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

Preservation, innovation and governance: Geographical indication of grapes in Jundiaí (Brazil)

The formation of the grape growing area of Jundiaí was influenced by Italian immigration and the diffusion of cultivar Isabella. After 1930, the coffee economy crisis, the destructuring of the large monoculture property and the emergence of the Niagara Rosada cultivar allowed for the specialization of the Jundiaí grape growing agglomeration. The diffusion of this cultivar characterized the physiognomy of the regional vineyard with the practice of the “espalier” conduction system, and developed the intangible heritage based on the religious character of the cultural manifestations and harvest celebrations. Currently, urban and industrial expansion provides negative externalities of the geographic proximity between the diverse uses of the agricultural space, a fact that imposes threats to the sustainability of the traditional grape growing activities. This work is based on the hypothesis that the Geographical Indication of the Niagara Rosada grape presupposes governance among the agents and constitutes a project of valuation of the traditional landscape and the cultural heritage, in order to contribute to adding value to the grape and to territorial development. The specific resources, even outside the market sphere, can contribute to the commercial valuation of the Niagara Rosada grape and wealth generation beyond the classic notion of “productivity”

Epidemiology of urinary tract infection at the pediatric section of Shahid Beheshti Hospital of Kashan

History and Objectives: Urinary tract infection is one of the most prevalent among children. Its diagnosis and treatment is very important. Urine analysis and leukocyte detection is the corner stone on the detection of urinary tract infection. The present study was carried out to find a relationship between the number of urinary leukocytes and the extent of infection (High temperature, high ESR) in Shaheed Beheshti hospital in 1994-1995. Materials and Methods: The present study was carried out on existing data from hospital records on patients with diagnosis of urinary tract infection. Personal records, leukocyte count, ESR body temperature was recorded. Results: From 117 children (105 girls, 12 boys), 42 were in the age group of 1-5 years, 30 were under the age of one and 28 were above the age of five. There were no correlation between leukocyte count and ESR and leukocyte count and body temperature among patients with urinary tract infection. Conclusion: Urinary tract infection is usually is accompanied with elevated leukocyte count, high ESR value and augmented body temperature. Since urine analysis with low leukocyte count dose not require extensive treatment and since ESR and urine culture is more informative in the assessment of the disease, further research is needed to require