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

Potential risk of Batrachochytrium salamandrivorans in Mexico.

The recent decline in populations of European salamanders caused by the chytrid fungus Batrachochytrium salamandrivorans (Bsal) has generated worldwide concern, as it is a major threat to amphibians. Evaluation of the areas most suitable for the establishment of Bsal combined with analysis of the distribution of salamander species could be used to generate and implement biosecurity measures and protect biodiversity at sites with high salamander diversity. In this study, we identified the areas most suitable for the establishment of Bsal in Mexico. Mexico has the second-highest salamander species diversity in the world; thus, we identified areas moderately to highly suitable for the establishment of Bsal with high salamander diversity as potential hotspots for surveillance. Central and Southern Mexico were identified as high-risk zones, with 13 hotspots where 30% of Mexican salamander species occur, including range-restricted species and endangered species. We propose that these hotspots should be thoroughly monitored for the presence of Bsal to prevent the spread of the pathogen if it is introduced to the country

Variation of amphibian and reptile composition in forest fragments of Veracruz highlands, Mexico

La región montañosa del centro de Veracruz es una de las regiones con mayor riqueza herpetofaunística de México. El gradiente topográfico de esta región está asociado con diferencias climáticas que permiten la presencia de comunidades herpetofaunísticas muy diversas. Analizamos las diferencias en la diversidad herpetofaunística entre un área urbana, bosque de pino, bosque de roble y bosque de ribera del municipio Camerino Z. Mendoza, Veracruz, México. Realizamos censos mensuales de dos días entre 2015 y 2017 en 69 sitios de fragmentos de un área urbana, bosque ribereño, bosque de Quercus y bosque de Quercus-Pinus y analizamos las diferencias de especies de herpetofauna entre estos fragmentos. Encontramos un total de 11 especies de anfibios y 33 de reptiles, y una alta disimilitud en la composición y el reemplazo de especies entre los sitios. Nuestros resultados aumentaron los registros de especies dentro de Camerino Z. Mendoza, y mostraron una gran variación en la composición de anfibios y reptiles entre sitios, destacando el papel actual de estos bosques como reservorio de herpetofauna y su importancia para futuras estrategias de conservación en la región.The central mountain region of Veracruz is one of the richest areas of herpetofauna in Mexico. The steep topographic gradient of this region is associated with climatic gradients that enable the occurrence of highly diverse herpetofauna communities. We tested differences among habitats to herpetofauna in an urban area, pine forest, oak forest, and riparian forest of municipality Camerino Z. Mendoza, Veracruz, Mexico. We conducted two-day monthly surveys between 2015 and 2017 in 69 sites from fragments of an urban area, riparian forest, Quercus forest, and Quercus-Pinus forest and tested for differences in herpetofauna species among these fragments. We found a total of 11 amphibian and 33 reptile species, and a high composition dissimilarity and species replacement among the sites. Our results amplified significantly the species-records within Camerino Z. Mendoza, and showed a great variation of amphibian and reptile composition among sites, highlighting the current role of these forests as a reservoir for herpetofauna and their importance for future conservation strategies in the region.A região montanhosa de Veracruz central é uma das regiões herpetofaunísticas mais ricas do México. O gradiente topográfico dessa região está associado a diferenças climáticas que permitem a presença de comunidades herpetofaunísticas muito diversas. Analisamos as diferenças na diversidade da herpetofauna entre uma área urbana, uma floresta de pinheiros, uma floresta de carvalhos e uma mata ciliar no município de Camerino Z. Mendoza, Veracruz, México. Entre 2015 e 2017, realizamos censos mensais de dois dias em 69 fragmentos de uma área urbana, uma floresta ribeirinha, uma floresta de Quercus e uma floresta de Quercus-Pinus e analisamos diferenças em espécies entre estes fragmentos. Encontramos um total de 11 espécies de anfíbios e 33 espécies de répteis, e uma grande disparidade na composição e substituição de espécies entre locais. Nossos resultados aumentaram os registos de espécies dentro do município Camerino Z. Mendoza e mostraram uma grande variação na composição de anfíbios e répteis entre sítios, destacando o papel atual dessas florestas como reservatório de herpetofauna e a sua importância para futuras estratégias de conservação da região

The fungal pathogen Batrachochytrium salamandrivorans is not detected in wild and captive amphibians from Mexico

The recent emergence of the pathogen Batrachochytrium salamandrivorans (Bsal) is associated with rapid population declines of salamanders in Europe and its arrival to new areas could cause dramatic negative effects on other amphibian populations and species. Amphibian species, present in areas with high amphibian diversity such as Mexico, could be highly threatened due to the arrival of Bsal, particularly salamander species which are more vulnerable to chytridiomycosis caused by this pathogen. Thus, immediate surveillance is needed as a strategy to efficiently contend with this emerging infectious disease. In this study, we analyzed 490 wild and captive amphibians from 48 species across 76 sites in the North, Central, and South of Mexico to evaluate the presence of Bsal. Amphibians were sampled in sites with variable degrees of amphibian richness and suitability for Bsal according to previous studies. From the 76 sampling sites, 10 of them were located in areas with high amphibian richness and potential moderate to high Bsal habitat suitability. We did not detect Bsal in any of the samples, and no signs of the disease were observed in any individual at the time of sampling. Our results suggest that Bsal has not yet arrived at the sampled sites or could be at low prevalence within populations with low occurrence probability. This is the first study that evaluates the presence of Bsal in different regions and amphibian species in Mexico, which is the second most diverse country in salamander species in the world. We highlight the risk and the importance of continuing surveillance of Bsal in Mexico and discuss control strategies to avoid the introduction and spread of Bsal in the country

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN