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

Przydatnosc metod analizy genomu w diagnostyce giardiozy i kryptosporydiozy

The article comprises a critical review on practical applications of molecular technology in parasitological diagnostics in a broad sense, also as a diagnosis of species and a method of epidemiological analysis. Techniques of genome analysis at different levels, as specific nucleic acid probes, DNA restriction profiles (RFLP), hybridization techniques, pulse-field gel electrophoresis, in vitro nucleic acid amplification, and DNA fingerprint technique used in studies on Giardia and Cryptosporidium were discussed. The essential reservation as far as this technology is concerned refers to its usefulness in parasitological diagnostics; there is no sense in working out methods for recognizing parasites which could otherwise be identified by well trained parasitologists and simple microscopic methods. The improved diagnosis of parasites resulting from the application of molecular technology significantly contributed to the armentarium of parasitologists. Application of recent molecular technology in diagnosis of giardiosis and cryptosporidiosis may basically support clinical diagnosis which provides possibilities of early and selective treatment and makes possible epidemiological studies. These assays will permit not only a rapid diagnosis and exact differentiation but will also enable a better recognition of Giardia and Cryptosporidium genome organization. However, in spite of the wide availability of this new techniques they have not been fully applied - as yet – in diagnosis and in epidemiological studies on these parasites. The authors share the opinion of BUSCH (1991) on the need of proper recognition of high-quality and rigorous work in employing new molecular assays, because their wide availability and high sensitivity could cause "false-positive" results by contamination with amplified DNA sequences. They totally support the conclusion made by THOMPSON and MELONI (1993) that the molecular data must be fairly interpreted by collaborating molecular biologists, parasitologists, and epidemiologists - and clinicians as well - to avoid forming of a confusing picture of genetic diversity of the parasites with no practical application

APPLICATION OF MOLECULAR BIOLOGY IN DIAGNOSIS OF GIARDIOSIS AND CRYPTOSPORIDIOSIS

The article comprises a critical review on practical applications of molecular technology in parasitological diagnostics in a broad sense, also as a diagnosis of species and a method of epidemiological analysis. Techniques of genome analysis at different levels, as specific nucleic acid probes, DNA restriction profiles (RFLP), hybridization techniques, pulse-field gel electrophoresis, in vitro nucleic acid amplification, and DNA fingerprint technique used in studies on Giardia and Cryptosporidium were discussed. The essential reservation as far as this technology is concerned refers to its usefulness in parasitological diagnostics; there is no sense in working out methods for recognizing parasites which could otherwise be identified by well trained parasitologists and simple microscopic methods. The improved diagnosis of parasites resulting from the application of molecular technology significantly contributed to the armentarium of parasitologists. Application of recent molecular technology in diagnosis of giardiosis and cryptosporidiosis may basically support clinical diagnosis which provides possibilities of early and selective treatment and makes possible epidemiological studies. These assays will permit not only a rapid diagnosis and exact differentiation but will also enable a better recognition of Giardia and Cryptosporidium genome organization. However, in spite of the wide availability of this new techniques they have not been fully applied - as yet – in diagnosis and in epidemiological studies on these parasites. The authors share the opinion of BUSCH (1991) on the need of proper recognition of high-quality and rigorous work in employing new molecular assays, because their wide availability and high sensitivity could cause "false-positive" results by contamination with amplified DNA sequences. They totally support the conclusion made by THOMPSON and MELONI (1993) that the molecular data must be fairly interpreted by collaborating molecular biologists, parasitologists, and epidemiologists - and clinicians as well - to avoid forming of a confusing picture of genetic diversity of the parasites with no practical application