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

Optimized removal of chloroform and DMDS using synthetic zeolite (Na-P1) and activated carbon composite

International audienceIn this study, pure synthesised zeolite (Na-P1) and synthetic activated carbon were investigated as adsorbents for volatile organic compounds (VOCs) such chloroform and dimethyl disulfide. Here, Na-P1 was synthesised from Illito-Kaolinitic clay of Tejra region (South-east of Tunisia), while a novel activated carbon was synthesised from wooden tongue depressor waste collected from hospitals during the first wave of covid-19 pandemic. The mineralogical properties of raw clay and the synthesized materials were determined using X-ray diffraction (XRD) and Attenuated Total Reflectance-Fourier Transform Infrared (ATR-FTIR) spectroscopy. Morphological characteristics were determined using scanning electron microscopy (SEM), which revealed a high degree of particle size uniformity in Na-P1 zeolite and a well-developed, clearly defined structure in activated carbon. The Na-P1 zeolite shows a high-cation exchange capacity, reaching 279 meq/100 g. BET (N2 adsorption-desorption) analysis reveal a high specific surface area (1511.842 m2/g) and a mean pore volume equal to 0.621 cc/g. A fraction of the synthesised activated carbon has been added to Na-P1 zeolite which enhanced its misopores characteristics, thus increasing its adsorption capacity. Additionally, Kinetic model data are well fitted to pseudo-second order. The Langmuir model provides the best fit for isothermal adsorption equilibrium data, and according to this model, the Na-P1-activated carbon composite demonstrated a maximum adsorption capacity of 54.13 mg/g for chloroform and 28.16 mg/g for dimethyl disulfide

Predicting Farmers’ Willingness to Adopt Liquid Pollination and Polycarbonate Drying House Technologies: A Case Study from the Date Palm Growers in the Sultanate of Oman

The aim of this research paper is to assess the adoption level of the two technologies (liquid pollination and polycarbonate drying houses) in the Sultanate of Oman with emphasis on identifying influencing factors of the adoption process and exploring resulting policy implications. The methodological framework used is based on the implementation of the ADOPT (Adoption and Diffusion Outcome Prediction Tool) tool in two localities of the Sultanate of Oman through focus groups discussion (FGD’s). Empirical findings obtained from the assessment of the Liquid Pollination (LP) technology indicate that peak adoption rate for liquid pollination technology in “North Al Batinah” is high and predicted to be around 95% (of the total population) after a period of 14.5 years. The predicted adoption level after 5 and 10 years from introducing the technology in the region is estimated to be 46.9% and 91.5%, respectively. The assessment of the rate of adoption of the Polycarbonate Drying Houses (PDH) technology and the identification of factors affecting the peak and adoption levels, and constraints that limit the adoption process and widespread of such technology among the date palm growers of Oman indicates that peak adoption rate for PDH technology in the target study region is predicted to be 95% after a period of 21 years. The predicted adoption level after 5 and 10 years is expected to be 23.5% and 72.9%, respectively. The presented results suggest that sustainable increase in date palm productivity can be achieved if farmers are encouraged to adopt the LP and PDH technologies. However, the adoption of such technology needs to be accompanied by a supporting extension system and an enabling policy environment to ensure the scaling-up and widespread use of these promising and profitable technologies

Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study

BackgroundThe frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). ObjectiveThe aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. MethodsA total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. ResultsAt the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. ConclusionsThe NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. Trial RegistrationClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675 International Registered Report Identifier (IRRID)DERR1-10.2196/1226

Epidemiology of heart failure and long-term follow-up outcomes in a north-African population: Results from the NAtional TUnisian REgistry of Heart Failure (NATURE-HF)

International audienceThe NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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