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

Harlequin ichthyosis from birth to 12 years

A neonate was born with generalised, erythrodermic, thick, fissured skin, severe ectropion, hypoplastic auricles and limb abnormalities. A clinical diagnosis of harlequin ichthyosis was made, allowing supportive therapies to be commenced promptly. Oral acitretin was initiated on day 3 of life, complemented by an intensive skin care regimen. Rehydration, prevention and treatment of infection, temperature control and nutritional support were all essential to see him through the neonatal period. Nearly 12 years later, this child continues to receive multidisciplinary input and enjoys a good quality of life.</jats:p

Trimethylaminuria

We report the case of a 9-year-old boy referred to secondary care with an unusual presentation of a fishy odour to his hands, feet, saliva and urine. Laboratory investigations including urine analysis and genetic testing confirmed the diagnosis of trimethylaminuria. The patient was referred to a geneticist and dietician, and consequently treated with dietary modification. He now has an arguably much improved quality of life

Knowledge Management: Creating Competitive Intelligence for the Future

In this knowledge era, the value of corporations, academic organizations and individuals is directly related to their knowledge and intellectual capital(IC). A newand potentially paradigm shift focus in the intersection between knowledge and intelligence is the recognition of the importance of understanding the intellectual capital of organizations. This paper explains how Cochin University of Science and Technology (CUSAT) is identifying and managing its intellectual capital for creating competitive advantage for the future. This paper also explores the different cost effective knowledge management strategies applied at CUSAT for managing its intellectual capitalCUSAT9th International CALIBER - 2013, INFLIBNET Centre, Gandhinagar, Gujarat, March 21-23, 201

IR: Knowledge Creation, Knowledge Management and Knowledge Dissemination

Open access iiiovemerit and open source software movement plays an important role in creation of knowledge, knowledge management and knowledge dissemination. Scholarly communication and publishing are increasingly taking place in the electronic environment. With a growing proportion of the scholarly record now existing only in digital format, serious issues regarding access and preservation are being raised that are central to future scholarship. Institutional Repositories provide access to past. present and future scholarly literature and research documentation; ensures its preservation; assists users in discovery and use; and offers educational programs to enable users to develop lifelong literacy. This paper explores these aspects on how IR of Cochin University of Science & Technology supports scientific community for knowledge creation. knowledge Management, and knowledge dissemination.Cochin University of Science And TechnologyJournal Of Library and Information Management Vol.1 No.1,January -June 2010,PP 38-4

Experiences in a Proprietary and Open Source Software

The Central Library of Cochin University of Science and Technology (CUSAT) has been automated by proprietary software (Adlib Library) since 2000. After 11 years, in 2011, the university authorities decided to shift to an open source software (OSS), for integrated library management system (ILMS), Koha for automating the library housekeeping operations. In this context, this study attempts to share the experiences in cataloging with both type of software. The features of the cataloging modules of both the software are analysed on the badis of certain check points. It is found that the cataloging module of Koha is almost in par with that of proven proprietary software that has been in market for the past 25 years. Some suggestions made by this study may be incorporated for the further development and perfection of Koha.Cochin University of Science & TechnologyDESIDOC Journal of Library & Information Technology, Vol. 34, No. 1, January 2014, pp. 16-2