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

COMPORTAMENTO ESPACIAL DA FUSARIOSE E DOS ATRIBUTOS DO SOLO NO CULTIVO DA PIMENTA-DO-REINO

A pimenta-do-reino é a especiaria mais consumida no mundo e o Brasil destaca-se como um dos maiores produtores. Um dos grandes limitantes no seu cultivo é a fusariose (Fusarium solani f. sp. piperis). Objetivou-se com a realização deste estudo caracterizar a variabilidade espacial da fusariose em pimenta-do-reino, verificando a existência de relação com os atributos físicos e químicos do solo. O estudo foi desenvolvido em uma lavoura localizada no município de São Mateus-ES, na qual foi estabelecida uma malha amostral irregular com 79 pontos, abrangendo uma área de um hectare.  Para a amostragem da fusariose foi realizado um levantamento, onde uma planta por ponto da malha amostral foi classificada em sadia, doente ou morta.  Os atributos do solo amostrados foram: pH em H2O, matéria orgânica, cálcio, magnésio, potássio e textura do solo. Os dados foram analisados através da estatística descritiva e ferramentas da geoestatística. Os semivariogramas ajustados apresentaram uma forte dependência espacial para as variáveis intensidade da fusariose, altimetria, matéria orgânica, textura do solo, pH, cálcio, magnésio potássio (89, 94, 92, 94, 93, 91, 100 e 85 % respectivamente). Os mapas gerados indicam que não há relação da intensidade da fusariose com os atributos do solo estudados no experimento.Palavra-chave: epidemiologia, Fusarium solani f. sp. piperis, geoestatística, Piper nigrum L. SPATIAL ANALYSIS OF FUSARIOSE AND SOIL ATTRIBUTES IN THE BLACK PEPPER CULTIVATION  ABSTRACT:Black pepper is the most consumed spice in the world, Brazil stands out as one of the largest producers. One of the major constraints in cultivation is fusariosis (Fusarium solani f. Piperis). The objective of this study was characterize the spatial variability of fusariosis in black pepper and verify the relationship of chemical attributes of the soil. The study was developed in a tillage located in the municipality of São Mateus - ES, which exist an irregular sampling network was established with 79 points, covering an area of one hectare. For the sampling of fusariosis intensity, the survey was performed, where one plant per point of the sample mesh was classified as healthy, symptomatic or dead. The attributes of the soil sampled were: pH in H2O, organic matter, nutrient content (calcium, magnesium, potassium) and soil texture. Data were analyzed through descriptive statistics and geostatistics tools. The adjusted semivariograms indicated a strong spatial dependence for the variables intensity of fusariosis, altimetry, organic matter, soil texture, pH, calcium, potassium magnesium (89, 94, 92, 94, 93, 91, 100 and 85%, respectively). The generated maps indicate that there is no relation between the incidence of fusariosis and the soil attributes studied in the experiment.Keywords: epidemiology, Fusarium solani f. sp. piperis, geostatistics, Piper nigrum L

COMPORTAMENTO ESPACIAL DA FUSARIOSE E DOS ATRIBUTOS DO SOLO NO CULTIVO DA PIMENTA-DO-REINO

A pimenta-do-reino é a especiaria mais consumida no mundo e o Brasil destaca-se como um dos maiores produtores. Um dos grandes limitantes no seu cultivo é a fusariose (Fusarium solani f. sp. piperis). Objetivou-se com a realização deste estudo caracterizar a variabilidade espacial da fusariose em pimenta-do-reino, verificando a existência de relação com os atributos físicos e químicos do solo. O estudo foi desenvolvido em uma lavoura localizada no município de São Mateus-ES, na qual foi estabelecida uma malha amostral irregular com 79 pontos, abrangendo uma área de um hectare.  Para a amostragem da fusariose foi realizado um levantamento, onde uma planta por ponto da malha amostral foi classificada em sadia, doente ou morta.  Os atributos do solo amostrados foram: pH em H2O, matéria orgânica, cálcio, magnésio, potássio e textura do solo. Os dados foram analisados através da estatística descritiva e ferramentas da geoestatística. Os semivariogramas ajustados apresentaram uma forte dependência espacial para as variáveis intensidade da fusariose, altimetria, matéria orgânica, textura do solo, pH, cálcio, magnésio potássio (89, 94, 92, 94, 93, 91, 100 e 85 % respectivamente). Os mapas gerados indicam que não há relação da intensidade da fusariose com os atributos do solo estudados no experimento.Palavra-chave: epidemiologia, Fusarium solani f. sp. piperis, geoestatística, Piper nigrum L. SPATIAL ANALYSIS OF FUSARIOSE AND SOIL ATTRIBUTES IN THE BLACK PEPPER CULTIVATION  ABSTRACT:Black pepper is the most consumed spice in the world, Brazil stands out as one of the largest producers. One of the major constraints in cultivation is fusariosis (Fusarium solani f. Piperis). The objective of this study was characterize the spatial variability of fusariosis in black pepper and verify the relationship of chemical attributes of the soil. The study was developed in a tillage located in the municipality of São Mateus - ES, which exist an irregular sampling network was established with 79 points, covering an area of one hectare. For the sampling of fusariosis intensity, the survey was performed, where one plant per point of the sample mesh was classified as healthy, symptomatic or dead. The attributes of the soil sampled were: pH in H2O, organic matter, nutrient content (calcium, magnesium, potassium) and soil texture. Data were analyzed through descriptive statistics and geostatistics tools. The adjusted semivariograms indicated a strong spatial dependence for the variables intensity of fusariosis, altimetry, organic matter, soil texture, pH, calcium, potassium magnesium (89, 94, 92, 94, 93, 91, 100 and 85%, respectively). The generated maps indicate that there is no relation between the incidence of fusariosis and the soil attributes studied in the experiment.Keywords: epidemiology, Fusarium solani f. sp. piperis, geostatistics, Piper nigrum L

A multi-country analysis of COVID-19 hospitalizations by vaccination status

Background: Individuals vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), when infected, can still develop disease that requires hospitalization. It remains unclear whether these patients differ from hospitalized unvaccinated patients with regard to presentation, coexisting comorbidities, and outcomes. Methods: Here, we use data from an international consortium to study this question and assess whether differences between these groups are context specific. Data from 83,163 hospitalized COVID-19 patients (34,843 vaccinated, 48,320 unvaccinated) from 38 countries were analyzed. Findings: While typical symptoms were more often reported in unvaccinated patients, comorbidities, including some associated with worse prognosis in previous studies, were more common in vaccinated patients. Considerable between-country variation in both in-hospital fatality risk and vaccinated-versus-unvaccinated difference in this outcome was observed. Conclusions: These findings will inform allocation of healthcare resources in future surges as well as design of longer-term international studies to characterize changes in clinical profile of hospitalized COVID-19 patients related to vaccination history. Funding: This work was made possible by the UK Foreign, Commonwealth and Development Office and Wellcome (215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z, and 220757/Z/20/Z); the Bill & Melinda Gates Foundation (OPP1209135); and the philanthropic support of the donors to the University of Oxford's COVID-19 Research Response Fund (0009109). Additional funders are listed in the "acknowledgments" section

Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19

Importance: Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines. Objectives: To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation. Design, setting, and participants: This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide. The data were collected under the auspices of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC)-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Analyses were restricted to patients hospitalized for severe COVID-19 (a subset of the ISARIC data set). Exposure: Corticosteroid use as reported to the ISARIC-WHO Clinical Characterisation Protocol for Severe Emerging Infections. Main outcomes and measures: Number and percentage of patients hospitalized with severe COVID-19 who received corticosteroids by time period and by WHO geographic region. Results: Among 434 851 patients with confirmed severe or critical COVID-19 for whom receipt of corticosteroids could be ascertained (median [IQR] age, 61.0 [48.0-74.0] years; 53.0% male), 174 307 (40.1%) received corticosteroids during the study period. Of the participants in clinical trials that informed the guideline, 91.6% were recruited from the United Kingdom. In all regions, corticosteroid use for severe COVID-19 increased, but this increase corresponded to the timing of the RECOVERY trial (time-interruption coefficient 1.0 [95% CI, 0.9-1.2]) and WHO guideline (time-interruption coefficient 1.9 [95% CI, 1.7-2.0]) publications only in Europe. At the end of the study period, corticosteroid use for treatment of severe COVID-19 was highest in the Americas (5421 of 6095 [88.9%]; 95% CI, 87.7-90.2) and lowest in Africa (31 588 of 185 191 [17.1%]; 95% CI, 16.8-17.3). Conclusions and relevance: The results of this cohort study showed that implementation of the guidelines for use of corticosteroids in the treatment of severe COVID-19 varied geographically. Uptake of corticosteroid treatment was lower in regions with limited clinical trial involvement. Improving research diversity and representativeness may facilitate timely knowledge uptake and guideline implementation

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc