Findings In this randomized trial that included 109 patients, the median number of days free of respiratory support within 28 days was 20 days in the group that received helmet noninvasive ventilation and 18 days in the group that received high-flow nasal oxygen, a difference that was not statistically significant.
Meaning Among critically ill patients with moderate to severe hypoxemic respiratory failure due to COVID-19, helmet noninvasive ventilation, compared with high-flow nasal oxygen, resulted in no significant difference in the number of days free of respiratory support within 28 days.
Main Outcomes and Measures The primary outcome was the number of days free of respiratory support within 28 days after enrollment. Secondary outcomes included the proportion of patients who required endotracheal intubation within 28 days from study enrollment, the number of days free of invasive mechanical ventilation at day 28, the number of days free of invasive mechanical ventilation at day 60, in-ICU mortality, in-hospital mortality, 28-day mortality, 60-day mortality, ICU length of stay, and hospital length of stay.
Conclusions and Relevance Among patients with COVID-19 and moderate to severe hypoxemia, treatment with helmet noninvasive ventilation, compared with high-flow nasal oxygen, resulted in no significant difference in the number of days free of respiratory support within 28 days. Further research is warranted to determine effects on other outcomes, including the need for endotracheal intubation.
During his time as a student and teacher, Khomeini had developed an "unorthodox personal philosophy" that drew from an obscure interpretation of Shia Islam which proposed that all power should derive from "a divinely appointed religious leader." Khomeini had first promised Iranians a new era where freedom of expression and the nation's oil wealth would be used for the benefit of the Iranian people, but once in Tehran, he implemented a radical Islamic agenda that went at odds with the desire of most of the Iranian public. Khomeini told Revolutionary Council that the new government would be "a government based on the Sharia", and that opposing this new government would mean also opposing the Sharia of Islam, and that "Revolt against God's government is a revolt against God, and revolt against God is Blasphemy".
Khomeini's fatwā was condemned across the Western world by governments on the grounds that it violated the universal human rights of free speech and freedom of religion. The fatwā has also been attacked for violating the rules of fiqh by not allowing the accused an opportunity to defend himself, and because "even the most rigorous and extreme of the classical jurist only require a Muslim to kill anyone who insults the Prophet in his hearing and in his presence."
In a speech on 1 February 1979 delivered to a huge crowd after returning to Iran from exile, Khomeini made a variety of promises to Iranians for his coming Islamic regime: a popularly elected government that would represent the people of Iran and with which the clergy would not interfere. He promised that "no one should remain homeless in this country," and that Iranians would have free telephone, heating, electricity, bus services and free oil at their doorstep.
Grand Ayatollah Hussein-Ali Montazeri, a former student of Khomeini and a major figure of the Revolution, was chosen by Khomeini to be his successor as Supreme Leader and approved as such by the Assembly of Experts in November 1985. The principle of velayat-e faqih and the Islamic constitution called for the Supreme Leader to be a marja (a grand ayatollah), and of the dozen or so grand ayatollahs living in 1981 only Montazeri qualified as a potential Leader (this was either because only he accepted totally Khomeini's concept of rule by Islamic jurists,[unreliable source?] or, as at least one other source stated, because only Montazeri had the "political credentials" Khomeini found suitable for his successor). The execution of Mehdi Hashemi in September 1987 on charges of counterrevolutionary activities was a blow to Ayatollah Montazeri, who knew Hashemi since their childhood. In 1989 Montazeri began to call for liberalization, freedom for political parties. Following the execution of thousands of political prisoners by the Islamic government, Montazeri told Khomeini: "Your prisons are far worse than those of the Shah and his SAVAK." After a letter of his complaints was leaked to Europe and broadcast on the BBC, a furious Khomeini ousted him in March 1989 from his position as official successor. His portraits were removed from offices and mosques.
Before taking power Khomeini expressed support for the Universal Declaration of Human Rights. "We would like to act according to the Universal Declaration of Human Rights. We would like to be free. We would like independence." However once in power Khomeini took a firm line against dissent, warning opponents of theocracy for example: "I repeat for the last time: abstain from holding meetings, from blathering, from publishing protests. Otherwise I will break your teeth."
Yes, we are reactionaries, and you are enlightened intellectuals: You intellectuals do not want us to go back 1400 years. You, who want freedom, freedom for everything, the freedom of parties, you who want all the freedoms, you intellectuals: freedom that will corrupt our youth, freedom that will pave the way for the oppressor, freedom that will drag our nation to the bottom. 2b1af7f3a8