Harmful algae and toxis in paranaguá bay , Brazil: bases for monitoring

O complexo estuarino de Paranaguá (CEP; 25º30'S, 48º30'W), localizado no litoral sul do Brasil, abriga extensas áreas preservadas de manguezais e tem a pesca e aqüicultura como importantes atividades econômicas. Este trabalho investigou a ocorrência de microalgas nocivas no CEP e a presença de ficotoxinas no molusco bivalve Mytella guyanensis. Para tanto, foram coletadas amostras com periodicidade aproximadamente mensal, entre agosto de 2002 e outubro de 2003. Foram avaliadas variáveis físico-químicas, densidade de espécies nocivas e a presença de toxinas nos moluscos através de bioensaio com camundongos (DSP e PSP) e por cromatografia líquida (ASP). As espécies nocivas encontradas foram Pseudo-nitzschia spp., Dinophysis acuminata,Prorocentrum minimum,Gymnodinium catenatum,Phaeocystis spp., Chattonella spp. e Heterosigma akashiwo. Além dessas, Trichodesmium erythraeum e Coscinodiscus wailesii foram também incluídas no estudo pelo potencial de produzirem eventos nocivos na região. Toxinas diarréicas (DSP) foram detectadas em moluscos em dezembro de 2002 associadas à presença de D. acuminata (até 4.566 cel.l-1). Toxinas paralisantes e amnésicas foram produzidas por cepas cultivadas em laboratório. Primavera (de outubro a dezembro no hemisfério Sul) e final do verão (fevereiro a abril) foram os períodos de maior abundância de algas nocivas principalmente nos setores euhalino e polihalino interno do CEP.The estuarine complex of Paranaguá - ECP (South Brazil, 25º30'S, 48º30'W) is a large subtropical system, where pristine mangrove forests are still present, and fishery and aquaculture are important economic activities. This work investigated the occurrence of harmful algae in Paranaguá Bay, as well as the presence of toxins in the filter feeding mussel Mytella guyanensis, a local fishery resource. Samples along the Paranaguá sub-system were collected almost monthly from August 2002 to October 2003. Besides physical and chemical variables, cell densities of harmful species and presence of toxins in the mussel by mouse bioassay (DSP, PSP) and HPLC (ASP) were performed. HAB species included Pseudo-nitzschia spp., Dinophysis acuminata,Prorocentrum minimum,Gymnodinium catenatum,Phaeocystis spp., Chattonella spp. and Heterosigma akashiwo.Trichodesmium erythraeum and Coscinodiscus wailesii were also included in this study due to their potential for harmful bloom formation. Toxin results showed the occurrence of DSP (December 2002) in shellfish related to the presence of D. acuminata (max. 4,566 cells.l-1). Additionally, cultivated strains produced paralytic and amnesic toxins in laboratory. Spring (October to December, Southern Hemisphere) and late summer (February to April) were the periods of higher abundance of harmful algae, mainly in euhaline and inner polyhaline sectors of the ECP

Harmful algae and toxis in paranaguá bay , Brazil: bases for monitoring

The estuarine complex of Paranaguá - ECP (South Brazil, 25º30'S, 48º30'W) is a large subtropical system, where pristine mangrove forests are still present, and fishery and aquaculture are important economic activities. This work investigated the occurrence of harmful algae in Paranaguá Bay, as well as the presence of toxins in the filter feeding mussel Mytella guyanensis, a local fishery resource. Samples along the Paranaguá sub-system were collected almost monthly from August 2002 to October 2003. Besides physical and chemical variables, cell densities of harmful species and presence of toxins in the mussel by mouse bioassay (DSP, PSP) and HPLC (ASP) were performed. HAB species included Pseudo-nitzschia spp., Dinophysis acuminata,Prorocentrum minimum,Gymnodinium catenatum,Phaeocystis spp., Chattonella spp. and Heterosigma akashiwo.Trichodesmium erythraeum and Coscinodiscus wailesii were also included in this study due to their potential for harmful bloom formation. Toxin results showed the occurrence of DSP (December 2002) in shellfish related to the presence of D. acuminata (max. 4,566 cells.l-1). Additionally, cultivated strains produced paralytic and amnesic toxins in laboratory. Spring (October to December, Southern Hemisphere) and late summer (February to April) were the periods of higher abundance of harmful algae, mainly in euhaline and inner polyhaline sectors of the ECP.O complexo estuarino de Paranaguá (CEP; 25º30'S, 48º30'W), localizado no litoral sul do Brasil, abriga extensas áreas preservadas de manguezais e tem a pesca e aqüicultura como importantes atividades econômicas. Este trabalho investigou a ocorrência de microalgas nocivas no CEP e a presença de ficotoxinas no molusco bivalve Mytella guyanensis. Para tanto, foram coletadas amostras com periodicidade aproximadamente mensal, entre agosto de 2002 e outubro de 2003. Foram avaliadas variáveis físico-químicas, densidade de espécies nocivas e a presença de toxinas nos moluscos através de bioensaio com camundongos (DSP e PSP) e por cromatografia líquida (ASP). As espécies nocivas encontradas foram Pseudo-nitzschia spp., Dinophysis acuminata,Prorocentrum minimum,Gymnodinium catenatum,Phaeocystis spp., Chattonella spp. e Heterosigma akashiwo. Além dessas, Trichodesmium erythraeum e Coscinodiscus wailesii foram também incluídas no estudo pelo potencial de produzirem eventos nocivos na região. Toxinas diarréicas (DSP) foram detectadas em moluscos em dezembro de 2002 associadas à presença de D. acuminata (até 4.566 cel.l-1). Toxinas paralisantes e amnésicas foram produzidas por cepas cultivadas em laboratório. Primavera (de outubro a dezembro no hemisfério Sul) e final do verão (fevereiro a abril) foram os períodos de maior abundância de algas nocivas principalmente nos setores euhalino e polihalino interno do CEP

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

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

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19

Background: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. Methods: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). Results: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. Conclusions: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use

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