Molecular identification and composition of cyclorrhaphan flies associated with cafeterias

Cafeterias are routinely visited by people to fulfil their daily feeding and drinking requirements. Unnoticed visitors, such as cyclorrhaphan flies, are also present in these places which can be a source of food poisoning and disease spread. These flies were collected from garbage piles, kitchen and vacant sites of two cafeterias (Cafeteria Serumpun and Cafeteria Agro-bio) within Universiti Putra Malaysia and one cafeteria (Cafeteria Old-flat) outside the university. A total of 1,037 fly specimens were collected and identified belonging to Calliphoridae, Muscidae and Sarcophagadae. The COI and COII gene sequences and phylogenetic results revealed five species of cyclorrhaphan flies, namely Chrysomya megacephala, Lucilia cuprina, Musca domestica, Ophyra spinigera and Sarcophaga dux. The highest number of flies was found at Cafeteria Serumpun (44%), followed by Cafeteria Old-flat (36%) and Cafeteria Agro-bio (20%). The most populated sampling site was kitchen and the abundant species was C. megacephala (92.66%). Analysis of data showed significant difference between individuals of different species at different cafeterias and sampling sites

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

Kvinnorollen och mansrollen i opera – då och nu

För att ligga i framkant vid operautbildningen på Högskolan för scen och musik (HSM) behöver vi kontinuerligt komplettera synen på vår musikdramatiska interpretationsmetod och lösa upp genrehierarkier, inte minst för att kunna möta och vinna den nya generationens publik, ”de icke redan frälsta”. Ovanstående KU-projekt Lucia möter Pajazzo är en fristående fortsättning på de två konstnärliga KU-projekten En kvinnas många röster, 2008 samt En kvinnas möten, 2009. Dessa tre KU-projekt har med progression och fördjupning behandlat specifika frågeställningar i utvalda operascener med syfte att: - utveckla en genreöverskridande/genrelös sångteknik för att främja ett fungerande musikdramatiskt skådespeleri med texten i fokus - belysa könsmaktsordningen samt kvinnorollens och mansrollens försvar av det egna perspektivet samt problematisera offer- och förövarrollen I detta tredje KU-projekt prövar och fördjupar jag de frågeställningar, som genomsyrat samtliga KU-projekt genom att arbeta med en större blandad ensemble och interpretera scener från den mer konservativa operalitteraturen. Dessa ”pärlor” ur 1800-talets operaverk är ofta musikaliskt excellenta men gällande könsroller och klass är de oftast berättarmässigt konservativa. Den genreöverskridande eller genrelösa sångmetod, som kontinuerligt utvecklats i de tre forskningsprojekten, ger den sceniske sångaren redskap och möjligheter att låta rösten direkt spegla de känslor som text och musik förmedlar. Detta leder till ett mer trovärdigt och mångdimensionellt musikdramatiskt skådespeleri. Till min hjälp i alla tre projekten har jag haft sångcoachen Marianne Khoso, lektor på HSM. Jag har under årens lopp utarbetat ett antal övningar, som stöttar denna ”genreöverskridande” metod. Marianne Khoso har i sin tur utarbetat en grundsångteknik, som hon kallar ”genrelös”. Vi brinner båda för att försöka få ”operavärlden” att våga förändra en konservativ tradition av alltför kontrollerad och ibland rentav endimensionell operasång med ett överdrivet vibrato, som gärna uppkommer i ett alltför starkt sångbeteende. Denna ”genrelösa” teknik grundar sig i alla de samlade och fungerande tekniker, som sångarna lagrat i sin kropps minnesbank. Sångarnas erfarenheter av olika tekniker, från jazz, visa, belting, modern opera och klassisk opera samt deras mod att inte ge efter för en traditionell och ”överkontrollerad operateknik” har här gett ett slående resultat. Vi har i detta projekt prövat våra frågeställningar i några klassiska operascener, där rollkaraktärer från olika århundraden går i klinch med varandra. Vi har mött Molly Cutpurse, en rollfigur inspirerad av en autentisk kvinna från det tidiga 1600-talets England. Hon har klätt ut sig till man för att få bättre förutsättningar för sitt leverne. Hon försörjer sig som entreprenör, musiker, hälare, hallick mm. Molly har gestaltats av Katarina A Karlsson (doktorand vid HSM). Över denna tidsvandring i operans värld har La Finta Pazza, (den falska galna), sångerska från 1600-talets Venedig, svävat . Denna roll har katalyserat rollernas känslor, mannens såväl som kvinnans, bland annat genom att ge dem möjlighet att låta förståndet och själen fly in i ”vansinnets räddande bubbla”, just som livets våndor blir som svårast att hantera. La Finta Pazza har gestaltats av Elisabeth Belgrano (doktorand vid HSM). Även om de flesta kvinnliga roller på 1600-talet spelades av män, så fanns under renässansen någon slags grogrund till att i opera- och teaterkonsten försöka försvara ett kvinnligt perspektiv. Hoppet om att erkänna kvinnan som en fullvärdig varelse på scenen och i livet kom dock på skam under 1800-talet. Man kan nog efter vårt arbete våga dra slutsatsen att 1800-talet inte blev en bra utveckling för operaberättandet, varken när det gäller jämställdhet eller när det gäller sångligt uttryck. Formen/operamallen blev dogmatisk, ja rent av ”fundamentalistisk” på båda dessa punkter. Därför är det extra viktigt att inte ge efter för denna förlegade syn utan försöka finna ett sätt att interpretera dessa operaskatter på ett för dagens generation relevant sätt. I detta projekt har processen utvecklats i en komplett miljö. Det har inneburit scenkonstnärliga studentmöten från grundutbildningsnivå till doktorandnivå. Två doktorander, en student från operaprogrammets masterutbildning, fem studenter från operaprogrammets kandidatutbildning årskurs 2 samt fyra musikerstudenter har mötts och samarbetat i utvalda klassiska operascener. De medverkande studenterna har med olika bakgrunder, olika nivåer och förutsättningar, under min ledning utvecklat ett samstämmigt musikdramatiskt uttryck, alltså försökt komma överens om en gemensam syn på berättandet, läsarten, i våra utvalda operascener. De två doktoranderna som burit med sig sina frågeställningar från sitt avhandlingsarbete rakt in i vårt projekt har utmanat och berikat allas vårt arbete med nya perspektiv när det gäller vår gemensamma process i arbetet

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc

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

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

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

International audienc

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4 % presented with RS, while 13.6 % had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7 % vs RS: 37.5 %). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1 % vs. RS 32.0 %), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders