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

Consumo e digestibilidade aparente da matéria seca, proteína e energia bruta, e balanço de nitrogênio das silagens de cinco genótipos de milho Consumption and apparent digestibility of dry matter, crude protein and crude energy, and balance of nitrogen of silages of five maize genotypes

Quantificaram-se o consumo voluntário e a digestibilidade aparente da matéria seca, proteína bruta, energia bruta e balanço de nitrogênio das silagens de cinco genótipos de milho (HT01, HT47C, HT129, AG 5011 e BR 3123). Foram utilizados 15 carneiros alojados em gaiolas metabólicas para coleta total de fezes e urina. O delineamento experimental foi o inteiramente ao acaso com cinco tratamentos e seis repetições. Não foram observadas diferenças entre os genótipos quanto ao consumo e digestibilidade da MS, da EB e da PB (P>0,05). Os consumos de MS, EB e PB digestíveis e energia metabolizável também não foram diferentes entre os híbridos (P>0,05). Quanto às relações consumo de energia digestível/consumo de MS e consumo de energia metabolizável/consumo de MS, o genótipo AG5011 foi semelhante ao HT01 (P>0,05) e superior aos demais (P<0,05). Todos os tratamentos apresentaram balanço de nitrogênio positivo e não diferiram entre si (P>0,05). Todos os genótipos produziram silagens de bom valor nutritivo, entretanto o genótipo AG5011 apresentou maior eficiência na utilização da energia (P<0,05).<br>The voluntary intake and the apparent digestibility of dry matter, crude protein and crude energy and the nitrogen balance, of silages of five maize genotypes (HT01, HT47C, HT129, AG5011 and BR3123) were quantified. Fifteen sheep were stored in metabolic cages for total collection of feces and urine. A complete randomized design, with five treatments and six repetitions was used. The intake and digestibility of dry matter, crude protein and crude energy did not differ (P>0.05) among treatments. The intake of digestible dry matter, crude protein, crude energy and metabolic energy did not differ (P>0.05) among the genotypes. The ratios of digestible energy intake/dry matter intake and metabolic energy intake/dry matter intake of the genotype AG5011 silage was similar (P>0.05) to HT01, and higher than the other genotypes (P<0.05). All genotypes showed similar and positive nitrogen balance, and all of them produced silages of good nutritional value. Nevertheless, silage of AG5011 genotype showed higher efficiency of energy (P<0.05) utilization

Effectiveness of the combination elvitegravir/cobicistat/tenofovir/emtricitabine (EVG/COB/TFV/FTC) plus darunavir among treatment-experienced patients in clinical practice : A multicentre cohort study

Background: The aim of this study was to investigate the effectiveness and tolerability of the combination elvitegravir/cobicistat/tenofovir/emtricitabine plus darunavir (EVG/COB/TFV/FTC + DRV) in treatment-experienced patients from the cohort of the Spanish HIV/AIDS Research Network (CoRIS). Methods: Treatment-experienced patients starting treatment with EVG/COB/TFV/FTC + DRV during the years 2014-2018 and with more than 24 weeks of follow-up were included. TFV could be administered either as tenofovir disoproxil fumarate or tenofovir alafenamide. We evaluated virological response, defined as viral load (VL) < 50 copies/ml and < 200 copies/ml at 24 and 48 weeks after starting this regimen, stratified by baseline VL (< 50 or ≥ 50 copies/ml at the start of the regimen). Results: We included 39 patients (12.8% women). At baseline, 10 (25.6%) patients had VL < 50 copies/ml and 29 (74.4%) had ≥ 50 copies/ml. Among patients with baseline VL < 50 copies/ml, 85.7% and 80.0% had VL < 50 copies/ml at 24 and 48 weeks, respectively, and 100% had VL < 200 copies/ml at 24 and 48 weeks. Among patients with baseline VL ≥ 50 copies/ml, 42.3% and 40.9% had VL < 50 copies/ml and 69.2% and 68.2% had VL < 200 copies/ml at 24 and 48 weeks. During the first 48 weeks, no patients changed their treatment due to toxicity, and 4 patients (all with baseline VL ≥ 50 copies/ml) changed due to virological failure. Conclusions: EVG/COB/TFV/FTC + DRV was well tolerated and effective in treatment-experienced patients with undetectable viral load as a simplification strategy, allowing once-daily, two-pill regimen with three antiretroviral drug classes. Effectiveness was low in patients with detectable viral loads