Inadequate use of antibiotics in the covid-19 era: effectiveness of antibiotic therapy

Background: Since December 2019, the COVID-19 pandemic has changed the concept of medicine. This work aims to analyze the use of antibiotics in patients admitted to the hospital due to SARS-CoV-2 infection. Methods: This work analyzes the use and effectiveness of antibiotics in hospitalized patients with COVID-19 based on data from the SEMI-COVID-19 registry, an initiative to generate knowledge about this disease using data from electronic medical records. Our primary endpoint was all-cause in-hospital mortality according to antibiotic use. The secondary endpoint was the effect of macrolides on mortality. Results: Of 13, 932 patients, antibiotics were used in 12, 238. The overall death rate was 20.7% and higher among those taking antibiotics (87.8%). Higher mortality was observed with use of all antibiotics (OR 1.40, 95% CI 1.21–1.62; p <.001) except macrolides, which had a higher survival rate (OR 0.70, 95% CI 0.64–0.76; p <.001). The decision to start antibiotics was influenced by presence of increased inflammatory markers and any kind of infiltrate on an x-ray. Patients receiving antibiotics required respiratory support and were transferred to intensive care units more often. Conclusions: Bacterial co-infection was uncommon among COVID-19 patients, yet use of antibiotics was high. There is insufficient evidence to support widespread use of empiric antibiotics in these patients. Most may not require empiric treatment and if they do, there is promising evidence regarding azithromycin as a potential COVID-19 treatment. © 2021, The Author(s)

Reconstruction of events recorded with the surface detector of the Pierre Auger Observatory

Cosmic rays arriving at Earth collide with the upper parts of the atmosphere, thereby inducing extensive air showers. When secondary particles from the cascade arrive at the ground, they are measured by surface detector arrays. We describe the methods applied to the measurements of the surface detector of the Pierre Auger Observatory to reconstruct events with zenith angles less than 60o using the timing and signal information recorded using the water-Cherenkov detector stations. In addition, we assess the accuracy of these methods in reconstructing the arrival directions of the primary cosmic ray particles and the sizes of the induced showers

Relationship of runoff, erosion and sediment yield to weather types in the Iberian Peninsula

Precipitation has been recognized as one of the main factors driving soil erosion and sediment yield (SY), and its spatial and temporal variability is recognized as one of the main reasons for spatial and temporal analyses of soil erosion variability. The weather types (WTs) approach classifies the continuum of atmospheric circulation into a small number of categories or types and has been proven a good indicator of the spatial and temporal variability of precipitation. Thus, the main objective of this study is to analyze the relationship between WTs, runoff, soil erosion (measured in plots), and sediment yield (measured in catchments) in different areas of the Iberian Peninsula (IP) with the aim of detecting spatial variations in these relationships. To this end, hydrological and sediment information covering the IP from several Spanish research teams has been combined, and related with daily WTs estimated by using the NMC/NCAR 40-Year Reanalysis Project. The results show that, in general, a few WTs (particularly westerly, southwesterly and cyclonic) provide the largest amounts of precipitation; and southwesterly, northwesterly and westerly WTs play an important role in runoff generation, erosion and sediment yield as they coincide with the wettest WTs. However, this study highlights the spatial variability of erosion and sediment yield in the IP according to WT, differentiating (1) areas under the influence of north and/or north-westerly flows (the north coast of Cantabria and inland central areas), (2) areas under the influence of westerly, southwesterly and cyclonic WTs (western and southwestern IP), (3) areas in which erosion and sediment yield are controlled by easterly flows (Mediterranean coastland), and (4) lastly, a transitional zone in the inland northeast Ebro catchment, where we detected a high variability in the effects of WTs on erosion. Overall results suggest that the use of WTs derived from observed atmospheric pressure patterns could be a useful tool for inclusion in future projections of the spatial variability of erosion and sediment yield, as models capture pressure fields reliably

Combined fit of spectrum and composition data as measured by the Pierre Auger Observatory

We present a combined fit of a simple astrophysical model of UHECR sources to both the energy spectrum and mass composition data measured by the Pierre Auger Observatory. The fit has been performed for energies above 5 c5 1018 eV, i.e. the region of the all-particle spectrum above the so-called "ankle" feature. The astrophysical model we adopted consists of identical sources uniformly distributed in a comoving volume, where nuclei are accelerated through a rigidity-dependent mechanism. The fit results suggest sources characterized by relatively low maximum injection energies, hard spectra and heavy chemical composition. We also show that uncertainties about physical quantities relevant to UHECR propagation and shower development have a non-negligible impact on the fit results

Search for Ultra-High Energy Photons with the Pierre Auger Observatory

One of key scientific objectives of the Pierre Auger Observatory is the search for ultra-high energy photons. Such photons could originate either in the interactions of energetic cosmic-ray nuclei with the cosmic microwave background (so-called cosmogenic photons) or in the exotic scenarios, e.g. those assuming a production and decay of some hypothetical super-massive particles. The latter category of models would imply relatively large fluxes of photons with ultra-high energies at Earth, while the former, involving interactions of cosmic-ray nuclei with the microwave background - just the contrary: very small fractions. The investigations on the data collected so far in the Pierre Auger Observatory led to placing very stringent limits to ultra-high energy photon fluxes: below the predictions of the most of the exotic models and nearing the predicted fluxes of the cosmogenic photons. In this paper the status of these investigations and perspectives for further studies are summarized

Search for photons with energies above 1018eV using the hybrid detector of the Pierre Auger Observatory

A search for ultra-high energy photons with energies above 1 EeV is performed using nine years of data collected by the Pierre Auger Observatory in hybrid operation mode. An unprecedented separation power between photon and hadron primaries is achieved by combining measurements of the longitudinal air-shower development with the particle content at ground measured by the fluorescence and surface detectors, respectively. Only three photon candidates at energies 1 - 2 EeV are found, which is compatible with the expected hadroninduced background. Upper limits on the integral flux of ultra-high energy photons of 0.027, 0.009, 0.008, 0.008 and 0.007 km-2 sr-1 yr-1 are derived at 95% C.L. for energy thresholds of 1, 2, 3, 5 and 10 EeV. These limits bound the fractions of photons in the all-particle integral flux below 0.1%, 0.15%, 0.33%, 0.85% and 2.7%. For the first time the photon fraction at EeV energies is constrained at the sub-percent level. The improved limits are below the flux of diffuse photons predicted by some astrophysical scenarios for cosmogenic photon production. The new results rule-out the early top-down models - in which ultra-high energy cosmic rays are produced by, e.g., the decay of super-massive particles - and challenge the most recent super-heavy dark matter models