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

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Not AvailableThe study has examined the impact of Water Users Associations (WUAs) on efficiency, equity and reliability in canal irrigation. The economic and data envelopment analyses have been carried out to measure the profitability and technical efficiency among the participating and non-participating farms. Reliability scores are developed to assess the reliability of canal water and Garrett ranking technique has been used to find constraints to participation in WUAs. The overall participation in WUAs has been found satisfactory and the participation increases as farm-size increases. However, the inputs and technical know-how supply has been found weak. The number of canal irrigation application and yield realization are higher on participating than non-participating farms. The participating farms are technically more efficient in crop production than the non-participating farms. The reliability scores for irrigation management parameters are more for participating than non-participating farmers. The lack of unity, cooperation and interest among water users has been found to be the most limiting factor, followed by the inequity in water allocation for the active participation in the WUAs. To realize the full benefits of scarce canal water resource, efforts should be directed towards enhancing participation of all sections of the farming community in WUAs. The WUAs should be multifunctional to facilitate the timely supply of good quality agricultural inputs along with irrigation water management.Not Availabl

Does Adoption of Soil and Water Conservation Practice Enhance Productivity and Reduce Risk Exposure? Empirical Evidence from Semi-Arid Tropics (SAT), India

This paper assessed the impact of soil and water conservation practices on farm productivity and risk exposure using data from 1204 plots in the semiarid tropics of India. A probit model was used to assess the determinants of adoption of soil bunds. We employed a moment-based approach for estimating crop revenue, its variability and downside risk exposure, i.e., crop failure. Furthermore, we also used a doubly robust method for assessing the impact of soil bunds on crop revenue, its variability and downside risk. Matching and propensity-based methods were also used to check robustness. The results show that training, access to credit and extension services are key determinants of adoption of soil bunds. Furthermore, the results also suggest that soil bunds not only improve the crop revenue but also reduce its variability. Most interestingly, we show that soil bunds also reduce the chances of downside risk, i.e., crop failure. Therefore, in view of increasing climate change and variability in the semiarid tropics, it can be suggested that soil bunds could be an important adaptation strategy for improving productivity and reducing risk exposure. This paper supports the investment in soil and water conservation technologies for sustaining the livelihood of resource-poor farmers of ecologically fragile regions such as the semiarid tropics

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Not AvailableTank irrigation is an important source of irrigation in rainfed region and has a less investment structure with few environmental problems. Despite several economic and environmental benefits, the performance of tanks has been poor due to lack of proper management and weak community participation. For effective management, the factors which affect the farmer’s participation need to be assessed. The study was undertaken in Andhra Pradesh and required data was collected through primary survey from farmers in Ananthapur and Chittor district for the agricultural year 2016-17. Principal component analysis and regression analysis were employed to analyze the data. The most important factors affecting farmer’s participation were farmer’s perceptions related to the water management system, tank structure, water accessibility and financial arrangement, explaining 72.8% of farmer’s participation in tank irrigation management. Further, level of farmers’ participation in tank irrigation management depends on increase in the net sown area, an increase in the need of irrigation water and cultivation of high water requirement crops, absence of membership in other organizations and increase in family size.Not Availabl

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Not AvailableEffects of high temperature stress during terminal stage on crop growth and genetic parameters were investigated in 18 advanced breeding lines and 4 varieties of Indian mustard [Brassica juncea (L.) Czernj. & Cosson] under normal (E1) and late sown (E2) conditions. Genotypes BPR 538-10 showed terminal heat tolerance for biological yield/plant, seed yield/plant, total dry matter (60 days after sowing (DAS)), crop growth rate (CGR) and relative growth rate (4060 DAS) and heat use efficiency while RH 0216 possessed terminal heat stress tolerance only for biological yield/plant. Terminal heat stress decreased heat use efficiency by 16.1% in BPR-538-10 to 66.3% in BPR-327-1-B. Heat use efficiency had high PCV and moderate GCV under E1.The seed yield/plant exhibited significant and positive association with leaf area index (LAI) at 40 days after sowing (r= 0.434*), CGR during 40–60 DAS (r = 0.592* *), total dry matter at 60 DAS (r = 0.590* *), and heat use efficiency (0.795* *) under high temperature stress. The study suggested that rapid leaf area development resulting in to high total dry matter production is vital for developing suitable varieties against terminal heat stress.Not Availabl

Insomnia in the elderly—A hospital-based study from North India

AbstractBackground/PurposeInsomnia affects the elderly population significantly. The Indian elderly population is growing rapidly and the epidemiology of insomnia needs to be studied in detail in this group.MethodsAn observational study was carried out using a standard questionnaire on 304 male and 200 female Indian elderly patients presenting to the geriatric clinic of the Sir Sunderlal Hospital of the Institute of Medical Sciences, Banaras Hindu University, to study the prevalence and nature of insomnia in this population. The mean age of the study group was 66.47 (±6.855) years. The distribution of insomnia in the various groups (based on sex, occupation, residence, habit-forming substance use, depression) was compared using the Chi-square test with SPSS version 16.0.ResultsInsomnia was present in 32% of the study population. A statistically significant association was found between increasing age and insomnia (p = 0.035) but no significant sex differences were appreciable (p = 0.173). Early insomnia was found to be the most common pattern of insomnia identified (39% of total affected). Most of the cases were of chronic insomnia (89.45%) and associated with some comorbidity (100%). Cardiovascular diseases were the most common comorbidity (27.3% of patients with insomnia). Further, positive and statistically significant correlation was found between insomnia and the place of living (p = 0.034), habit-forming substance use (p = 0.045) and depression (p < 0.001).ConclusionThe nature and attributes of insomnia in the Indian elderly are identified by this study. The scope for cause-finding studies is highlighted and points regarding adequate intervention are suggested

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Not AvailableEffects of high temperature stress during terminal stage on crop growth and genetic parameters were investigated in 18 advanced breeding lines and 4 varieties of Indian mustard [Brassica juncea (L.) Czernj. & Cosson] under normal (E1) and late sown (E2) conditions. Genotypes BPR 538-10 showed terminal heat tolerance for biological yield/ plant, seed yield/plant, total dry matter 60 days after sowing (DAS), crop growth rate (CGR) and relative growth rate (40- 60 DAS) and heat use efficiency while RH 0216 possessed terminal heat stress tolerance only for biological yield/plant. Terminal heat stress decreased heat use efficiency by 16.1% in BPR-538-10 to 66.3% in BPR-327-1-B. Heat use efficiency had high PCV and moderate GCV under E1. The seed yield/ plant exhibited significant and positive association with leaf area index (LAI) at 40 days after sowing (r= 0.434*), CGR during 40-60 DAS (r = 0.592* *), total dry matter at 60 DAS (r = 0.590* *), and heat use efficiency (0.795* *) under high temperature stress. The study suggested that rapid leaf area development resulting in to high total dry matter production is vital for developing suitable varieties against terminal heat stress.Not Availabl