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Management of the global crisis of the coronavirus disease 2019 pandemic requires detailed appraisal of evidence to support clear, actionable, and consistent public health messaging. The use of cloth masks for general public use is being debated, and is in flux. We searched the MEDLINE and EMBASE databases and Google for articles reporting the filtration properties of flat cloth or cloth masks. We reviewed the reference lists of relevant articles to identify further articles and identified articles through social and conventional news media. We found 25 articles. Study of protection for the wearer used healthy volunteers, or used a manikin wearing a mask, with airflow to simulate different breathing rates. Studies of protection of the environment, also known as source control, used convenience samples of healthy volunteers. The design and execution of the studies was generally rigorously described. Many descriptions of cloth lacked the detail required for reproducibility; no study provided all the expected details of material, thread count, weave, and weight. Some of the homemade mask designs were reproducible. Successful masks were made of muslin at 100 threads per inch (TPI) in 3 to 4 layers (4-layer muslin or a muslin-flannel-muslin sandwich), tea towels (also known as dish towels), made using 1 layer (2 layers would be expected to be better), and good-quality cotton T-shirts in 2 layers (with a stitched edge to prevent stretching). In flat-cloth experiments, linen tea towels, 600-TPI cotton in 2 layers, and 600-TPI cotton with 90-TPI flannel performed well but 80-TPI cotton in 2 layers did not. We therefore recommend cotton or flannel at least 100 TPI, at least 2 layers. More layers, 3 or 4, will provide increased filtration but there is a trade-off in that more layers increases the resistance to breathing. Although this is not a systematic review, we included all the articles that we identified in an unbiased way. We did not include gray literature or preprints. A plain language summary of these data and recommendations, as well as information on making, wearing and cleaning cloth masks is available at www.clothmasks.ca.

Diabetes is a multisystem disorder associated with a nearly twofold excess risk for a broad range of adverse cardiovascular outcomes including coronary heart disease, stroke, and cardiovascular death. Liraglutide is a human glucagon-like peptide receptor analog approved for use in patients with type 2 diabetes mellitus (T2DM). To formally assess the cardiovascular safety of liraglutide, the Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome Results (LEADER) trial was commenced in 2010. LEADER is a phase 3B, multicenter, international, randomized, double-blind, placebo-controlled clinical trial with long-term follow-up. Patients with T2DM at high risk for cardiovascular disease (CVD) who were either drug naive or treated with oral antihyperglycemic agents or selected insulin regimens (human NPH, long-acting analog, or premixed) alone or in combination with oral antihyperglycemics were eligible for inclusion. Randomized patients are being followed for up to 5 years. The primary end point is the time from randomization to a composite outcome consisting of the first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. LEADER commenced in September 2010, and enrollment concluded in April 2012. There were 9,340 patients enrolled at 410 sites in 32 countries. The mean age of patients was 64.3 ± 7.2 years, 64.3% were men, and mean body mass index was 32.5 ± 6.3 kg/m2. There were 7,592 (81.3%) patients with prior CVD and 1,748 (18.7%) who were high risk but without prior CVD. It is expected that LEADER will provide conclusive data regarding the cardiovascular safety of liraglutide relative to the current standard of usual care for a global population of patients with T2DM.

In this trial, patients with CKD (with or without type 2 diabetes) were randomly assigned to receive dapagliflozin or placebo. The primary composite outcome — a sustained decline in the estimated GFR of at least 50%, end-stage kidney disease, or death from renal or cardiovascular causes — was less frequent with dapagliflozin.

In a randomized, controlled trial, liraglutide (a glucagon-like peptide 1 receptor agonist) or placebo was added to usual care in patients with type 2 diabetes. In secondary analyses, rates of development and progression of diabetic kidney disease were lower with liraglutide.

This open-label trial randomly assigned patients with IgA nephropathy to supportive care or supportive care plus immunosuppression. The added immunosuppression did not significantly improve outcomes; more adverse events occurred, with no change in the rate of decrease in eGFR. IgA nephropathy is the most common form of glomerulonephritis. 1 Several findings support the use of immunosuppressive therapy to target mesangial IgA deposits and circulating IgA autoantibodies. 2 The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines regarding IgA nephropathy recommend treatment with a blocker of the renin–angiotensin system (i.e., an angiotensin-converting–enzyme inhibitor or an angiotensin II–receptor blocker) in patients who have proteinuria with urinary protein excretion of more than 1 g per day. 3 – 5 The KDIGO guidelines also suggest the use of systemic glucocorticoids in patients who have a proteinuria level above 1 g of urinary protein excretion per day and a . . .

Patients with type 2 diabetes and high cardiovascular risk were assigned to receive either the glucagon-like peptide 1 analogue liraglutide or placebo. The rate of first occurrence of cardiovascular death, nonfatal MI, or nonfatal stroke was lower with liraglutide. Type 2 diabetes is a complex metabolic disorder that is characterized by hyperglycemia and associated with a high risk of cardiovascular, microvascular, and other complications. 1 , 2 Although glycemic control is associated with reductions in the risk of microvascular complications, the macrovascular benefits of glycemic control are less certain. Furthermore, concern has been raised about the cardiovascular safety of antihyperglycemic therapies. 3 Consequently, regulatory authorities have mandated cardiovascular safety assessments of new diabetes treatments. 4 , 5 Liraglutide, an analogue of human glucagon-like peptide 1 (GLP-1), 6 has been approved for the treatment of type 2 diabetes. Its efficacy in lowering glucose levels has been . . .

Patients are often advised to reduce sodium and potassium intake, but supporting evidence is limited. To help provide such evidence we estimated 24h urinary sodium and potassium excretion in 28,879 participants at high cardiovascular risk who were followed for a mean of 4.5 years in the ONTARGET and TRANSCEND trials. The primary outcome was eGFR decline of 30% or more or chronic dialysis. Secondary outcomes were eGFR decline of 40% or more or chronic dialysis, doubling of serum creatinine or chronic dialysis, an over 5%/year loss of eGFR, progression of albuminuria, and hyperkalemia. Multinomial logit regression with multivariable fractional polynomials, adjusted for confounders, determined the association between urinary sodium and potassium excretion and renal outcomes, with death as a competing risk. The primary outcome occurred in 2,052 (7.6%) patients. There was no significant association between sodium and any renal outcome (primary outcome odds ratio 0.99; 95% CI 0.89–1.09 for highest [median 6.2g/day] vs. lowest third [median 3.3g/day]). Higher potassium was associated with lower odds of all renal outcomes (primary outcome odds ratio 0.74; 95% CI 0.67–0.82 for highest [median 2.7g/day] vs. lowest third [median 1.7g/day], except hyperkalemia nonsignificant. Thus, urinary potassium, but not sodium, excretion predicted clinically important renal outcomes. Our findings do not support routine low sodium and potassium diets for prevention of renal outcomes in people with vascular disease with or without chronic kidney disease.

Statins reduce cardiovascular events in persons with type 2 diabetes mellitus. This study randomly assigned patients with type 2 diabetes receiving hemodialysis to receive 20 mg of atorvastatin per day or matching placebo. Atorvastatin reduced all cardiac events combined but not all cerebrovascular events combined or total mortality. In patients with type 2 diabetes receiving hemodialysis and 20 mg of atorvastatin per day, atorvastatin reduced all cardiac events combined but not all cerebrovascular events combined or total mortality. Primary and secondary prevention trials, including those involving persons with diabetes mellitus, have documented substantial cardiovascular benefit from the administration of statins. 1 , 2 The recent Collaborative Atorvastatin Diabetes Study (CARDS) reported a decrease in deaths from cardiovascular causes among persons with type 2 diabetes mellitus in the absence of marked renal insufficiency. 3 There are no prospective data on the effects of statins in patients with end-stage renal disease with type 2 diabetes mellitus who are receiving hemodialysis, although type 2 diabetes is the most common diagnosis among patients at excessive risk of cardiovascular events 4 whose condition requires hemodialysis in both . . .

In animals with experimentally induced renal disease, drugs that inhibit angiotensin-converting enzyme reduce glomerular-capillary pressure, inhibit renal cellular growth, and reduce glomerular-capillary permeability to protein, thus reducing proteinuria and preventing the development of glomerulosclerosis. 1 – 4 Whether this protective effect also occurs in humans is less clear. In patients with diabetes and incipient nephropathy, angiotensin-converting–enzyme inhibitors prevent the progression from microalbuminuria to proteinuria, 5 , 6 whereas in patients with overt nephropathy, these drugs provide protection against a deterioration in renal function, an effect that is independent of their antihypertensive properties. 7 Small studies suggest that the drugs may have a similar kidney-protecting effect . . .

Experimental and observational studies suggest that vitamin E may reduce the risk of cardiovascular (CV) events and of microvascular complications in people with diabetes. However, data from randomized clinical trials are limited. Therefore, we evaluated the effects of vitamin E supplementation on major CV outcomes and on the development of nephropathy in people with diabetes. The Heart Outcomes Prevention Evaluation (HOPE) trial is a randomized clinical trial with a 2 x 2 factorial design, which evaluated the effects of vitamin E and of ramipril in patients at high risk for CV events. Patients were eligible for the study if they were 55 years or older and if they had CV disease or diabetes with at least one additional coronary risk factor. The study was designed to recruit a large number of people with diabetes, and the analyses of the effects of vitamin E in this group were preplanned. Patients were randomly allocated to daily treatment with 400 IU vitamin E and with 10 mg ramipril or their respective placebos and were followed for an average of 4.5 years. The primary study outcome was the composite of myocardial infarction, stroke, or CV death. Secondary outcomes included total mortality, hospitalizations for heart failure, hospitalizations for unstable angina, revascularizations, and overt nephropathy. There were 3,654 people with diabetes. Vitamin E had a neutral effect on the primary study outcome (relative risk = 1.03, 95% CI 0.88-1.21; P = 0.70), on each component of the composite primary outcome, and on all predefined secondary outcomes. The daily administration of 400 IU vitamin E for an average of 4.5 years to middle-aged and elderly people with diabetes and CV disease and/or additional coronary risk factor(s) has no effect on CV outcomes or nephropathy.