Reno-protective effects of renin–angiotensin system blockade in type 2 diabetic patients: a systematic review and network meta-analysis

AIMS/HYPOTHESIS: This meta-analysis aimed to compare the renal outcomes between ACE inhibitor (ACEI)/angiotensin II receptor blocker (ARB) and other antihypertensive drugs or placebo in type 2 diabetes. METHODS: Publications were identified from Medline and Embase up to July 2011. Only randomised controlled trials comparing ACEI/ARB monotherapy with other active drugs or placebo were eligible. The outcome of end-stage renal disease, doubling of serum creatinine, microvascular complications, microalbuminuria, macroalbuminuria and albuminuria regression were extracted. Risk ratios were pooled using a random-effects model if heterogeneity was present; a fixed-effects model was used in the absence of heterogeneity. RESULTS: Of 673 studies identified, 28 were eligible (n = 13-4,912). In direct meta-analysis, ACEI/ARB had significantly lower risk of serum creatinine doubling (pooled RR = 0.66 [95% CI 0.52, 0.83]), macroalbuminuria (pooled RR = 0.70 [95% CI 0.50, 1.00]) and albuminuria regression (pooled RR 1.16 [95% CI 1.00, 1.39]) than other antihypertensive drugs, mainly calcium channel blockers (CCBs). Although the risks of end-stage renal disease and microalbuminuria were lower in the ACEI/ARB group (pooled RR 0.82 [95% CI 0.64, 1.05] and 0.84 [95% CI 0.61, 1.15], respectively), the differences were not statistically significant. The ACEI/ARB benefit over placebo was significant for all outcomes except microalbuminuria. A network meta-analysis detected significant treatment effects across all outcomes for both active drugs and placebo comparisons. CONCLUSIONS/INTERPRETATION: Our review suggests a consistent reno-protective effect of ACEI/ARB over other antihypertensive drugs, mainly CCBs, and placebo in type 2 diabetes. The lack of any differences in BP decrease between ACEI/ARB and active comparators suggest this benefit is not due simply to the antihypertensive effect

Cryo-electron tomography of cells: connecting structure and function

Cryo-electron tomography (cryo-ET) allows the visualization of cellular structures under close-to-life conditions and at molecular resolution. While it is inherently a static approach, yielding structural information about supramolecular organization at a certain time point, it can nevertheless provide insights into function of the structures imaged, in particular, when supplemented by other approaches. Here, we review the use of experimental methods that supplement cryo-ET imaging of whole cells. These include genetic and pharmacological manipulations, as well as correlative light microscopy and cryo-ET. While these methods have mostly been used to detect and identify structures visualized in cryo-ET or to assist the search for a feature of interest, we expect that in the future they will play a more important role in the functional interpretation of cryo-tomograms

(13)N-ammonia myocardial perfusion imaging with a PET/CT scanner: impact on clinical decision making and cost-effectiveness

PURPOSE: The purpose of the study is to determine the impact of 13N-ammonia positron emission tomography (PET) myocardial perfusion imaging (MPI) on clinical decision making and its cost-effectiveness. MATERIALS AND METHODS: One hundred consecutive patients (28 women, 72 men; mean age 60.9 +/- 12.0 years; range 24-85 years) underwent 13N-ammonia PET scanning (and computed tomography, used only for attenuation correction) to assess myocardial perfusion in patients with known (n = 79) or suspected (n = 8) coronary artery disease (CAD), or for suspected small-vessel disease (SVD; n = 13). Before PET, the referring physician was asked to determine patient treatment if PET would not be available. Four weeks later, PET patient management was reassessed for each patient individually. RESULTS: Before PET management strategies would have been: diagnostic angiography (62 of 100 patients), diagnostic angiography and percutaneous coronary intervention (PCI; 6 of 100), coronary artery bypass grafting (CABG; 3 of 100), transplantation (1 of 100), or conservative medical treatment (28 of 100). After PET scanning, treatment strategies were altered in 78 patients leading to: diagnostic angiography (0 of 100), PCI (20 of 100), CABG (3 of 100), transplantation (1 of 100), or conservative medical treatment (76 of 100). Patient management followed the recommendations of PET findings in 97% of the cases. Cost-effectiveness analysis revealed lower costs of 206/patient as a result of PET scanning. CONCLUSION: In a population with a high prevalence of known CAD, PET is cost-effective and has an important impact on patient management

Estratégia saúde da família no tratamento de doenças crônico-degenerativas: avanços e desafios Estrategia de salud de la familia en el tratamiento de las enfermedades crónico-degenerativas: logros y retos Family health strategy in the treatment of chronic-degenerative diseases: achievements and challenges

Estudo retrospectivo, exploratório, de natureza quantitativa realizado em uma Equipe de Saúde da Família (ESF) no município de Maringá, Estado do Paraná, Brasil, com o objetivo de avaliar a efetividade da ESF no tratamento de doenças crônico-degenerativas. Foram utilizados dados do período de maio de 2006 a setembro de 2009, de 94 pacientes portadores de hipertensão arterial sistêmica e/ou diabetes mellitus, por meio da análise do sistema de acompanhamento de hipertensos e diabéticos e prontuários. Foi verificado um pequeno aumento no número de indivíduos com valores de pressão arterial (p = 0,773) e glicemia de jejum (p = 0,745) considerados adequados, no período analisado; apesar das mudanças na farmacoterapia destes pacientes e acompanhamento domiciliar. Conclui-se que apenas alterações na farmacoterapia prescrita são insuficientes para o controle adequado destas enfermidades, sendo necessário o desenvolvimento de intervenções da equipe de saúde, que promova a prática do autocuidado nos indivíduos e seus familiares.<br>Estudio retrospectivo, exploratorio, cuantitativo desarollado en un Equipo de Salud de la Familia (ESF) en la ciudad de Maringá, Paraná, Brasil, con lo objetivo de evaluar la eficacia de la ESF en el tratamiento de las enfermedades crónicas. Se utilizaron dados recogidos entre mayo de 2006 y septiembre de 2009, de 94 pacientes con hipertensión arterial y/o diabetes mellitus, mediante el análisis de los registros del sistema de control de hipertensos y diabéticos y registros. Se observó ligero incremento en el número de individuos con presión arterial (p = 0,773) y glucosa en sangre en ayunas (p = 0,745) considerados adecuados, en el periodo analizado; pesar de los cambios en la farmacoterapia y cuidados en el hogar. Se concluye que solamente cambios en la farmacoterapia no son suficientes para un adecuado control destas enfermedades, siendo necesario el desarrollo de intervenciones de la ESF, que promuevan la práctica de autocuidado en las personas y sus familias.<br>A retrospective, exploratory, quantitative study was carried in a team of heath care unit (ESF) in the municipalitie of Maringá, Paraná, Brasil, to evaluate the effectiveness of ESF in the treatment of chronic diseases. It was used data collected between May 2006 to September 2009, of 94 patients with hypertension and/or diabetes, through the analysis of the records of registration of the monitoring system of hypertensive and diabetics and charts. It was found a slight increase in the number of individual with blood pressure (p = 0.773) and fasting glucose levels (p = 0.745) considered appropriate, in the reporting period; despite changes in the pharmacotherapy of patients and home care. It was concluded that only changes in the pharmacotherapy prescribed, are insufficient for an adequate control of these diseases, being necessary the development of interventions of the health team, which promote the practice of self-care in individuals and their families

Risk factors in patients with type 2 diabetes mellitus Factores de riesgo en pacientes con diabetes mellitus tipo 2 Fatores de risco em pacientes com diabetes mellitus tipo 2

This study was carried out to evaluate the risk factors of type 2 diabetic patients through sociodemographic data, habits of health, anthropometric and biochemist profiles, assisted at a basic public health care unit in Maringá, Paraná. Sixty-six patients, 56 women aged over than 50 years-old were interviewed. High prevalence factors for cardiovascular risk were observed, such as: overweight and obesity, hypertension, dyslipidemia, sedentariness and inadequate diet. Data suggested the need for multidisciplinary intervention programs in health care units associated to educative programs, adjusted diet intake and regular physical activity for these diabetic patients.<br>El objetivo de este estudio fue verificar los factores de riesgo de las complicaciones de la diabetes mellitus tipo 2, por medio del levantamiento de datos sociodemográficos, hábitos de salud, perfil antropométrico y bioquímico, de pacientes diabéticos tipo 2 atendidos en una Unidad Básica de Salud en la ciudad de Maringá, Paraná. Fueron entrevistados y evaluados 66 pacientes con más de 50 años; 56 eran del sexo femenino. Se verificó una elevada presencia de factores de riesgo cardiovascular en los pacientes investigados: sobrepeso y obesidad, hipertensión, dislipidemia, sedentarismo y dieta no saludable. Los resultados indican la necesidad de la implantación de programas de intervención multidisciplinares en unidades básicas de la salud asociada a prácticas educativas, estimulando la adopción de una dieta saludable y la práctica de actividad física regular para estos pacientes.<br>O objetivo deste estudo foi verificar os fatores de risco das complicações do diabetes mellitus tipo 2, por meio de levantamento de dados sociodemográficos, hábitos de saúde, perfil antropométrico e bioquímico de pacientes diabéticos tipo 2, atendidos em Unidade Básica de Saúde, na cidade de Maringá, Paraná. Foram entrevistados e avaliados 66 pacientes acima de 50 anos, sendo 56 do sexo feminino. Verificou-se elevada prevalência de fatores de risco cardiovascular nos pacientes investigados: sobrepeso e obesidade, hipertensão, dislipidemia, sedentarismo e dieta não saudável. Os resultados indicam a necessidade da implantação de programas de intervenção multidisciplinares em unidades básicas de saúde, associados a práticas educativas, estimulando a adoção de dieta saudável e a prática de atividade física regular para esses pacientes

Data for: Learning Analytics in European Higher Education-Trends and Barriers

This dataset contains responses to an institutional survey that investigated existing learning analytics initiatives, institutional infrastructures for learning analytics, adopted strategies and policies for learning analytics, considerations of legal and ethical issues, existing evaluation frameworks, and evaluations of the engagement of key stakeholders (i.e., teaching staff, students, and managers), success of learning analytics, institutional culture, data and research capabilities, legal and ethical awareness, and existing training