Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.

Abstract BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)

Mechanical properties of dental restorative materials: relative contribution of laboratory tests Propriedades mecânicas dos materiais dentários restauradores: contribuição relativa dos ensaios laboratoriais

A wide variety of dental products that are launched on the market becomes the correct selection of these materials a difficult task. Although the mechanical properties do not necessarily represent their actual clinical performance, they are used to guide the effects of changes in their composition or processing on these properties. Also, these tests might help somehow the clinician to choose once comparisons between former formulations and new ones, as well as, with the leading brand, are highlighted by manufactures. This paper presents a review of the most important laboratory tests. In this manner, the knowledge of these tests will provide a critical opinion related to the properties of different dental materials.<br>Uma grande variedade de produtos odontológicos que são lançados no mercado faz da seleção do material uma difícil tarefa. Apesar das propriedades mecânicas não representarem necessariamente o seu real desempenho clínico, os testes são utilizados para orientar os efeitos das alterações das composições do material ou a evolução das suas propriedades. Além disso, estas propriedades podem ajudar o clínico de alguma forma na seleção correta, uma vez que a comparação entre as formulações anteriores e as mais recentes, assim como as líderes de mercado são mais destacadas pelos fabricantes. Este artigo apresenta uma revisão dos testes laboratoriais mais importantes. Desta forma, o conhecimento destes ensaios fornecerá uma opinião crítica relacionada às propriedades dos diferentes materiais dentários

Obstetricians' knowledge of periodontal disease as a potential risk factor for preterm delivery and low birth weight

There is little information about the knowledge and attitudes of physicians regarding oral care. This study aimed to assess the knowledge and attitudes of obstetricians about the relationship between periodontal disease and preterm/low birth weight. A questionnaire was emailed to members of the Brazilian Federation of Gynecology and Obstetrics (FEBRASGO). The questionnaire elicited both personal information and knowledge and attitudes regarding the relationship between periodontal diseases and preterm labor. A total of 875 obstetricians responded to the questionnaire. The majority of respondents were female (54.1%), resided in the Southeast (45.6%), worked in both the public and private sectors (61.4%), and had over 15 years of experience in obstetrics (48.9%). A large proportion of obstetricians (93.4%) stated that bacteria were associated with periodontal disease, and 94% reported that periodontitis was a condition more severe than gingivitis. In total, over 80% of participating obstetricians reported smoking, preeclampsia, bacterial vaginosis and periodontal disease as risk factors or possible risk factors for preterm birth or low birth weight. A correlation between the experience of the obstetricians and referral of their patients for dental examinations (p < 0.001) was observed. Also, obstetricians who had had their own dental visits more recently were more likely to recommend the same for their patients (p < 0.001). It is concluded that, although obstetricians were aware of the association between gingival inflammation and adverse obstetric outcomes, the attitudes of these professionals were not in agreement with their apparent knowledge regarding periodontal diseases and their possible repercussions