Prevalence And Clinical Significance Of Potential Drug-drug Interactions In Diabetic Patients Attended In A Tertiary Care Outpatient Center, Brazil

The aim of this study is to investigate the prevalence of potential drug-drug interactions (PDDIs), as well as classifying them in relation to level of severity, scientific evidence, time of onset, and potential clinical impact in adult and older adult patients with diabetes mellitus 2 (DM2). This cross-sectional study was conducted in a tertiary care outpatient center. The consecutive sample was made up of 140 patients with DM2. The Anatomical-Therapeutic-Chemical Classification was used for classifying the classes of medications. The PDDIs were analyzed using the DRUG-REAXA (R) system. The relationships between PDDI and the associated factors were ascertained using a multiple logistic regression model. The prevalence of total PDDI was 75 %, and the prevalence of major severity PDDI was 20.7 %. Simvastatin (30.8 %), captopril/enalapril (12.8 %), and oral anti-diabetics/insulin (12.8 %) were the medications which were most involved in the major PDDI, bringing relevant potential clinical impacts such as rhabdomyolysis, hyperkalemia, and important glycemic alterations. Polypharmacy was associated with PDDI (adjusted odds ratio = 10.46, 95 % confidence interval = 4.10-26.71). Diabetics were highly exposed to clinically significant PDDI. It is important that health professionals should be aware of the risks related to PDDI, so that measures may be implemented in order to assure safe care for the patient.36328328

On network backbone extraction for modeling online collective behavior

Collective user behavior in social media applications often drives several important online and offline phenomena linked to the spread of opinions and information. Several studies have focused on the analysis of such phenomena using networks to model user interactions, represented by edges. However, only a fraction of edges contribute to the actual investigation. Even worse, the often large number of non-relevant edges may obfuscate the salient interactions, blurring the underlying structures and user communities that capture the collective behavior patterns driving the target phenomenon. To solve this issue, researchers have proposed several network backbone extraction techniques to obtain a reduced and representative version of the network that better explains the phenomenon of interest. Each technique has its specific assumptions and procedure to extract the backbone. However, the literature lacks a clear methodology to highlight such assumptions, discuss how they affect the choice of a method and offer validation strategies in scenarios where no ground truth exists. In this work, we fill this gap by proposing a principled methodology for comparing and selecting the most appropriate backbone extraction method given a phenomenon of interest. We characterize ten state-of-the-art techniques in terms of their assumptions, requirements, and other aspects that one must consider to apply them in practice. We present four steps to apply, evaluate and select the best method(s) to a given target phenomenon. We validate our approach using two case studies with different requirements: online discussions on Instagram and coordinated behavior in WhatsApp groups. We show that each method can produce very different backbones, underlying that the choice of an adequate method is of utmost importance to reveal valuable knowledge about the particular phenomenon under investigation

Governance in the implementation of the UN sustainable development goals in higher education : global trends

Governance is a key component for implementing sustainable development (SD) initiatives in university teaching, research, and projects. This line of thinking also applies to implementing the United Nations (UN) sustainable development goals (SDGs). Despite the role of governance in guiding processes related to the SDGs, few studies have examined these relations in an integrative manner in higher education. To bridge this knowledge gap, this study assesses the connections between governance and implementing the SDGs at higher education institutions (HEIs). Specifically, it relies on two main methods. The first is a bibliometric analysis, where the literature on the topic has been analyzed. The second method uses case studies from a sample of universities. The combined dual approach has identified the extent to which governance issues influence how these organizations perceive and handle the SDGs. The study provides valuable recommendations that may assist HEIs in implementing the SDGs with a due emphasis on governance.peer-reviewe

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