Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Synthesis of some new 1-(6-fluorobenzothiazol-2-yl)- 3-(4-fluoro- phenyl)-5-arylpyrazolines and their iodine(III) mediated oxidation to corresponding pyra-zoles

1332-1336The reaction of fluorinated chalcones 2 and 6-fluorobenzothiazol-2-ylhydrazine 1 in presence of catalytic amount of glacial acetic acid in refluxing ethanol yields 1-(6-fluorobenzothiazol-2-yl)-3- (4-fluorophenyl)-5-arylpyrazolines 3, which undergo facile oxidation to the corresponding pyrazoles 4 in good yield using iodobenzene diacetate (IBD). The structures of the synthesized compounds have been established on the basis of their elemental analysis, MS and ¹H and ¹³C NMR spectroscopy

Synthesis and NMR spectral studies of some new 1-heteroaryl-5-amino- 3-alkyl/aryl-4-cyanopyrazoles

1426-1430Reaction of heteroarylhydrazines 1 with alkylidenemalononitriles 2 may, in principle, result in the formation of 1-heteroaryl-5-amino-3-alkyl/aryl-4-cyanopyrazoles 3 and/or isomeric I-heteroaryl-3-amino-5-alkyl/aryl-4-cyanopyrazoles 4. However, in the present investigation, only a single isomer 3 has been obtained. The structure of the products has been assigned on the basis of a rigorous analysis of their 1H and 13C NMR spectral data. </span

Water level status of Indian reservoirs: A synoptic view from altimeter observations

International audienceMost of the part of India is already under water-stressed condition. In this regard, the continuous monitoring of the water levels (WL) and storage capacity of reservoirs, lakes, and rivers is very important for the estimation and utilization of water resources effectively. The long term ground observed WL of many of the water bodies is not easily available, which may be very critical for proper water resources management. Satellite radar altimetry is the remote sensing technique, which is being used to study sea surface height for the last three decades. The advancement in radar technology with time has provided the opportunity to exploit the technique to retrieve the WL of inland water bodies. In the current study, an attempt has been made to generate long term time series on WL of around 29 geometrically complicated inland water bodies in India. These water bodies are mainly large reservoirs namely Ban Sagar, Balimela, Bargi, Bhakra, Gandhi Sagar, Hasdeo, Indravati, Jalaput, Kadana, Kolab, Mahi Bajaj, Maithon, Massanjore, Pong, Ramganga, Ranapratap Sagar, Rihand, Sardar Sarovar, Shivaji Sagar, Tilaiya, Ujjani, and Ukai. The WL of these water bodies was retrieved for around two decades using the European Remote-Sensing Satellite - 2 (ERS-2), ENVISAT Radar Altimeter - 2 (ENVISAT RA-2), and Saral-AltiKa altimeters data through Ice-1 retracking algorithm. Further, an attempt has also been made to estimate the WL of gauged/ungauged lakes namely Mansarovar, Pangong, Chilika, Bhopal, and Rann of Kutch over which Saral-AltiKa pass was there. As after July 2016, the SARAL-AltiKa is operating in the drifting orbit, systematic repeated observation of WL data of all reservoirs was not possible. The data of drifted tracks of Saral-AltiKa were tested for WL estimation of Ban Sagar reservoir. As the ERS-2, ENVISAT RA-2 and Saral-AltiKa all were having almost the same passing tracks, a long term WL series of these lakes could be generated from 1997 to 2016. However, at present only Sentinel - 3 is in orbit, the continuous altimeter based WL monitoring of some of these reservoirs (Gandhi Sagar, Nathsagar, Ranapratap, Ujjani, and Ukai) was attempted through Sentinel-3A satellite data from 2016 to 2018. The accuracy of the retrieved WL was than validated against the observed WL. In most of the reservoirs, a systematic bias was found due to the different characteristics and geoid height of each reservoir. The coefficient of determination, R2, value for a majority of reservoirs was as good as 0.9. In the case of ERS-2, the values of R2 varied for 0.44-0.97 with root mean square error (RMSE) in the range of 0.63-2.72 m. These statistics improved with the ENVISAT RA-2 data analysis, the R2 value reached more than 0.90 for around 11 reservoirs. The highest, 0.99, for Hasdeo and Shivaji Sagar Reservoirs with RMSE of 0.44 and 0.56, respectively. Further, the accuracy improved with the analysis of Saral-AltiKa data. The R2 was always more than 0.9 for each reservoir and the lowest RMSE reduced to 0.03. Therefore, it can be said that the accuracy and consistency of WL retrieval through satellite altimetry has improved with time. Furthermore, the altimeter based retrieved WL may be used in hydrological studies and can contribute to better water resources management