Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Attitude of Nurses towards Care of Elderly People in Teaching Hospitals of Kathmandu Valley

Introduction: Globally, the numbers of elderly population are increasing which is one of the challenges for nurses in health care setting. Nurses' attitude towards elderly people is associated to quality of care they provide. &#x0D; Objective To identify attitude of nurses towards care of elderly people in teaching hospitals of Kathmandu valley. &#x0D; Methodology A cross sectional research design was used to identify attitude of nurses towards care of elderly people. Proportionate stratified random sampling technique was used to select 450 nurses. Ethical approval was taken from Institutional Review Board of Nepal Health Research Council. Data collection was done from 17 April 2017 to 16 April 2018 by using self-administrative questionnaire on socio-demographic characteristics and Multi-factorial Attitude Questionnaires (MAQ) to measure attitude. Data analysis was done using descriptive and inferential statistics. &#x0D; Results The study revealed that 55.3% of respondents had negative attitude and 44.7% had positive attitude towards care of elderly people. There was significant association between age, marital status, studied geriatric nursing and work experiences in nursing with attitudes of nurses. However, there is no association found of ethnicity, religion, type of family, living with elderly, education and currently working with elderly with attitudes of nurses. &#x0D; Conclusion From these findings, it is concluded that about more than half of the nurses had negative attitude towards care of elderly. Gerontological nursing course plays significant role in the attitude of nurses. Therefore, it should be given continuity in all level of nursing education for providing quality care of elderly people.</jats:p

Oral toxicity evaluation of probiotic strains isolated from Finger millet [Eleusine coracana (L.) Gaertn.] in Wistar rat models (in vivo)

This study evaluates the oral toxicity of five probiotic strains recently isolated from fermented flour of finger-millet (Eleusine coracana) varieties of Sri Lanka. Probiotic strains; Lactobacillus plantarum MF405176, Lactobacillus fermentum MF033346, Lactococcus lactis subspecies lactis MF480428, Enterococcus faecium MF480431and Pediococcus acidilactici MF480434 were evaluated for acute and sub-chronic oral toxicity in Wistars.  Three individual doses (108 CFU/g, 1010 CFU/g and 1012 CFU/g) of each probiotic strain at single oral dose of 5000 mg/kg bw were orally administered to rats and observations were done till 14th day. Since no animals demonstrated signs of toxicity as a result of the administrated probiotics strains, repeated dose sub-chronic oral toxicity study was conducted by oral administration of three doses (108 CFU/g, 1010 CFU/g, 1012 CFU/g) of each probiotic strain at 1000 mg/kg bw/day for consecutive 90 days. Administration of probiotic strains to rats did not caused mortality in any of the tested doses. No changes in animal behavior, feed or water intake and negative effects on body weight observed. Probiotic feeding did not cause changes in analyzed biochemical and hematological parameters attributed to toxicity. Bacteremia, bacterial translocation and histopathological changes in rat organs were not observed. No significant difference in liver enzymes observed in treatment groups compared to control. In conclusion, all tested probiotic strains are nonpathogenic therefore could be considered as safe for human consumption.</jats:p