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

Potential and existing mechanisms of enteric methane production in ruminants

Enteric methane (CH4) emissions in ruminants have attracted considerable attention due to their impact on greenhouse gases and the contribution of agricultural practices to global warming. Over the last two decades, a number of approaches have been adopted to mitigate CH4 emissions. However, the mechanisms of methanogenesis have still not been fully defined. According to the genome sequences of M. ruminantium in the rumen and of M. AbM4 in the abomasum, the pathways of carbon dioxide (CO2) reduction and formate oxidation to CH4 have now been authenticated in ruminants. Furthermore, in the light of species or genera description of methanogens, the precursors of methanogenesis discovered in the rumen and research advances in related subjects, pathways of acetate dissimilation via Methanosarcina and Methanosaeta as well as metabolism of methanol to CH4 might be present in the rumen, although neither process has yet been experimentally demonstrated in the rumen. Herein the research advances in methanogenesic mechanisms including existing and potential mechanisms are reviewed in detail. In addition, further research efforts to understand the methanogenesis mechanism should focus on isolation and identification of more specific methanogens, and their genome sequences. Such increased knowledge will provide benefits in terms of improved dietary energy utilization and a reduced contribution of enteric CH4 emissions to total global greenhouse gas emissions from the ruminant production system