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

Crossing Over. stories of the transition, or “history from the inside”

CITATION: Gaylard, R. 1997. Crossing over. stories of the transition, or “history from the inside”. Literator, 18(3): 103-118, doi: 10.4102/lit.v18i3.552.The original publication is available at http://literator.org.zaCrossing Over: stories of the transition, or “history from the inside” The collection of stories entitled Crossing Over: New Stories for a New South Africa (1995) commemorates a remarkable turning point in this country's history, the election of South Africa's first-ever democratic government. By inviting contributions from writers from a variety of backgrounds, and in any of the eleven official languages, the compilers hoped to provide "a rounded picture of our times ” and to contribute to the making of a new South African culture o f inclusivity. Contributors were asked for stories dealing with "some kind of crossing over, " and exploring the response of young people to the transition. In spite of limitations as regards representativeness, the collection does bring together an unusually varied group of writers. This article explores the extent to which, by promoting a renewed awareness of "self in relation to "others", the anthology goes some way towards uncovering and undoing the racism and stereotyping that have been endemic to our society. In doing so, it provides us with a kind of "history from the inside However, the collection also demonstrates the continuing presence o f the past, and suggests the extent to which the lives o f many ordinary people have not changed significantly.http://www.literator.org.za/index.php/literator/article/view/552Publisher's versio

Writing black: the South African short story by black writers

Thesis (DLitt (English))--University of Stellenbosch, 2008.This study attempts a re-reading and re-evaluation of the work of black South African short story writers from R.R.R. Dhlomo (circa 1930) to Zoë Wicomb (at the end of the 1980s). The short story, along with the autobiography, was the dominant genre of black writing during this period, and the reasons for this are examined, as well as the ways in which black writers adapt or transform this familiar literary genre. The title – “Writing Black” – alludes to well-known works by Richard Rive (Writing Black) and J.M. Coetzee (White Writing), and foregrounds the issue of race and racialised identities. While one would not want to neglect other factors (class, gender), it is hardly possible to underestimate the impact of racial classification during the apartheid era. However, the difficulty of asserting the unproblematic existence of a homogeneous “black” identity also becomes evident. The approach adopted here reflects the need to recognise both the singularity of particular texts (their “literariness”) as well as their embeddedness in their particular place and time (their “worldliness” or their “circumstantiality”). Literary texts are complex verbal artefacts of an unusual kind, but they cannot be separated from their contexts of production and reception; black writing in this country would be largely incomprehensible if this were not taken into account. Close attention is given to the obvious spatial, temporal and ideological shifts in South African cultural production during this period, and to the two major phases of black writing (the Sophiatown and District Six writers of the 50s, and the Staffrider writers of the 70s and 80s). The work of these writers is not, however, subsumed into a political meta-narrative. In particular, this study resists the tendency to lump the work of black writers into one large, undifferentiated category (“protest writing” or “spectacular” representation). This approach has had the effect of flattening out or homogenising a body of work that is much more varied and interesting than many critical accounts would suggest. Finally, the contribution of three writers of the “interregnum” (Ndebele, Matlou, Wicomb) is explored. What is of particular interest is their break from established conventions of representation: their work reveals a willingness to resist over-simplification, to experiment, and to explore issues of identity and gender. By examining these texts from the vantage point of the post-apartheid present, one is able to arrive at an enhanced understanding of the form that black writing took under apartheid, and the pressures to which it was responding

An unusual freedom : Mbulelo Mzamane's Mzala

The original publication is available at http://www.tandfonline.comMzamane's comments over the years seem to reflect a doubt or ambivalence over the status of his first collection of stories, Mzala (1980). In his introduction Mzamane describes himself as 'a teacher first, an aspiring literary critic next and only very incidentally a writer'. In an interview in 1983 in the Nigerian journal Okella, he repeats this, and adds, 'I do not consider myself very seriously as a writer. However, in the same interview he also defends himself against the criticism that his stories are 'escapist' or 'trivialize life'; people have tended to see him, he says, as 'a writer who is not very serious'Preprin

Very Long Baseline Interferometry with the SKA

Adding VLBI capability to the SKA arrays will greatly broaden the science of the SKA, and is feasible within the current specifications. SKA-VLBI can be initially implemented by providing phased-array outputs for SKA1-MID and SKA1-SUR and using these extremely sensitive stations with other radio telescopes, and in SKA2 by realising a distributed configuration providing baselines up to thousands of km, merging it with existing VLBI networks. The motivation for and the possible realization of SKA-VLBI is described in this paper