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

Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation &lt;92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p&lt;0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p&lt;0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Synthesis and Lithium Storage Properties of Zn, Co and Mg doped SnO2 Nano Materials

In this paper, we show that magnesium and cobalt doped SnO2 (Mg-SnO2 and Co-SnO2) nanostructures have profound influence on the discharge capacity and coulombic efficiency of lithium ion batteries (LIBs) employing pure SnO2 and zinc doped SnO2 (Zn-SnO2) as benchmark materials. The materials were synthesized via sol-gel technique. The structural, chemical and morphological characterization indicates that the Zn, Mg and Co dopants were effectively implanted into the SnO2 lattice and that Co doping significantly reduced the grain growth. The electrochemical performances of the nanoparticles were investigated using galvanostatic cycling, cyclic voltammetry and electrochemical impedance spectroscopy (EIS). The Co-SnO2 electrode delivered a reversible capacity of around 575 mAh g−1 at the 50th cycle with capacity retention of ∼83% at 60 mA g−1current rate. A capacity of ∼415 mAh g−1 when cycling at 103 mA g−1and >60% improvement in coulombic efficiency compared to the pure compound clearly demonstrate the superiority of Co-SnO2 electrodes. The improved electrochemical properties are attributed to the reduction in particle size of the material up to a few nanometers, which efficiently reduced the distance of lithium diffusion pathway and reduction in the volume change by alleviating the structural strain caused during the Li+ intake/outtake process. The EIS analyses of the electrodes corroborated the difference in electrochemical performances of the electrodes: the Co-SnO2 electrode showed the lowest resistance at different voltages during cycling among other electrodes

Embryology and cytogenetics of Eupatorium pauciflorum and E. intermedium (Compositae)

The embryology of Eupatorium pauciflorum indicates diplospory with autonomous endosperm development. The embryo sac is of the polygonum type and the polar nuclei mostly fuse before anthesis. The occurrence of precocious embryo and endosperm development in unopened florets, and the total absence of germinated pollen grains on exposed stigmas, as well as the absence of pollen tubes in the ovules, indicate agamospermy to be obligate and embryo and endosperm development autonomous. The study of microsporogenesis revealed the total absence of pollen production in consequence of microsporocyte degeneration before the onset of meiosis, which resulted in absolute male sterility. E. pauciflorum was demonstrated to be an autotriploid with a basic set of 10 chromosomes, each represented three times. Embryological studies showed E. intermedium to undergo reductive meiosis with tetrad formation during megasporogenesis, followed by monosporic embryo sac development of the polygonum type. The polar nuclei fuse before anthesis. The egg cell invariably attains anthesis still undivided, without precocious embryony. Meiosis of microsporogenesis results in the regular formation of 10 bivalents and the subsequent stages of microsporogenesis are normal. Stigmatic loads indicate the regular occurrence of pollination with viable, functional grains. Karyotypic studies revealed a complement of 20 chromosomes separable into 10 pairs. It is concluded that E. pauciflorum, as represented by the material studied, is apomictic while E. intermedium is sexual.<br>Os estudos embriológicos indicam que Eupatorium pauciflorum apresenta diplosporia com desenvolvimento autônomo do endosperma. O saco embrionário é do tipo polygonum e os núcleos polares se fundem antes da antese. A ocorrência de embrionia precoce e desenvolvimento do endosperma em flores fechadas, e a total ausência de grãos de pólen germinados em estigmas expostos, bem como a ausência de tubos polínicos nos óvulos, indicam que agamospermia é obrigatória e o desenvolvimento do embrião e do endosperma é autônomo. O estudo da microsporogênese revelou completa ausência de produção de pólen, em razão da degeneração dos microsporócitos antes do início da meiose, o que resulta em absoluta esterilidade masculina. E. pauciflorum demonstrou ser autotriplóide com um conjunto básico de 10 cromossomos repetidos três vezes. Os estudos embriológicos mostraram que E. intermedium sofre meiose reducional, com formação de tétrades durante a megasporogênese, seguida pelo desenvolvimento monospórico do saco embrionário do tipo polygonum. Os núcleos polares se fundem antes da antese. A oosfera invariavelmente permanece até a antese sem se dividir, impedindo a ocorrência de embrionia precoce. A meiose da microsporogênese resulta na formação regular de 10 bivalentes; os estágios subseqüentes da microsporogênese são normais e a análise da superfície estigmática indica a ocorrência regular de polinização, com grãos de pólen viáveis e funcionais. Estudos de cariótipo revelaram um complemento de 20 cromossomos separados em 10 pares. É possível concluir que E. pauciflorum, como representada pelo material estudado, é apomítica, enquanto E. intermedium é sexuada