Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years

Ecos de la academia: Revista de la Facultad de Educación, Ciencia y Tecnología - FECYT Nro 6

Ecos de la academia, Revista de la Facultad de Educación Ciencia y Tecnología es una publicación científica de la Universidad Técnica del Norte, con revisión por pares a doble ciego que publica artículos en idioma español, quichua, portugués e inglés. Se edita con una frecuencia semestral con dos números por año.En ella se divulgan trabajos originales e inéditos generados por los investigadores, docentes y estudiantes de la FECYT, y contribuciones de profesionales de instituciones docentes e investigativas dentro y fuera del país, con calidad, originalidad y relevancia en las áreas de ciencias sociales y tecnología aplicada.Modelos multidimensionales del bienestar en contextos de enseñanza- aprendizaje: una revisión sistemática. Nuevas tendencias para el área académica de la Publicidad en la zona 1 del Ecuador. Propuesta de un curso de escritura académica bajo la base de modelos experienciales. Aproximación al estudio de las emociones. Seguimiento a egresados y graduados para actualizar el perfil de egreso y profesional. Impacto de la Gerencia de Calidad en el clima organizacional en Educación Básica. Comunicación efectiva del gerente educativo orientada al manejo de conflictos en el personal docente. Meritocracia: Democratización o exclusión en el acceso a la educación superior en Ecuador. Asertividad y desempeño académico en estudiantes universitarios. La creatividad en la formación profesional. Aspectos metodológicos en el proceso de enseñanza- aprendizaje de la gimnasia en estudiantes de Educación Física. English Language Learning Interaction through Web 2.0 Technologies. La sistematización de la práctica educativa y su relación con la metodología de la investigación. El ozono y la oxigenación hiperbárica: una vía para mejorar la recuperación en lesiones deportivas. La labor tutorial: Independencia del aprendizaje en el contexto universitario. Motivación hacia la profesión docente en la Enseñanza Secundaria. El uso académico de Facebook y WhatsApp en estudiantes universitarios... La educación superior en Ecuador: situación actual y factores de mejora de la calidad. El Proyecto de Investigación “Imbabura Étnica”

GWAS meta-analysis of intrahepatic cholestasis of pregnancy implicates multiple hepatic genes and regulatory elements

Intrahepatic cholestasis of pregnancy (ICP) is a pregnancy-specific liver disorder affecting 0.5–2% of pregnancies. The majority of cases present in the third trimester with pruritus, elevated serum bile acids and abnormal serum liver tests. ICP is associated with an increased risk of adverse outcomes, including spontaneous preterm birth and stillbirth. Whilst rare mutations affecting hepatobiliary transporters contribute to the aetiology of ICP, the role of common genetic variation in ICP has not been systematically characterised to date. Here, we perform genome-wide association studies (GWAS) and meta-analyses for ICP across three studies including 1138 cases and 153,642 controls. Eleven loci achieve genome-wide significance and have been further investigated and fine-mapped using functional genomics approaches. Our results pinpoint common sequence variation in liver-enriched genes and liver-specific cis-regulatory elements as contributing mechanisms to ICP susceptibility

Coloniality and Intersectionality in Social Work Education and Practice

The history of social work education is deeply entangled with the structures of White supremacy and coloniality. Through an analysis of coloniality, the system from which social work operates, this article outlines an alternative framework of intersectionality, which decodes the dominant discourse in relation to power, privilege, White supremacy, and gender oppression. The framework of intersectionality moves professional social work pedagogy and practice from the trenches of coloniality toward decoloniality. The concepts of intersectionality and critical consciousness are operationalized to demonstrate how social work education can effect structural and transformational change through de-linking from its white supremacists roots

Headache-related disability among medical students in Amazon: a cross-sectional study

ABSTRACT Objective To evaluate the prevalence of headache in medical students, and quantify the degree of disability through HIT-6 and MIDAS scale. Method The criteria established by International Headache Society were used and the HIT-6 and MIDAS, to asses disability. Results 140 medical students from UFAM were evaluated. 16.43% cases of migraine headache, 6.43% of probable migraine, and 23.57% of tension headaches were detected. 6.42% reported an absence of headache; and another 11.42% had secondary headache. According to the HIT-6 questionnaire, in 7.14% and 18.57% of the students, headaches were classified as having substantial to severe impact, respectively. Conclusion Migraine and probable migraine had higher scores than the other types of headache and, therefore, led to higher levels of disability. The present study did not find a significant correlation between student semester, age or extracurricular activities on the impact generated by headache

Chapter 19. Battering, Forgiveness, and Redemption: Exploring Alternative Models for Addressing Domestic Violence in Communities of Color

This is a thoughtful and scholarly addition to the unfortunately scarce literature on domestic violence and oppression in all its forms. —Jacquelyn C. Campbell, Anna D. Wolf Chair, Johns Hopkins University School of Nursing An exciting and powerful collection that eloquently critiques some of the current thinking in domestic violence and raises key concerns for advocates and scholars working in the area. —Sujata Warrier, president, board of directors, Manavi: An organization for South Asian women Sokoloff has assembled an impressive array of authors who challenge us to `think outside of our contemporary domestic violence box.\u27 —Angela M. Moore Parmley, chief, violence and victimization research division, National Institute of Justice This groundbreaking anthology reorients the field of domestic violence research by bringing long-overdue attention to the structural forms of oppression in communities marginalized by race, ethnicity, religion, sexuality, or social class. Reprints of the most influential recent work in the field as well as more than a dozen newly commissioned essays explore theoretical issues, current research, service provision, and activism among Latinos, African Americans, Asian Americans, Jewish Americans, and lesbians. The volume rejects simplistic analyses of the role of culture in domestic violence by elucidating the support systems available to battered women within different cultures, while at the same time addressing the distinct problems generated by that culture. Together, the essays pose a compelling challenge to stereotypical images of battered women that are racist, homophobic, and xenophobic. The most up-to-date and comprehensive picture of domestic violence available, this anthology is an essential text for courses in sociology, criminology, social work, and women\u27s studies. Beyond the classroom, it provides critical information and resources for professionals working in domestic violence services, advocacy, social work, and law enforcement.https://digitalcommons.wcl.american.edu/facsch_bk_contributions/1266/thumbnail.jp

Chapter 19. Battering, Forgiveness, and Redemption: Exploring Alternative Models for Addressing Domestic Violence in Communities of Color

This is a thoughtful and scholarly addition to the unfortunately scarce literature on domestic violence and oppression in all its forms. —Jacquelyn C. Campbell, Anna D. Wolf Chair, Johns Hopkins University School of Nursing An exciting and powerful collection that eloquently critiques some of the current thinking in domestic violence and raises key concerns for advocates and scholars working in the area. —Sujata Warrier, president, board of directors, Manavi: An organization for South Asian women Sokoloff has assembled an impressive array of authors who challenge us to `think outside of our contemporary domestic violence box.\u27 —Angela M. Moore Parmley, chief, violence and victimization research division, National Institute of Justice This groundbreaking anthology reorients the field of domestic violence research by bringing long-overdue attention to the structural forms of oppression in communities marginalized by race, ethnicity, religion, sexuality, or social class. Reprints of the most influential recent work in the field as well as more than a dozen newly commissioned essays explore theoretical issues, current research, service provision, and activism among Latinos, African Americans, Asian Americans, Jewish Americans, and lesbians. The volume rejects simplistic analyses of the role of culture in domestic violence by elucidating the support systems available to battered women within different cultures, while at the same time addressing the distinct problems generated by that culture. Together, the essays pose a compelling challenge to stereotypical images of battered women that are racist, homophobic, and xenophobic. The most up-to-date and comprehensive picture of domestic violence available, this anthology is an essential text for courses in sociology, criminology, social work, and women\u27s studies. Beyond the classroom, it provides critical information and resources for professionals working in domestic violence services, advocacy, social work, and law enforcement.https://digitalcommons.wcl.american.edu/facsch_bk_contributions/1266/thumbnail.jp