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

Mapping density, diversity and species-richness of the Amazon tree flora

Using 2.046 botanically-inventoried tree plots across the largest tropical forest on Earth, we mapped tree species-diversity and tree species-richness at 0.1-degree resolution, and investigated drivers for diversity and richness. Using only location, stratified by forest type, as predictor, our spatial model, to the best of our knowledge, provides the most accurate map of tree diversity in Amazonia to date, explaining approximately 70% of the tree diversity and species-richness. Large soil-forest combinations determine a significant percentage of the variation in tree species-richness and tree alpha-diversity in Amazonian forest-plots. We suggest that the size and fragmentation of these systems drive their large-scale diversity patterns and hence local diversity. A model not using location but cumulative water deficit, tree density, and temperature seasonality explains 47% of the tree species-richness in the terra-firme forest in Amazonia. Over large areas across Amazonia, residuals of this relationship are small and poorly spatially structured, suggesting that much of the residual variation may be local. The Guyana Shield area has consistently negative residuals, showing that this area has lower tree species-richness than expected by our models. We provide extensive plot meta-data, including tree density, tree alpha-diversity and tree species-richness results and gridded maps at 0.1-degree resolution

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time, and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space. While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes, vast areas of the tropics remain understudied. In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity, but it remains among the least known forests in America and is often underrepresented in biodiversity databases. To worsen this situation, human-induced modifications may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge, it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Sinais clínicos, distribuição das lesões no sistema nervoso e epidemiologia da raiva em herbívoros na região Nordeste do Brasil Clinical signs, distribution of the lesions in the central nervous system and epidemiology of rabies in northeastern Brazil

Descrevem-se 24 surtos de raiva em bovinos (25 casos), 4 em eqüinos (5 casos), 2 em caprinos (2 casos) e 2 em ovinos (4 casos). Todos os surtos ocorreram na Paraíba, exceto um em eqüinos que ocorreu no Rio Grande do Norte. Todos os surtos, com a exceção de um em ovinos, foram transmitidos provavelmente por morcegos hematófagos; no entanto, não se descarta a possibilidade de transmissão por raposas (Dusicyon vetulus). Os sinais clínicos foram representativos da localização das lesões no sistema nervoso central (SNC). Em bovinos os sinais eram, principalmente, da forma paralítica, causados por lesões da medula, tronco encefálico e cerebelo; mas alguns animais apresentaram depressão, excitação e outros sinais associados a lesões cerebrais. Três dos 5 eqüinos apresentaram sinais de lesões cerebrais e 2 apresentaram a forma paralítica. De 4 ovinos e 2 caprinos, 4 apresentaram a forma paralítica, mas em um caprino e um ovino os sinais foram predominantemente de lesões cerebrais. Todos os animais afetados, exceto um caprino, tiveram um curso clínico de 2-8 dias. As únicas lesões macros-cópicas observadas foram a dilatação da bexiga em 4 bovinos e a dilatação da ampola retal em 2. Dois cavalos apresentaram lesões da pele causadas por traumatismos. As lesões histológicas foram de encefalomielite e meningite difusa não supurativa. Nos eqüinos e em um caprino com evolução clínica de 35 dias as lesões foram mais severas, observando-se necrose neuronal, neuronofagia e presença de esferóides axonais. Corpúsculos de Negri foram observados em 87% (20/23) dos bovinos examinados e em 83% (5/6) dos ovinos e caprinos. Nessas 3 espécies os corpúsculos foram mais freqüentes no cerebelo, mas ocorreram também no tronco encefálico, medula e cérebro. Em cavalos, corpúsculos de Negri foram menos numerosos, sendo observados somente no córtex de um animal e no córtex e hipocampo em outro. No gânglio trigeminal, as lesões histológicas e os corpúsculos de Negri foram menos freqüentes que no SNC. Esses resultados mostram que na raiva dos herbívoros os sinais clínicos e a distribuição das lesões histológicas do SNC são variáveis, e que para o correto diagnóstico da enfermidade são necessários um bom exame clínico e o estudo histológico das diferentes regiões do SNC. Sugere-se, também, que perante resultados negativos nos testes de imunofluo-rescência e inoculação em camundongos, estes devam ser repetidos com amostras de diferentes regiões do SNC. Utilizando-se dados sobre a freqüência de doenças, de 4 laboratórios de diagnóstico, foi realizada uma estimativa das mortes de bovinos causadas pela raiva, anualmente, em 3 Estados. Na Paraíba, com uma população de 918.262 bovinos, o número de mortes é estimado em 8.609 cabeças por ano. No Mato Grosso do Sul, com uma população de 23 milhões de bovinos, as perdas por raiva são estimadas em 149.500 cabeças e, no Rio Grande do Sul, com uma população de 13 milhões de bovinos, as mortes são estimadas em 13.000 a 16.250 animais por ano. Se estas estimativas forem extrapoladas para todo o Brasil, com 195 milhões de bovinos, as mortes podem ser estimadas em 842.688 cabeças por ano.<br>Twenty four outbreaks of rabies in cattle, 4 in horses, 2 in sheep, and 2 in goats are reported in northeastern Brazil. All outbreaks occurred in the state of Paraíba, except one in horses that occurred in the state of Rio Grande do Norte. All outbreaks, except one in sheep, were probably transmitted by vampire-bats, but the transmission by foxes (Dusicyon vetulus) is also possible. Clinical signs were characteristic for distribution of the lesions in the central nervous system (CNS). In cattle, signs were mainly of the paralytic form of rabies, caused by lesions on the spinal cord, brain stem and cerebellum; but some animals showed also depression, excitation and other signs due to cerebral lesions. In 3 out of 5 horses, the main clinical signs were due to lesions in the cerebrum, and 2 had the paralytic form. From 4 sheep and 2 goats affected, 4 showed clinical signs of the paralytic form; but in 1 goat and 1 sheep the main clinical signs were caused by cerebral lesions. All affected animals, except 1 goat, had a clinical manifestation period of 2-8 days. The only gross lesions were distention of the urinary bladder in 4 cattle and distention of the rectum in 2 others. Two horses had skin lesions due to traumatic injury. Histologic lesions were diffuse non-suppurative encephalomyelitis and meningitis. In the horses, and in one goat with a clinical manifestation period of 35 days, the lesions were more severe, with neuronal necrosis, neuronophagia, and presence of axonal spheroids. Negri bodies were found in 87% (20/23) of the cattle cases examined histologically. In small ruminants Negri bodies were found in 83% (5/6) of the cases. In sheep, goats and cattle, Negri bodies were more frequent in the cerebellum, but they were found also in brain stem, spinal cord and cerebrum. In horses, Negri bodies were found in small amounts only in the cortex of one animal, and in the cortex and hippocampus of another. Histologic lesions and Negri bodies in the trigeminal ganglia were less frequent than in the CNS. These results show that in rabies of herbivores, clinical signs and distribution of lesions in the CNS are variable, so that for the diagnosis and adequate clinical evaluation and the histologic study of different areas of the CNS are necessary. This also suggests that when the fluorescent antibody test and mouse inoculation test are negative, they should be repeated with samples from different areas of the brain and spinal cord. Frequency data of diseases from 4 diagnostic laboratories were used to estimate cattle deaths due to rabies in 3 Brazilian states. In Paraíba, with a population of 918,262 cattle, the annual death rate is estimated in 8,609 heads. In Mato Grosso do Sul, with a population of 23 millions cattle, deaths caused by rabies are estimated in 149,500 heads, and in Rio Grande do Sul, with a cattle population of 13 millions, cattle deaths due to rabies are estimated in 13,000 to 16,250 heads. If these data are used to estimate cattle losses in Brazil, with a cattle population of 195 millions, it can be estimated that 842,688 deaths are caused annually by rabies

Yield performance and leaf nutrient levels of coffee cultivars under different plant densities Produtividade e níveis foliares de nutrientes em cultivares de café sob diferentes populações de plantas

Coffee (Coffea Arabica L.) plantations using adapted cultivars to regional environmental conditions with optimal plant population density and adequate nutrition are expected to show high yield responses. The triennial production and leaf macronutrient concentrations of four coffee cultivars were studied under different plant population densities. Catuaí Amarelo (IAC 47), Obatã (IAC 1669-20), Acaiá (IAC 474-19) and Icatu Amarelo (IAC 2944) were planted in densities of 2,500; 5,000; 7,519; and 10,000 plants ha-1 with one plant per hole and two plants per hole in the 2,500 plant ha-1. Plants were homogeneously fertilized without liming. As the population density increased the triennial coffee productivity increased, the yield per plant decreased, and leaf concentrations of phosphorus (P), potassium (K) and sulfur (S) increased. Coffee plants under dense systems presented equal or higher leaf macronutrient concentrations compared to the plants under conventional population. Taller cultivars presented the highest nutrient concentration values, and Obatã, a dwarf cultivar, the lowest values. Higher coffee yields and lower leaf P, Ca and S concentrations were observed in plots with one plant compared to the plots with two plants. In general, the coffee cultivars had leaf N and S concentrations above the reference limits reported in the literature, but leaf concentrations of other macronutrients were within adequate ranges.<br>Cultivares de cafeeiro (Coffea Arabica L.) adaptadas às regiões de cultivo, com população de plantas otimizada e adequado estado nutricional são premissas para a obtenção de produções elevadas de café. Estudou-se a produção trienal de café e o teor foliar de macronutrientes de cultivares de cafeeiro em função das densidades de plantio. Foram utilizados os cultivares Catuaí Amarelo (IAC 47), Obatã (IAC 1669-20), Acaiá (IAC 474-19) e Icatu Amarelo (IAC 2944) nas populações de 2.500 plantas ha-1 com duas plantas por cova; e, 5.000, 7.519 e 10.000 plantas ha-1 com uma planta por cova. As plantas foram adubadas de modo homogêneo, porém, sem calagem. À medida que a população de cafeeiros aumentou, a produtividade trienal de café aumentou, a produção de frutos por planta diminuiu e os teores foliares de fósforo (P), potássio (K) e enxofre (S) aumentaram. Nos cafeeiros sob adensamento encontrou-se igual ou maior teor de macronutrientes do que naqueles sob espaçamento convencional, sendo que os maiores teores foram observados nas cultivares de porte alto, e os menores, na cultivar Obatã, de porte baixo. Nos cafeeiros das covas com uma planta observou-se maior produção de café e menores concentrações de P, Ca e S do que naqueles das covas com duas plantas. No geral, os cultivares e as populações de cafeeiros estavam com teores de N e S acima dos limites de referência citados na literatura, mas com teores dos demais macronutrientes dentro da faixa adequada