On the ocurrence of Philornis angustifrons and P. deceptiva (Diptera, Muscidae) in nests of Suiriri affinis and S. islerorum (Aves, Tyrannidae) in the savanna of Distrito Federal, Brazil

The first report of Philornis angustifrons and P. deceptiva infesting nests of Suiriri affinis and S. islerorum in area of Distrito Federal's savanna is presented. It is known that larvae of these species have a strict relationship of parasitism with birds. The pupae were collected after the abandonment of the nests and the flies emerged in a period of about 13 days

Does anxiety predict the use of urgent care by people with long term conditions? A systematic review with meta-analysis.

Objective: The role of anxiety in the use of urgent care in people with long term conditions is not fully understood. A systematic review was conducted with meta-analysis to examine the relationship between anxiety and future use of urgent healthcare among individuals with one of four long term conditions: diabetes; coronary heart disease, chronic obstructive pulmonary disease and asthma. Methods: Electronic searches of MEDLINE, EMBASE, PSYCINFO, CINAHL, the British Nursing Library and the Cochrane Library were conducted These searches were supplemented by hand-searching bibliographies, citation tracing eligible studies and asking experts within the field about relevant studies. Studies were eligible for inclusion if they: a) used a standardised measure of anxiety, b) used prospective cohort design, c) included adult patients diagnosed with coronary heart disease (CHD), asthma, diabetes or chronic obstructive pulmonary disease (COPD), d) assessed urgent healthcare use prospectively. Data regarding participants, methodology, and association between anxiety and urgent care use was extracted from studies eligible for inclusion. Odds ratios were calculated for each study and pooled using random effects models. Results: 8 independent studies were identified for inclusion in the meta-analysis, with a total of 28,823 individual patients. Pooled effects indicate that anxiety is not associated with an increase in the use of urgent care (OR. =. 1.078, p. =. 0.476), regardless of the type of service, or type of medical condition. Conclusions: Anxiety is not associated with increased use of urgent care. This finding is in contrast to similar studies which have investigated the role of depression as a risk factor for use of urgent care

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In 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). INTERVENTIONS Patients 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 MEASURES The 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. RESULTS On 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 RELEVANCE In 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 REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Fogo, fenologia foliar e a fauna de lagartas em Byrsonima coccolobifolia kunth (malpighiaceae)

Dissertação (mestrado)—Universidade de Brasília, Instituto de Ciências Biológicas, Programa de Pós-Graduação em Biologia Animal, 2007.Apesar da alta riqueza de espécies de Lepidoptera, o conhecimento a respeito da biologia e da interação destas espécies com suas plantas hospedeiras, bem como sobre o efeito de queimas sobre comunidades de lagartas no Cerrado se restringe a poucos estudos. Sendo assim, este trabalho teve como objetivos avaliar o efeito do fogo sobre a fenologia foliar de Byrsonima coccolobifolia Kunth (Malpighiaceae) na freqüência, riqueza e composição de espécies de lagartas de Lepidoptera em duas áreas de Cerrado com queimadas prescritas e comparar esses parâmetros a uma área preservada do fogo. Durante os meses de dezembro de 2005 a agosto de 2006 foram vistoriados 900 indivíduos de B. coccolobifolia não-marcados em cada uma das três áreas de cerrado sensu stricto submetidas a diferentes regimes de fogo na Reserva Ecológica do IBGE (RECOR): uma área protegida há mais de 20 anos (P) e duas com queimas bienais (QI e QII). Para cada área foram anotadas a proporção de folhas novas e o número de lagartas, quando presentes. Todas as lagartas encontradas foram transportadas e criadas no laboratório de ecologia da Universidade de Brasília para posterior identificação dos adultos. A fenologia foliar de B. coccolobifolia diferiu significativamente entre as três áreas, com uma predominância de plantas com somente folhas maduras. A principal diferença entre áreas foi entre os indivíduos com até 50% de folhas novas, a qual apresentou maior proporção nas duas áreas queimadas. As freqüências de cada classe fenológica variaram ao longo do período de coletas. A freqüência de plantas com lagartas foi de 12% para as três áreas, sendo observada uma correlação significativa entre as classes fenológicas e o total de plantas com lagartas. A área P teve maior freqüência de plantas com lagartas (22,4%) e foi responsável por 62% do total de plantas ocupadas por lagartas. Os meses de maior ocorrência de lagartas foram maio e junho. A área P teve maior abundância de lagartas (n=321), bem como maior riqueza de espécies (n=36). A área QI (1º ano pós-fogo) apresentou um terço da abundância de P e riqueza 1,5 vezes menor, enquanto QII (2º ano pós-queima) teve abundância 5,2 vezes 7 menor que a de P, e 2,5 vezes menos espécies que aquela. Houve diferença entre as áreas quanto às espécies dominantes, sendo Cerconota achatina (Elachistidae) a mais abundante em P, Concana mundissima (Noctuidae), em QI, e Stenoma salome (Elachistidae), em QII. A dissimilaridade entre área P e as áreas queimadas foi de 63,94%. Os resultados indicam alteração da fenologia foliar devida a eventos de fogo nas áreas QI e QII (produção contínua de folhas) e um impacto negativo sobre a riqueza e abundância de lagartas de Lepidoptera. _____________________________________________________________________ ABSTRACTDespite the abundance of lepidopteran species, there are few studies focusing on lepidopteran caterpillars, such as their biology, the interactions with their host plants and the effects of fire on their community structure in Cerrado. The aim of the present study was to evaluate the effects of fire on foliar phenology of Byrsonima coccolobifolia Kunth (Malpighiaceae) and compare the frequencies, abundances and species composition of Lepidoptera larvae present in two areas of Cerrado sensu stricto disturbed by fire (nominated QI and QII) with a third area preserved for three decades from fire (P), in the RECOR. From December 2005 until August 2006, 900 plants of B. coccolobifolia were sampled at random in each area observed and the proportion of new leaves was registered along with the number of caterpillars found. The immatures collected were reared in the Ecology Laboratory of the Universidade de Brasilia. Leaf phenology of B. coccolobifolia differed significantly among areas, due to the larger proportion of plants with almost 50% of new leaves in the burnt areas. Area P showed the highest abundance (n=321), caterpillar richness (n=36) and frequency of plants with larvae (22.4%). The abundance in QI was 33% of Area P and richness 67%, while in QII abundance was 38% of area P and richness 40%. The dominant species were different in each area: Cerconota achatina (Elachistidae) in area P, Concana mundissima (Noctuidae) in area QI and Stenoma salome (Elachistidae) in area QII. The dissimilarity between P and the burnt areas was 63.94%. The results indicated leaf phenology alterations due to fire events and a negative impact on richness and abundance of caterpillars