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

Design of a Circularly Polarized Implantable Monopole Antenna for Biomedical Application

A circularly polarized monopole antenna has been proposed in this paper for implantable biomedical application. The monopole antenna is designed as an inverted ‘Y’ structure with unequal arm lengths (L1 and L2). The inverted ‘Y’ structure helps to achieve compactness and the difference in length between two arms causes the circular polarization (CP). This proposed antenna has been fed with co-planar waveguide (CPW) and it shows the near omnidirectional radiation pattern with gain of -6 dB at 2.45 GHz operating frequency. 4.41% axial ratio bandwidth defines the circular polarization property of the antenna. Specific absorption rate for a single layered human skin model is also obtained

Oxygen deficiency induced nickel based oxides for UV & IR sensitive photo-conductive devices

Ni(NO3)(3)center dot 6H(2)O has been thermally decomposed to synthesize NiOx (0 < x < 1) and a modified citrate-nitrate route has been employed for LaNiO3-delta synthesis. These metal oxides have been characterized by XRD, SEM, TEM, XPS and UV-vis spectroscopy for the determination of their crystal structures, structural morphologies, oxidation states and optical band gaps. The devices, made of nanocrystalline-composites or nanocomposites, have been fabricated on gold coated soda lime glasses, where the device based on NiOx has been found applicable for UV photo-conducting and LaNiO3-delta has been recognized as a potential IR photo-conducting sensors. Their respective current amplifications have been recorded 8 and 2.2 times more than the dark current at 2 V of DC bias. The UV sensor has been explained by direct band gap semiconducting nature of NiOx and IR sensitivity of LaNiO3-delta was explained in terms oxygen deficiency induced band gap opening