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

USO DE HERRAMIENTAS CLICKERS EN SESIONES PRÁCTICAS EN LOS GRADOS DE INGENIERÍA CIVIL Y DE HISTORIA

This work studies the impact on students’ performance of inserting student-response-systems in practical lessons at the University of Córdoba. Innovative methodologies based on student-response-systems has been developed to be implemented during practical lessons in higher education. A pretest-posttest design is developed and presented in this work to assess the evolution in performance by the students of third course in Civil Engineering Grade at the University of Córdoba during a single course. Finally, motivational questionnaire towards the use of the innovative methodologies and clikers are filled by the students belonging to both Civil Engineering and History grades. The results of this pilot experience show a positive impact on the students’ performance by a rapid feedback, in which a conceptual reminder at the beginning of the practical lessons allow to boost the enhancement. The motivational questionnaires described an overall positive students’ awareness of the use of the methodologies and clickers. Both motivation and engagement are boosted by the application of the conceptual reminder at the beginning of the practical lessons and, therefore, its consideration is recommended.Este trabajo presenta un estudio sobre el rendimiento y la motivación de los estudiantes de grado en la Universidad de Córdoba a través de la implementación de clickers durante las sesiones de prácticas. Nuevas metodologías a aplicar durante las sesiones prácticas en ingeniería civil basadas en el uso de clickers son desarrolladas en este trabajo. Para medir el impacto de estas nuevas metodologías, se elabora y se presenta un diseño pretest-postest que se aplicó a los estudiantes de tercer curso del grado en ingeniería civil en la Universidad de Córdoba. Finalmente, los estudiantes de tercer curso del grado de Ingeniería civil y los procedentes del primer curso del grado en Historia completaron cuestionarios de satisfacción para medir el grado de motivación con respecto al uso de las nuevas metodologías y clickers en las sesiones prácticas. Los resultados de esta experiencia piloto demuestran una mejoría en el rendimiento motivado por un feedback casi instantáneo, donde un recordatorio conceptual al comienzo de las sesiones juega un papel fundamental. La motivación de los estudiantes hacia el uso de clickers en las sesiones prácticas es elevada y notable. Tanto la motivación como la atención son potenciadas por el uso del recordatorio conceptual al comienzo de las sesiones prácticas y, por tanto, se recomienda su aplicación

Plasma and cerebrospinal fluid nonenzymatic protein damage is sustained in Alzheimer's disease

Background: Oxidative stress is considered to play an important role in the pathogenesis of Alzheimer's disease (AD). It has been observed that oxidative damage to specific protein targets affecting particular functional networks is one of the mechanisms by which oxidative stress contributes to neuronal failure and consequently loss of cognition and AD progression. Studies are lacking in which oxidative damage is measured at both systemic and central fluid levels and in the same cohort of patients. We aimed to determine the levels of both plasma and cerebrospinal fluid (CSF) nonenzymatic protein damage in patients in the continuum of AD and to evaluate the relation of this damage with clinical progression from mild cognitive impairment (MCI) to AD. Methods: Different markers of nonenzymatic post-translational protein modification, mostly from oxidative processes, were detected and quantified in plasma and CSF by isotope dilution gas chromatography‒mass spectrometry using selected ion monitoring (SIM-GC/MS) for 289 subjects: 103 AD, 92 MCI, and 94 control subjects. Characteristics of the study population such as age, sex, Mini-mental state examination, CSF AD biomarkers, and APOE ϵ4, were also considered. Results: Forty-seven (52.8%) MCI patients progressed to AD during follow-up (58 ± 12.5 months). After controlling for age, sex, and APOE ϵ4 allele, plasma and CSF concentrations of protein damage markers were not associated with either diagnosis of AD or MCI. The CSF levels of nonenzymatic protein damage markers were associated with none of the CSF AD biomarkers. In addition, neither in CSF nor in plasma were the levels of protein damage associated with the MCI to AD progression. Conclusion: The lack of association between both CSF and plasma concentrations of nonenzymatic protein damage markers and AD diagnosis and progression suggests that oxidative damage in AD is a pathogenic mechanism specifically expressed at the cell-tissue level, not in extracellular fluids

Plant Physiological Assessments on Promising New HLB-Tolerant Citrus Rootstocks after Inoculation with the Phytopathogenic Ascomycete Rosellinia necatrix

Citriculture is considered the most important fruit industry and involves the cultivation of several fruit varieties, which are susceptible to many plant pathogens. In this sense, soil-borne pathogenic fungi, such Rosellinia necatrix, threaten citrus fruit production worldwide because they can cause fruit loss. Therefore, we assayed the physiological reaction of novel citrus rootstocks against white root rot disease during long-term management. Data from above-ground symptoms and chlorophyll content were periodically obtained during the experimental process. In addition, plant leaf area and percentage of biomass reduction were determined for each rootstock when the experiment finished. The behavior of the inoculated tolerant rootstocks was as follows: the lowest symptom rate of SAUDPC was achieved by B11R5T25 and N40R3T25; AMB+CZO manifested the highest disease incidence; B11R5T25 and A+VOLK × Orange 19-11-8 displayed the highest and the lowest chlorophyll content, respectively; AMB+CZO and A+VOLK × Orange 19-11-8 showed the highest biomass reduction, and the lowest was detected in B11R5T25 and N40R2T19; concerning the leaf area, N40R1T18, N40R3T25 and N40R2T19 showed the lowest response, and 2247 × 2075-01-2 achieved the highest rate. In summary, B11R5T25 and N40R3T25 displayed the lowest disease rate

Red para la innovación en la selvicultura y los sistemas de integración de riesgos en la gestión forestal

La forêt, en plus de ses fonctions économiques reconnues par tous les acteurs du milieu rural tels que le développement de l'emploi rural et le marché local du bois pour la transformation ou pour l'énergie, rend de nombreux autres services. Cependant, de multiples risques sont identifiables et doivent être gérés dans et pourront éventuellement être aggravés par les changements climatiques: futures sécheresses favorables aux pathogènes et ravageurs ainsi qu'à la propagation des incendies, et le risque de la modification du vent. Le projet FORRISK se focalisera ainsi sur les risques en forêt dont l'intensité est modulée par le changement climatique. L'histoire des forêts du sud de l'Europe nous rappelle que pour de nombreux problèmes, une approche seulement nationale n'a pas de sens. C'est-à-dire, les risques concernés, les réponses à apporter peuvent être soit au niveau technique soit au niveau de l'organisation des institutions. Pour cette raison, FORRISK vise à coordonner et mettre en réseau trois communautés différentes que sont les acteurs politiques, les gestionnaires et les scientifiques, dans le but d'obtenir que la gestion des risques soit partie intégrante des décisions prises à tous les niveaux du secteur forestier. Cela permettra d'initier une plateforme européenne sur les risques forestiers en facilitant des recommandations et des informations pertinentes à tous les niveaux. Pour y parvenir, le projet analysera et comparera les outils institutionnels, les systèmes et organisations liés à la gestion de risques dans les régions étudiées. Ensuite, FORRISK développera sur le terrain des techniques de lutte écologique, génétique et sylvicole, dont les résultats feront l'objet de guides de bonne pratique. Les outils produits consisteront à des cartes de risques à l'échelle régionale ou subrégionale, ainsi que à des modèles informatiques permettant de faire des diagnostics sur le terrain et de modéliser la propagation du fomès dans les peuplements de pin maritime. Ainsi, décideurs politiques, gestionnaires et scientifiques auront entre leurs mains des outils adaptés à la gestion de nombreux risques menaçant la forêt dans leurs régions

FORRISK. Réseau pour l’innovation dans les sylvicultures et les systèmes de gestion intégrée des risques de forêt

La forêt, en plus de ses fonctions économiques reconnues par tous les acteurs du milieu rural tels que le développement de l'emploi rural et le marché local du bois pour la transformation ou pour l'énergie, rend de nombreux autres services. Cependant, de multiples risques sont identifiables et doivent être gérés dans et pourront éventuellement être aggravés par les changements climatiques: futures sécheresses favorables aux pathogènes et ravageurs ainsi qu'à la propagation des incendies, et le risque de la modification du vent. Le projet FORRISK se focalisera ainsi sur les risques en forêt dont l'intensité est modulée par le changement climatique. L'histoire des forêts du sud de l'Europe nous rappelle que pour de nombreux problèmes, une approche seulement nationale n'a pas de sens. C'est-à-dire, les risques concernés, les réponses à apporter peuvent être soit au niveau technique soit au niveau de l'organisation des institutions. Pour cette raison, FORRISK vise à coordonner et mettre en réseau trois communautés différentes que sont les acteurs politiques, les gestionnaires et les scientifiques, dans le but d'obtenir que la gestion des risques soit partie intégrante des décisions prises à tous les niveaux du secteur forestier. Cela permettra d'initier une plateforme européenne sur les risques forestiers en facilitant des recommandations et des informations pertinentes à tous les niveaux. Pour y parvenir, le projet analysera et comparera les outils institutionnels, les systèmes et organisations liés à la gestion de risques dans les régions étudiées. Ensuite, FORRISK développera sur le terrain des techniques de lutte écologique, génétique et sylvicole, dont les résultats feront l'objet de guides de bonne pratique. Les outils produits consisteront à des cartes de risques à l'échelle régionale ou subrégionale, ainsi que à des modèles informatiques permettant de faire des diagnostics sur le terrain et de modéliser la propagation du fomès dans les peuplements de pin maritime. Ainsi, décideurs politiques, gestionnaires et scientifiques auront entre leurs mains des outils adaptés à la gestion de nombreux risques menaçant la forêt dans leurs régions

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.</p

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

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