Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase

Turbulent Kinetic Energy Distribution of Nutrient Solution Flow in NFT Hydroponic Systems Using Computational Fluid Dynamics

Hydroponics is crucial for providing feasible and economical alternatives when soils are not available for conventional farming. Scholars have raised questions regarding the ideal nutrient solution flow rate to increase the weight and height of hydroponic crops. This paper presents the turbulent kinetic energy distribution of the nutrient solution flow in a nutrient film technique (NFT) hydroponic system using the computational fluid dynamics (CFD) method. Its main objective is to determine the dynamics of nutrient solution flow. To conduct this study, a virtual NFT hydroponic system was modeled. To determine the turbulent kinetic energy distribution in the virtual NFT hydroponic system, we conducted a CFD analysis with different pipe diameters (3.5, 9.5, and 15.5 mm) and flow rates (0.75, 1.5, 3, and 6 L min−1). The simulation results indicate that different pipe diameters and flow rates in NFT hydroponic systems vary the turbulent kinetic energy distribution of nutrient solution flow around plastic mesh pots

Derechos humanos en Paraguay 2003

Índice. Presentación. 1. Análisis socio-político y económico: Análisis de coyuntura sociopolítica / María Lis Rodríguez. Análisis Económico: El sistema económico heredado / Lila Molinier. 2. Derecho a la Vida: Violencia policial, fatales desenlaces / Hugo Valiente. 3. Derecho a la libertad, seguridad personal e integridad física: Tortura: impunidad garantizada / Hugo Valiente. La crisis del sistema penitenciario paraguayo no es nueva / Elizabeth Flores Negri, Hernán Mayor y Jorge Rolón Luna. 4. Derecho a la protección judicial: Estalla la crisis del sistema de justicia / Luis Emilio Escobar Faella. Derecho a las Garantías Judiciales y al Debido Proceso / Alfredo Enrique Kronawetter Zarza. Signo de esperanza de lograr la reparación: la Comisión Verdad y Justicia / Dionisio Gauto y Raquel Talavera. 5. Derecho a la igualdad y a la no discriminación: La igualdad de las mujeres y los desafíos ante el nuevo gobierno / Ofelia Martínez y Myrian González. Institucionalidad de género: El acceso a cargos en la administración de justicia / Carmen Vallejo. Buscando un espacio contra la intolerancia / Grupo de Acción Gay Lésbico (GAG-L). Situación de los migrantes en el país / Tomás Palau Viladesau. La situación de exclusión de las personas con discapacidad en las políticas sociales nacionales / Claudia Pacheco y Martha Horvath. 6. Derecho a la libertad ideológica, religiosa y de conciencia: La objeción de conciencia: 10 años de crecimiento constante / Orlando Castillo Caballero y Enrique Gauto Bozzano. 7. Derecho a la información y a la libertad de expresión: No disminuyen obstáculos para el acceso a información pública / Sindicato de Periodistas del Paraguay (SPP). Libertad de expresión a través de las radios comunitarias / Mirian Candia S. Derechos humanos, sociedad de la información y acceso informacional / Roberto L. Céspedes y Luis Ortiz Sandoval. 8. Derecho a la asociación, reunión y participación: Organizaciones campesinas / Quintin Riquelme. Movimiento sindical: aún mucho por resolver / Roberto Villalba. La participación para la defensa de los derechos / Laura Bareiro. 9. Derechos Políticos: Elecciones generales 2003: avances y retrocesos de la participación ciudadana / Rossana Gómez. 10. Derecho al Desarrollo Sostenible: Pobreza y desigualdad / Domingo M. Rivarola. Un año de intensa "descampesinización" por empobrecimiento / Gladys Fariña. 11. Derecho al Empleo: Un marco normativo global que atienda condiciones particulares / Verónica Serafini Geoghegan y Hugo Royg Aranda. 12. Derecho a la Seguridad Social: El estado del Derecho a la Seguridad Social en Paraguay / José María Amarilla. 13. Derecho a la Salud: Se aguardan medidas en el sector salud / Esperanza Martínez. La reestructuración de los servicios de atención en salud mental / Carlos Portillo. 14. Derecho a la Seguridad Alimentaria: Seguridad alimentaria: cada vez menos segura, cada vez menos alimentaria / Tomás Palau Viladesau. 15. Derecho a la Educación: Desafíos impostergables en Educación / Cristina Coronel y Marta Almada Denis. 16. Derechos Culturales: Cultura: el derecho postergado / Gabriel Lema. 17. Derecho a la Vivienda: El déficit de vivienda crece año a año / Cristina Vila y Ricardo Canese. 18. Derechos de la Infancia y la Adolescencia: Avances que se deben consolidar / Heve Otero. 19. Derechos de los Pueblos Indígenas: Pocos avances para los pueblos indígenas / Andrés Ramírez. 20. Derecho a la Paz y al Desarme: El riesgo de la militarización de los problemas sociales / Orlando Castillo. Víctimas de violencia institucional en las Fuerzas Armadas / María Noguera y Andrés Vázquez. 21. Derecho al Ambiente Sano: La falta de políticas públicas y de instituciones como contraste / Beatriz Silvero. 22. Cumplimiento de Compromisos Internacionales: Aumenta la conciencia ciudadana a favor de una política exterior en pro de los derechos humanos / Raquel Talavera. 23. Temas del Año: Oportunidad para la democracia del Paraguay: implementación y funcionamiento de la Comisión de Verdad y Justicia / Aldo Antonio Pelli. Significativo aumento de la criminalización de las luchas sociales / Marielle Palau y Raquel Talavera. Síntesis General de las recomendaciones. Directorio de organizaciones integrantes de la CODEHUPY

Riociguat treatment in patients with pulmonary arterial hypertension: Final safety data from the EXPERT registry

International audienc

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension (CTEPH) following Phase 3 randomized trials. The EXPosurE Registry RiociguaT in patients with pulmonary hypertension (EXPERT) study was designed to monitor the long-term safety of riociguat in clinical practice. Methods: EXPERT was an international, multicenter, prospective, uncontrolled, non-interventional cohort study of patients treated with riociguat. Patients were followed for at least 1 year and up to 4 years from enrollment or until 30 days after stopping riociguat treatment. Primary safety outcomes were adverse events (AEs) and serious adverse events (SAEs) coded using Medical Dictionary for Regulatory Activities preferred terms and System Organ Classes version 21.0, collected during routine clinic visits and collated via case report forms. Results: In total, 956 patients with CTEPH were included in the analysis. The most common AEs in these patients were peripheral edema/edema (11.7%), dizziness (7.5%), right ventricular (RV)/cardiac failure (7.7%), and pneumonia (5.0%). The most common SAEs were RV/cardiac failure (7.4%), pneumonia (4.1%), dyspnea (3.6%), and syncope (2.5%). Exposure-adjusted rates of hemoptysis/pulmonary hemorrhage and hypotension were low and comparable to those in the long-term extension study of riociguat (Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase-Stimulator Trial [CHEST-2]). Conclusion: Data from EXPERT show that in patients with CTEPH, the safety of riociguat in routine practice was consistent with the known safety profile of the drug, and no new safety concerns were identified

Riociguat treatment in patients with chronic thromboembolic pulmonary hypertension: Final safety data from the EXPERT registry

International audienc

Riociguat treatment in patients with pulmonary arterial hypertension: Final safety data from the EXPERT registry

Objective: The soluble guanylate cyclase stimulator riociguat is approved for the treatment of adult patients with pulmonary arterial hypertension (PAH) and inoperable or persistent/recurrent chronic thromboembolic pulmonary hypertension following Phase 3 randomized trials. The EXPosurE Registry RiociguaT in patients with pulmonary hypertension (EXPERT) study was designed to monitor the long-term safety of riociguat in clinical practice. Methods: EXPERT was an international, multicenter, prospective, uncontrolled, non-interventional cohort study of patients treated with riociguat. Patients were followed for at least 1 year and up to 4 years from enrollment or until 30 days after stopping riociguat treatment. Primary safety outcomes were adverse events (AEs) and serious adverse events (SAEs) coded using Medical Dictionary for Regulatory Activities preferred terms and System Organ Classes version 21.0, collected during routine clinic visits (usually every 3-6 months) and collated via case report forms. Results: In total, 326 patients with PAH were included in the analysis. The most common AEs in these patients were dizziness (11.7%), right ventricular (RV)/cardiac failure (10.7%), edema/peripheral edema (10.7%), diarrhea (8.6%), dyspnea (8.0%), and cough (7.7%). The most common SAEs were RV/cardiac failure (10.1%), pneumonia (6.1%), dyspnea (4.0%), and syncope (3.4%). The exposure-adjusted rate of hemoptysis/pulmonary hemorrhage was 2.5 events per 100 patient-years. Conclusion: Final data from EXPERT show that in patients with PAH, the safety of riociguat in clinical practice was consistent with clinical trials, with no new safety concerns identified and a lower exposure-adjusted rate of hemoptysis/pulmonary hemorrhage than in the long-term extension of the Phase 3 trial in PAH

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research