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

Retrospective clinico-pathological study of germ cell tumours managed in a single institution

Objective: To study the clinico-pathological characteristics and outcome of germ cell tumours treated in the Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong. Methods: This was a single-institution retrospective review of patients with extrancranial, non-ovarian germ cell tumours treated in the department from 1995 to 2004. Clinico-pathological characteristics and outcome were analysed. Overall, cause-specific, and event-free survivals were evaluated by the Kaplan-Meier method and compared using the log rank test. Results: In all, 110 male patients were followed up for a median of 8 years. Their median age was 33 (range, 17-79) years. Ninety-eight (89%) of the patients had a testicular primary, and 12 (11%) had mediastinal primaries. Seventy-two (65%) were seminomas, and 38 (35%) were non-seminomas. The mean 5-year overall survivals for patients with stage I, 11, and 111 testicular tumour were 100%, 92%, and 81%, respectively. The mean 5-year overall survival for patients with mediastinal primaries was 75%. For stage I seminoma, 29 (62%) of the patients were managed by chemotherapy, 11 (23%) by radiotherapy, 2 (4%) by sequential chemotherapy and radiotherapy, and 5 (11%) by surveillance; all of whom survived 5 years. For advanced germ cell tumours, the respective mean 5-year overall survivals were 90%, 100%, and 36% for patients classified as having a good, intermediate, and poor prognosis (according to the International Germ Cell Cancer Collaborative Group prognostic grouping). Conclusion: Patients having early-stage germ cell tumours have an excellent prognosis with a high cure rate. The outcome of patients having an International Germ Cell Cancer Collaborative Group classified as poor, remains unfavourable. Overall, the treatment outcome in our cohort was comparable to the global experience. © 2010 Hong Kong College of Radiologists.Link_to_subscribed_fulltex

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80–100%) vs low (21–35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with $222 for low FiO2 leading to a −$6 (95% confidence interval [CI]: −$13 to −$1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a −$11 (95$15 to −$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with $1257 for low FiO2 leading to a −$93 (95% CI: −$132 to −$65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a −1.05 (95% CI: −1.14 to −0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this