Mechanically Ventilated COVID-19 Patients Admitted to the Intensive Care Unit in the United States With or Without Respiratory Failure Secondary to COVID-19 Pneumonia: A Retrospective Comparison of Characteristics and Outcomes

BACKGROUND: There is increasing heterogeneity in the clinical phenotype of patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19,) and reasons for mechanical ventilation are not limited to COVID pneumonia. We aimed to compare the characteristics and outcomes of intubated patients admitted to the ICU with the primary diagnosis of acute hypoxemic respiratory failure (AHRF) from COVID-19 pneumonia to those patients admitted for an alternative diagnosis. METHODS: Retrospective cohort study of adults with confirmed SARS-CoV-2 infection admitted to nine ICUs between March 18, 2020, and April 30, 2021, at an urban university institution. We compared characteristics between the two groups using appropriate statistics. We performed logistic regression to identify risk factors for death in the mechanically ventilated COVID-19 population. RESULTS: After exclusions, the final sample consisted of 319 patients with respiratory failure secondary to COVID pneumonia and 150 patients intubated for alternative diagnoses. The former group had higher ICU and hospital mortality rates (57.7% vs. 36.7%, P CONCLUSIONS: Mechanically ventilated COVID-19 patients admitted to the ICU with COVID-19-associated respiratory failure are at higher risk of hospital death and have worse ICU utilization outcomes than those whose reason for admission is unrelated to COVID pneumonia

Mechanically ventilated COVID-19 patients admitted to the intensive care unit in the United States with or without respiratory failure secondary to COVID-19 pneumonia: a retrospective comparison of characteristics and outcomes

Background There is increasing heterogeneity in the clinical phenotype of patients admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19,) and reasons for mechanical ventilation are not limited to COVID pneumonia. We aimed to compare the characteristics and outcomes of intubated patients admitted to the ICU with the primary diagnosis of acute hypoxemic respiratory failure (AHRF) from COVID-19 pneumonia to those patients admitted for an alternative diagnosis. Methods Retrospective cohort study of adults with confirmed SARS-CoV-2 infection admitted to nine ICUs between March 18, 2020, and April 30, 2021, at an urban university institution. We compared characteristics between the two groups using appropriate statistics. We performed logistic regression to identify risk factors for death in the mechanically ventilated COVID-19 population. Results After exclusions, the final sample consisted of 319 patients with respiratory failure secondary to COVID pneumonia and 150 patients intubated for alternative diagnoses. The former group had higher ICU and hospital mortality rates (57.7% vs. 36.7%, P<0.001 and 58.9% vs. 39.3%, P<0.001, respectively). Patients with AHRF secondary to COVID-19 pneumonia also had longer ICU and hospital lengths-of-stay (12 vs. 6 days, P<0.001 and 20 vs. 13.5 days, P=0.001). After risk-adjustment, these patients had 2.25 times higher odds of death (95% confidence interval, 1.42–3.56; P=0.001). Conclusions Mechanically ventilated COVID-19 patients admitted to the ICU with COVID-19-associated respiratory failure are at higher risk of hospital death and have worse ICU utilization outcomes than those whose reason for admission is unrelated to COVID pneumonia

Body mass index and blood pressure in a semi-urban community in Ota, Nigeria

This study was designed to establish the relationship between body mass index (BMI) and blood pressure (BP) in an increasingly industrialised town in Nigeria due to the rising prevalence of hypertension in non-industrialised countries. Factors associated with BMI and BP levels were determined in three hundred adult male and female subjects in Ota community of Ogun State, Nigeria. The levels of the overweight among the male and female subjects were 53.03 % and 47.37 % respectively. The levels of hypertensive male and female subjects were 40.91 % and 35.34 % respectively. The overweight and underweight among the hypertensive male were 54.29 % and 0 % respectively; while the overweight and underweight among the hypertensive female were 42.86 % and 28.57 % respectively. Hypertension among the overweight, and hypotension among the underweight, are major health concern in Ota that requires intensive medical care

NCCN Guidelines Insights: Survivorship, Version 2.2019.

The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of cancer and cancer treatment to aid healthcare professionals who work with survivors of adult-onset cancer. Guidance is also provided to help promote physical activity, weight management, and proper immunizations in survivors and to facilitate care coordination to ensure that all needs are addressed. These NCCN Insights summarize some of the topics discussed by the NCCN Survivorship Panel during the 2019 update of the guidelines, including the survivorship population addressed, ways to improve care coordination, and pain management

NCCN Guidelines Insights: Survivorship, Version 2.2020.

The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of adult-onset cancer and its treatment, with the goal of helping healthcare professionals who work with survivors, including those in primary care. The guidelines also provide recommendations to help clinicians promote physical activity, weight management, and proper immunizations in survivors and facilitate care coordination to ensure that all of the survivors needs are addressed. These NCCN Guidelines Insights summarize additions and changes made to the guidelines in 2020 regarding cardiovascular disease risk assessment and screening for subsequent primary malignancies

Boron isotopic composition of olivine-hosted melt inclusions from Gorgona komatiites, Colombia : new evidence supporting wet komatiite origin

Author Posting. © The Author(s), 2011. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Earth and Planetary Science Letters 312 (2011): 201–212, doi:10.1016/j.epsl.2011.09.033.A fundamental question in the genesis of komatiites is whether 30 these rocks originate from partial melting of dry and hot mantle, 400−500°C hotter than typical sources of MORB and OIB magmas, or if they were produced by hydrous melting of the source at much lower temperatures, similar or only moderately higher than those known today. Gorgona Island, Colombia, is a unique place where Phanerozoic komatiites occur and whose origin is directly connected to the formation of the Caribbean Large Igneous Province. The genesis of Gorgona komatiites remains controversial, mostly because of the uncertain origin of volatile components which they appear to contain. These volatiles could equally result from shallow level magma contamination, melting of a “damp” mantle or fluid-induced partial melting of the source due to devolatilization of the ancient subducting plate. We have analyzed boron isotopes of olivine40 hosted melt inclusions from the Gorgona komatiites. These inclusions are characterized by relatively high contents of volatile components and boron (0.2−1.0 wt.% H2O, 0.05−0.08 wt.% S, 0.02−0.03 wt.% Cl, 0.6−2.0 μg/g B), displaying positive anomalies in the overall depleted, primitive mantle (PM) normalized trace element and REE spectra ([La/Sm]n = 0.16−0.35; [H2O/Nb]n = 8−44; [Cl/Nb]n = 27−68; [B/Nb]n = 9-30, assuming 300 μg/g H2O, 8 μg/g Cl and 0.1 μg/g B in PM; Kamenetsky et al., 2010. Composition and temperature of komatiite melts from Gorgona Island constrained from olivine-hosted melt inclusions. Geology 38, 1003–1006). The inclusions range in δ11B values from −11.5 to +15.6 ± 2.2‰ (1 SE), forming two distinct trends in a δ11B vs. B-concentration diagram. Direct assimilation of seawater, seawater-derived components, altered oceanic crust or marine sediments by ascending komatiite magma cannot readily account for the volatile contents and B isotope variations. Alternatively, injection of <3% of a 11B enriched fluid to the mantle source could be a plausible explanation for the δ11B range that also may explain the H2O, Cl and B excess.Financial support to AAG during data acquisition and manuscript preparation was provided by Northeast National Ion Microprobe Facility (Woods Hole Oceanographic Institution, USA) and the Centre de Recherches Pétrographiqueset Géochimiques (France). This research was also supported by the Australian Research Council (Research Fellowship and Discovery grants to VSK). We acknowledge partial support of the Alexander von Humboldt Foundation, Germany (F.W. Bessel Award to VSK and Wolfgang Paul Award to A.V. Sobolev who provided access to the electron microprobe at the Max Planck Institute, Mainz, Germany

African Trypanosomiasis-associated anemia : the contribution of the interplay between parasites and the mononuclear phagocyte system

African trypanosomosis (AT) is a chronically debilitating parasitic disease of medical and economic importance for the development of sub-Saharan Africa. The trypanosomes that cause this disease are extracellular protozoan parasites that have developed efficient immune escape mechanisms to manipulate the entire host immune response to allow parasite survival and transmission. During the early stage of infection, a profound pro-inflammatory type 1 activation of the mononuclear phagocyte system (MPS), involving classically activated macrophages (i.e., M1), is required for initial parasite control. Yet, the persistence of this M1-type MPS activation in trypanosusceptible animals causes immunopathology with anemia as the most prominent pathological feature. By contrast, in trypanotolerant animals, there is an induction of IL-10 that promotes the induction of alternatively activated macrophages (M2) and collectively dampens tissue damage. A comparative gene expression analysis between M1 and M2 cells identified galectin-3 (Gal-3) and macrophage migration inhibitory factor (MIF) as novel M1-promoting factors, possibly acting synergistically and in concert with TNF-alpha during anemia development. While Gal-3 enhances erythrophagocytosis, MIF promotes both myeloid cell recruitment and iron retention within the MPS, thereby depriving iron for erythropoiesis. Hence, the enhanced erythrophagocytosis and suppressed erythropoiesis lead to anemia. Moreover, a thorough investigation using MIF-deficient mice revealed that the underlying mechanisms in AT-associated anemia development in trypanosusceptible and tolerant animals are quite distinct. In trypanosusceptible animals, anemia resembles anemia of inflammation, while in trypanotolerant animals' hemodilution, mainly caused by hepatosplenomegaly, is an additional factor contributing to anemia. In this review, we give an overview of how trypanosome-and host-derived factors can contribute to trypanosomosis-associated anemia development with a focus on the MPS system. Finally, we will discuss potential intervention strategies to alleviate AT-associated anemia that might also have therapeutic potential

Praxes of “The Human” and “The Digital”: Spatial Humanities and the Digitization of Place

The spatial humanities have evolved much in the last ten years or so, and much of this evolution has been driven by project and problem-based GIS applications. It is argued here that the field lacks a theoretical framework analogous to Critical GIS in human geography. I argue that, just as Critical GIS drew on the intellectual hinterlands of human and hybrid geography, so must the spatial humanities draw on the intellectual hinterlands of how humanities discourse have always formed and transmitted concepts of place. Rhetoric, and especially the rhetorical devices of ekphrasis are given as an example of this; a project co-led by the author, the Heritage Gazetteer of Cyprus, is given as an example of how the digitzation of (humanistic) place has been operationalized

Genome-wide meta-analysis of cerebral white matter hyperintensities in patients with stroke.

OBJECTIVE: For 3,670 stroke patients from the United Kingdom, United States, Australia, Belgium, and Italy, we performed a genome-wide meta-analysis of white matter hyperintensity volumes (WMHV) on data imputed to the 1000 Genomes reference dataset to provide insights into disease mechanisms. METHODS: We first sought to identify genetic associations with white matter hyperintensities in a stroke population, and then examined whether genetic loci previously linked to WMHV in community populations are also associated in stroke patients. Having established that genetic associations are shared between the 2 populations, we performed a meta-analysis testing which associations with WMHV in stroke-free populations are associated overall when combined with stroke populations. RESULTS: There were no associations at genome-wide significance with WMHV in stroke patients. All previously reported genome-wide significant associations with WMHV in community populations shared direction of effect in stroke patients. In a meta-analysis of the genome-wide significant and suggestive loci (p < 5 × 10(-6)) from community populations (15 single nucleotide polymorphisms in total) and from stroke patients, 6 independent loci were associated with WMHV in both populations. Four of these are novel associations at the genome-wide level (rs72934505 [NBEAL1], p = 2.2 × 10(-8); rs941898 [EVL], p = 4.0 × 10(-8); rs962888 [C1QL1], p = 1.1 × 10(-8); rs9515201 [COL4A2], p = 6.9 × 10(-9)). CONCLUSIONS: Genetic associations with WMHV are shared in otherwise healthy individuals and patients with stroke, indicating common genetic susceptibility in cerebral small vessel disease.Funding for collection, genotyping, and analysis of stroke samples was provided by Wellcome Trust Case Control Consortium-2, a functional genomics grant from the Wellcome Trust (DNA-Lacunar), the Stroke Association (DNA-lacunar), the Intramural Research Program of National Institute of Ageing (Massachusetts General Hospital [MGH] and Ischemic Stroke Genetics Study [ISGS]), National Institute of Neurological Disorders and Stroke (Siblings With Ischemic Stroke Study, ISGS, and MGH), the American Heart Association/Bugher Foundation Centers for Stroke Prevention Research (MGH), Deane Institute for Integrative Study of Atrial Fibrillation and Stroke (MGH), National Health and Medical Research Council (Australian Stroke Genetics Collaborative), and Italian Ministry of Health (Milan). Additional support for sample collection came from the Medical Research Council, National Institute of Health Research Biomedical Research Centre and Acute Vascular Imaging Centre (Oxford), Wellcome Trust and Binks Trust (Edinburgh), and Vascular Dementia Research Foundation (Munich). MT is supported by a project grant from the Stroke Association (TSA 2013/01). HSM is supported by an NIHR Senior Investigator award. HSM and SB are supported by the NIHR Cambridge University Hospitals Comprehensive Biomedical Research Centre. VT and RL are supported by grants from FWO Flanders. PR holds NIHR and Wellcome Trust Senior Investigator Awards. PAS is supported by an MRC Fellowship. CML’s research is supported by the National Institute for Health Research Biomedical Research Centre (BRC) based at Guy's and St Thomas' NHS Foundation Trust and King's College London, and the BRC for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London. This is the final version of the article. It first appeared from Wolters Kluwer via http://dx.doi.org/10.1212/WNL.000000000000226