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

Socialização de conceitos de microbiologia no ensino fundamental através de atividades práticas

As abordagens tradicionais de ensino tendem a ser menos estimulantes e de maior dificuldade de compreensão, principalmente ao tratar-se de assuntos mais distantes da realidade dos alunos e, de certa forma, abstratos, como alguns conceitos de Microbiologia. Tal realidade reforça a importância do estudo e aplicação de novas formas de ensino no ambiente escolar. Nesse sentido, o objetivo deste artigo é relatar a experiência de ações de extensão realizadas com o tema “Dia do Cientista”, nas quais os métodos utilizados foram baseados no protagonismo dos alunos, através da participação ativa em experimentos, discussões e visitações. Ao longo da execução das ações, observou-se o despertar do interesse em assuntos até então desconhecidos e distantes da realidade dos estudantes do Ensino Fundamental I (4.º e 5.º ano), que puderam reconhecer o que a Microbiologia representa no seu cotidiano, a partir da execução de atividades práticas, como: I) Detecção de microrganismos em diferentes espaços da escola, como salas de aula e dos professores, banheiros e pátio; II) “Carimbo de mãos”; III) Utilização de fermento biológico para o crescimento microbiano e IV) Visita à Universidade Federal de Alagoas - Campus Arapiraca, onde puderam conhecer laboratórios de ensino prático do tema. Dessa forma, percebeu-se que estratégias com abordagens ativas e práticas auxiliaram numa maior interação dos alunos com os temas propostos, além de aguçar a curiosidade, estimular o aprendizado e permitir maior crescimento pessoal por parte dos escolares, bem como de todos os participantes do projeto. Palavras-chave: Extensão comunitária; Ensino; Aprendizagem   Socialization of microbiology concepts in elementary school through practical activities Abstract: Traditional teaching approaches tend to be less stimulating and more difficult to understand, especially when dealing with subjects that are more distant from the reality of students and, in a way, abstract, such as some topics of microbiology. This reality reinforces the importance of studying and applying new forms of teaching in the school environment. In this sense, the objective of this article is to report the experience of extension actions carried out with the theme "Scientist's Day", in which the methods used were based on the protagonism of the students, through active participation in experiments, discussions, and visits. Throughout the actions, it was possible to notice an awakening of interest in subjects previously unknown and distant from the reality of the students at elementary school (4th and 5th), who were able to recognize what microbiology represents in their daily lives, from the execution of practical activities such as I) Detection of microorganisms in different locations of the school, such as classrooms and teachers’ room, bathrooms and courtyard; II) "Hand Stamp"; III) Use of biological yeast for microbial growth and IV) Visit to the Federal University of Alagoas - Campus Arapiraca (Arapiraca, Brazil), where they got to know the laboratories. Therefore, it was noticed that strategies with active and practical approaches made the interaction of students with the proposed themes easier, besides to whet curiosity, stimulate learning and allow greater personal growth by the schoolers, as well as all the participants of the project. Keywords: Community extension; Teaching; Learnin