Chloroquine for treatment of COVID-19 results in subtherapeutic exposure and prolonged QTc intervals

Item does not contain fulltex

Patterns and determinants of shorebird species richness in the circumpolar Arctic

Aim The intention with this study was first to investigate and describe the broad-scale geographical patterns of species richness of breeding shorebirds (Charadriiformes; families: Charadriidae, Scolopacidae and Haematopodidae) throughout the arctic tundra biome. Secondly, after compensating for the positive relationship between net primary productivity (NPP) and species richness, the relative importance of additional ecological and historical variables for species richness was investigated. The main variables considered are NPP, length of snow- and ice-free season, accessibility of regions depending on migratory flyway systems, tundra area at Pleistocene (120 and 20-18 ka bp) and Holocene (8 ka bp) times, and tundra area at present. Methods Information on shorebird species breeding distributions was compiled from distribution atlases and species accounts. The breeding distributions of shorebirds with ranges partly or completely in the Arctic (a total of 50 species) were mapped in ArcView 3.2 to create a raster grid layer of shorebird species richness at a 1degrees latitude x longitude resolution. The total and mean species richness value was calculated per each 10degrees of longitude sector of the Arctic. The relationships between species richness and the different climatic and environmental variables were analysed on the basis of this sector-wise division of the arctic tundra. The influence of each variable on species richness was investigated using univariate and multivariate analyses (multivariate linear regression and general linear model). Results We found that patterns of breeding shorebird species richness in the Arctic tundra biome are to a large degree determined by the NPP, the length of the snow- or ice-free season, the diversity of migratory flyways, as well as the historical extent of tundra habitat area during the maximum cooling of the last glacial period. Essentially, two main regions are distinguishable in the circumpolar Arctic regarding shorebird community richness. These are a species-rich Beringia-centred region and a species-poor Atlantic-centred region. Main conclusions The underlying explanations to these major trends may primarily be attributed to factors that operate at present through accessibility of areas from contemporary migration flyways, as well as processes that operated in the past during and after the last glacial cycle. The most prominent influence on the shorebird diversity was found for NPP in combination with the diversity of migratory flyways. These flyways provide the links between breeding and wintering resources, often separated by huge distances, and the geographical and ecological conditions associated with the shorebirds' migration seem to be of particular importance for their breeding diversity in different sectors of circumpolar tundra

Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set

Background: The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. Methods: This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson’s Chi-squared and continuous variables by Mann–Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the “full” matching method. Results: Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. Conclusions: In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021). Graphical abstract: [Figure not available: see fulltext.]. © 2022, The Author(s)