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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Cmv-dna Detection In Patients With Thrombocytopenia [1]

[No abstract available]120262Karpatkin, S., Autoimmune thrombocytopenia purpura (1995) Semin Hematol, 22, pp. 260-288Van Spronsen, D.J., Breed, W.P.M., Cytomegalovirus-induced thrombocytopenia and hemolysis in an immunocompetent adult (1996) Br J Haematol, 92, pp. 218-220Arruda, V.R., Rossi, C.L., Nogueira, E., Cytomegalovirus infection as a cause of severe thrombocytopenia in a non-immunosuppressed patient (1997) Acta Hematologica, 98, pp. 228-230Demmler, G.J., Buffone, G.J., Schimbor, C.M., May, R.A., Detection of cytomegalovirus in urine from newborn by using polymerase chain reaction DNA amplification (1988) J Infect Dis, 158, pp. 1177-1184Glatt, A.E., Anand, A., Thrombocytopenia in patients infected with human immunodeficiency virus: Treatment update (1995) Clin Infec Dis, 21, pp. 415-423Lazzarotto, T., Dal Monte, P., Boccuni, M.C., Ripalti, A., Landini, N.V., Lack of correlation between virus detection and serologic tests for diagnosis of active cytomegalovirus infection in patients with AIDS (1992) J Clin Microbiol, 30, pp. 1027-1029Chanarin, I., Walford, D.M., Thrombocytopenia in cytomegalovirus mononucleosis (1993) Lancet, 2, pp. 238-23

Análise da dinâmica espacial da ocupação das terras e seus conflitos de uso no perímetro urbano de Santa Maria - RS (1975 - 2002) Spatial dynamic analysis of the land occupation and their conflicts of use in the urban perimiter of Santa Maria - RS (1975 - 2002)

As cidades brasileiras, em escala variável, têm apresentado problemas resultantes do uso indevido do espaço urbano, principalmente, em relação aos recursos naturais. Neste caso, o estudo da dinâmica de uso das terras é importante na compreensão dos processos ocorridos no ambiente urbano. O objetivo deste trabalho foi analisar a dinâmica espacial e temporal de ocupação das terras em áreas urbanas de Santa Maria - RS, determinando seus conflitos de uso através do Sistema de Avaliação do Potencial de Uso Urbano das Terras (SAPUT), considerando informações do período de 1975 a 2002. O uso urbano das terras cresceu de 9%, em 1975, para 33%, em 2002. Os conflitos de uso das terras aumentaram de 19%, em 1975, para 37%, em 1995, reduzindo para 33% em 2002. Os principais problemas de uso indevido das terras se relacionam à fragilidade do material geológico e do recurso solo para uso em construções e agricultura urbana.<br>The Brazilian cities have been facing problems due to the improper use of the urban space, mainly, related to the natural resources. In this case, the study of the dynamics of land use is important in the understanding of the processes occured in the urban environment. This research was aimed at analysing the space and temporal dynamics of land occupation in urban areas of Santa Maria - RS, Brazil, determining the conflicts of the land use through the Urban Land Use Potencial System (SAPUT), considering information from 1975 to 2002. The urban land use raised from 9% in 1975 to 33% in 2002. The conflicts of land use have increased from 19% in 1975, to 37% in 1995, reducing to 33% in 2002. The main problems of the improper land use are linked to the fragility of the geological material and soil resource when used for constructions and urban agriculture