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

Απόψεις εκπαιδευτικών πρωτοβάθμιας για την κοινωνική ένταξη μαθητών με σοβαρά προβλήματα όρασης

Η παρούσα διπλωματική εργασία αποτελεί αντικείμενο διερεύνησης των αντιλήψεων των εκπαιδευτικών πρωτοβάθμιας αναφορικά με την ένταξη των μαθητών με οπτική αναπηρία σε τάξεις των σχολείων γενικής εκπαίδευσης. Αρχικά, γίνεται λόγος για την ένταξη στην εκπαίδευση στο γενικό της φάσμα και στην συνέχεια αναλύεται η συμβολή της ενταξιακής εκπαίδευσης και ιδίως οι τρόποι που μπορεί να αναπτυχθεί στα πλαίσια οργάνωσης της εκπαίδευσης των παιδιών με οπτική αναπηρία. Επιπλέον, γίνεται εκτενής αναφορά στα εμπόδια και στις δυσκολίες που αντιμετωπίζουν οι μαθητές με οπτική αναπηρία τόσο σε εκπαιδευτικό όσο και σε κοινωνικό επίπεδο. Γίνεται αντιληπτό ότι το ζήτημα της ενταξιακής εκπαίδευσης είναι μεγάλης σημασίας καθώς παρέχονται περισσότερες ευκαιρίες για τους μαθητές να ενταχθούν σε μία αποτελεσματική διαδικασία μάθησης και να κοινωνικοποιηθούν σωστά. Τέλος, εξετάζεται η κοινωνική και συναισθηματική ανάπτυξη των παιδιών με οπτική αναπηρία και ιδιαίτερα η κοινωνική στήριξη που παρέχεται εντός εκπαιδευτικού πλαισίου, η οποία συμβάλλει στην αντιμετώπιση των δυσκολιών που δημιουργούν συχνά εμπόδια τόσο στην κοινωνικοποίηση όσο και στη μαθησιακή επίδοση. Λέξεις κλειδιά: στάσεις εκπαιδευτικών, ενταξιακή εκπαίδευση, οπτική αναπηρία, κοινωνική ένταξη, κοινωνική στήριξη.This dissertation is intended to investigate the perceptions of primary school teachers regarding the inclusion of visually impaired students in general education schools. Initially, there is talk of inclusion in education in its general scope, and then the contribution of integration education is analyzed, and in particular the ways in which it can be developed in the context of organizing the education of visually impaired children. In addition, extensive reference is made to the barriers and difficulties faced by visually impaired students, both educationally and socially. It is understood that the issue of inclusive education is of great importance as more opportunities are provided for students to integrate into an effective learning process and to be socialized properly. Finally, the social and emotional development of children with visual impairments is examined, and in particular the social support provided within the educational context, which helps to address the difficulties that often create obstacles in both socialization and learning performance. Keywords: teacher attitudes, integration education, visual impairment, social inclusion, social support

Percutaneous Endoscopic Gastro-Jejunostomy (PEGJ): Could Drug Administation be the Only Indication for Insertion? The Levodopa/Carbidopa Infusion Treatment Experience. A Retrospective Evaluation of the Method

Enteral feeding is the preferred means of nutritional support in patients unable to eat normally. Percutaneous endoscopic gastro-jejunostomy (PEGJ) is widely used in such cases. It is also accepted that medication will be administered through the tube. In patients with severe Parkinson’s disease, a continuous delivery system of levodopa/carbidopa, formulated as a gel suspension (Duodopa®), reaches the small intestine through a jejunostomy and represents an alternative treatment method. The continuous release results in less variability in levodopa serum concentrations and fewer motor fluctuations and dyskinesias compared to oral administration. The method requires a very good collaboration between neurologists and gastroenterologists and is used in specializing centers in patients as mentioned with severe disease. A modified percutaneous endoscopic gastrostomy (PEG) kit is placed under sedation. This allows the passage of a pig tail catheter which is advanced to the jejunum and a portable pump is attached on it through a specially designed tubing system. This is the only case, known to us, where PEGJ is inserted for drug administration. We present our experience of nine cases (7 males, 2 females, mean age 72.4 years) with a follow up of up to five years. In three patients the tubing system had to be changed; the first it was accidentally pulled out, the second because of bezoar formation around the intragastric part of the tube and the third because of knot formation at the intragastric part of the jejunal tube. At the end of this five year period, all patients agreed that the neurological benefit was welcome and they had all come in terms with the undoubted difficulties the procedure causes