Adjunctive Dexamethasone for Tuberculous Meningitis in HIV-Positive Adults.

BACKGROUND: Adjunctive glucocorticoids are widely used to treat human immunodeficiency virus (HIV)-associated tuberculous meningitis despite limited data supporting their safety and efficacy. METHODS: We conducted a double-blind, randomized, placebo-controlled trial involving HIV-positive adults (≥18 years of age) with tuberculous meningitis in Vietnam and Indonesia. Participants were randomly assigned to receive a 6-to-8-week tapering course of either dexamethasone or placebo in addition to 12 months of antituberculosis chemotherapy. The primary end point was death from any cause during the 12 months after randomization. RESULTS: A total of 520 adults were randomly assigned to receive either dexamethasone (263 participants) or placebo (257 participants). The median age was 36 years; 255 of 520 participants (49.0%) had never received antiretroviral therapy, and 251 of 484 participants (51.9%) with available data had a baseline CD4 count of 50 cells per cubic millimeter or less. Six participants withdrew from the trial, and five were lost to follow-up. During the 12 months of follow-up, death occurred in 116 of 263 participants (44.1%) in the dexamethasone group and in 126 of 257 participants (49.0%) in the placebo group (hazard ratio, 0.85; 95% confidence interval, 0.66 to 1.10; P = 0.22). Prespecified analyses did not reveal a subgroup that clearly benefited from dexamethasone. The incidence of secondary end-point events, including cases of immune reconstitution inflammatory syndrome during the first 6 months, was similar in the two trial groups. The numbers of participants with at least one serious adverse event were similar in the dexamethasone group (192 of 263 participants [73.0%]) and the placebo group (194 of 257 participants [75.5%]) (P = 0.52). CONCLUSIONS: Among HIV-positive adults with tuberculous meningitis, adjunctive dexamethasone, as compared with placebo, did not confer a benefit with respect to survival or any secondary end point. (Funded by the Wellcome Trust; ACT HIV ClinicalTrials.gov number, NCT03092817.)

Magnetoelectric Effect in Ceramics Based on Bismuth Ferrite

Solid-state sintering method was used to prepare ceramic materials based on bismuth ferrite, i.e., (BiFeO3)1 − x–(BaTiO3)x and Bi1 − xNdxFeO3 solid solutions and the Aurivillius Bi5Ti3FeO15 compound. The structure of the materials was examined using X-ray diffraction, and the Rietveld method was applied to phase analysis and structure refinement. Magnetoelectric coupling was registered in all the materials using dynamic lock-in technique. The highest value of magnetoelectric coupling coefficient αME was obtained for the Bi5Ti3FeO15 compound (αME ~ 10 mVcm−1 Oe−1). In the case of (BiFeO3)1 − x–(BaTiO3)x and Bi1 − xNdxFeO3 solid solutions, the maximum αME is of the order of 1 and 2.7 mVcm−1 Oe−1, respectively. The magnitude of magnetoelectric coupling is accompanied with structural transformation in the studied solid solutions. The relatively high magnetoelectric effect in the Aurivillius Bi5Ti3FeO15 compound is surprising, especially since the material is paramagnetic at room temperature. When the materials were subjected to a preliminary electrical poling, the magnitude of the magnetoelectric coupling increased 2–3 times