Browsing by Subject "ASIA"

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  • CVD-REAL Investigators Study Grp; Khunti, Kamlesh; Kosiborod, Mikhail; Kim, Dae Jung; Eriksson, Johan G.; Fenici, Peter (2021)
    Background Randomized, controlled cardiovascular outcome trials may not be fully representative of the management of patients with type 2 diabetes across different geographic regions. We conducted analyses of data from the multinational CVD-REAL consortium to determine the association between initiation of sodium-glucose cotransporter-2 inhibitors (SGLT-2i) and cardiovascular outcomes, including subgroup analyses based on patient characteristics. Methods De-identified health records from 13 countries across three continents were used to identify patients newly-initiated on SGLT-2i or other glucose-lowering drugs (oGLDs). Propensity scores for SGLT-2i initiation were developed in each country, with 1:1 matching for oGLD initiation. In the matched groups hazard ratios (HRs) for hospitalization for heart failure (HHF), all-cause death (ACD), the composite of HHF or ACD, myocardial infarction (MI) and stroke were estimated by country, and pooled using a weighted meta-analysis. Multiple subgroup analyses were conducted across patient demographic and clinical characteristics to examine any heterogeneity in treatment effects. Results Following matching, 440,599 new users of SGLT-2i and oGLDs were included in each group. Mean follow-up time was 396 days for SGLT-2i initiation and 406 days for oGLDs initiation. SGLT-2i initiation was associated with a lower risk of HHF (HR: 0.66, 95%CI 0.58-0.75; p < 0.001), ACD (HR: 0.52, 95%CI 0.45-0.60; p < 0.001), the composite of HHF or ACD (HR: 0.60, 95%CI 0.53-0.68; p < 0.001), MI (HR: 0.85, 95%CI 0.78-0.92; p < 0.001), and stroke (HR: 0.78, 95%CI 0.72-0.85; p < 0.001); regardless of patient characteristics, including established cardiovascular disease, or geographic region. Conclusions This CVD-REAL study extends the findings from the SGLT-2i clinical trials to the broader setting of an ethnically and geographically diverse population, and across multiple subgroups. Trial registration NCT02993614
  • Chan, Juliana C. N.; Paldanius, Päivi M.; Mathieu, Chantal; Stumvoll, Michael; Matthews, David R.; Del Prato, Stefano (2021)
    We analysed glycaemic durability (sustained glycaemic control) with early combination therapy (metformin plus vildagliptin) versus metformin monotherapy, among patients with type 2 diabetes diagnosed before (young-onset [YOD]) and after (late-onset [LOD]) the age of 40 years, enrolled in the VERIFY trial. The primary endpoint was time to initial treatment failure (TF), defined as HbA1c of 7.0% or higher at two consecutive scheduled visits after randomization. The time to secondary TF was assessed when both groups were receiving and failing on the combination. A total of 186 (9.3%) patients had YOD and 1815 (90.7%) had LOD with a mean age difference of 20.4 years. Compared with metformin monotherapy, early combination reduced the risk of time to initial TF for both YOD (48%,P<.0006) and LOD (46%,P<.0001). With early combination, risk for time to secondary TF was reduced by 48% (P<.0035) in YOD and 24% (P<.0009) in LOD. Both treatment approaches were well tolerated with no unexpected safety concerns. In treatment-naive patients with YOD (HbA1c 6.5%-7.5%), an early combination strategy improved attainment of the glycaemic target with durability and delayed treatment escalation compared with initial metformin monotherapy.
  • Irfan, Furqan B.; Bhutta, Zain Ali; Castren, Maaret; Straney, Lahn; Djarv, Therese; Tariq, Tooba; Thomas, Stephen Hodges; Alinier, Guillaume; Al Shaikh, Loua; Owen, Robert Campbell; Al Suwaidi, Jassim; Shuaib, Ashfaq; Singh, Rajvir; Cameron, Peter Alistair (2016)
    Background: Out-of-hospital cardiac arrest (OHCA) studies from the Middle East and Asian region are limited. This study describes the epidemiology, emergency health services, and outcomes of OHCA in Qatar. Methods: This was a prospective nationwide population-based observational study on OHCA patients in Qatar according to Utstein style guidelines, from June 2012 to May 2013. Data was collected from various sources; the national emergency medical service, 4 emergency departments, and 8 public hospitals. Results: The annual crude incidence of presumed cardiac OHCA attended by EMS was 23.5 per 100,000. The age sex standardized incidence was 87.8 per 100,000 population. Of the 447 OHCA patients included in the final analysis, most were male (n = 360, 80.5%) with median age of 51 years (IQR = 39-66). Frequently observed nationalities were Qatari (n = 89, 19.9%), Indian (n = 74, 16.6%) and Nepalese (n = 52, 11.6%). Bystander cardiopulmonary resuscitation (CPR) was carried out in 92 (20.6%) OHCA patients. Survival rate was 8.1% (n = 36) and multivariable logistic regression indicated that initial shockable rhythm (OR 13.4, 95% CI 5.4-33.3, p = 0.001) was associated with higher odds of survival while male gender (OR 0.27, 95% CI 0.1-0.8, p = 0.01) and advanced cardiac life support (ACLS) (OR 0.15, 95% CI 0.04-0.5, p = 0.02) were associated with lower odds of survival. Conclusions: Standardized incidence and survival rates were comparable to Western countries. Although expatriates comprise more than 80% of the population, Qataris contributed 20% of the total cardiac arrests observed. There are significant opportunities to improve outcomes, including community-based CPR and defibrillation training. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
  • the AANZDEM and EuroDEM study groups; Kelly, Anne-Maree; Van Meer, Oene; Laribi, Said (2020)
    Background: Exacerbations of chronic obstructive pulmonary disease (COPD) are common in emergency departments (ED). Guidelines recommend administration of inhaled bronchodilators, systemic corticosteroids and antibiotics along with non-invasive ventilation (NIV) for patients with respiratory acidosis. Aim: To determine compliance with guideline recommendations for patients treated for COPD in ED in Europe (EUR) and South East Asia/Australasia (SEA) and to compare management and outcomes. Methods: In each region, an observational prospective cohort study was performed that included patients presenting to ED with the main complaint of dyspnoea during three 72-h periods. This planned sub-study included those with an ED primary discharge diagnosis of COPD. Data were collected on demographics, clinical features, treatment, disposition and in-hospital mortality. We determined overall compliance with guideline recommendations and compared treatments and outcome between regions. Results: A total of 801 patients was included from 122 ED (66 EUR and 46 SEA). Inhaled bronchodilators were administered to 80.3% of patients, systemic corticosteroids to 59.5%, antibiotics to 44 and 60.6% of patients with pH Conclusion: Compliance with guideline recommended treatments, in particular administration of corticosteroids and NIV, was sub-optimal in both regions. Improved compliance has the potential to improve patient outcome.
  • Matthews, David R.; Del Prato, Stefano; Mohan, Viswanathan; Mathieu, Chantal; Vencio, Sergio; Chan, Juliana C. N.; Stumvoll, Michael; Paldanius, Päivi M. (2020)
  • Yoo, Soon-Jib; Chang, Sang-Ah; Sohn, Tae Seo; Kwon, Hyuk-Sang; Lee, Jong Min; Moon, Sungdae; Proot, Pieter; Paldanius, Päivi M.; Yoon, Kun Ho (2021)
    We assessed the glycaemic durability with early combination (EC; vildagliptin+metformin [MET], n=22) versus MET monotherapy (n=17), among newly-diagnosed type 2 diabetes mellitus (T2DM) enrolled (between 2012 and 2014) in the VERIFY study from Korea (n=39). Primary endpoint was time to initial treatment failure (TF) (glycosylated hemoglobin [HbA1c]>= 7.0% at two consecutive scheduled visits after randomization [end of period 1]). Time to second TF was assessed when both groups were receiving and failing on the combination (end of period 2). With EC the risk of initial TF significantly reduced by 78% compared to MET (n=3 [15%] vs. n=10 [58.7%], P=0.0228). No secondary TF occurred in EC group versus five patients (29.4%) in MET. Patients receiving EC treatment achieved consistently lower HbA1c levels. Both treatment approaches were well tolerated with no hypoglycaemic events. In Korean patients with newly diagnosed T2DM, EC treatment significantly and consistently improved the long-term glycaemic durability as compared with MET.
  • Paoli, Gary D.; Carlson, Kimberly M.; Hooijer, Aljosja; Page, Susan E.; Curran, Lisa M.; Wells, Philip L.; Morrison, Ross; Jauhiainen, Jyrki; Pittman, Alice M.; Gilbert, David; Lawrence, Deborah (2011)
  • Lazkov, Georgy A.; Sennikov, Alexander N. (2017)
    The taxonomic applications of two species names of Iris subgen. Scorpiris, I. albomarginata R.C. Foster and I. willmottiana Foster, are clarified. These species are confirmed to be taxonomically separate, and they are redescribed and mapped for the first time. Both species are endemic to the Western Tian-Shan. Iris albomarginata has evenly pale-blue flowers and occurs in the Ugam and Pskem Ranges (Uzbekistan, Kazakhstan), whereas I. willmottiana has blue flowers with white-blotched blades of the outer segments of the perianth and occurs in the Karatau and Boralday Ranges, and also in the northern part of the Talas Range (Kazakhstan, Kyrgyzstan). Iris willmottiana is reported as new to Kyrgyzstan. An identification key for blue-flowered juno irises of the Western Tian-Shan is provided.