Differences in the characteristics and management of patients with atrial fibrillation followed-up by cardiologists and other specialists

Carta científic

Anticoagulantes orales directos frente a antagonistas de la vitamina K en pacientes del «mundo real» con fibrilación auricular no valvular: estudio FANTASIIA

Observational study[Abstract] Introduction and objectives: To compare the long-term results of direct oral anticoagulants (DOAC) vs vitamin K antagonists (VKA) in real-world-patients with nonvalvular atrial fibrillation (NVAF) in a nationwide, prospective study. Methods: The FANTASIIA registry prospectively included outpatients with AF anticoagulated with DOAC or VKA (per protocol, proportion of VKA and DOAC 4:1), consecutively recruited from June 2013 to October 2014 in Spain. The incidence of major events was analyzed and compared according to the anticoagulant treatment received. Results: A total of 2178 patients were included in the study (mean age 73.8±9.4 years), and 43.8% were women. Of these, 533 (24.5%) received DOAC and 1645 (75.5%) VKA. After a median follow up of 32.4 months, patients receiving DOAC vs those receiving VKA had lower rates of stroke-0.40 (95%CI, 0.17-0.97) vs 1.07 (95%CI,0.79-1.46) patients/y, P=.032-, severe bleedings-2.13 (95%CI, 1.45-3.13) vs 3.28 (95%CI, 2.75-3.93) patients/y; P = .044-, cardiovascular death-1.20 (95%CI, 0.72-1.99) vs 2.45 (95%CI, 2.00-3.00) patients/y; P = .009-, and all-cause death-3.77 (95%CI, 2.83-5.01) vs 5.54 (95%CI, 4.83-6.34) patients/y; P = .016-. In a modified Cox regression model by the Andersen-Gill method for multiple events, hazard ratios for patients receiving DOAC were: 0.42 (0.16-1.07) for stroke; 0.47 (0.20-1.16) for total embolisms; 0.76 (0.50-1.15) for severe bleedings; 0.67 (0.39-1.18) for cardiovascular death; 0.86 (0.62-1.19) for all-cause death, and 0.82 (0.64-1.05) for the combined event consisting of stroke, embolism, severe bleeding, and all-cause death. Conclusions: Compared with VKA, DOAC is associated with a trend to a lower incidence of all major events, including death, in patients with NVAF in Spain.[Resumen] Introducción y objetivos. Comparar los resultados a largo plazo de los anticoagulantes orales directos (ACOD) frente a los antagonistas de la vitamina K (AVK) en pacientes del mundo real con fibrilación auricular no valvular (FANV) en un estudio nacional prospectivo. Métodos. El estudio FANTASIIA incluyó consecutivamente a pacientes ambulatorios con FANV anticoagulados con ACOD o AVK desde junio de 2013 hasta octubre de 2014. Se compararon las tasas de eventos según el anticoagulante administrado. Resultados. Se incluyó a 2.178 pacientes (edad, 73,8 ± 9,4 años; el 43,8% mujeres); de ellos, 533 (24,5%) recibían ACOD y 1.645 (75,5%), AVK. Tras una mediana de seguimiento de 32,4 meses, los pacientes con ACOD tuvieron tasas más bajas de ictus —0,40 (IC95%, 0,17-0,97) frente a 1,07 (IC95%, 0,79-1,46) pacientes/año; p = 0,032—, hemorragias mayores —2,13 (IC95%, 1,45-3,13) frente a 3,28 (IC95%, 2,75-3,93) pacientes/año; p = 0,044—, muerte cardiovascular —1,20 (IC95%, 0,72-1,99) frente a 2,45 (IC95%, 2,00-3,00) pacientes/año; p = 0,009— y muerte total —3,77 (IC95%, 2,83-5,01) frente a 5,54 (IC95%, 4,83-6,34) pacientes/año; p = 0,016—. En el análisis de Cox modificado según el método de Andersen-Gill para datos con múltiples eventos, las razones de riesgos instantáneos para los pacientes con ACOD fueron 0,42 (0,16-1,07) para el ictus; 0,47 (0,20-1,16) para la embolia sistémica en general; 0,76 (0,50-1,15) para las hemorragias mayores; 0,67 (0,39-1,18) para la muerte cardiovascular; 0,86 (0,62-1,19) para la mortalidad total y 0,82 (0,64-1,05) para el combinado de ictus, embolias, hemorragias mayores y muerte. Conclusiones. El tratamiento con ACOD se asocia con una tendencia a una menor tasa de todos los eventos graves, incluida la mortalidad, en relación con los AVK en pacientes con FANV en España

Use of the Box–Behnken Experimental Design for the Optimization of Orange II (Acid Orange 7) Adsorption on <i>Aloe vera</i>

Industrial wastewater effluents containing dyes are considered to pollute and be harmful to the environment. Among the various removal techniques, the adsorption process using low-cost adsorbents has been successfully used to remove pollutants. In this work, Aloe vera leaves (AVs) have been used as adsorbent for the removal of Orange II (O-II). A three-level three-factor Box–Behnken factorial design, including three replicates of center points, was applied to investigate the main parameters affecting the biosorption of O-II dye in aqueous solutions by AVs. The selected parameters were adsorbent dose, initial dye concentration, and contact time. The Box–Behnken experiment design has given a satisfactory result for the optimization of the adsorption process. The obtained value of R2 (0.9993) shows that the quadratic response model adequately represents the relationship between each response and the chosen variables. The pH influences the adsorption capacity, obtaining at pH 2 the maximum adsorption capacity value. From the kinetic models studied, the one that best describes the adsorption of Orange II on Aloe vera is the Bangham model (ARE = 1.06%). The isotherm model that best represents the experimental data is the Toth model. The maximum adsorption capacity obtained by this model was 15.9 mg·g−1

Nitrogen transformation in two subsurface infiltration systems at pilot scale

Nitrogen removal and transformations were studied in two pilot-scale combinations of a special configuration of a subsurface wastewater infiltration system with vertical flow named symbiotic treatment®. Both pilot-scale combinations operated in parallel and each one consists of four stages in series, one of them with a vertical distribution of stages and the other one with a horizontal distribution. The main differences between them were the separation between stages (presence (the horizontal distribution)/absence (the vertical distribution) of filtration between steps), the hydraulic load (0.113 m3/m2·h and 0.082 m3/m2·h for the horizontal and the vertical distribution, respectively) and the depth of the soil filters (1 m each stage in the horizontal distribution whereas the depths in the vertical distribution ranges from 20 cm to 40 cm). Results of both configurations showed elevated dissolved oxygen concentration, and high removal of organic matter and total suspended solids (with mean removal values of 96 % for COD for both plants and 90 % and 98 % for TSS for the vertical and the horizontal distribution, respectively). High total kjeldahl nitrogen removals were obtained in both configurations (mean removals of 70 % and 90 % for the vertical and the horizontal distribution, respectively). Whereas the nitrification potential was higher in the configuration with horizontal distribution which includes pumping and filtering between stages and higher depth of the soil filters, both tested configurations showed promise for nitrification of wastewater, ammonium nitrogen was efficiently transformed to nitrate