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

Development in The Analytical Gas Chromatography of Metal Dialkydithiophospate Complexes

The gas chromotographic analysis of metal-containing compounds has been a small but reasonably active field for about 25 yeras. Analyses cover such as organometalics, metal complexes, and compounds such as hydrides and halides. Reviews of the fiels may be seen in the books by Moshier and Sievers (1), Guichon and Pommier (2) and Crompton (3), as well as the papers by Uden and Henderson (4) abd Rodrigues-Vasquez (5)

Biometric, nutritional and sensory characteristic modifications in farmed Murray cod (Maccullochella peelii peelii) during the purging process

Intensively farmed, market-size Murray cod (~ 600 g), were purged (transferred into a clean water system and starved) and sampled at three day intervals for a total of 18 days (D0, D3, D6, D9, D12, D15 and D18). Purged fish lost from 6% (D3) to 14% (D18) body weight, and the weight loss was highly correlated to the number of days of purging/starvation. Condition factor and Hepatosomatic Index decreased significantly (P &lt; 0.05) only after 18 days of purging compared to the control (D0). Fillet lipid content (%) did not vary during the trial. Eicosapentaenoic acid (EPA: 20:5 n&minus;3) decreased and docosapentaenoic acid (DPA: 22:5 n&minus;3) increased (P &lt; 0.05) during the trial, while docosahexaenoic acid (DHA: 22:6 n&minus;3) did not show any significant variation. Purging contributed positively to the improvement of the volatile flavour compound composition, with a significant (P &lt; 0.05) reduction in total volatile aldehydes and an increase in total volatile hydrocarbons. Since no major differences were found between samples during the last stages of the purging process (D12, D15 and D 18), it is possible to conclude that, under these experimental conditions, 12 days is the minimum duration to obtain an improvement in the volatile compound profile of intensively farmed Murray cod whilst keeping body weight loss to a minimum.<br /