Clinical presentation, disease course and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease – a cohort study across eighteen countries

AimsPatients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality.Methods and resultsWe used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66–75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02–1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10–1.30; P ConclusionConsiderable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.</div

MIRI/JWST observations reveal an extremely obscured starburst in the z=6.9 system SPT0311-58

Luminous infrared starbursts in the early Universe are thought to be the progenitors of massive quiescent galaxies identified at redshifts 2–4. Using the Mid-IRfrared Instrument (MIRI) on board the James Webb Space Telescope (JWST), we present mid-infrared sub-arcsec imaging and spectroscopy of such a starburst: the slightly lensed hyper-luminous infrared system SPT0311-58 at z = 6.9. The MIRI IMager (MIRIM) and Medium Resolution Spectrometer (MRS) observations target the stellar (rest-frame 1.26 μm emission) structure and ionised (Paα and Hα) medium on kpc scales in the system. The MIRI observations are compared with existing ALMA far-infrared continuum and [C II]158μm imaging at a similar angular resolution. Even though the ALMA observations imply very high star formation rates (SFRs) in the eastern (E) and western (W) galaxies of the system, the Hα line is, strikingly, not detected in our MRS observations. This fact, together with the detection of the ionised gas phase in Paα, implies very high internal nebular extinction with lower limits (AV) of 4.2 (E) and 3.9 mag (W) as well as even larger values (5.6 (E) and 10.0 (W)) by spectral energy distribution (SED) fitting analysis. The extinction-corrected Paα lower limits of the SFRs are 383 and 230 M⊙ yr−1 for the E and W galaxies, respectively. This represents 50% of the SFRs derived from the [C II]158 μm line and infrared light for the E galaxy and as low as 6% for the W galaxy. The MIRIM observations reveal a clumpy stellar structure, with each clump having 3–5×109 M⊙ mass in stars, leading to a total stellar mass of 2.0 and 1.5×1010 M⊙ for the E and W galaxies, respectively. The specific star formation (sSFR) in the stellar clumps ranges from 25 to 59 Gyr−1, assuming a star formation with a 50–100 Myr constant rate. This sSFR is three to ten times larger than the values measured in galaxies of similar stellar mass at redshifts 6–8. Thus, SPT0311-58 clearly stands out as a starburst system when compared with typical massive star-forming galaxies at similar high redshifts. The overall gas mass fraction is Mgas/M* ∼ 3, similar to that of z ∼ 4.5–6 star-forming galaxies, suggesting a flattening of the gas mass fraction in massive starbursts up to redshift 7. The kinematics of the ionised gas in the E galaxy agrees with the known [C II] gas kinematics, indicating a physical association between the ionised gas and the cold ionised or neutral gas clumps. The situation in the W galaxy is more complex, as it appears to be a velocity offset by about +700 km s−1 in the Paα relative to the [C II] emitting gas. The nature of this offset and its reality are not fully established and require further investigation. The observed properties of SPT0311-58, such as the clumpy distribution at sub(kpc) scales and the very high average extinction, are similar to those observed in low- and intermediate-z luminous (E galaxy) and ultra-luminous (W galaxy) infrared galaxies, even though SPT0311-58 is observed only ∼800 Myr after the Big Bang. Such massive, heavily obscured clumpy starburst systems as SPT0311-58 likely represent the early phases in the formation of a massive high-redshift bulge, spheroids and/or luminous quasars. This study demonstrates that MIRI and JWST are, for the first time, able to explore the rest-frame near-infrared stellar and ionised gas structure of these galaxies, even during the Epoch of Reionization.</p

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background Colorectal cancer is the third leading cause of cancer deaths worldwide. Given the recent increasing trends in colorectal cancer incidence globally, up-to-date information on the colorectal cancer burden could guide screening, early detection, and treatment strategies, and help effectively allocate resources. We examined the temporal patterns of the global, regional, and national burden of colorectal cancer and its risk factors in 204 countries and territories across the past three decades. Methods Estimates of incidence, mortality, and disability-adjusted life years (DALYs) for colorectal cancer were generated as a part of the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019 by age, sex, and geographical location for the period 1990–2019. Mortality estimates were produced using the cause of death ensemble model. We also calculated DALYs attributable to risk factors that had evidence of causation with colorectal cancer. Findings Globally, between 1990 and 2019, colorectal cancer incident cases more than doubled, from 842 098 (95% uncertainty interval [UI] 810 408–868 574) to 2·17 million (2·00–2·34), and deaths increased from 518 126 (493 682–537 877) to 1·09 million (1·02–1·15). The global age-standardised incidence rate increased from 22·2 (95% UI 21·3–23·0) per 100 000 to 26·7 (24·6–28·9) per 100 000, whereas the age-standardised mortality rate decreased from 14·3 (13·5–14·9) per 100 000 to 13·7 (12·6–14·5) per 100 000 and the age-standardised DALY rate decreased from 308·5 (294·7–320·7) per 100 000 to 295·5 (275·2–313·0) per 100 000 from 1990 through 2019. Taiwan (province of China; 62·0 [48·9–80·0] per 100 000), Monaco (60·7 [48·5–73·6] per 100 000), and Andorra (56·6 [42·8–71·9] per 100 000) had the highest age-standardised incidence rates, while Greenland (31·4 [26·0–37·1] per 100 000), Brunei (30·3 [26·6–34·1] per 100 000), and Hungary (28·6 [23·6–34·0] per 100 000) had the highest age-standardised mortality rates. From 1990 through 2019, a substantial rise in incidence rates was observed in younger adults (age Interpretation The increase in incidence rates in people younger than 50 years requires vigilance from researchers, clinicians, and policy makers and a possible reconsideration of screening guidelines. The fast-rising burden in low SDI and middle SDI countries in Asia and Africa calls for colorectal cancer prevention approaches, greater awareness, and cost-effective screening and therapeutic options in these regions.</p

TeV Emission of Galactic Plane Sources with HAWC and H.E.S.S.

The High Altitude Water Cherenkov (HAWC) observatory and the High Energy Stereoscopic System (H.E.S.S.) are two leading instruments in the ground-based very-high-energy γ-ray domain. HAWC employs the water Cherenkov detection (WCD) technique, while H.E.S.S. is an array of Imaging Atmospheric Cherenkov Telescopes (IACTs). The two facilities therefore differ in multiple aspects, including their observation strategy, the size of their field of view, and their angular resolution, leading to different analysis approaches. Until now, it has been unclear if the results of observations by both types of instruments are consistent: several of the recently discovered HAWC sources have been followed up by IACTs, resulting in a confirmed detection only in a minority of cases. With this paper, we go further and try to resolve the tensions between previous results by performing a new analysis of the H.E.S.S. Galactic plane survey data, applying an analysis technique comparable between H.E.S.S. and HAWC. Events above 1 TeV are selected for both data sets, the point-spread function of H.E.S.S. is broadened to approach that of HAWC, and a similar background estimation method is used. This is the first detailed comparison of the Galactic plane observed by both instruments. H.E.S.S. can confirm the γ-ray emission of four HAWC sources among seven previously undetected by IACTs, while the three others have measured fluxes below the sensitivity of the H.E.S.S. data set. Remaining differences in the overall γ-ray flux can be explained by the systematic uncertainties. Therefore, we confirm a consistent view of the γ-ray sky between WCD and IACT techniques