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

Egg length of Anastrepha obliqua Macquart (Diptera, Tephritidae) according to oviposition rate and maternal age

The length of the entire egg, micropile and vitellus regions of Anastrepha obliqua Macquart, 1835 were measured during all opposition period. Obtained values were compared among them and with oviposition rate. The smallest eggs were produced during the first 35 oviposition days, period where the highest oviposition rate occured. The decrease in egg length was found to be due to a descrease in the vitellus region. Micropile length was found to be pratically constant throughout oviposition. Furthermore, no relationship between maternal age and length was detectable

Plantas com possível atividade hipolipidêmica: uma revisão bibliográfica de livros editados no Brasil entre 1998 e 2008 Plants with possible hypolipidemic activity: a review of books published in Brazil between 1998 and 2008

O objetivo deste trabalho foi realizar levantamento sobre as plantas medicinais indicadas para o tratamento da hiperlipidemia, hipercolesterolemia e/ou aterosclerose. Este estudo foi feito a partir da pesquisa bibliográfica em 32 livros publicados no Brasil entre 1998 e 2008, resultando em lista de 85 espécies distribuídas em 53 famílias, principalmente Asteraceae e Fabaceae, com 54 espécies exóticas e 31 nativas. As espécies mais citadas foram Allium sativum (Alliaceae), Cynara scolymus (Asteraceae), Curcuma longa (Zingiberaceae), Allium cepa (Alliaceae), Echinodorus grandiflorus (Alismataceae), Taraxacum officinale (Asteraceae), Vernonia condensata (Asteraceae), Cuphea carthagenensis (Lythraceae) e Curcuma zedoaria (Zingiberaceae). As espécies nativas, citadas em pelo menos 2 livros, foram investigadas para alguma evidencia científica relacionada a possíveis efeitos hipolipidêmico, hipocolesterolêmico e/ou contra aterosclerose. Somente foram encontrados estudos científicos, relacionados a estes efeitos, para as espécies nativas Cuphea carthagenensis e Echinodorus grandiflorum, indicando a necessidade de pesquisas que possam garantir a segurança e a eficácia do uso destas espécies.<br>The aim of this study was to survey medicinal plants indicated for the treatment of hyperlipidemia, hypercholesterolemia and/or atherosclerosis. This study was performed from a review of 32 books published in Brazil between 1998 and 2008, resulting in a list of 85 species belonging to 53 families, especially Asteraceae and Fabaceae, with 54 exotic and 31 native species. The species most often cited were Allium sativum (Alliaceae), Cynara scolymus (Asteraceae), Curcuma longa (Zingiberaceae), Allium cepa (Alliaceae), Echinodorus grandiflorus (Alismataceae), Taraxacum officinale (Asteraceae), Vernonia condensata (Asteraceae), Cuphea carthagenensis (Lythraceae) and Curcuma zedoaria (Zingiberaceae). Native species cited in at least 2 books were investigated for some scientific evidence related to possible hypolipidemic and hypocholesterolemic effects and/or action against atherosclerosis. Scientific studies related to these effects were found only for the native species Cuphea carthagenensis and Echinodorus grandiflorum, indicating the need for studies capable of assuring the safety and the efficacy as to the use of these species