Corticosteroids for pneumonia

BackgroundPneumonia is a common and potentially serious illness. Corticosteroids have been suggested for the treatment of different types of infection, however their role in the treatment of pneumonia remains unclear. This is an update of a review published in 2011.ObjectivesTo assess the efficacy and safety of corticosteroids in the treatment of pneumonia.Search methodsWe searched the Cochrane Acute Respiratory Infections Group's Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS on 3March 2017, together with relevant conference proceedings and references of identified trials. We also searched three trials registers for ongoing and unpublished trials.Selection criteriaWe included randomised controlled trials (RCTs) that assessed systemic corticosteroid therapy, given as adjunct to antibiotic treatment, versus placebo or no corticosteroids for adults and children with pneumonia.Data collection and analysisWe used standard methodological procedures expected by Cochrane. Two review authors independently assessed risk of bias and extracted data. We contacted study authors for additional information. We estimated risk ratios (RR) with 95% confidence intervals (CI) and pooled data using the Mantel-Haenszel fixed-effect model when possible.Main resultsWe included 17 RCTs comprising a total of 2264 participants; 13 RCTs included 1954 adult participants, and four RCTs included 310 children. This update included 12 new studies, excluded one previously included study, and excluded five new trials. One trial awaits classification.All trials limited inclusion to inpatients with community-acquired pneumonia (CAP), with or without healthcare-associated pneumonia (HCAP). We assessed the risk of selection bias and attrition bias as low or unclear overall. We assessed performance bias risk as low for nine trials, unclear for one trial, and high for seven trials. We assessed reporting bias risk as low for three trials and high for the remaining 14 trials.Corticosteroids significantly reduced mortality in adults with severe pneumonia (RR 0.58, 95% CI 0.40 to 0.84; moderate-quality evidence), but not in adults with non-severe pneumonia (RR 0.95, 95% CI 0.45 to 2.00). Early clinical failure rates (defined as death from any cause, radiographic progression, or clinical instability at day 5 to 8) were significantly reduced with corticosteroids in people with severe and non-severe pneumonia (RR 0.32, 95% CI 0.15 to 0.7; and RR 0.68, 95% CI 0.56 to 0.83, respectively; high-quality evidence). Corstocosteroids reduced time to clinical cure, length of hospital and intensive care unit stays, development of respiratory failure or shock not present at pneumonia onset, and rates of pneumonia complications.Among children with bacterial pneumonia, corticosteroids reduced early clinical failure rates (defined as for adults, RR 0.41, 95% CI 0.24 to 0.70; high-quality evidence) based on two small, clinically heterogeneous trials, and reduced time to clinical cure.Hyperglycaemia was significantly more common in adults treated with corticosteroids (RR 1.72, 95% CI 1.38 to 2.14). There were no significant differences between corticosteroid-treated people and controls for other adverse events or secondary infections (RR 1.19, 95% CI 0.73 to 1.93).Authors' conclusionsCorticosteroid therapy reduced mortality and morbidity in adults with severe CAP; the number needed to treat for an additional beneficial outcome was 18 patients (95% CI 12 to 49) to prevent one death. Corticosteroid therapy reduced morbidity, but not mortality, for adults and children with non-severe CAP. Corticosteroid therapy was associated with more adverse events, especially hyperglycaemia, but the harms did not seem to outweigh the benefits

Cm-Wavelength Total Flux and Linear Polarization Properties of Radio-Loud BL Lacertae Objects

Results from a long-term program to quantify the range of behavior of the cm-wavelength total flux and linear polarization variability properties of a sample of 41 radio-loud BL Lac objects using weekly to tri-monthly observations with the University of Michigan 26-m telescope operating at 14.5, 8.0, and 4.8 GHz are presented; these observations are used to identify class-dependent differences between these BL Lacs and QSOs in the Pearson-Readhead sample. The BL Lacs are found to be more highly variable in total flux density than the QSOs, exhibiting changes that are often nearly-simultaneous and of comparable amplitude at 14.5 and 4.8 GHz in contrast to the behavior in the QSOs and supporting the existence of class-dependent differences in opacity within the parsec-scale jet flows. Structure function analyses of the flux observations quantify that a characteristic timescale is identifiable in only 1/3 of the BL Lacs. The time-averaged fractional linear polarizations are only on the order of a few percent and are consistent with the presence of tangled magnetic fields within the emitting regions. In many sources a preferred long-term orientation of the EVPA is present; when compared with the VLBI structural axis, no preferred position angle difference is identified. The polarized flux typically exhibits variability with timescales of months to a few years and shows the signature of a propagating shock during several resolved outbursts. The observations indicate that the source emission is predominately due to evolving source components and support the occurrence of more frequent shock formation in BL Lac parsec-scale flows than in QSO jets. The differences in variability behavior and polarization between BL Lacs and QSOs can be explained by differences in jet stability.Comment: 1 LaTex (aastex) file, 21 postscript figure files, 2 external LaTex table files. To appear in the Astrophysical Journa

Sub-milliarcsecond Imaging of Quasars and AGN

We have used the VLBA at 15 GHz to image the structure of 132 strong compact AGN and quasars with a resolution better than one milliarcsecond and a dynamic range typically exceeding 1000 to 1. These observations were made as part of a program to investigate the sub-parsec structure of quasars and AGN and to study the changes in their structure with time. Many of the sources included in our study, particularly those located south of +35 degrees, have not been previously imaged with milliarcsecond resolution. Each of the sources has been observed at multiple epochs. In this paper we show images of each of the 132 sources which we have observed. For each source we present data at the epoch which had the best quality data. The milliarcsecond jets generally appear one-sided but two-sided structure is often found in lower luminosity radio galaxies and in high luminosity quasars with gigahertz peaked spectra. Usually the structure is unresolved along the direction perpendicular to the jet, but a few sources have broad plumes. In some low luminosity radio galaxies, the structure appears more symmetric at 2 cm than at long wavelengths. The apparent long wavelength symmetry in these sources is probably due to absorption by intervening material. A few sources contain only a single component with any secondary feature at least a thousand times weaker. We find no obvious correlation of radio morphology and the detection of gamma-ray emission by EGRET.Comment: 19 pages, 3 tables, 3 figures. Figure 2 (132 contour diagrams) is long and is omitted here. Figure 2 may be viewed at http://www.cv.nrao.edu/2cmsurvey/ In press, Astronomical Journal, April 199

Jet Collimation in Action: Re-alignment on Kiloparsec Scales in 3C279

We report a change in the trajectory of a well studied jet component of the quasar 3C279. The component changes in apparent projected speed and direction, and we find it to be moving with a Lorentz factor gamma >~ 15 at an initial angle of <~ 1 degree to the line of sight. The new trajectory of the component has approximately the same speed and direction as an earlier superluminal feature, originally seen in the early 1970s. The new direction for the component is also much better aligned with larger scale VLBA and VLA structure out to 0.1 arcseconds. We suggest that the trajectory change is a collimation event occurring at >~ 1 kiloparsec (deprojected) along the jet. While the change in trajectory on the sky appears to be 26 degrees the intrinsic change is <~ 1 degree. We estimate the Doppler factor prior to the change in direction to be D >~ 28 and after the change to be D >~ 23. Comparison to independent constraints on the Doppler factor suggest that the energy in the radiating particles cannot greatly exceed the energy in the magnetic field unless the volume filling factor is very much less than one.Comment: 4 pages, 4 figures, Accepted by ApJ Letters. Replaced version adds a comment to the discussio

Distributed GIS for automated natural hazard zonation mapping internet-SMS warning towards sustainable society

Today, open systems are needed for real time analysis and warnings on geo-hazards and over time can be achieved using Open Source Geographical Information System (GIS)-based platform such as GeoNode which is being contributed to by developers around the world. To develop on an open source platform is a very vital component for better disaster information management as far as spatial data infrastructures are concerned and this would be extremely vital when huge databases are to be created and consulted regularly for city planning at different scales, particularly satellite images and maps of locations. There is a big need for spatially referenced data creation, analysis, and management. Some of the salient points that this research would be able to definitely contribute with GeoNode, being an open source platform, are facilitating the creation, sharing, and collaborative use of geospatial data. The objective is development of an automated natural hazard zonation system with Internet-short message service (SMS) warning utilizing geomatics for sustainable societies. A concept of developing an internet-resident geospatial geohazard warning system has been put forward in this research, which can communicate alerts via SMS. There has been a need to develop an automated integrated system to categorize hazard and issue warning that reaches users directly. At present, no web-enabled warning system exists which can disseminate warning after hazard evaluation at one go and in real time. The objective of this research work has been to formalize a notion of an integrated, independent, generalized, and automated geo-hazard warning system making use of geo-spatial data under popular usage platform. In this paper, a model of an automated geo-spatial hazard warning system has been elaborated. The functionality is to be modular in architecture having GIS-graphical user interface (GUI), input, understanding, rainfall prediction, expert, output, and warning modules. A simplified but working prototype of the system without the GIS-GUI module has been already tested, validated, and reported. Through this paper, a significantly enhanced system integrated with web-enabled-geospatial information has been proposed, and it can be concluded that an automated hazard warning system has been conceptualized and researched. However, now the scope is to develop it further

Satellite telemetry of Blue-throated Macaws in Barba Azul Nature Reserve (Beni, Bolivia) reveals likely breeding areas

The Blue-throated Macaw (Ara glaucogularis) is a Critically Endangered species endemic to the Llanos de Moxos ecosystem of Beni, Bolivia. To aid conservation of the northwestern population that utilizes the Barba Azul Nature Reserve during the non-breeding season, we set out to learn the sites where these birds breed using satellite telemetry. We describe preliminary tests conducted on captive birds (at Loro Parque Foundation, Tenerife, Spain) that resulted in choosing Geotrak Parrot Collars, a metal, battery-operated unit that provides data through the Argos satellite system. In September 2019, we tagged three birds in Barba Azul with Geotrak collars, and received migration data for two birds, until battery depletion in November and December 2019. Our two migrant birds were tracked leaving Barba Azul on the same date (27 September), but departed in divergent directions (approximately 90 degrees in separation). They settled in two sites approximately 50-100 km from Barba Azul. Some details of the work are restricted out of conservation concern as the species still faces poaching pressures. Knowing their likely breeding grounds, reserve managers conducted site visits to where the birds were tracked, resulting in the discovery of breeding birds, although no birds still carrying a transmitter were seen then. A single individual still carrying its collar was spotted 13 August 2021 at Barba Azul. The work suggests that the Blue-throated Macaws of Barba Azul use breeding sites that are scattered across the Llanos de Moxos region, although within the recognized boundaries of the northwestern subpopulation. We conclude that the use of satellite collars is a feasible option for research with the species and could provide further conservation insights

Cross-sectional study of nutritional intake among patients undergoing tuberculosis treatment along the Myanmar-Thailand border

OBJECTIVE: This study summarises nutritional intake among patients with tuberculosis (TB) along the Myanmar-Thailand border according to the local diet. SETTING: TB clinic along the Myanmar-Thailand border. PARTICIPANTS: Cross-sectional surveys of 24-hour food recall were conducted with participants receiving anti-TB treatment. Participants were purposively selected to reflect proportion of age, sex and HIV co-infection based on historical patient records. Out of a total of 28 participants, 20 (71.4%) were men and 5 (17.9%) were co-infected with HIV. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome compared actual recorded intake to recommended intake. Secondary outcomes compared weight gain and body mass index (BMI) from diagnosis to time of survey. RESULTS: There were no significant differences in macronutrient or micronutrient intake by sex or for patients supplementing their rations. Mean treatment length at time of survey was 20.7 weeks (95% CI: 16.5 to 24.8). A significantly higher proportion of women (8/8, 100%) met caloric requirements compared with men (9/20, 45.0%, p=0.010), but few participants met other macronutrient or micronutrient requirements, with no significant differences by sex or for patients supplementing their rations. From diagnosis to the time of the survey, participants averaged significant weight gain of 6.48 kg (95% CI: 3.87 to 9.10) and increased BMI of 2.47 kg/m(2) (95% CI: 1.45 to 3.49; p=0.0001 for both). However, 50% (14/28) still had mild or more severe forms of malnutrition. CONCLUSIONS: This cross-sectional survey of nutritional intake in patients undergoing TB treatment in a sanatorium setting demonstrates the difficulty in sufficiently meeting nutritional demands, even when providing nutritional support

Searches for very high energy gamma rays from blazars with CANGAROO-III telescope in 2005-2009

We have searched for very high energy (VHE) gamma rays from four blazars using the CANGAROO-III imaging atmospheric Cherenkov telescope. We report the results of the observations of H 2356-309, PKS 2155-304, PKS 0537-441, and 3C 279, performed from 2005 to 2009, applying a new analysis to suppress the effects of the position dependence of Cherenkov images in the field of view. No significant VHE gamma ray emission was detected from any of the four blazars. The GeV gamma-ray spectra of these objects were obtained by analyzing Fermi/LAT archival data. Non-simultaneous wide range (radio to VHE gamma-ray bands) spectral energy distributions (SEDs) including CANGAROO-III upper limits, GeV gamma-ray spectra, and archival data are discussed using a one-zone synchrotron self-Compton (SSC) model in combination with a external Compton (EC) radiation. The HBLs (H 2356-309 and PKS 2155-304) can be explained by a simple SSC model, and PKS 0537-441 and 3C 279 are well modeled by a combination of SSC and EC model. We find a consistency with the blazar sequence in terms of strength of magnetic field and component size.Comment: 11 pages, 8 figures, Accepted for publication in Astroparticle Physic

Cohort profile: molecular signature in pregnancy (MSP): longitudinal high-frequency sampling to characterise cross-omic trajectories in pregnancy in a resource-constrained setting

A successful pregnancy relies on the interplay of various biological systems. Deviations from the norm within a system or intersystemic interactions may result in pregnancy-associated complications and adverse pregnancy outcomes. Systems biology approaches provide an avenue of unbiased, in-depth phenotyping in health and disease. The molecular signature in pregnancy (MSP) cohort was established to characterise longitudinal, cross-omic trajectories in pregnant women from a resource constrained setting. Downstream analysis will focus on characterising physiological perturbations in uneventful pregnancies, pregnancy-associated complications and adverse outcomes.; First trimester pregnant women of Karen or Burman ethnicity were followed prospectively throughout pregnancy, at delivery and until 3 months post partum. Serial high-frequency sampling to assess whole blood transcriptomics and microbiome composition of the gut, vagina and oral cavity, in conjunction with assessment of gene expression and microbial colonisation of gestational tissue, was done for all cohort participants.; 381 women with live born singletons averaged 16 (IQR 15-18) antenatal visits (13 094 biological samples were collected). At 5% (19/381) the preterm birth rate was low. Other adverse events such as maternal febrile illness 7.1% (27/381), gestational diabetes 13.1% (50/381), maternal anaemia 16.3% (62/381), maternal underweight 19.2% (73/381) and a neonate born small for gestational age 20.2% (77/381) were more often observed than preterm birth.; Results from the MSP cohort will enable in-depth characterisation of cross-omic molecular trajectories in pregnancies from a population in a resource-constrained setting. Moreover, pregnancy-associated complications and unfavourable pregnancy outcomes will be investigated at the same granular level, with a particular focus on population relevant needs such as effect of tropical infections on pregnancy. More detailed knowledge on multiomic perturbations will ideally result in the development of diagnostic tools and ultimately lead to targeted interventions that may disproportionally benefit pregnant women from this resource-limited population.; NCT02797327