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

Real Ordenanza de Cavalleria del Reyno : con las ilustraciones correspondientes ... para la mejor instruccion de los tribunales y profesores ... a fin de conseguir el restablecimiento de abundantes crias de cavallos ...

Sign.: [calderón]\p8\s, 2[calderón]\p4\s, 3[calderón]\p2\s, A-Z\p8\s, 2A-2B\p8\s, 2C\p3\sAntepLa h. de grab. xil., esc. nobiliari

Genetic selection for natural disease resistance against brucellosis and foot and mouth disease virus in colombian criollo cattle

IP 2121-12-134-94resistencia natural a las infecciones virales / Albeiro Lopez,Ana E. Arango, Jorge E. Ossa. -- En: Revista;colombiana de ciencias pecuarias. -- Vol. 13, no. 1 (2000); p.37-45. -- ISSN 01200690 -- Caracterizacion de;recursos geneticos autoctonos en Colombia / Olivera AngelM. ...[et al.]'-- en: Revista escuela nacional de;policia general Santander seccional Rafael Reyes. -- No. 3(dic.2001); p.39-40. -- ISSN 0124549X--;Resistencia natural del ganado blanco ojinegro (Bon) a lainfeccion por virus de estomatitis vesicular (Vev) y;rinotraqueitis infecciosa bovina (RIB) / Restrepo S. ... [et al.] -- En: susceptibilidad a los subtipos A24-C;y O1-C de la fiebre aftosa y la capacidad de produccion deIFN,por parte1 (2000); p. 37-45. -- ISSN 01200690;'-- caracterizacion de Recursos geneticos autoctonos en COLombia/ Olivera(BON) / Albeiro Lopez, Ana E.;Arango, Fabio N. Zuluaga, Jose Barrera, Jorge E. Ossa. --En:Iatreia. --Vol. 13, no. 2 (jun. 2000); p.;53-120. -- ISSN 01210793. -- Genotipicacion de la resistencianatural delganado blanco ojinegro (BON) a la;salmonella dublin / Omar A. Saldarriaga, Maria T. Rugeles,JaimeI. Velasquez, Gabriel Bedoya, Gary Adams,;Jorge E. Ossa. -- En: Iatreia. -- vol. 13, no. 2 (jun. 2000);p.53-120. -- ISSN 01210793. -- Caracterizacion;'-- en: Proceedings of the Global Conference On Conservation ofDomestic Animal Genetic Resources (4 : 1998;Aug. 17-21 : Colombia) -- [s.l. : s.n.], 1998 -- p. ; 28 cm. --Ifn mediated restriction of fmdv in bovine;fibroblast / A. Lopez ... [et al.] -- En: International symposium on positive strand RNA visure cm. --;ARTICULO(S) EN REVISTA: Receptores celulares, interferon yapoptosis en laresistencia natural a las;infecciones virales / Albeiro Lopez, Ana E. Arango, JorgeE. Ossa. -- En:Revista colombiana de ciencias;pecuarias. -- Vol. 13 (2000); p. 37-45. -- ISSN 01200690 -'- Biologia molecular y epizootiologia del virus de;la fiebre aftosa / Albeiro Lopez, Ana E. Arango, Jorge E.Ossa.'-- en: Revista colombiana de ciencias;PONENCIAS EN CONGRESO(S): Toward the recovery of criollo cattlein Colombia / M. Olivera Angel. ... [et al.];pecuarias. -- Vol. 13 (2000); p. 37-45. -- ISSN 01200690 -'- Ganado blancoorejinegro (BON): una alternativa;genotipica y fenotipica de la resistencia natural del ganado blanco oreginegro (BON) a la salmonella dublin /;O. A. Saldarriaga, M. T. Rugeles, J. I. Velasquez, G. Bedoya,J.E. Ossa.'-- en: Revista colombiana Ciencias;pecuarias. -- Vol. 12 (sep. 1999); p. 51-52. -- ISSN 01200690--Analisisde resistencia/susceptibilidad al;virus de la fiebre aftosa en el ganado blanco orejinegro (BON)/A. Lopez,... [et al.] -- En: Revista;colombiana ciencias pecuarias. -- Vol. 12 (sep. 1999); p.51-52.-- ISSN 01200690 -- Estructura molecular y;poblacional del ganado criollo Colombiano (GCC) / GabrielBedoya... [et al.] -- En: Revista colombiana;ciencias pecuarias. -- vol. 14, no. 2 (2001); p. 107-125.'-- ISSN 01200690-- Receptores celulares, interferon;y apoptosis en la resistencia natural a las infecciones virales/ AlbeiroLopez, Ana E. Arango, Jorge Ossa. --;para la produccion en Colombia / Albeiro Lopez ... [et al.] --En: Revistacolombiana de ciencias pecuarias.; Vol. 13 (2000 ); p. 37-45. -- ISSN 01200690 -- Receptores celulares, interferon y apoptosis en la;En: Revista colombiana ciencias pecuarias. -- vol. 13, no.1 (2000); p. 14-18. -- ISSN 0120069

Non-motor symptoms burden, mood, and gait problems are the most significant factors contributing to a poor quality of life in non-demented Parkinson's disease patients: Results from the COPPADIS Study Cohort

[Objective] To identify factors related to a poor health-related and global quality of life (QoL) in a cohort of non-demented Parkinson's disease (PD) patients and compare to a control group.[Methods] The data correspond to the baseline evaluation of the COPPADIS-2015 Study, an observational, 5-year follow-up, multicenter, evaluation study. Three instruments were used to assess QoL: (1) the 39-item Parkinson's disease Questionnaire (PDQ-39), (2) a subjective rating of global QoL (PQ-10), and (3) the EUROHIS-QOL 8-item index (EUROHIS-QOL8). Multiple linear regression methods were used to evaluate the direct impact of different variables on these QoL measures.[Results] QoL was worse in PD patients (n = 692; 62.6 ± 8.9 years old, 60.3% males) than controls (n = 206; 61 ± 8.3 years old, 49.5% males): PDQ-39, 17.1 ± 13.5 vs 4.4 ± 6.3 (p < 0.0001); PQ-10, 7.3 ± 1.6 vs 8.1 ± 1.2 (p < 0.0001); EUROHIS-QOL8, 3.8 ± 0.6 vs 4.2 ± 0.5 (p < 0.0001). A high correlation was observed between PDQ-39 and Non-Motor Symptoms Scale (NMSS) (r = 0.72; p < 0.0001), and PDQ-39 and Beck Depression Inventory-II (BDI-II) (r = 0.65; p < 0.0001). For health-related QoL (PDQ-39), non-motor symptoms burden (NMSS), mood (BDI-II), and gait problems (Freezing Of Gait Questionnaire [FOGQ]) provided the highest contribution to the model (β = 0.32, 0.28, and 0.27, respectively; p < 0.0001); whereas mood and gait problems contributed the most to global QoL (PQ-10, β = -0.46 and −0.21, respectively; EUROHIS-QOL8, β = -0.44 and −0.23, respectively).[Conclusions] QoL is worse in PD patients than in controls. Mood, non-motor symptoms burden, and gait problems seem to be the most relevant factors affecting health-related and global perceived QoL in non-demented PD patients.Peer reviewe

Delaying surgery for patients with a previous SARS-CoV-2 infection

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The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease