Biodiversity of tropical Saturniidae, as measured through traditionally described and catalogued species, strongly risks pooling cryptic species under one name. We examined the DNA barcodes, morphology, habitus and ecology of 32 ‘well known’ species of dry forest saturniid moths from Area de Conservacion Guanacaste (ACG) in north-western Costa Rica and found that they contain as many as 49 biological entities that are probably separate species. The most prominent splitting of traditional species – Eacles imperialis, Automeris zugana, Automeris tridens, Othorene verana, Hylesia dalina, Dirphia avia, Syssphinx molina, Syssphinx colla, and Syssphinx quadrilineata – is where one species was believed to breed in dry forest and rain forest, but is found to be two biological entities variously distinguishable by DNA barcodes and morphology, habitus, and/or microecological distribution. This implies that ‘standard’ biological information about each traditional species may be an unconscious mix of interspecific information, and begs renewed DNA barcoding, closer attention to so-called intraspecific variation, and increased museum collection and curation of specimens from more individual and ecologically characterised sites – as well as eventually more species descriptions. Simultaneously, this inclusion of sibling species as individual entities in biodiversity studies, rather than pooled under one traditional name, reduces the degree of ecological and evolutionary generalisation perceived by the observer.
BACKGROUND: Transcutaneous carbon dioxide (P tcCO 2 ) monitoring is being used increasingly to assess acute respiratory failure. However, there are conflicting findings concerning its reliability when evaluating patients with high levels of P aCO 2 . Our study evaluates the accuracy of this method in subjects with respiratory failure according to the severity of hypercapnia. METHODS: We included subjects with respiratory failure, admitted to a respiratory intermediate care unit, who required arterial blood gas analysis. Simultaneously, P tcCO 2 was measured using a digital monitor. Relations between P aCO 2 and P tcCO 2 were assessed by the Pearson correlation coefficient. BlandAltman analysis was used to test data dispersion, and an analysis of variance test was used to compare the differences between P aCO 2 and the corresponding P tcCO 2 at different levels (level 1, <50 mm Hg; level 2, 50 -60 mm Hg; level 3, >60 mm Hg). RESULTS: Eighty-one subjects were analyzed. The main diagnosis was COPD exacerbation (45%). P tcCO 2 correlated well with P aCO 2 (r2 ؍ 0.93, P < .001). Bland-Altman analysis showed a mean P aCO 2 ؊ P tcCO 2 difference of 4.9 ؎ 4.4 with 95% limits of agreement ranging from ؊3.6 to 13.4. The difference between variables increased in line with P aCO 2 severity: level 1, 1.7 ؎ 3.2 mm Hg; level 2, 3.7 ؎ 2.8; level 3, 6.8 ؎ 4.7 (analysis of variance, P < .001). CONCLUSIONS: Our study showed an acceptable agreement of P tcCO 2 monitoring with arterial blood gas analysis. However, we should consider that P tcCO 2 underestimates P aCO 2 levels, and its accuracy depends on the level of hypercapnia, so this method would not be suitable for acute patients with severe hypercapnia.
Introduction: Many severe COVID-19 patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the clinical outcomes of severe COVID-19 patients admitted to an IMCU.Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 pneumonia during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6 vs. 24.2%; p < 0.001). Multivariable proportional hazards model showed that age ≥65 years (HR 4.14; 95%CI 2.31–7.42; p < 0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38–3.99; p = 0.002) and chronic kidney disease (HR 2.96; 95%CI 1.61–5.43; p < 0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06–0.40; p < 0.001).Conclusions: IMCU may be a useful tool for the multidisciplinary management of severe COVID-19 patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.
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