Dapagliflozin in patients with critical illness: rationale and design of the DEFENDER study

BACKGROUND

Critical illness is a major ongoing health care burden worldwide and is associated with high mortality rates. Sodium-glucose cotransporter-2 inhibitors have consistently shown benefits in cardiovascular and renal outcomes. The effects of sodium-glucose cotransporter-2 inhibitors in acute illness have not been properly investigated.

METHODS

DEFENDER is an investigator-initiated, multicenter, randomized, open-label trial designed to evaluate the efficacy and safety of dapagliflozin in 500 adult participants with acute organ dysfunction who are hospitalized in the intensive care unit. Eligible participants will be randomized 1:1 to receive dapagliflozin 10mg plus standard of care for up to 14 days or standard of care alone. The primary outcome is a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and intensive care unit length of stay, up to 28 days. Safety will be strictly monitored throughout the study.

CONCLUSION

DEFENDER is the first study designed to investigate the use of a sodium-glucose cotransporter-2 inhibitor in general intensive care unit patients with acute organ dysfunction. It will provide relevant information on the use of drugs of this promising class in critically ill patients.

CLINICALTRIALS.GOV REGISTRY

NCT05558098.

[Analysis of maternal mortality in the municipality of Ribeirao Preto -- SP-- in 1991-1995]

This study aims at learning about and identifying the causes leading to maternal death. Data were obtained from the Ribeirão Preto Committee for Studies and Prevention of Maternal Death and from obituaries. It is an exploratory study in which 72 maternal deaths occurring in Ribeirão Preto were analyzed from 1991 to 1995. In 1995, the maternal death rate was 60.3 in 100,000 births, with the predominance of avoidable causes, such as hemorrhage (33.3%), other causes (26.4%), hypertension (15.3%), abortion (11.1%), infection (8.3%) and puerperium (5.6%). Maternal death is a public health problem which must be faced by government authorities.

[Positive and negative aspects of prenatal care in the district of Ribeirao Preto]

This study had the purpose to identify the positive and negative aspects of pre natal care at the public health system of the city of Ribeirão Preto-SP, considering users and health professionals' opinions. Authors used a qualitative approach and found some improvements regarding pre-natal care such as: the proximity of the Health Unit, the improvement of physical and human resources structures and the opening of places for the obstetrics unit. Despite these positive aspects, authors were unable to find a hospital reference at the different levels of the Unified Health System. Results also showed a lack of articulation among prenatal, birth and puerperium periods.

[Who are the women who seek prenatal care in the health units of Ribeirao Preto and why do they do it?]

The present article presents the sociological analysis of the nursing profession, focussing the specificities of the profession on the basis of the component elements of a profession, according to the theoretical system of the sociology of professions. At the end of the 20th century and the beginning of the new millennium, nursing faces crucial questions for the profession, which bring back the need to restructure the strategic considerations that make up the political agenda of the nursing profession. Specific knowledge, professional qualification, particularities of the work process, monopoly of the professional exercise, and the configuration of the hierarchy of the nursing team are some of the items dealt within this article. As one of the essential professions in the health area, nursing needs to reach the next century with a new perspective, knowing how and in which conditions it will develop in a context of paradigmatic changes. Considering this new context, a political agenda for nursing professionals will have to contemplate the several aspects that make up a profession, that is, specific knowledge, exclusive labor market, form of organization, among others.

[Precariousness of records of prenatal care in a basic health unit in the city of Ribeirao Preto-SP]

This survey aimed at characterizing the population of pregnant women utilizing prenatal care services of a Basic Health Unit in the city of Ribeirão Preto, São Paulo, Brazil in July 1995 and analyzing the records of the service given to pregnant women who went to this Unit in terms of general and specific anamnesis, general and tocogynecological physical examination and the diagnostic procedures used in this service. The records showed a lack of information about patients' general and specific anamnesis, general and tocogynecological physical examination and clinical condition, characterizing a more ritualistic procedure. Therefore, records did not meet the objectives proposed by the Program for Comprehensive Women Health Care of the Ribeirão Preto City Health Department with the São Paulo State Health Department and the Health Ministry: to ensure good quality in women's care service regarding their clinical, gynecological, obstetric and mental needs; to identify, prevent, and control risk factors which may affect women's health; to diagnose and treat women's pathologies as soon as possible, among others.

[The indicators for a restructuring of the nursing degree curriculum: the expectations of professionals and a curriculum assessment by former students]

Two kinds of evidence were used to guide curriculum changes in the Nursing School of Ribeirão Preto (University of São Paulo): 1) a survey of nurses' expectations on their profession, their functions, the other members of the team and on the Nursing School teachers; 2) graduates' (ex-students) curriculum evaluation. We inquired 115 nurses working in 5 general hospitals of Ribeirão Preto, and had a return of 49 questionnaires (42.6%). This questionnary was delivered by the authors personally to the nurses, along with guidances on answering and date for return, and had 9 opened questions. The classification of answers makes possible to assert: the assistance function is the most emphasized by nurses; the student's expectations change during the professional practice; 60% of the informants considered the content of the curriculum disciplines adequate; 69.4% considered the habilitations dispensable.

[What do young people know about sexually transmitted diseases?]

Os autores realizaram um trabalho de levantamento para avaliar o grau de conhecimento sobre as Doenças Sexualmente Transmitidas (DST), entre jovens, durante uma Feira de Nutrição e Saúde (FENUSA), destinada a alunos da rede de ensino de Ribeirão Preto. A população constou de 924 estudantes com idade superior a12 anos, de ambos os sexos, pertencentes às diversas classes sócio-econômicas e com nível de escolaridade variado. Nesse estudo pode-se observar que muitos dos estudantes desconhecem ainda tais doenças e outros apresentam conhecimentos inadequados.