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

Vejiga neurogénica no neurogénica (síndrome de Hinman). Dos tratamientos diferentes a un mismo problema

ResumenEl síndrome de vejiga neurogénica no neurogénica, también conocido como síndrome de Hinman, es una entidad rara caracterizada por disfunción vesical miccional no neurogénica. Su diagnóstico es hecho por exclusión y se asigna a aquellos niños que tienen las características clínicas, radiológicas y urodinámicas de una vejiga neurogénica con disinergia del esfínter externo, pero sin evidencia de una alteración neurológica. Hinman y Baumann fueron los primeros en reportar en 1973, una serie de 14 casos de síndrome de vejiga neurogénica no neurogénica. Hinman y Baumann trataron a dichos pacientes con reeducación vesical e hipnosis. Estableciéndose que el reentrenamiento vesical y el tratamiento médico son efectivos para su manejo, sin embargo cuando ya hay un daño establecido al sistema urinario superior o está en riesgo, el tratamiento conservador se deja de lado y se prefiere un tratamiento quirúrgico. Debido a la baja incidencia de la enfermedad, aún no hay un consenso sobre el tratamiento o manejo más adecuado, por lo que es indispensable describir cada caso en lo posible para ayudar a generar el conocimiento que favorezca al mejor tratamiento de los pacientes con síndrome de Hinman.Presentamos de manera simultánea 2 casos de pacientes masculinos de 10 y 12 años de edad con síndrome de Hinman, en quienes el tratamiento conservador no fue suficiente, ya que ellos presentaban un daño en el sistema urinario superior, siendo sometidos a tratamiento quirúrgico individualizado de acuerdo a cada caso. De esta manera describimos 2 soluciones diferentes para un mismo problema con buenos resultados.AbstractNonneurogenic neurogenic bladder, also known as Hinman syndrome, is a rare entity characterized by nonneurogenic urinary bladder dysfunction. It is a diagnosis of exclusion and is assigned to those children that present with clinical, radiologic, and urodynamic characteristics of a neurogenic bladder with external sphincter dyssynergia, but with no evidence of any neurologic alteration. In 1973, Hinman and Baumann were the first to report a case series of 14 children with nonneurogenic neurogenic bladder and treated these patients with bladder reeducation and hypnosis. Bladder re-training and medical treatment have been recognized as effective management. However, when there is established damage to the upper urinary system, or risk thereof, surgery is preferred over conservative treatment. Due to the low incidence of the disease, there is still no consensus as to the most adequate treatment or management, making it essential to describe every case possible in order to gain the necessary knowledge for providing the best treatment for patients with this syndrome.We present the cases of two boys with Hinman syndrome, 10 and 12 years old, for whom conservative treatment was not sufficient given that they already presented with upper urinary system damage. They underwent successful surgical treatment that was individualized for each case, resulting in 2 different solutions for the same problem

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Background: Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods: Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results: This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p &lt; 0.01. Conclusion: A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed. © 2021, The Author(s)