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

Road Traffic Accident and its Characteristics in Kathmandu Valley

Introduction: Road traffic accident is alarming in Nepal. The objective of this research is to find out the characteristics of RTA in central part of Nepal. Methods: A prospective descriptive study was taken from 1 August 2014 to 31 July 2015. Data were collected from postmortem department and nine hospitals in Kathmandu Valley. Inventory sheets with targeted variables for secondary sources were created. Results: A total of 3461 morbidity cases from hospitals and 265 mortality cases from postmortem department were included in this study. The ratio of male victim to female was 2.3:1. Around 75% of victims were between 15-49 years old. Pedestrians were the most vulnerable (33%) followed by riders of motorized 2-3 wheelers. Two wheeler motorized vehicles were most frequently (67.2%)involved in RTAs. More RTA occurred on daytime, Saturdays, July and November. Around half of the victims did not arrive in hospitals in one hour. The most common injury type was soft tissue injury (37.6%), followed by open wound (20.9%), fracture (18%) and traumatic brain injuries (12.7%). Conclusions: According to the characteristic of RTA found in this study, following preventive measures are recommended Helmet was necessary for two wheeled backseat riders. Road safety education towards age group of 15-49 was compulsory. Precaution should neither be omitted regarding road safety on weekends, holidays, nor in rainy and festival season. Future studies could be focused on estimation of burden of disease caused by RTA and its determinants in Nepal. Keywords: injury; Nepal; road traffic accident; road safety. | PubMe

Burden of road traffic accidents in Nepal by calculating disability-adjusted life years

Objective: To calculate the burden of road traffic accidents in Kathmandu Valley and then extrapolate this to the national level. Methods: A prospective study was performed to compute the burden of road traffic accidents by quantification of disability-adjusted life years (DALYs) using the Global Burden of Disease Study method on the basis of 1-year data from nine hospitals in Nepal and the Department of Forensic Medicine and cross-checked with the Nepal Traffic Directorate. Multiple methods were applied to the extrapolated population metrics of the burden of road traffic accidents in Nepal. Results: The total number of years of life lived in disability, years of life lost, and DALYs in Nepal were 38,848±194, 119,935±1464, and 158,783±1658 (95% confidence interval) respectively. The number of years lost because of morbidity and death was similar in Kathmandu Valley. Most (75%) of the DALYs resulted from years of life lost in Nepal. Males accounted for 73% of DALYs. Almost half (44%) of the DALYs were contributed by the group aged 15–29 years. Conclusion: This study is the first to calculate the burden of road traffic accidents in Nepal using Nepal’s own data. Nepal needs to develop and enhance its own system to identify significant public health issues so as to set national priorities for prevention of road traffic accidents