Some 300,000 reservists are being called up, according to Russia, as it seeks to halt a wave of successful Ukrainian counterattacks. Military expert Philip Ingram has the latest. 📺 Sky 501, Virgin 602, Freeview 233 and YouTube
The defence ministry in Belarus has released images of Russian troops arriving in the country as part of a"regional grouping" .The situation on day 234 of the war
"Per the conventional wisdom, leaders responsible for starting a war are uniquely susceptible to blame and punishment for how a war ends and are thus prone to keep fighting even with little hope of victory.
"It might not even need a land operation," Mr Zagorodnyuk writes."The Western coalition could credibly tell the Kremlin that it would hit Russian capabilities with direct missile strikes and airstrikes, destroying its military facilities and disabling its Black Sea Fleet. "My feeling is next year there will be a ceasefire in which the Ukrainians will be better placed and that ceasefire will be unstable and it will break down and there will be a third war and then a ceasefire and a fourth war.
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In critically ill patients, anti-anaerobic antibiotics increase risk of adverse clinical outcomesBackground Critically ill patients routinely receive antibiotics with activity against anaerobic gut bacteria. Yet in other disease states and animal models, gut anaerobes are protective against pneumonia, organ failure, and mortality. We therefore designed a translational series of analyses and experiments to determine the effects of anti-anaerobic antibiotics on the risk of adverse clinical outcomes among critically ill patients. Methods We conducted a retrospective single-center cohort study of 3032 critically ill patients, comparing patients who did and did not receive early anti-anaerobic antibiotics. We compared ICU outcomes (ventilator-associated pneumonia[VAP]-free survival, infection-free survival, overall survival) in all patients, and changes in gut microbiota in a 116-patient subcohort. In murine models, we studied the effects of anaerobe depletion in infectious ( K. pneumoniae and S. aureus pneumonia) and noninfectious ( hyperoxia ) injury models. Results Early administration of anti-anaerobic antibiotics was associated with decreased VAP-free survival (HR 1.24, 95% CI 1.06–1.45), infection-free survival (1.22, 95% CI 1.09–1.38), and overall survival (HR 1.14, 95% CI 1.02–1.28). Patients who received anti-anaerobic antibiotics had decreased initial gut bacterial density (p=0.00038), increased microbiome expansion during hospitalisation (p=0.011), and domination by Enterobacteriaceae spp. (p=0.045). Enterobacteriaceae were also enriched among respiratory pathogens in anti-anaerobic treated patients (p|2.2×10−16). In murine models, treatment with anti-anaerobic antibiotics increased susceptibility to Enterobacteriaceae pneumonia (p|0.05) and increased the lethality of hyperoxia (p=0.0002). Conclusions In critically ill patients, early treatment with anti-anaerobic antibiotics is associated with increased mortality. Mechanisms may include enrichment of the gut with respiratory pathogens, but increased mortality is incompletely explained by infections alone
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