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

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

Molecular identification of deep-sea blind lobster Willemoesia forceps (Crustacea: Decapoda: Polychelidae) from the Central Indian Ridge

The deep-sea blind lobster Willemoesia forceps A. Milne-Edwards, 1880 was collected at a water depth of 3433 m and is reported for the first time from the Central Indian Ridge (CIR). The species was identified based on morphological examination and supported by mitochondrial Cytochrome Oxidase Subunit I (mtCOI) gene. The phylogenetic analysis shows that W. leptodactyla is sister species of W. forceps. Our findings expand the distributional range of the specimen in the southern hemisphere

Denitrification activity in mangrove sediments varies with associated vegetation

International audienceTo test the hypothesis that mangrove vegetation associated sediment characteristics could influence an ecologically important function such as denitrification, a study was carried out at the Divar mangrove ecosystem in Goa, India. The composition of intertidal mangroves was assessed based on which the down-core (0-10 cm) variation in environmental variables and denitrification activity (DNT) associated with dominant vegetation types was examined. Our observations revealed a distinct zonation pattern of mangroves with the dominance of Rhizophora mucronata (RM) in the lower intertidal zone followed by Avicennia marina (AM) in the mid region. Acanthus ilicifolius (AI) was restricted to the upper intertidal zone (UIZ) which was characterized by relatively lower sediment temperatures, higher porewater salinity and intense reducing conditions. A zonation pattern in occurrence of DNT was also observed. Denitrification activity generally decreased with depth and increased in intensity from the seaward to the landward side. Maximum DNT of 4.06 +/- 0.44 nmol N2O g(-1) h(-1) was recorded in the surficial AI sediments followed by AM and RM sediments. Surface plant litter content also increased from the lower to UIZ. A negative relationship of NH4+ and total organic carbon content (n=15, r=-0.388, p<0.05) in AI sediments was observed. This suggested that re-mineralization of accumulated organic matter (up to 3.07 + 0.58% at 0-2 cm) enhanced NH4+ availability in the porewater which in turn could support nitrification-denitrification. Thus, degradation of vegetation-derived organic matter was important in sustaining nutrients mainly towards the landward side proving our hypothesis that vegetation could have an influence on DNT, albeit indirectly. (C) 2016 Published by Elsevier B.V

Bacterial diversity in relatively pristine and anthropogenically-influenced mangrove ecosystems (Goa, India)

To appreciate differences in benthic bacterial community composition at the relatively pristine Tuvem and the anthropogenically-influenced Divar mangrove ecosystems in Goa, India, parallel tag sequencing of the V6 region of 16S rDNA was carried out. We hypothesize that availability of extraneously-derived anthropogenic substrates could act as a stimulatant but not a deterrent to promote higher bacterial diversity at Divar. Our observations revealed that the phylum Proteobacteria was dominant at both locations comprising 43-46&#37; of total tags. The Tuvem ecosystem was characterized by an abundance of members belonging to the class Deltaproteobacteria (21&#37;), ~ 2100 phylotypes and 1561 operational taxonomic units (OTUs) sharing &gt; 97&#37; similarity. At Divar, the Gammaproteobacteria were ~ 2x higher (17&#37;) than at Tuvem. A more diverse bacterial community with &gt; 3300 phylotypes and &gt; 2000 OTUs mostly belonging to Gammaproteobacteria and a significantly higher DNT (n = 9, p < 0.001, df = 1) were recorded at Divar. These findings suggest that the quantity and quality of pollutants at Divar are perhaps still at a level to maintain high diversity. Using this technique we could show higher diversity at Divar with the possibility of Gammaproteobacteria contributing to modulating excess nitrate