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

Efecto antihelmíntico in vitro de extractos de plantas sobre larvas infectantes de nematodos gastrointestinales de rumiantes/In vitro anthelmintic effect of plant extracts against infective larvae of ruminants gastrointestinal nematode parasites

[Abstract English]: With the purpose of studying the anthelmintic efficacy of some plant species presents in Queensland State, Australia, we tested in vitro the effect of plant extracts on infective larvae (L3) migration of Haemonchus placei, Cooperia sp., Haemonchus contortus and Trichostrongylus colubriformis. In general, plant extracts reduced the larval migration of Haemonchus placei and Cooperia sp. The most effective plants against Haemonchus placei and Cooperia sp. (P < 0.0001) were Allocasuarina torulosa, Neolitsea dealbata, Acacia holosericea, Acacia salicina, Callitris endlicheri and Casuarina cunninghamiana. Plants extracts were less effective on L3 migration of Haemonchus conforms and Trichostrongylus colubriformis. Callitris endlicheri, Casuarina cunninghamiana, Acacia farnesiana, Acacia holosericea and Acacia nilotica were the plant extracts that shown an important larval migration inhibition against H. contortus and Trichostrongylus colubriformis (P < 0.0001). Callitris endlicheri was the plant that consistently inhibited the larval migration of every nematode species under study. These in vitro results suggest anthelmintic properties associate with some of the plant species we studied.\ud \ud [Abstract Spanish]: Con el objeto de estudiar la capacidad antihelmíntica de algunas especies de plantas presentes en el Estado de Queensland, Australia, se evaluó el efecto in vitro de extractos de hojas de plantas en la migración de larvas infectantes (L3) de Haemonchus placei, Cooperia sp., Haemonchus contortus y Trichostrongylus colubriformis. En general, los extractos de plantas redujeron la migración de larvas de H. placei y Cooperia sp. Las plantas con mayor actividad antihelmíntica contra estas especies de nematodos fueron Allocasuarina torulosa, Neolitsea dealbata, Acacia holosericea, Acacia salicina, Callitris endlicheri y Casuarina cunninghamiana (P < 0,0001). Los extractos fueron menos efectivos en inhibir la migración de larvas de H. contortus y T. colubriformis. Las plantas que mostraron una mayor inhibición de la migración larval contra estas especies de nematodos fueron Callitris endlicheri, Casuarina cunninghamiana, Acacia farnesiana, Acacia holosericea y Acacia nilotica (P < 0,0001). Callitris endlicheri fue la especie que más consistentemente inhibió la migración de todas las especies de nematodos estudiadas. Estos resultados in vitro sugieren la existencia de propiedades antihelmínticas asociadas con algunas de las especies de plantas evaluadas

Efecto antihelmíntico in vitro de extractos de plantas sobre larvas infectantes de nematodos gastrointestinales de rumiantes/In vitro anthelmintic effect of plant extracts against infective larvae of ruminants gastrointestinal nematode parasites

[Abstract English]: With the purpose of studying the anthelmintic efficacy of some plant species presents in Queensland State, Australia, we tested in vitro the effect of plant extracts on infective larvae (L3) migration of Haemonchus placei, Cooperia sp., Haemonchus contortus and Trichostrongylus colubriformis. In general, plant extracts reduced the larval migration of Haemonchus placei and Cooperia sp. The most effective plants against Haemonchus placei and Cooperia sp. (P < 0.0001) were Allocasuarina torulosa, Neolitsea dealbata, Acacia holosericea, Acacia salicina, Callitris endlicheri and Casuarina cunninghamiana. Plants extracts were less effective on L3 migration of Haemonchus conforms and Trichostrongylus colubriformis. Callitris endlicheri, Casuarina cunninghamiana, Acacia farnesiana, Acacia holosericea and Acacia nilotica were the plant extracts that shown an important larval migration inhibition against H. contortus and Trichostrongylus colubriformis (P < 0.0001). Callitris endlicheri was the plant that consistently inhibited the larval migration of every nematode species under study. These in vitro results suggest anthelmintic properties associate with some of the plant species we studied.\ud \ud [Abstract Spanish]: Con el objeto de estudiar la capacidad antihelmíntica de algunas especies de plantas presentes en el Estado de Queensland, Australia, se evaluó el efecto in vitro de extractos de hojas de plantas en la migración de larvas infectantes (L3) de Haemonchus placei, Cooperia sp., Haemonchus contortus y Trichostrongylus colubriformis. En general, los extractos de plantas redujeron la migración de larvas de H. placei y Cooperia sp. Las plantas con mayor actividad antihelmíntica contra estas especies de nematodos fueron Allocasuarina torulosa, Neolitsea dealbata, Acacia holosericea, Acacia salicina, Callitris endlicheri y Casuarina cunninghamiana (P < 0,0001). Los extractos fueron menos efectivos en inhibir la migración de larvas de H. contortus y T. colubriformis. Las plantas que mostraron una mayor inhibición de la migración larval contra estas especies de nematodos fueron Callitris endlicheri, Casuarina cunninghamiana, Acacia farnesiana, Acacia holosericea y Acacia nilotica (P < 0,0001). Callitris endlicheri fue la especie que más consistentemente inhibió la migración de todas las especies de nematodos estudiadas. Estos resultados in vitro sugieren la existencia de propiedades antihelmínticas asociadas con algunas de las especies de plantas evaluadas

Anthelmintic efficacy of five tropical native Australian plants against Haemonchus contortus and Trichostrongylus colubriformis in experimentally infected goats (Capra hircus)

The study of the anthelmintic properties of plants rich in plant secondary metabolites can provide ecologically sound methods for the treatment of parasites on grazing animals. The purpose of the present study was to evaluate the anthelmintic effect of five tropical native Australian plant species rich in plant secondary metabolites on adult Haemonchus contortus and Trichostrongylus colubriformis in experimentally infected goats. Thirty young, nematode-free goats were infected with 2500 H. contortus and 5000 T. colubriformis infective larvae thrice weekly for a week (day 1-7 of the experiment). On day 27 after first infection, the goats were allocated into six groups of five animals per group. From day 28 to day 35, fresh leaves from Acacia salicina, Acacia nilotica, Eucalyptus corymbia, Casuarina cunninghamiana and Eucalyptus drepanophylla were included in the goats diet. Five groups were offered leaves from one of these plant species and one group, the untreated control, received only the basal diet formulated with 20% Medicago sativa and 80% Avena sativa. Following plant material administration, the goats were monitored daily until day 40 and then slaughtered on day 41. Total faecal worm egg output, total production of larvae recovered from faecal cultures, total post-mortem worm burdens and the per capita fecundity of female worms were estimated. The toxicity of the plant species for the goats was measured by histopathological analyses of liver and kidney samples. Results showed that goats feeding on the plant material rich in plant secondary metabolites had significantly lower egg output compared to the control goats (P < 0.05). A similar response was found for larval production in both H. contortus and T. colubriformis supporting that egg output was affected in both species. Although the total worm burdens were not affected by the plant material (P > 0.05), the per capita fecundity was significantly reduced by E. corymbia, A. nilotica and A. salicina (P < 0.05). No signs of toxicity were detected in the liver or kidney samples. It is concluded that goats can benefit from the short-term ingestion of plant secondary metabolites, which reduce the total faecal egg output and thus decrease the potential for re-infection from the pasture