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

Isolamento de Haemophiliis aegyptius associado à Febre Purpúrica Brasileira, de cloropídeos (Diptera) dos gêneros Hippelates e Liohippelates Isolation of Haemophilus aegyptius associated to Brazilian purpuric fever from Hippelates and Liohippelates flies (Diptera: Chloropidae)

O reconhecimento da Febre Purpúrica Brasileira (FPB), em 1984, originou uma série de estudos que revelaram uma correlação desta doença com conjuntivites causadas por Haemophiliis aegyptius. A associação do aumento de conjuntivites em crianças e a maior densidade populacional de cloropídeos do gênero Hippelates já havia sido verificada desde o século passado. Este fenômeno está relacionado ao tropismo que estes insetos apresentam pelos olhos, secreções e feridas de onde se alimentam. Embora haja evidências do papel destes cloropídeos na transmissão mecânica de conjuntivites bacterianas, o isolamento de Haemophilus aegyptius a partir dos mesmos, no seu habitat natural, ainda não havia sido verificado. No presente trabalho obtivemos o isolamento de cepas invasivas de Haemophilus aegyptius, associadas à FPB, de duas coleções de cloropídeos, classificados como Liohippelates peruanus e uma espécie nova, Hippelates neoproboscideus, coletados ao redor dos olhos de crianças com conjuntivite.<br>The recognition of the Brazilian purpuric fever (BPF) in 1984 led to a number of studies which showed a relation between this disease and conjunctivitis caused by Haemophilus aegyptius. The increase in cases of conjunctivitis in children associated with higher population density of eye gnats (Chloropidae: Hippelates) has been reported since last century. This phenomenon is related to the attraction that those flies show for the eyes, secretions and wounds, from where they feed on. Although there are evidences on the role of these flies in the mechanical transmission of seasonal bacterial conjunctivitis, the isolation of Haemophilus aegyptius from them in their natural habitat had not been demonstrated yet. In this study Haemophilus aegyptius associated to BPF was isolated from two pools of chloropids collected around the eyes of children with conjuntivitis which were identified as Liohippelates peruanus (Becker) and a new species Hippelates neoproboscideus