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

A indisciplina do retrato : do circunstancial ao relacional

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Uma escrita de instantâneos

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Sentidos do fotográfico : campo, mediação, receção

The overwhelming proliferation of images and of its multiple hybrid forms are significant phenomena of contemporary visual culture. In this scenario of imagery conflagration, stimulated by the recent innovations in image and communication technologies, but also by the softening of the medium specificities in the field of arts, we believe that it is essential to rethink the visual nature and horizon that it is radiated from each mean of representation. In this sense, this dissertation aims at a comprehensive and transmedia reflection on photography, as a representation device and as a category linked to the experience of perception, imagination and memory. We are interested to inquire the qualities, migrations and articulations of what we define as the photographic, a notion that cannot be confined to the field of photography because it comprises modes of perceiving, thinking and imagining that have become transversal to several image genres, genealogies and practices – from painting to photography, through cinema and video, and more recent by the “new” images associates to the digital devices.The themes and works analysed throughout the dissertation aim to sustain the idea that in this critical context – between the technological supplanting and the undifferentiated and indiscernible dispersion of the properties of photography – we have been witnessing impetus of reconfiguration and reinvention of the medium that reinforce the value of the photographic as a peculiar substance, bound to a aesthetical and visual regime that articulates aspects linked to the experience of reality, the experience of time, to the possibilities of a play with the appearances in which its projective, speculative and mnemonic competences remain necessary and strongly active and that, in a certain sense, emphasize the imagery level of reception and the (free, creative, imaginative, critical) place that is still possible to allocate to the contemporary spectator, before the art, before the world

Jovens e idosos : contextos, interacções e redes de suporte : com enfoques no exemplo metropolitano de Cascais

Intervenção social. - ISSN 0874-1611. - N. 20 (1999). - p. 57-78.Este artigo, tomando como referência o trabalho de diagnóstico social que a equipa do CEIA tem vindo a desenvolver no Concelho de Cascais, procura decifrar configurações, efeitos e dinâmicas das políticas sociais de âmbito local no que respeita aos "suportes geracionais ": em relação aos Jovens, o objectivo principal tem sido o de conhecer, descrever e interpretar a complexidade de relações entre contextos escolares e contextos familiares e os respectivos papéis que os agentes educativos desempenham nos processos de socialização; em relação aos idosos, intimamente ligada às conhecidas tendências de envelhecimento crescente da população, constituiu objectivo principal, a sistematização e interpretação simultânea dos perfis da população idosa inserida nas redes de suporte formal e institucional e dos perfis dos idosos que não frequentam este modelo de apoio institucional

Um horizonte de proximidades : Uma topologia a partir da Coleção António Cachola

" With the title A Horizon of Proximities, a Topology from the António Cachola Collection, the show is structured in a sequence of segments, which aim to explore the articulations between the different works and the architectonic and symbolic circumstances of the exhibition spaces within Arquipélago – Contemporary Art Center. " -- Publisher's website