 × 2 factorial arrangement of treatments. Cows were randomly assigned to one of two dry period treatments and one of two nutritional treatments. The dry period treatments were continuous milking (CM) or an 8-week standard dry period (SDP), and the nutritional treatments were a standard energy diet (SE) or a high energy diet (HE). Actual dry period lengths were 6.3 ± 1.7 days and 62.1 ± 1.9 days for cows for the CM and SDP treatments, respectively. Milk samples were collected at 2, 6 and 10 weeks postpartum. The concentration of fat, protein and lactose was determined in each sample. The rennet gelation properties were measured at 31 ° C using dynamic low-amplitude strain oscillatory rheometry. The following parameters were obtained from the resultant elastic shear modulus (G′): gelation time (GT), maximum curd firming rate (CFRmax) and gel strength (GS). Reducing dry period duration from 62 to 6 days resulted in increases in milk protein concentration (31.8 vs. 34.7 g/kg; P < 0.001), CFRmax (2.58 vs. 3.60 Pa/min; P < 0.001) and GS (69.4 vs. 90.5 Pa; P = 0.003). Raising the dietary energy density decreased percentage milk fat (43.1 vs. 37.7 g/kg; P < 0.001) but otherwise had no effect. GS was correlated with CFRmax (r = 0.98; P < 0.001), and both variables were correlated with milk protein concentration (r = 0.71; P < 0.001, and r = 0.73; P < 0.001, respectively). The results indicate that decreasing the duration of DP increased milk protein concentration and improved the rennet gelation properties of milk, but that dietary energy density had little effect

The effect of dry period duration and dietary energy density on milk production, bioenergetic status and postpartum ovarian function in Holstein-Friesian dairy cows

Peer-reviewed.This is the author’s version of a work that was accepted for publication in Journal of Dairy Science. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Dairy Science, 92(12), Dec 2009. DOI: 10.3168/jds.2009-2374Following parturition, it is typical for dairy cows to enter a period of negative energy balance (NEB) and body condition loss to support mammary milk synthesis, and this is associated with compromised reproductive performance. Alternative management strategies during the prepartum (dry) and early post partum periods may ameliorate this. Forty mature Holstein-Friesian cows were assigned to one of two dry period treatments (standard 8 week dry period (SDP) or no planned dry period (NDP)) and one of two dietary energy density treatments (standard TMR (STMR) or high quality TMR (HTMR)). Milk yield during weeks 1 to 12 postpartum was reduced (P = 0.01) in cows assigned to the NDP treatment. Energy balance (P < 0.001) and body condition score (P = 0.07) during weeks 1 to 4 postpartum were increased in cows assigned to the NDP treatment compared to the cows assigned to the SDP, and BCS increased (P<0.001) from weeks 5 to 12 postpartum in the NDP cows compared to the SDP cows. During the first 12 weeks postpartum, cows assigned to the HTMR had greater (P = 0.02) milk yields and reduced (P < 0.001) milk fat concentration compared to the cows assigned the STMR diet. BCS was greater (P = 0.01) from weeks 5 to 12 postpartum in HTMR cows compared to STMR cows. During the period from weeks -3 to +3 relative to parturition, circulating concentrations of insulin (P = 0.001), glucose (P < 0.001) and IGF-I (P = 0.004) were greater in cows on the NDP treatment compared to cows on the SDP treatment. Cows assigned to the HTMR had greater circulating insulin (P = 0.04) and glucose (P = 0.001) concentrations compared to the STMR cows from weeks -3 to +3 relative to parturition. The first postpartum ovulation occurred earlier for cows on the NDP treatment compared to cows on the SDP treatment (16.9 vs. 24.8 days postpartum; P = 0.02). Cows assigned to the STMR tended to have a higher conception rate to first service (P = 0.07) compared to cows assigned to the HTMR. Energy balance and metabolic status can be improved by either eliminating the dry period or by feeding a higher energy diet, but effects on the reproductive axis appear to be different

The effect of strain of Holstein-Friesian cow on size of ovarian structures, periovulatory circulating steroid concentrations, and embryo quality following superovulation

Peer-reviewedThis is the author’s version of a work that was accepted for publication in Theriogenology. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Theriogenology, 70(7), Oct. 2008, DOI: 10.1016/j.theriogenology.2008.06.030When managed under grass-based systems of production, the NZ strain of Holstein-Friesian cow has superior reproductive performance compared to the NA strain despite having similar SCM yields. This study compared the ontogeny of early pregnancy events in NZ and NA cows. Ten NZ and 10 NA cows were submitted to a superovulation protocol on three occasions. Blood samples were collected daily from every cow from day -3 to +7 relative to a synchronised oestrus during each superovulation protocol. Pre-ovulatory oestradiol concentrations, follicle diameter, post-ovulatory progesterone concentrations, CL diameter, and circulating insulin-like growth factor-I concentrations did not differ between the two strains. Uteri were non-surgically flushed 7 d post AI, embryos were isolated and graded. The proportion of transferable embryos recovered was higher (P<0.01) in the NZ cows compared with the NA cows. A greater (P=0.01) proportion of the recovered structures were at the blastocyst stage in the NZ cows. Peak SCM yield and BCS at the time of peak SCM yield were not different between strains. However during the experimental period the NA cows maintained significantly higher daily SCM yields, whereas the NZ cows replenished significantly greater levels of BCS. The results indicate that differences in periovulatory steroid concentrations and size of ovarian structures do not explain the differences in embryo quality between the two strains. However, strain differences in nutrient partitioning from the time of peak SCM yield through late lactation may provide the key signals responsible for superior embryo quality in NZ cows