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

Professor Sajjad Shaikh: English Translator of Ahmad Nadeem Qasmi

This article contains an analysis of the English translation of Ahmad Nadeem Qasimi’s short stories. These translations are the result of the skill and diligence of Professor Sajjad Shaikh. He translated twenty Urdu short stories of Ahmad Nadeem Qasimi into English for the first time. This book was first published by National Book Foundation, Islamabad in 1981. Professor Sajjad Shaikh was awarded the Ahmad Nadeem Qasimi Literary Award for this endeavor. In these translations, Ahmad Nadeem Qasimi’s stories seem to travel from one language to another without any strangeness. Proficient in Urdu and English, Prof. Sajjad Shaikh has made a successful attempt to make Urdu Literature stand out on the world’s stage by translating the subject matter of these short stories

Professor Sajjad Shaikh: English Translator of Ahmad Nadeem Qasmi

This article contains an analysis of the English translation of Ahmad Nadeem Qasimi&rsquo;s short stories. These translations are the result of the skill and diligence of Professor Sajjad Shaikh. He translated twenty Urdu short stories of Ahmad Nadeem Qasimi into English for the first time. This book was first published by National Book Foundation, Islamabad in 1981. Professor Sajjad Shaikh was awarded the Ahmad Nadeem Qasimi Literary Award for this endeavor. In these translations, Ahmad Nadeem Qasimi&rsquo;s stories seem to travel from one language to another without any strangeness. Proficient in Urdu and English, Prof. Sajjad Shaikh has made a successful attempt to make Urdu Literature stand out on the world&rsquo;s stage by translating the subject matter of these short stories.</p

Professor Sajjad Shaikh: English Translator of Ahmad Nadeem Qasmi

This article contains an analysis of the English translation of Ahmad Nadeem Qasimi&rsquo;s short stories. These translations are the result of the skill and diligence of Professor Sajjad Shaikh. He translated twenty Urdu short stories of Ahmad Nadeem Qasimi into English for the first time. This book was first published by National Book Foundation, Islamabad in 1981. Professor Sajjad Shaikh was awarded the Ahmad Nadeem Qasimi Literary Award for this endeavor. In these translations, Ahmad Nadeem Qasimi&rsquo;s stories seem to travel from one language to another without any strangeness. Proficient in Urdu and English, Prof. Sajjad Shaikh has made a successful attempt to make Urdu Literature stand out on the world&rsquo;s stage by translating the subject matter of these short stories

Professor Sajjad Shaikh: English Translator of Ahmad Nadeem Qasmi

This article contains an analysis of the English translation of Ahmad Nadeem Qasimi&rsquo;s short stories. These translations are the result of the skill and diligence of Professor Sajjad Shaikh. He translated twenty Urdu short stories of Ahmad Nadeem Qasimi into English for the first time. This book was first published by National Book Foundation, Islamabad in 1981. Professor Sajjad Shaikh was awarded the Ahmad Nadeem Qasimi Literary Award for this endeavor. In these translations, Ahmad Nadeem Qasimi&rsquo;s stories seem to travel from one language to another without any strangeness. Proficient in Urdu and English, Prof. Sajjad Shaikh has made a successful attempt to make Urdu Literature stand out on the world&rsquo;s stage by translating the subject matter of these short stories.</p

The Spatial Effect of Industrial Intelligence on High-Quality Green Development of Industry under Environmental Regulations and Low Carbon Intensity

In order to thoroughly investigate how industrial intelligence influences green industrial development through direct, indirect, and spatial spillover effects in China and fill in the gaps left by earlier studies, the study combines industrial intelligence and green industrial development into a single analytical framework. The findings show that implementing industrial intelligence can proactively encourage high-quality green industrial development; additionally, a strong spatial correlation is shown between industrial intelligence and high-quality green industrial development. According to spatial spillover analysis, industrial intelligence fosters the development of green industries both inside and between regions. When regional heterogeneity is analyzed, it is revealed that the eastern part of China experiences industrial intelligence effects more strongly than the central region, while the western areas are unaffected. Environmental regulations are a crucial mediating mechanism for the operation of industrial intelligence; in particular, public-participation environmental regulation and market base environmental regulations strengthen the baseline relationship; however, industrial intelligence does not impact high-quality green industrial development through administrative environmental regulation. The partial mediating effect of carbon intensity was also observed. The findings could be used as a guide for decision-making by experts and policymakers in China and other developing nations to use industrial intelligence and support the green development of the sector during economic transformation

An Association of Dietary Diversity with the Nutritional Status of Cardiovascular Diseased Patients in the Private Tertiary Care Unit of District Peshawar

OBJECTIVES The aim of this study was to analyze the effect of socio-demographic and dietary intake patterns on the nutritional status of cardiovascular disease (CVD) patients and to determine the dietary diversity of the households. METHODOLOGY This cross-sectional study was conducted from May 2018 to June 2018 at the Rehman Medical Institute, Peshawar. Based on written consent, a sample of 250 adult CVD patients was selected through a convenient sampling method. The data was collected through a structured questionnaire containing demographic, anthropometry, biochemical, clinical data, and a dietary record. RESULTS In a sample of 250 patients mean age was 55.41±12.558. On the basis of BMI, almost 52.8% were overweight and 0.8% of the patients were obese. Overweight was the major trend among the patients where this tendency was more common in males (57.5%) as compared to females (41%). Diabetes and hypertension were the major complications among these patients. Daily and per week food frequency and dietary diversity scores showed high intake of meat, milk, saturated fats, high glycemic index fruits, intake of processed foods along with goodconsumption of vegetables. The regression coefficient of DDI showed whole milk, cream, meat and processed meat as a strong predictor of obesity, overweight and CVD. CONCLUSION The overall dietary diversity of the patients showed a trend toward western dietary patterns with a focus on meat, whole milk, and processed foods. Among the financially stable families of Khyber Pakhtunkhwa, this dietary trend may pose a serious health concern in the context of non -communicable diseases in this region and demand for nutrition education at all levels of the society

The Spatial Effect of Industrial Intelligence on High-Quality Green Development of Industry under Environmental Regulations and Low Carbon Intensity

In order to thoroughly investigate how industrial intelligence influences green industrial development through direct, indirect, and spatial spillover effects in China and fill in the gaps left by earlier studies, the study combines industrial intelligence and green industrial development into a single analytical framework. The findings show that implementing industrial intelligence can proactively encourage high-quality green industrial development; additionally, a strong spatial correlation is shown between industrial intelligence and high-quality green industrial development. According to spatial spillover analysis, industrial intelligence fosters the development of green industries both inside and between regions. When regional heterogeneity is analyzed, it is revealed that the eastern part of China experiences industrial intelligence effects more strongly than the central region, while the western areas are unaffected. Environmental regulations are a crucial mediating mechanism for the operation of industrial intelligence; in particular, public-participation environmental regulation and market base environmental regulations strengthen the baseline relationship; however, industrial intelligence does not impact high-quality green industrial development through administrative environmental regulation. The partial mediating effect of carbon intensity was also observed. The findings could be used as a guide for decision-making by experts and policymakers in China and other developing nations to use industrial intelligence and support the green development of the sector during economic transformation

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4&nbsp;% presented with RS, while 13.6&nbsp;% had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7&nbsp;% vs RS: 37.5&nbsp;%). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1&nbsp;% vs. RS 32.0&nbsp;%), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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