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

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

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

Background: In this study, we aimed to evaluate the effects of tocilizumab in adult patients admitted to hospital with COVID-19 with both hypoxia and systemic inflammation. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]), is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. Those trial participants with hypoxia (oxygen saturation <92% on air or requiring oxygen therapy) and evidence of systemic inflammation (C-reactive protein ≥75 mg/L) were eligible for random assignment in a 1:1 ratio to usual standard of care alone versus usual standard of care plus tocilizumab at a dose of 400 mg–800 mg (depending on weight) given intravenously. A second dose could be given 12–24 h later if the patient's condition had not improved. The primary outcome was 28-day mortality, assessed in the intention-to-treat population. The trial is registered with ISRCTN (50189673) and ClinicalTrials.gov (NCT04381936). Findings: Between April 23, 2020, and Jan 24, 2021, 4116 adults of 21 550 patients enrolled into the RECOVERY trial were included in the assessment of tocilizumab, including 3385 (82%) patients receiving systemic corticosteroids. Overall, 621 (31%) of the 2022 patients allocated tocilizumab and 729 (35%) of the 2094 patients allocated to usual care died within 28 days (rate ratio 0·85; 95% CI 0·76–0·94; p=0·0028). Consistent results were seen in all prespecified subgroups of patients, including those receiving systemic corticosteroids. Patients allocated to tocilizumab were more likely to be discharged from hospital within 28 days (57% vs 50%; rate ratio 1·22; 1·12–1·33; p<0·0001). Among those not receiving invasive mechanical ventilation at baseline, patients allocated tocilizumab were less likely to reach the composite endpoint of invasive mechanical ventilation or death (35% vs 42%; risk ratio 0·84; 95% CI 0·77–0·92; p<0·0001). Interpretation: In hospitalised COVID-19 patients with hypoxia and systemic inflammation, tocilizumab improved survival and other clinical outcomes. These benefits were seen regardless of the amount of respiratory support and were additional to the benefits of systemic corticosteroids. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Some medicinal plant leaves used by Boro (tribal) people of Goalpara district, Assam

88-90North Eastern region of India has abounds in floristic wealth which will depend on proper utilization of plant reserve. The present study is concerned with 31 numbers of plant species leaves, which have been used as medicine for several common diseases like diarrhoea, dysentery, boils, pain, etc. Among the Boro (tribal) people of Goalpara district of Assam

Spin reorientations in Tb-Fe films grown on polyimide substrates

This paper reports the effect of film thickness and rapid thermal annealing on the spin reorientations in Tb-Fe films grown on flexible polyimide substrates. Magnetization studies indicated that the spins reorient from in-plane to out-of-plane direction with increase in film thicknesses. This was confirmed by magnetic force microscopy studies which showed weak featureless contrast for films deposited with lower thickness and a strong out-of-plane contrast for films grown with higher thicknesses. On subsequent rapid thermal annealing all the Tb-Fe films exhibited in-plane magnetic anisotropy. The results were explained based on competition between uniaxial and shape anisotropies, nature of residual stresses as well as nucleation of crystalline Fe phase in an amorphous Tb-Fe matrix on rapid thermal annealing

Geochemical, stable isotopic, palynological characterization of surface dry soils and atmospheric particles over Jodhpur city (Thar Desert, Rajasthan) during peak summer of 2013

Atmospheric dust originating from the Thar Desert (India) acts as the local source of mineral dust in South Asia, spreading over an area of 0.32 x 10(6) km(2). Regional studies conducted during peak boreal summer are required to characterize this mineral dust that blows in form of episodic dust storms towards Indo-Gangetic Plains (IGP), using a multi-tracer approach. To achieve this goal, atmospheric PM10 particles were collected along with surface dry soils between 3 and 11 June, 2013, from in and around the Jodhpur city (26.2389 degrees N, 73.0243 degrees E) to glean elemental composition, stable isotopic and palynological (pollen types) database. Typical crustal elemental ratios, e.g. Si/Al, Ca/Al, Fe/Al, K/Al, Mg/Al, Ti/Al, varied in narrow ranges 8.1 +/- 1.21, 1.02 +/- 1.53, 0.50 +/- 0.14, 0.34 +/- 0.06, 0.19 +/- 0.06 and 0.06 +/- 0.02, respectively. Average Sr/Al, Rb/Al and Zr/Al ratios were found to be 39.70 +/- 12.24, 18.00 +/- 2.0 and 70.83 +/- 13.11 (mu g gm(-1)/wt%), respectively. Average delta C-13, delta N-15, delta S-34 values of surface soils were - 10.5 parts per thousand +/- 4.0, 11.4 parts per thousand +/- 1.6 and 3.6 parts per thousand +/- 2.1, while delta C-13 and delta N-15 of atmospheric PM10 particles varied in ranges - 25.6 parts per thousand +/- 0.67 and 9.9 parts per thousand +/- 1.7, respectively. Observed palynoassemblage indicated the open nature of vegetation that usually grows under warm-humid conditions with traces of few allergens and pathogens. Generated chemical-isotopic-pollen database could be utilized for deciphering origin of dust storms in IGP. Detailed multi-proxy characterization of mineral dust from the Thar Desert can further help to determine its role in influencing air quality and human health

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease