A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

Meeting abstrac

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

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

Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.

OBJECTIVES: To provide an accurate, web-based tool for stratifying patients with atrial fibrillation to facilitate decisions on the potential benefits/risks of anticoagulation, based on mortality, stroke and bleeding risks. DESIGN: The new tool was developed, using stepwise regression, for all and then applied to lower risk patients. C-statistics were compared with CHA2DS2-VASc using 30-fold cross-validation to control for overfitting. External validation was undertaken in an independent dataset, Outcome Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). PARTICIPANTS: Data from 39 898 patients enrolled in the prospective GARFIELD-AF registry provided the basis for deriving and validating an integrated risk tool to predict stroke risk, mortality and bleeding risk. RESULTS: The discriminatory value of the GARFIELD-AF risk model was superior to CHA2DS2-VASc for patients with or without anticoagulation. C-statistics (95% CI) for all-cause mortality, ischaemic stroke/systemic embolism and haemorrhagic stroke/major bleeding (treated patients) were: 0.77 (0.76 to 0.78), 0.69 (0.67 to 0.71) and 0.66 (0.62 to 0.69), respectively, for the GARFIELD-AF risk models, and 0.66 (0.64-0.67), 0.64 (0.61-0.66) and 0.64 (0.61-0.68), respectively, for CHA2DS2-VASc (or HAS-BLED for bleeding). In very low to low risk patients (CHA2DS2-VASc 0 or 1 (men) and 1 or 2 (women)), the CHA2DS2-VASc and HAS-BLED (for bleeding) scores offered weak discriminatory value for mortality, stroke/systemic embolism and major bleeding. C-statistics for the GARFIELD-AF risk tool were 0.69 (0.64 to 0.75), 0.65 (0.56 to 0.73) and 0.60 (0.47 to 0.73) for each end point, respectively, versus 0.50 (0.45 to 0.55), 0.59 (0.50 to 0.67) and 0.55 (0.53 to 0.56) for CHA2DS2-VASc (or HAS-BLED for bleeding). Upon validation in the ORBIT-AF population, C-statistics showed that the GARFIELD-AF risk tool was effective for predicting 1-year all-cause mortality using the full and simplified model for all-cause mortality: C-statistics 0.75 (0.73 to 0.77) and 0.75 (0.73 to 0.77), respectively, and for predicting for any stroke or systemic embolism over 1 year, C-statistics 0.68 (0.62 to 0.74). CONCLUSIONS: Performance of the GARFIELD-AF risk tool was superior to CHA2DS2-VASc in predicting stroke and mortality and superior to HAS-BLED for bleeding, overall and in lower risk patients. The GARFIELD-AF tool has the potential for incorporation in routine electronic systems, and for the first time, permits simultaneous evaluation of ischaemic stroke, mortality and bleeding risks. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier for GARFIELD-AF (NCT01090362) and for ORBIT-AF (NCT01165710)

Two-year outcomes of patients with newly diagnosed atrial fibrillation: results from GARFIELD-AF.

AIMS: The relationship between outcomes and time after diagnosis for patients with non-valvular atrial fibrillation (NVAF) is poorly defined, especially beyond the first year. METHODS AND RESULTS: GARFIELD-AF is an ongoing, global observational study of adults with newly diagnosed NVAF. Two-year outcomes of 17 162 patients prospectively enrolled in GARFIELD-AF were analysed in light of baseline characteristics, risk profiles for stroke/systemic embolism (SE), and antithrombotic therapy. The mean (standard deviation) age was 69.8 (11.4) years, 43.8% were women, and the mean CHA2DS2-VASc score was 3.3 (1.6); 60.8% of patients were prescribed anticoagulant therapy with/without antiplatelet (AP) therapy, 27.4% AP monotherapy, and 11.8% no antithrombotic therapy. At 2-year follow-up, all-cause mortality, stroke/SE, and major bleeding had occurred at a rate (95% confidence interval) of 3.83 (3.62; 4.05), 1.25 (1.13; 1.38), and 0.70 (0.62; 0.81) per 100 person-years, respectively. Rates for all three major events were highest during the first 4 months. Congestive heart failure, acute coronary syndromes, sudden/unwitnessed death, malignancy, respiratory failure, and infection/sepsis accounted for 65% of all known causes of death and strokes for <10%. Anticoagulant treatment was associated with a 35% lower risk of death. CONCLUSION: The most frequent of the three major outcome measures was death, whose most common causes are not known to be significantly influenced by anticoagulation. This suggests that a more comprehensive approach to the management of NVAF may be needed to improve outcome. This could include, in addition to anticoagulation, interventions targeting modifiable, cause-specific risk factors for death. CLINICAL TRIAL REGISTRATION: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Environmental contribution of Los Tajos wastewater treatment plant in the removal of physicochemical and microbiological pollutants

AbstractThe objective of the study was to analyze the environmental contribution, in terms of removal of physicochemical and microbiological pollutants, from the Los Tajos Wastewater Treatment Plant (WWTP) to the Torres River. Physicochemical and microbiological data was analyzed including WWTP inflows and outflows (OBD, OCD, TSS, STT, N-NH4+, P-PO43-, Oils, MBAS, and fecal coliforms). The difference in the concentration of pollutants in the Torres River before and after the construction of the WWTP was analyzed using R 3.6.1, associated with seasonality. According to the Dutch Index Methodology, the Torres River was severely polluted before the construction of the WWTP, and the degree of contamination increases following the WWTP discharge, mainly during the rainy season. The WWTP shows significant removal of seven of the eight parameters analyzed, with the most representative removal percentages being: TSS (68.5%), OBD (49.8%), and Oils (54.7%). The quantitative contribution of the WWTP to the Torres River was demonstrated by removing thousands of Mg of pollutants from wastewater during the years of operation (2015-2020), mainly OCD (26,791.8 Mg), STT (24,162.6 Mg), OBD (12,290.0 Mg), and TSS (30,267.7 Mg). Finally, building the WWTP’s next stages, including secondary treatment, is needed to improve the removal of organic matter, surfactants, and nutrients.El objetivo del estudio fue analizar el aporte ambiental hacia la calidad del río Torres considerando la remoción de contaminantes fisicoquímicos y microbiológicos de la planta de tratamiento de aguas residuales (PTAR) Los Tajos.Se realizó el análisis de datos fisicoquímicos y microbiológicos de las aguas de afluente y efluente de la PTAR (DBO, DQO, SST, STT, N-NH4+, P-PO43-, GyA, SAAM y coliformes fecales principalmente) y se analizó la variación en concentración de contaminantes en el río Torres previo y posterior a la construcción de la PTAR, que realiza un tratamiento primario a las aguas, todo asociado a la estacionalidad. Los datos se analizaron en R versión 3.6.1. Según la metodología del índice holandés, el río Torres se clasificó severamente contaminado previo a la construcción de la PTAR, y actualmente aumenta su grado de contaminación después de la descarga de la PTAR, principalmente en época lluviosa. La PTAR presenta remoción significativa para siete de los ocho parámetros analizados, los porcentajes de remoción más representativos son: SST (68.5 %), DBO (49.8 %) y GyA (54.7 %). Se demostró el aporte cuantitativo de la PTAR al río Torres removiendo toneladas de contaminantes de las aguas residuales desde el 2015 hasta el 2020, principalmente DQO (26,791.8 Mg), SST (24,162.6 Mg), DBO (12,290.0 Mg) y STT (30,267.7 Mg). Finalmente se dejó en evidencia la necesidad de construir las siguientes etapas de la PTAR que incluyen tratamiento secundario, que mejoraría la remoción de materia orgánica, surfactantes y nutrientes.Escuela de QuímicaEscuela de Ciencias Biológica

Relevância e impacto das teses de Biologia e das Ciências no contexto nacional: três décadas de pesquisa na Universidad Nacional, Costa Rica

Esta investigación tuvo como objetivo analizar en un periodo de 35 años (1985-2019) todas las investigaciones de las tesis de grado de la Escuela de Ciencias Biológicas de la Universidad Nacional. Se analizaron un total de 418 tesis que fueron categorizadas en rasgos bibliométricos, como año, carrera, temáticas y zona del país. Además, las tesis de la última década (2009-2019) se consultaron en Google Académico, así como en otras bases de datos electrónicos. Finalmente, todos los títulos de las tesis fueron analizados mediante minería de texto para determinar los conceptos más frecuentes por carrera. Se encontró que el 26.5% fueron tesis de la carrera en manejo de recursos marinos y dulceacuícolas, el 52.7% en manejo de recursos naturales y finalmente el 20.8% en enseñanza de las ciencias. El análisis de las tesis desde la última década (2009 y 2019) mostró que el 26% generaron publicaciones en revistas indexadas, de las cuales el 69% fueron en español y el 75% incluyó al estudiante como primer autor. La carrera en biología está dominada por temas aplicados al manejo de recursos y la acuicultura. En la carrera de enseñanza de las ciencias se aboga por el diseño de experiencias para potenciar y mejorar los procesos de enseñanza y aprendizaje en varios campos disciplinarios y pedagógicos. Estos resultados evidencian la coincidencia entre las temáticas emergentes de interés nacional específicamente en el área de la enseñanza de las ciencias y de la biología. Además, señala que existe un retraso en la difusión del patrimonio científico que se desprende de las tesis y que es un desafío impostergable que estos estudios trascienden más allá de los repositorios universitarios.This research aimed to analyze all the undergraduate thesis research of the School of Biological Sciences of Universidad Nacional encompassing a period of 35 years (1985-2019). A total of 418 theses were analyzed and categorized according to bibliometric features, such as year, career, subject, and country area. In addition, theses from the last decade (2009-2019) were consulted in Google Scholar and other electronic databases. Finally, all thesis titles were analyzed by text mining to determine the most frequent concepts by career. It was found that 26.5% were theses in marine and freshwater resource management, 52.7% in natural resource management, and 20.8% in science education. The analysis of theses from the last decade (2009 and 2019) showed that 26% generated publications in indexed journals, of which 69% were in Spanish, and 75% included the student as the first author. The Biology major is dominated by topics applied to resource management and aquaculture. The Teaching Science career plan advocates the design of experiences to enhance and improve teaching and learning processes in various disciplinary and pedagogical fields. These results evidence the coincidence between emerging topics of national interest, specifically in science and biology teaching. In addition, it points out that there is a delay in disseminating the scientific heritage that emerges from the theses and that it is an urgent challenge that these studies transcend beyond the university repositories.Esta pesquisa teve como objetivo analisar durante um período de 35 anos (1985-2019) todas as pesquisas de tese de graduação na Faculdade de Ciências Biológicas da Universidade Nacional. Um total de 418 teses foram analisadas e categorizadas de acordo com características bibliométricas, tais como ano, carreira, temas e área do país. Além disso, as teses da última década (2009-2019) foram consultadas no Google Acadêmico, bem como em outros bancos de dados eletrônicos. Finalmente, todos os títulos de tese foram analisados por mineração de texto para determinar os conceitos mais frequentes por carreira. Constatou-se que 26,5% eram teses da carreira de gestão de recursos marinhos e de água doce, 52,7% em gestão de recursos naturais e 20,8% no ensino das ciências. A análise das teses da última década (2009 e 2019) mostrou que 26% geraram publicações em revistas indexadas, das quais 69% foram em espanhol e 75% incluíram o estudante como primeiro autor. A carreira de biologia é dominada por tópicos aplicados à gestão de recursos e à aquicultura. A carreira de ensino das ciências defende o desenho de experiências para potencializar e aprimorar os processos de ensino e aprendizagem em vários campos disciplinares e pedagógicos. Estes resultados mostram a coincidência entre as questões emergentes de interesse nacional especificamente na área do ensino da ciência e da biologia. Além disso, aponta que há um atraso na divulgação do patrimônio científico que emerge das teses e que é um desafio urgente e inadiável que estes estudos transcendam além dos repositórios universitários.Universidad Nacional, Costa RicaEscuela de Ciencias Biológica

Infuence of soil characteristics on physiological and growth responses of Cytharexyllum myrianthum Cham. (Verbenaceae) to fooding

The success of watershed riparian forest restoration programs can be afected by the selection of plant species tolerant to fooding and soil types that occur along water courses. We evaluated physiological and growth responses of Cytharexyllum myrianthum seedlings to fooding in three diferent soil types representative of the Almada River Watershed (ARW), southern Bahia, Brazil. The soils selected, based on the relative abundance and importance in the ARW, were: Luvisol, Argisol, and Spodosol. After 35 days of fooding, the Argisol had the lowest and the Spodosol had the highest reduction–oxidation (redox) potential (Eh). After 35 days of fooding, the Luvisol had higher pH and electrical conductivity (Ec) than the other soils. Stomatal conductance (gs) and net photosynthesis (A) signifcantly declined in all soil types after 7 days of fooding. After that period, morphological changes characteristic of food-tolerant plants, such as lenticel hypertrophy and adventitious root formation, were observed in all fooded plants. Following the morphological changes, gs and A in fooded plants increased to values close to those of the non-fooded plants. The highest relative growth rates based on mass (RGRm) and net assimilation rates (NAR) for the non-fooded plants were observed in the Argisol. After 35 days of fooding, no signifcant diferences in RGRm or NAR were observed between non-fooded and fooded plants in the Luvisol, but large signifcant decreases in RGRm and NAR were observed for the fooded plants in the Spodosol. Our results demonstrated that the ability of seedlings of the same species to acclimate to fooded soil conditions difers among soil types. Therefore, the characteristics of soils present in a watershed should be considered when selecting tree species for the reforestation of riparian forests.El éxito de los programas de restauración de bosques ribereños de cuencas hidrográficas puede verse afectado por la selección de especies de plantas tolerantes a la alimentación y los tipos de suelo que se encuentran a lo largo de los cursos de agua. Evaluamos las respuestas fisiológicas y de crecimiento de plántulas de Cytharexyllum myrianthum a la alimentación en tres diferentes tipos de suelo representativos de la Cuenca del Río Almada (ARW), sur de Bahía, Brasil. Los suelos seleccionados, en base a la relativa abundancia e importancia en el ARW, fueron: Luvisol, Argisol y Spodosol. Después de 35 días de alimentación, el Argisol tuvo el menor y el Spodosol el mayor potencial de reducción-oxidación (redox) (Eh). Después de 35 días de alimentación, el Luvisol tenía un pH y una conductividad eléctrica (Ec) más altos que los otros suelos. La conductancia estomática (gs) y la fotosíntesis neta (A) disminuyeron significativamente en todos los tipos de suelo después de 7 días de alimentación. Después de ese período, se observaron cambios morfológicos característicos de las plantas tolerantes a los alimentos, como la hipertrofia de las lenticelas y la formación de raíces adventicias, en todas las plantas inundadas. A raíz de los cambios morfológicos, gs y A en plantas sembradas aumentaron a valores cercanos a los de las plantas no sembradas. Las tasas de crecimiento relativo más altas basadas en la masa (RGRm) y las tasas de asimilación neta (NAR) para las plantas no alimentadas se observaron en Argisol. Después de 35 días de alimentación, no se observaron diferencias significativas en RGRm o NAR entre las plantas no alimentadas y alimentadas en Luvisol, pero se observaron grandes disminuciones significativas en RGRm y NAR para las plantas alimentadas en Spodosol. Nuestros resultados demostraron que la capacidad de las plántulas de la misma especie para aclimatarse a las condiciones del suelo inundado difiere entre los tipos de suelo. Por lo tanto, las características de los suelos presentes en una cuenca deben ser consideradas al seleccionar especies de árboles para la reforestación de bosques ribereños.Universidade Estadual de Santa Cruz, BrasilUniversidade Federal do Sul da Bahia, BrasilUniversidad de Florida, Estados UnidosUniversidad Nacional, Costa RicaEscuela de Ciencias Biológica