IMPORTANCEOveractivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19.ObjectiveTo determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19.DESIGN, SETTING, AND PARTICIPANTSIn 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).INTERVENTIONSPatients 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 MEASURESThe 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.RESULTSOn 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 RELEVANCEIn 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 REGISTRATIONClinicalTrials.gov Identifier: NCT02735707

Over 20 million people worldwide have abnormal electrocardiogram (ECG) signals, i.e., arrhythmias, each year. Most of the cardiac patients are elders.And if they increasingly move to nursing homes, it is a necessary tendency to reduce the medical labor cost by deploying self-organized wireless cardiacmonitoring hardware/ software systems in an area with a radius of hundreds of feet. Such medical information networks could allow the doctors to immediately capture the arrhythmia events of any patient without leaving their offices. In this paper, a wavelet based steganography technique has been introduced which combines encryption and LSB embedding technique to protect patient confidential data.Huge amount of ECG signal collected by Body Sensor Networks (BSNs) from remote patients at homes will be transmitted along with other physiological readings such as blood pressure, temperature, glucose level etc. and diagnosed by those remote patient monitoring systems. An added benefit is the freedom of movement for patients due to the wireless networking technologies. To evaluate the effectiveness of the proposed technique on the ECG signal, distortion measurement metrics, the Percentage Residual Difference (PRD) has been used.

Background: Stress is not inherently deleterious, however, each individual's cognitive appraisal, their perceptions, and interpretations, gives meaning to events and determines whether events are viewed as threatening or positive. Nurses regularly face emotionally charged situations and encounter intense interpersonal and inter professional situations and conflict in the workplace while trying to make appropriate and safe decisions. Therefore, this study help to assess the level of stress among staff nurses and Information Guide Sheet may be help to manage that occupational stress among them. Aims: The aim of the study was to assess the occupational stress among staff nurses at HSK Hospital and Research Centre, Bagalkot. Methodology: The occupational stress was measured using Expanded Nurses Stress Scale from a convenient sample of 50 staff nurses working at HSK Hospital and Research Centre, Bagalkot in a cross sectional survey. Data were analyzed using descriptive and inferential statistics. Findings: Result indicates that majority 70% of respondents had mild stress level, 30% moderate stress level. There is no presence of normal and severe stress. The overall mean stress score was found to be 56.82% with SD as 7.3%.The mean stress score was found to be higher 64.1% in the aspect of interaction, followed by 63.8% in professional status and 60.3% payment and 56.4% in organizational policies. Further, the less stress score (45.08) found in the area of autonomy and 51.28% in task requirement. Chi-square test was calculated to assess the association between socio- demographic variables and occupational stress among staff nurses, there is no significant relationship found between occupational stress of staff nurses and socio- demographic variables such as age, gender, religion, marital status, qualification, year of experience, family monthly income and number of beds. Conclusion: The finding of the study concluded that most of the staff nurses having mild and moderate level of stress. This study is effective to identify the occupational stress among staff nurses and how to overcome the stress. Keywords:Occupational stress, Staff nurses, HSK Hospital, Information Guide sheet.