Fewer COVID-19 neurological complications with dexamethasone and remdesivir

OBJECTIVE: To assess the impact of treatment with dexamethasone, remdesivir or both on neurological complications in acute COVID-19. METHODS: We used observational data from the International Severe Acute and emerging Respiratory Infection Consortium (ISARIC) WHO Clinical Characterisation Protocol UK (CCP-UK). Hospital inpatients aged ≥18 years with laboratory-confirmed SARS-CoV-2 infection admitted between 31 January 2020 and 29 June 2021 were included. Treatment allocation was non-blinded and performed by reporting clinicians. A propensity scoring methodology was used to minimize confounding. Treatment with remdesivir, dexamethasone or both was assessed against standard of care. The primary outcome was a neurological complication occurring at the point of death, discharge, or resolution of the COVID-19 clinical episode. RESULTS: Out of 89,297 hospital inpatients, 64,088 had severe COVID-19 and 25,209 had non-hypoxic COVID-19. Neurological complications developed in 4.8% and 4.5% respectively. In both groups, neurological complications associated with increased mortality, ICU admission, worse self-care on discharge and time to recovery. In severe COVID-19, treatment with dexamethasone (n=21,129), remdesivir (n=1,428) and both combined (n=10,846) associated with a lower frequency of neurological complications: OR=0.76 (95% CI=0.69-0.83), OR 0.69 (95% CI=0.51-0.90) and OR=0.54, (95% CI=0.47-0.61) respectively. In non-hypoxic COVID-19, dexamethasone (n=2,580) associated with less neurological complications (OR=0.78, 95% CI 0.62-0.97), while the dexamethasone/remdesivir combination (n=460) showed a similar trend (OR=0.63, 95% CI=0.31-1.15). INTERPRETATION: Treatment with dexamethasone, remdesivir or both in patients hospitalised with COVID-19 associated with a lower frequency of neurological complications in an additive manner, such that the greatest benefit was observed in patients who received both drugs together. This article is protected by copyright. All rights reserved

Palaeoclimatic events, dispersal and migratory losses along the Afro-European axis as drivers of biogeographic distribution in Sylvia warblers

<p>Abstract</p> <p>Background</p> <p>The Old World warbler genus <it>Sylvia </it>has been used extensively as a model system in a variety of ecological, genetic, and morphological studies. The genus is comprised of about 25 species, and 70% of these species have distributions at or near the Mediterranean Sea. This distribution pattern suggests a possible role for the Messinian Salinity Crisis (from 5.96-5.33 Ma) as a driving force in lineage diversification. Other species distributions suggest that Late Miocene to Pliocene Afro-tropical forest dynamics have also been important in the evolution of <it>Sylvia </it>lineages. Using a molecular phylogenetic hypothesis and other methods, we seek to develop a biogeographic hypothesis for <it>Sylvia </it>and to explicitly assess the roles of these climate-driven events.</p> <p>Results</p> <p>We present the first strongly supported molecular phylogeny for <it>Sylvia</it>. With one exception, species fall into one of three strongly supported clades: one small clade of species distributed mainly in Africa and Europe, one large clade of species distributed mainly in Africa and Asia, and another large clade with primarily a circum-Mediterranean distribution. Asia is reconstructed as the ancestral area for <it>Sylvia</it>. Long-distance migration is reconstructed as the ancestral character state for the genus, and sedentary behavior subsequently evolved seven times.</p> <p>Conclusion</p> <p>Molecular clock calibration suggests that <it>Sylvia </it>arose in the early Miocene and diverged into three main clades by 12.6 Ma. Divergence estimates indicate that the Messinian Salinity Crisis had a minor impact on <it>Sylvia</it>. Instead, over-water dispersals, repeated loss of long-distance migration, and palaeo-climatic events in Africa played primary roles in <it>Sylvia </it>divergence and distribution.</p

Ecological Energetics of an Abundant Aerial Insectivore, the Purple Martin

We thank T. Fagin for help with estimating the seasonal range area occupied by Purple Martins. We thank an anonymous reviewer, Mark Brigham, and J Boyles for their comments on this manuscript.Conceived and designed the experiments: JFK ESB WFF PBC. Performed the experiments: JFK PBC. Analyzed the data: JFK PBC. Wrote the manuscript: JFK ESB WFF PBC. Developed the model in Matlab: JFK PBC.The atmospheric boundary layer and lower free atmosphere, or aerosphere, is increasingly important for human transportation, communication, environmental monitoring, and energy production. The impacts of anthropogenic encroachment into aerial habitats are not well understood. Insectivorous birds and bats are inherently valuable components of biodiversity and play an integral role in aerial trophic dynamics. Many of these insectivores are experiencing range-wide population declines. As a first step toward gaging the potential impacts of these declines on the aerosphere’s trophic system, estimates of the biomass and energy consumed by aerial insectivores are needed. We developed a suite of energetics models for one of the largest and most common avian aerial insectivores in North America, the Purple Martin (Progne subis). The base model estimated that Purple Martins consumed 412 (± 104) billion insects*y-1 with a biomass of 115,860 (± 29,192) metric tonnes*y-1. During the breeding season Purple Martins consume 10.3 (+ 3.0) kg of prey biomass per km3 of aerial habitat, equal to about 36,000 individual insects*km-3. Based on these calculations, the cumulative seasonal consumption of insects*km-3 is greater in North America during the breeding season than during other phases of the annual cycle, however the maximum daily insect consumption*km-3 occurs during fall migration. This analysis provides the first range-wide quantitative estimate of the magnitude of the trophic impact of this large and common aerial insectivore. Future studies could use a similar modeling approach to estimate impacts of the entire guild of aerial insectivores at a variety of temporal and spatial scales. These analyses would inform our understanding of the impact of population declines among aerial insectivores on the aerosphere’s trophic dynamics.Yeshttp://www.plosone.org/static/editorial#pee