New early Miocene protoceratids (Mammalia, Artiodactyla) from Panama

<div><p>ABSTRACT</p><p>Although Cenozoic protoceratid artiodactyls are known from throughout North America, species referred to the Miocene protoceratine <i>Paratoceras</i> are restricted to subtropical areas of the Gulf Coast and southern Mexico and tropical areas of Panama. Newly discovered fossils from the late Arikareean Lirio Norte Local Fauna, Panama Canal basin, include partial dentitions of a protoceratid remarkably similar to those of <i>Paratoceras tedfordi</i> from Mexico, suggesting a rapid early Miocene colonization of recently emerged tropical volcanic terrains (Las Cascadas Formation). Partial lower dentitions from the overlying shallow marine to transitional Culebra Formation (early Centenario Fauna) are here referred to <i>Paratoceras orarius</i>, sp. nov., based on relatively small size, shallow mandible anterior to p3, and narrow cheek teeth. New early Hemingfordian protoceratine fossils from the upper part of the Cucaracha Formation (late Centenario Fauna) include a partial male skull and several dentitions that, together with specimens previously referred to <i>P. wardi</i> (only known from the Barstovian of Texas), are here referred to <i>Paratoceras coatesi</i>, sp. nov., based on distinctly more gracile cranial ornamentation, relatively longer nasals, a smaller and wider lower p4 (relative to m1), and more bulbous lower premolars. Results from a cladistic analysis of 15 craniodental characters coded for 11 protoceratine species suggests that <i>Paratoceras</i> is a monophyletic clade with its origin in subtropical areas of Central America, spreading into the tropics of Panama during the early Miocene (Arikareean through Hemingfordian North American Land Mammal Ages [NALMAs]), and later inhabiting subtropical areas of the Gulf Coast during the middle–late Miocene (Barstovian through Clarendonian NALMAs).</p><p>SUPPLEMENTAL DATA—Supplemental materials are available for this article for free at www.tandfonline.com/UJVP</p><p>http://zoobank.org/urn:lsid:zoobank.org:pub:31FFF397-6362-443C-A612-E9279FF122</p></div

Nuevas tortugas (Chelonia) desde el Eoceno tardío hasta el Mioceno tardío de la Cuenca del Canal de Panamá

Four distinct fossil turtle assemblages (Chelonia) are recognized from the Panama Canal Basin. The oldest, from the late Eocene–early Oligocene Gatuncillo Formation, is dominated by podocnemidid pleurodires. The early Miocene Culebra Formation includes both podocnemidids and trionychids. The early to middle Miocene Cucaracha Formation includes taxa classified in Geoemydidae (including Rhinoclemmys panamaensis n. sp.), Kinosternidae (represented by Staurotypus moschus n. sp.), large testudinids, trionychids, and podocnemidids, and finally, the late Miocene Gatun Formation records cheloniid sea turtles. These fossils include the oldest known representatives of Rhinoclemmys, the oldest record of kinosternids in Central America with a more extensive southern paleodistribution for Staurotypus and staurotypines in general, early occurrences of giant tortoises in the Neotropics, the oldest occurrence of soft-shell turtles in the tropics, the oldest late Eocene–early Oligocene Neotropical occurrences of podocnemidids. The Panamanian fossil turtles represent clades that are primarily endemic to North America, showing their very early arrival into the Neotropics prior to the complete emergence of the Isthmus of Panama, as well as their first contact with Caribbean-South American pleurodires by the early Miocene

Association of Country Income Level With the Characteristics and Outcomes of Critically Ill Patients Hospitalized With Acute Kidney Injury and COVID-19

Introduction: Acute kidney injury (AKI) has been identified as one of the most common and significant problems in hospitalized patients with COVID-19. However, studies examining the relationship between COVID-19 and AKI in low- and low-middle income countries (LLMIC) are lacking. Given that AKI is known to carry a higher mortality rate in these countries, it is important to understand differences in this population. Methods: This prospective, observational study examines the AKI incidence and characteristics of 32,210 patients with COVID-19 from 49 countries across all income levels who were admitted to an intensive care unit during their hospital stay. Results: Among patients with COVID-19 admitted to the intensive care unit, AKI incidence was highest in patients in LLMIC, followed by patients in upper-middle income countries (UMIC) and high-income countries (HIC) (53%, 38%, and 30%, respectively), whereas dialysis rates were lowest among patients with AKI from LLMIC and highest among those from HIC (27% vs. 45%). Patients with AKI in LLMIC had the largest proportion of community-acquired AKI (CA-AKI) and highest rate of in-hospital death (79% vs. 54% in HIC and 66% in UMIC). The association between AKI, being from LLMIC and in-hospital death persisted even after adjusting for disease severity. Conclusions: AKI is a particularly devastating complication of COVID-19 among patients from poorer nations where the gaps in accessibility and quality of healthcare delivery have a major impact on patient outcomes

Thrombotic and hemorrhagic complications of COVID-19 in adults hospitalized in high-income countries compared with those in adults hospitalized in low- and middle-income countries in an international registry

Background: COVID-19 has been associated with a broad range of thromboembolic, ischemic, and hemorrhagic complications (coagulopathy complications). Most studies have focused on patients with severe disease from high-income countries (HICs). Objectives: The main aims were to compare the frequency of coagulopathy complications in developing countries (low- and middle-income countries [LMICs]) with those in HICs, delineate the frequency across a range of treatment levels, and determine associations with in-hospital mortality. Methods: Adult patients enrolled in an observational, multinational registry, the International Severe Acute Respiratory and Emerging Infections COVID-19 study, between January 1, 2020, and September 15, 2021, met inclusion criteria, including admission to a hospital for laboratory-confirmed, acute COVID-19 and data on complications and survival. The advanced-treatment cohort received care, such as admission to the intensive care unit, mechanical ventilation, or inotropes or vasopressors; the basic-treatment cohort did not receive any of these interventions. Results: The study population included 495,682 patients from 52 countries, with 63% from LMICs and 85% in the basic treatment cohort. The frequency of coagulopathy complications was higher in HICs (0.76%-3.4%) than in LMICs (0.09%-1.22%). Complications were more frequent in the advanced-treatment cohort than in the basic-treatment cohort. Coagulopathy complications were associated with increased in-hospital mortality (odds ratio, 1.58; 95% CI, 1.52-1.64). The increased mortality associated with these complications was higher in LMICs (58.5%) than in HICs (35.4%). After controlling for coagulopathy complications, treatment intensity, and multiple other factors, the mortality was higher among patients in LMICs than among patients in HICs (odds ratio, 1.45; 95% CI, 1.39-1.51). Conclusion: In a large, international registry of patients hospitalized for COVID-19, coagulopathy complications were more frequent in HICs than in LMICs (developing countries). Increased mortality associated with coagulopathy complications was of a greater magnitude among patients in LMICs. Additional research is needed regarding timely diagnosis of and intervention for coagulation derangements associated with COVID-19, particularly for limited-resource settings

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable