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

Quinine treatment in severe Plasmodium falciparum malaria in children: a holter monitoring

Aim. Malaria has elevated incidence and mortality rate especially in African children. Standard treatment in severe Plasmodium falciparum malaria is parenteral quinine in most rural hospitals of developing countries, but little is known about the toxicity of quinine in children. Quinine has potential heart toxicity due to prolongation of the QT that could lead to the onset of dangerous ventricular arrhythmias. The aim of our work is the evaluation of cardiac toxicity of i.v. quinine in children affected by severe Plasmodium falciparum malaria. Methods. Ten children admitted to Mugana hospital (North Tanzania) affected by severe malaria, were treated with a loading dose of 20 mg/kg salt of quinine followed by 10 mg/kg every 8 hours. Holter monitoring was performed for the first 24 hours of treatment with special attention to ventricular and supraventricular arrhythmias, QT prolongation and RR variability. Results. No patient died, and treatment was well tolerated. Heart rate means ranged between 100 and 156 bpm in the population studied, with single values from 56 to 186 bpm. Minimal not significant supraventricular and ventricular arrhythmias were recorded, with no more than 6 isolated supraventricular extrasystoles and 6 supraventricular pairs of extrasystoles, and no more than 15 isolated ventricular extrasystoles. No major, life threatening ventricular arrhythmias were observed. RR analysis did not show significant fluctuations. Conclusion. These data suggest that in the pediatric African population affected by severe Plasmodium falciparum malaria quinine infusion seems to be well tolerated

Nuclear physics midterm plan at Legnaro National Laboratories (LNL)

The next years will see the completion of the radioactive ion beam facility SPES (Selective Production of Exotic Species) and the upgrade of the accelerators complex at Istituto Nazionale di Fisica Nucleare – Legnaro National Laboratories (LNL) opening up new possibilities in the fields of nuclear structure, nuclear dynamics, nuclear astrophysics, and applications. The nuclear physics community has organised a workshop to discuss the new physics opportunities that will be possible in the near future by employing state-of-the-art detection systems. A detailed discussion of the outcome from the workshop is presented in this report