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Clinicians must individualize pharmacotherapy for patients with acute neurological injury based on multiple factors, including age, comorbidities, and chronic medication use. Many pharmacokinetic and pharmacodynamic properties are altered during acute illness, particularly absorption, distribution, metabolism, and elimination, which may result in loss of drug effect or toxicity. This article provides clinicians with general pharmacologic knowledge of the following drug regimens commonly prescribed to neurocritically ill adults: sedatives, analgesics, osmotherapy, antiseizure medications, antishivering agents, vasoactive agents, and antithrombotic reversal agents.

A pots experiment was conducted during the two consecutive winter seasons 2019/2020 and 2020/2021 at the demonstration farm, Collage of Agricultural studies, (CAS), Shambat, Sudan University of Science and Technology, Khartoum Bahri Locality, Khartoum state, Sudan (Latitude15° 40` N and Longitude 32° 23` E,) to evaluate two botanical aqueousextracts (Neem leaves, Heglig seeds) and three levels of nitrogen on S.hermonthica incidence and growth and yield of wheat. Combined analysis of both winter seasons showed that Striga emergence increased with the increasing number of weeks after sowing, Neem 10%, Heglig 10% and Nitrogen 80 lb/fed., were the best treatments which achieved significantly lowest number of Striga emergence, lowest Striga shoot fresh weight (g)/plant, shoot dry weight (g)/plant. and gave comparable to that obtained by the Striga free control. Neem 10% and nitrogen at 80 lb/fed., were the best treatments which achieved significantly highest wheat shoot fresh weight (g)/plant, shoot dry weight (g)/ plant and gave comparable to that obtained by Striga free control treatment. Nitrogen at 80 lb/fed.Only the best treatment, which achieved the highest number of tillers/plants and gave comparable to that obtained by Striga free control treatment. Neem 10% and nitrogen at 80 lb/fed., significantly increased wheat plant height (cm) and they were the best treatments, which achieved comparable to that obtained by the Striga free control treatment. A combined analysis of both winter seasons indicated that Striga significantly reduced wheat grain yield by 14.58%. Within all treatments nitrogen at 80 lb/fed, was the best treatment which gave the highest wheat grain yield and gave comparable to that obtained by Striga free controltreatment, followed by Neem 10%. Nitrogen at 80 lb/fed, significantly increased wheat grain yield (kg/fed.,) by 38.02%.

Supplemental Digital Content is available in the text., IMPORTANCE: At the start of the coronavirus disease 2019 pandemic, medications repurposed for management of coronavirus disease 2019 were used in the absence of clinical trial evidence. OBJECTIVES: To describe the variation and evolution in use of repurposed medications for coronavirus disease 2019. DESIGN, SETTING, AND PARTICIPANTS: Observational cohort study of adults hospitalized with coronavirus disease 2019 between February 15, 2020, and April 12, 2021, across 76 United States and international hospitals within the Society of Critical Care Medicine’s Discovery Viral Infection and Respiratory Illness Universal Study coronavirus disease 2019 registry. MAIN OUTCOMES AND MEASURES: Hospital variation was quantified using multivariable adjusted random effects logistic regression models and unsupervised clustering. Repurposed medications included antivirals, corticosteroids, hydroxychloroquine, immunomodulators, and therapeutic dose anticoagulants. RESULTS: Among 7,069 adults hospitalized with coronavirus disease 2019, 1,979 (28%) received antivirals, 2,876 (41%) received corticosteroids, 1,779 (25%) received hydroxychloroquine, 620 (9%) received immunomodulators, and 2,154 (31%) received therapeutic dose anticoagulants. Contribution of hospital site to risk-adjusted variation was 46% for antivirals, 30% for corticosteroids, 48% for hydroxychloroquine, 46% for immunomodulators, and 52% for therapeutic dose anticoagulants. Compared with the early pandemic, the later pandemic practice phenotypes converged with increased use of antivirals (odds ratio, 3.14; 95% CI, 2.40–4.10) and corticosteroids (odds ratio, 5.43; 95% CI, 4.23–6.97), with decreased use of hydroxychloroquine (odds ratio, 0.02; 95% CI, 0.01–0.04) and immunomodulators (odds ratio, 0.49; 95% CI, 0.34–0.70). There was no clinically significant change in the use of therapeutic dose anticoagulants (odds ratio, 1.01; 95% CI, 1.01–1.02). There were no differences in risk-adjusted mortality between hospitals with high rates of repurposed medication use compared with hospitals with low rates of use. CONCLUSIONS AND RELEVANCE: Hospital variation in the use of repurposed medications varied widely across hospitals early in the pandemic and later converged with the emergence of randomized clinical trials. Platforms developed for rapid activation and enrollment in clinical trials of repurposed medications are needed prior to the next pandemic to expedite effective, evidence-based practice.

INTRODUCTION: ARDS contributes to high mortality and morbidity observed with coronavirus disease 2019 (COVID-19) Epoprostenol has antithrombotic, antiproliferative, and vasodilatory properties and improves respiratory parameters in ARDS The role of aerosolized epoprostenol (aEPO) in COVID-19 has not been evaluated We hypothesized that aEPO may improve oxygenation in intubated COVID-19 patients METHODS: We performed a single-center, retrospective, propensity-score matched cohort study A medical chart review was conducted for COVID-19 ARDS adult patients admitted between March 1, 2020 and May 1, 2020 Patients receiving aEPO (0 05 mcg/kg/minute) versus patients not receiving aEPO were matched for Rothman index and baseline PaO2:FiO2 (PF) ratios, and evaluated for effect of aEPO on PF ratio, gradient between arterial to end-tidal CO2, and dead space (primary endpoints) Secondary endpoints evaluated included in-hospital mortality, mechanical ventilation-free days, and ICU and hospital length of stay Safety endpoints evaluated included incidence of hypotension, significant bleeding, thrombocytopenia, and rebound hypoxemia RESULTS: Nineteen patients treated with aEPO were compared to 19 propensity-matched controls Baseline characteristics were well matched Management of ARDS was similar between groups The mean ± SD duration of aEPO treatment was 5 ± 2 8 days There were no significant differences in PF ratios between aEPO cohort and non-aEPO cohort at 3 hours (125 ± 56 vs 115 ± 40 mmHg), 6 hours (124 ± 41 vs 147 ± 73 mmHg), 12 hours (112 ± 39 vs 163 ± 62 mmHg), 24 hours (114 ± 33 vs 176 ± 64 mmHg), and 48 hours (150 ± 54 vs 212 ± 84 mmHg), although there was a trend toward higher PF ratios for the control group There were no significant differences in gradient between arterial to end-tidal CO2 and dead space between cohorts There were significantly more deaths in the control group compared to aEPO by day 10 (21% vs 0, p

tudy Objectives To describe compliance with antibiotic recommendations based on a previously published procalcitonin (PCT)-guided algorithm in clinical practice, to compare PCT algorithm compliance rates between PCT assays ordered in the antibiotic initiation setting (PCT concentration measured < 24 hours after antibiotic initiation or prior to antibiotic initiation) with those in the antibiotic continuation setting (PCT concentration measured ≥ 24 hours after antibiotic initiation), and to evaluate patient- and PCT-related factors independently associated with algorithm compliance in patients in the medical intensive care unit. Design Single-center, retrospective cohort study. Setting Large medical intensive care unit (ICU) in a tertiary care academic medical center. Patients A total of 527 adults admitted to the medical ICU unit over a 2-year period (November 1, 2011–October 31, 2013) who had a total of 957 PCT assays performed. PCT assays whose results were determined in the medical ICU were allocated retrospectively to either the initiation setting cohort or the continuation setting cohort based on timing of the PCT assay. Measurements and Main Results Each PCT assay was treated as a separate episode. Antibiotic regimens were compared between the 24-hour periods before and after each PCT assay was resulted and evaluated against an algorithm to determine compliance. Clinical, laboratory, PCT-related, and microbiologic variables were assessed during the 24-hour period after the PCT assay was resulted to determine their influence on PCT algorithm compliance. A larger proportion of PCT episodes occurred in the initiation setting (540 [56.4%]) than in the continuation setting (417 [43.5%]). Overall, compliance with PCT algorithm recommendations was low (48.5%) and not significantly different between the initiation setting and the continuation setting (49.1% vs 47.7%, p=0.678). No patient-related or PCT-related factors were independently associated with PCT algorithm compliance on multivariable logistic regression. Conclusion Compliance with PCT algorithm antibiotic recommendations in both the initiation and continuation settings was lower than that reported in published randomized studies. No factors were independently associated with PCT algorithm compliance. Institutions using PCT assays to guide antibiotic use should assess compliance with algorithm antibiotic recommendations. Inclusion of a formalized antimicrobial stewardship program along with a PCT-guided algorithm is highly recommended. This article is protected by copyright. All rights reserved.

This paper presents new excavation data and new radiometric dates for Jebel Moya, south-central Sudan. These data suggest revisions to previous chronological understandings of the site. New excavations, initiated in 2017, show a longer, more continuous occupation of the site than has been previously recognised. Archaeozoological and archaeobotanical analyses provide evidence for domesticated taxa. Archaeobotanical evidence is dominated by domesticated sorghum (Sorghum bicolor), radiocarbon dated to c. 2550–2210 BC. Faunal remains include cattle and goat/sheep. A late third-millennium BC date on the human skeleton excavated in the 2017 season also shows that mortuary activity began early in the site’s history, contemporary with domesticated faunal and botanical remains. These initial results indicate the long-term association of the site with pastoralism and agriculture and with environmental change. Jebel Moya’s continued potential to serve as a chronological and cultural reference point for future studies in south-central Sudan and the eastern Sahel is reinforced.

This paper presents new excavation data and new radiometric dates for Jebel Moya, south-central Sudan. These data suggest revisions to previous chronological understandings of the site. New excavations, initiated in 2017, show a longer, more continuous occupation of the site than has been previously recognised. Archaeozoological and archaeobotanical analyses provide evidence for domesticated taxa. Archaeobotanical evidence is dominated by domesticated sorghum (Sorghum bicolor), radiocarbon dated to c. 2550–2210 BC. Faunal remains include cattle and goat/sheep. A late third-millennium BC date on the human skeleton excavated in the 2017 season also shows that mortuary activity began early in the site’s history, contemporary with domesticated faunal and botanical remains. These initial results indicate the long-term association of the site with pastoralism and agriculture and with environmental change. Jebel Moya’s continued potential to serve as a chronological and cultural reference point for future studies in south-central Sudan and the eastern Sahel is reinforced.