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

La creación de los nuevos intelectuales: investigación etnohistórica y construcción de una comunidad en el sur rural de Texas

Este articulo describe los hallazgos de los rasgos historicos de! Valle Bajo del Rio Grande, presta atencion especial a la igualdad educativa y, al mismo tiempo, sostiene que los nuevos lideres latinos gozan de una formacion caracterizada.por la tendencia creciente a usar metodos de investigacion etnohistorica para preparar a la juventud para los desafios de! futuro. El fundamento de esta posicion estriba en que la etnohistoria proporciona lideres latinos con la vision y la capacidad necesarias para superar obstaculos educativos y economicos. Ademis, este articulo sugiere que lo que hace la investigacion etnohistorica es aumentar el descubrimiento y la concienciacion de los lideres tenien­do en cuenta sus propios valores intelectuales y economicos

Critical Ethnography for the Study of Immigrants

We can argue that, in a strictly historical sense, the first critical ethnographies were constructed by the oppressed… In a strict and more technical sense, critical ethnography has deep roots in psychological anthropology, and it was later relined in sociology and philosophy with the seminal work of Paulo Freire. The ideas of early anthropologists to improve the schooling and overall human development of all children were revealed in a conference held at Stanford University on 9- 14 June 1954, organized by George Spindler. Renowned scholars such as Solorn T. Kimball, Alfred L. Kroeber, Dorothy Lee, Margaret Mead, Felix M. Keesing, John Gillin, and Cora DuBois shared their concerns relating to the overall development of all children, the preparation of ethnically diverse children, and the need to pursue pedagogically appropriate methods of teaching (Spindler 1955).https://digitalcommons.chapman.edu/education_books/1093/thumbnail.jp