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

Autonomous Attitude Stabilization of a Quadrotor

Quadrotor are four rotor helicopters that fly using a pair of rotors spinning in opposite directions. It is an under actuated system: it uses four different types of controllers: pitch, roll, yaw and altitude to control six degrees of freedom. To obtain the control there is translational rotational coupling. Thus the system is highly non-linear. The aim of the present work is stabilize the quad rotor using a Proportional, Integral and Derivative Controller in real time autonomously. The controller calculates the proximity of the input to the set value, the rate at which the input is moving to the set point and the duration for which the input is away from the set point. These form respectively the proportional, derivative and integral components of the controller and they are weighted and tuned to combine to obtain the motor offset value

Platelet cold agglutinins and thrombocytopenia: A diagnostic dilemma in the intensive care unit

We report a case of pseudo-thrombocytopenia due to cold agglutinins against platelets. These cold agglutinins were the cause for diagnostic confusion and resulted in extensive workup and unnecessary therapeutic precautions. A thirty two year old female with Guillain-Barre syndrome was admitted in the ICU and serial work-up showed markedly low levels of platelets. The patient had no symptoms of bleeding and patient was investigated extensively for deciphering the etiology of low platelet count. In-vitro clumping of platelets was suspected and in-vitro studies showed marked clumping of platelets with ethylene-diamine-tetra-acetic acid, citrate and heparinized samples. The manual platelet count was found to be within normal limits. Thrombocytopenia as a result of platelet cold agglutinins is a rare cause of in-vitro low platelet counts. No clinical problems have been reported due to the same

Visualization of Urban Growth Pattern in Chennai Using Geoinformatics and Spatial Metrics

Urban growth is the spatial pattern of land development to accommodate anthropogenic demand that influences other land uses (e.g.: open spaces, water bodies, etc.). Driven by population increase, urban growth alters the community's social, political and economic institutions with changing land use and also affects the local ecology and environment. India's urban population has increased by 91 million between 2001 and 2011, with migration, the inclusion of new/adjoining areas within urban limits, etc. Evidently, the percentage of urban population in India has increased tremendously: from 1901 (10.8 %) to 2011 (31.16 %). Chennai has an intensely developed urban core, which is surrounded by rural or peri-urban areas that lack basic amenities. Studying the growth pattern in the urban areas and its impact on the core and periphery are important for effective management of natural resources and provision of basic amenities to the population. Spatial metrics and the gradient approach were used to study the growth patterns and status of urban sprawl in Chennai city's administrative boundary and areas within a 10 km buffer, for the past forty years. It is found that though Chennai experiences high sprawl at peri-urban regions, it also has the tendency to form a single patch, clumped and simple shaped growth at the core. During this transition, substantial agricultural and forest areas have vanished. Visualization of urban growth of Chennai for 2026 using cellular automata indicates about 36 % of the total area being converted to urban with rapid fragmented urban growth in the periphery and outskirts of the city. Such periodic land-use change analysis monitoring, visualization of growth pattern would help the urban planner to plan future developmental activities more sustainably and judiciously

Monitoring urbanization and its implications in a mega city from space: Spatiotemporal patterns and its indicators

Rapid and invasive urbanization has been associated with depletion of natural resources (vegetation and water resources), which in turn deteriorates the landscape structure and conditions in the local environment. Rapid increase in population due to the migration from rural areas is one of the critical issues of the urban growth. Urbanisation in India is drastically changing the land cover and often resulting in the sprawl. The sprawl regions often lack basic amenities such as treated water supply, sanitation, etc. This necessitates regular monitoring and understanding of the rate of urban development in order to ensure the sustenance of natural resources. Urban sprawl is the extent of urbanization which leads to the development of urban forms with the destruction of ecology and natural landforms. The rate of change of land use and extent of urban sprawl can be efficiently visualized and modelled with the help of geo-informatics. The knowledge of urban area, especially the growth magnitude, shape geometry, and spatial pattern is essential to understand the growth and characteristics of urbanization process. Urban pattern, shape and growth can be quantified using spatial metrics. This communication quantifies the urbanisation and associated growth pattern in Delhi. Spatial data of four decades were analysed to understand land over and land use dynamics. Further the region was divided into 4 zones and into circles of 1 km incrementing radius to understand and quantify the local spatial changes. Results of the landscape metrics indicate that the urban center was highly aggregated and the outskirts and the buffer regions were in the verge of aggregating urban patches. Shannon's Entropy index clearly depicted the outgrowth of sprawl areas in different zones of Delhi. (C) 2014 Elsevier Ltd. All rights reserved

GHG footprint of major cities in India

Concentration of greenhouse gases (GHG) in the atmosphere has been increasing rapidly during the last century due to ever increasing anthropogenic activities resulting in significant increases in the temperature of the Earth causing global warming. Major sources of GHG are forests (due to human induced land cover changes leading to deforestation), power generation (burning of fossil fuels), transportation (burning fossil fuel), agriculture (livestock, farming, rice cultivation and burning of crop residues), water bodies (wetlands), industry and urban activities (building, construction, transport, solid and liquid waste). Aggregation of GHG (CO2 and non-CO2 gases), in terms of Carbon dioxide equivalent (CO(2)e), indicate the GHG footprint. GHG footprint is thus a measure of the impact of human activities on the environment in terms of the amount of greenhouse gases produced. This study focuses on accounting of the amount of three important greenhouses gases namely carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) and thereby developing GHG footprint of the major cities in India. National GHG inventories have been used for quantification of sector-wise greenhouse gas emissions. Country specific emission factors are used where all the emission factors are available. Default emission factors from IPCC guidelines are used when there are no country specific emission factors. Emission of each greenhouse gas is estimated by multiplying fuel consumption by the corresponding emission factor. The current study estimates GHG footprint or GHG emissions (in terms of CO2 equivalent) for Indian major cities and explores the linkages with the population and GDP. GHG footprint (Aggregation of Carbon dioxide equivalent emissions of GHG's) of Delhi, Greater Mumbai, Kolkata, Chennai, Greater Bangalore, Hyderabad and Ahmedabad are found to be 38,633.2 Gg, 22,783.08 Gg, 14,812.10 Gg, 22,090.55 Gg, 19,796.5 Gg, 13,734.59 Gg and 91,24.45 Gg CO2 eq., respectively. The major contributors sectors are transportation sector (contributing 32%, 17.4%, 13.3%, 19.5%, 43.5%, 56.86% and 25%), domestic sector (contributing 30.26%, 37.2%, 42.78%, 39%, 21.6%, 17.05% and 27.9%) and industrial sector (contributing 7.9%, 7.9%, 17.66%, 20.25%, 1231%, 11.38% and 22.41%) of the total emissions in Delhi, Greater Mumbai, Kolkata, Chennai, Greater Bangalore, Hyderabad and Ahmedabad, respectively. Chennai emits 4.79 t of CO2 equivalent emissions per capita, the highest among all the cities followed by Kolkata which emits 3.29 t of CO2 equivalent emissions per capita. Also Chennai emits the highest CO2 equivalent emissions per GDP (2.55 t CO2 eq./Lakh Rs.) followed by Greater Bangalore which emits 2.18 t CO2 eq./Lakh Rs. (C) 2015 Elsevier Ltd. All rights reserved

Fusion of multi resolution remote sensing data for urban sprawl analysis

Urban population is growing at around 2.3 percent per annum in India. This is leading to urbanisation and often fuelling the dispersed development in the outskirts of urban and village centres with impacts such as loss of agricultural land, open space, and ecologically sensitive habitats. This type of upsurge is very much prevalent and persistent in most places, often inferred as sprawl. The direct implication of such urban sprawl is the change in land use and land cover of the region and lack of basic amenities, since planners are unable to visualise this type of growth patterns. This growth is normally left out in all government surveys (even in national population census), as this cannot be grouped under either urban or rural centre. The investigation of patterns of growth is very crucial from regional planning point of view to provide basic amenities in the region. The growth patterns of urban sprawl can be analysed and understood with the availability of temporal multi-sensor, multi-resolution spatial data. In order to optimise these spectral and spatial resolutions, image fusion techniques are required. This aids in integrating a lower spatial resolution multispectral (MSS) image (for example, IKONOS MSS bands of 4m spatial resolution) with a higher spatial resolution panchromatic (PAN) image (IKONOS PAN band of 1m spatial resolution) based on a simple spectral preservation fusion technique - the Smoothing Filter-based Intensity Modulation (SFIM). Spatial details are modulated to a co-registered lower resolution MSS image without altering its spectral properties and contrast by using a ratio between a higher resolution image and its low pass filtered (smoothing filter) image. The visual evaluation and statistical analysis confirms that SFIM is a superior fusion technique for improving spatial detail of MSS images with the preservation of spectral properties