Predictors of Duration and Treatment Failure of Severe Pneumonia in Hospitalized Young Nepalese Children

Background

Pneumonia in young children is still the most frequent cause of death in developing countries. We aimed to identify predictors for recovery and treatment failure in children hospitalized with severe pneumonia.

Methods

We enrolled 610 Nepalese children, aged 2 – 35 months from February 2006 to June 2008. Study participants were provided with standard treatment for pneumonia and followed up until discharge. Three multiple regression models representing clinical variables, clinical and radiological combined and all variables, including C-reactive protein (CRP) and viral etiology were used to assess the associations.

Results

The median age of study participants was 6 months with 493 (82%) infants and 367 (61%) males. The median time (IQR) till recovery was 49 (31, 87) hours and treatment failure was experienced by 209 (35%) of the children. Younger age, hypoxia on admission and radiographic pneumonia were independent predictors for both prolonged recovery and risk of treatment failure. While wasting and presence of any danger sign also predicted slower recovery, Parainfluenza type 1 isolated from the nasopharynx was associated with earlier resolution of illness. Gender, being breastfed, stunting, high fever, elevated CRP, presence of other viruses and supplementation with oral zinc did not show any significant association with these outcomes.

Conclusion

Age, hypoxia and consolidation on chest radiograph were significant predictors for time till recovery and treatment failure in children with severe pneumonia. While chest radiograph is not always needed, detection and treatment of hypoxia is a crucial step to guide the management of hospitalized children with pneumonia.     

Contrasting responses of two passerine bird species to moose browsing

Large herbivores may modify the ecosystem in a way that affects habitat quality and resource availability for other fauna. The increase in wild ungulate abundance in many areas may therefore lead to ecosystem changes, affecting distribution and reproduction of other species. Moose (Alces alces) in Scandinavia is a good example of a herbivore that has recently increased in abundance and has the potential to affect the ecosystem. In this study, we investigated how different levels of moose winter activity around supplementary feeding stations for moose affect reproduction in two insectivorous passerines: great tits (Parus major) and pied flycatchers (Ficedula hypoleuca). The two bird species showed contrasting responses to high moose activity at feeding stations. Great tits avoided habitats with high moose activity, where fledging success and feeding frequency was lower than at low moose activity habitats. Flycatchers nested more often at high moose activity habitats where fledging weight and feeding frequency were higher than at low moose activity habitats. Filming of nest boxes with great tits showed an increase in adult Lepidoptera in the diet at supplementary feeding stations for moose, and a smaller size of caterpillar prey at intermediate moose activity. The results support the hypothesis that herbivores may affect insectivorous passerines through changed arthropod food availability.     

Feedlot dust stimulation of interleukin-6 and -8 requires protein kinase Cepsilon in human bronchial epithelial cells

Individuals exposed to dusts from concentrated animal feeding operations report increased numbers of respiratory tract symptoms, and bronchoalveolar lavage samples from such individuals demonstrate elevated lung inflammatory mediators, including interleukin (IL)-8 and IL-6. We previously found that exposure of bronchial epithelial cells to hog barn dusts resulted in a protein kinase C (PKC)-dependent increase in IL-6 and IL-8 release. We hypothesized that cattle feedlot dusts would also generate bronchial epithelial interleukin release in vitro. To test this, we used interleukin ELISAs and direct PKC isoform assays. We found that a dust extract from cattle feedlots [feedlot dust extract (FLDE)] augments PKC activity of human bronchial epithelial cells in vitro. A 5-10% dilution of FLDE stimulated a significant release of IL-6 and IL-8 at 6-24 h in a PKC-dependent manner vs. control medium-treated cells. An increase in PKCalpha activity was observed with 1 h of FLDE treatment, and PKCepsilon activity was elevated at 6 h of FLDE exposure. The PKCalpha inhibitor, G?-6976, did not inhibit FLDE-stimulated IL-8 and IL-6 release. However, the PKCepsilon inhibitor, Ro 31-8220, effectively inhibited FLDE-stimulated IL-8 and IL-6 release. Inhibition of FLDE-stimulated IL-6 and IL-8 was confirmed in a dominant-negative PKCepsilon-expressing BEAS-2B cell line but not observed in a PKCalpha dominant negative BEAS-2B cell line. These data support the hypothesis that FLDE exposure stimulates bronchial epithelial IL-8 and IL-6 release via a PKCepsilon-dependent pathway.     

Stimulation of conversion rates and bacterial activity in a silage-fed two-phase biogas process by initiating liquid recirculation

The effects of liquid recirculation on a liquefaction-acidogenic reactor in an anaerobic two-phase digesting system operating with grass-clover silage was studied during 40 days after initiating recirculation of effluent from the methanogenic reactor to the liquefaction-acidogenic reactor. An increase in alkalinity and, thus, an increase in pH from 5.2 to 6.0 occurred in the liquefaction-acidogenic reactor. During the same period, a 10-fold increase (from 0.2 to 1.9 g·l^–1·h^–1) in the degradation rate of mannitol and an almost 9-fold increase in the activity of hydrogenotrophic methanogens was observed. The estimated number of these bacteria increased by one order of magnitude. The average degradation rate of lactate increased 3-fold, probably as a consequence of the more efficient hydrogen consumption by the hydrogenotrophic methanogens. An observed increase in net mineralization of organic nitrogen compounds was probably the main reason for an enhanced net production of organic acids (from 0.2 to 0.9 g·l^–1·d^–1). The liquefaction of cellulose and hemicellulose was low from the start of recirculation (3% and 20% reduction, respectively) and did not seem to be affected by the liquid recirculation. This was in accordance with the low number of cellulose degraders (4.0·10² counts·ml^–1) observed. The results from this investigation show that the initiation of liquid recirculation in silage-fed two-phase biogas processes will stimulate the activity of hydrogenotrophic methanogens in the liquefaction-acidogenic reactor. This will lead to more thermodynamically favourable conditions for acidification reactions which are dependent upon interspecies transfer of reducing equivalents.Abbreviations COD chemical oxygen demand - CSTR completely stirred tank reactor - HRT hydraulic retention time - LA-reactor liquefaction-acidogenic reactor - M-reactor methanogenic reactor - MPN most probable number - OLR organic loading rate - SMA specific methanogenic activity - SRT solids retention time - TKN total Kjeldahl nitrogen - ts total solids - tss total suspended solids - vs volatile solids - vss volatile suspended solids     

Recombinant glucagon-like peptide-1 (7-36 amide) lowers fasting serum glucose in a broad spectrum of patients with type 2 diabetes.

AIMS: To evaluate the safety and efficacy of various doses of recombinant glucagon-like peptide-1 (7-36) amide (rGLP-1) administered subcutaneously (s. c.) via bolus injection or continuous infusion to lower fasting serum glucose (FSG) levels in subjects with type 2 diabetes treated by diet, hypoglycemic drugs, or insulin injection. METHODS: rGLP-1 was administered s. c. to 40 type 2 diabetics currently treated by diet, sulfonylurea (SU), metformin, or insulin in a double-blind, placebo-controlled, cross-over trial; preexisting treatments were continued during the study. In the bolus injection protocol, 32 subjects (8 from each of the 4 treatment groups) received 0.0, 0.5, 1.0, and 1.5 nmol rGLP-1/kg per injection (two injections, two hours apart, beginning one hour after the evening meal) in a randomized order on separate days. In the continuous s. c. infusion protocol, 40 subjects received rGLP-1 at 0.0, 1.5, 2.5, 3.5, and 4.5 pmol/kg/min for 10-12 hours overnight starting one hour after the evening meal. Fasting bloods were taken the morning after for glucose, insulin, and glucagon measurements. RESULTS: In the diet, SU, and metformin cohorts, bolus rGLP-1 injections produced modest reductions in mean FSG levels, averaging 17.4 mg/dl (7.3-27.5; 95 % CI) at the highest dose (p < 0.001 vs. placebo). Reductions in FSG levels were greater by continuous infusion at up to 30.3 mg/dl (18.8 - 41.8; 95 % CI; p < 0.001 vs. placebo). The greatest reduction in mean FSG occurred in the SU cohort (up to 43.9 mg/dl, 24.7 - 63.1; 95 % CI; p < 0.001). rGLP-1 infusions resulted in significant increases in fasting plasma insulin and decreases in fasting plasma glucagon levels. There were no serious adverse events; GI-related symptoms were dose-related and more commonly associated with injections. CONCLUSIONS: rGLP-1 (7-36) amide dose-dependently lowered FSG in a broad spectrum of type 2 diabetics when added to their existing treatment. Subcutaneous infusion was more effective than injection, and the combination with SU was more effective than with metformin.     

Monitoring growth of the methanogenic archaea Methanobacterium formicicum using an electronic nose

Growth of the methanogenic archaea, Methanobacterium formicicum, in pure culture was monitored by analysing samples from the gas phase with an array of chemical gas sensors (an `electronic nose'). Analyses of the methane and protein formation rates were used as independent parameters of growth, and the data obtained from the electronic nose were evaluated using principal component analysis (PCA). We found that different growth phases can be distinguished with the electronic nose followed by PCA evaluation. The fast response of the sensors in combination with the high correlations with other parameters measuring growth show that the electronic nose can be a useful tool to rapidly determine methanogenic growth.     

Induction of vitellogenin synthesis in an Atlantic salmon (Salmo salar) hepatocyte culture: a sensitive in vitro bioassay for the oestrogenic and anti-oestrogenic activity of chemicals

A variety of organic compounds have been documented to bind to the oestrogen receptor and induce oestrogenic effects in different vertebrates. The presence of these environmental oestrogens or oestrogen mimics in the aquatic environment has been suspected of disrupting the normal endocrinology of wild populations of fish. In this study, induction of vitellogenin synthesis in primary hepatocytes from Atlantic salmon (Salmo salar) was optimized and validated as an oestrogenic in vitro bioassay using a sensitive capture vitellogenin enzyme-linked immunosorbent assay. After proper optimization (cell media supplements, cell density, temperature and exposure time), this assay gave a sensitive and reproducible response to both endogenous steroids (relative potency: 17β-oestradiol?oestriol>oestrone>17α-oestradiol) and a range of common oestrogen mimics (relative potency: ethynyloestradiol and diethylstilboestrol?genistein and zearalenone?bisphenol A and 4-t-octylphenol>4-n-nonylphenol and 2′-chloro,4-chloro-diphenyltrichloroethane (o,p′-DDT). However, the androgen testosterone and the putative oestrogen mimics dieldrin and toxaphene were not shown to be oestrogenic using this hepatocyte bioassay. Oestrogen-induced vitellogenin synthesis was efficiently inhibited by the anti-oestrogen ZM 189.154, suggesting that this bioassay may be used for testing both the oestrogenic and the anti-oestrogenic properties of chemicals.     

Species richness,vegetation structure,and floristic composition of woody plants along the elevation gradient of Mt. Meru,Tanzania

Understanding the change in vegetation composition along elevational gradients is critical for species conservation in a changing world. We studied the species richness, tree height, and floristic composition of woody plants along an elevation gradient of protected habitats on the eastern slope of Mount Meru and analyzed how these vegetation variables are influenced by the interplay of temperature and precipitation. Vegetation data were collected on 44 plots systematically placed along five transects spanning an elevational gradient of 1600 to 3400 m a.s.l. We used ordinary linear models and multivariate analyses to test the effect of mean annual temperature and precipitation on woody plant species richness, tree height, and floristic composition. We found that species richness, mean tree height, and maximum tree height declined monotonically with elevation. Models that included only mean annual temperature as an explanatory variable were generally best supported to predict changes in species richness and tree height along the elevation gradient. We found significant changes in woody plant floristic composition with elevation, which were shaped by an interaction of mean annual temperature and precipitation. While plant communities consistently changed with temperature along the elevation gradient, levels of precipitation were more important for plant communities at lower than for those at higher elevations. Our study suggests that changes in temperature and precipitation regimes in the course of climate change will reshape elevational gradients of diversity, tree height, and correlated carbon storage in ecosystems, and the sequence of tree communities on East African mountains.     

Arctic life adaptation--I. The function of reindeer hemoglobin

1. The functional properties of hemoglobin from the reindeer (Rangifer tarandus tarandus L.) are characterized as a function of pH, temperature and organic phosphate concentration. 2. Alongside overall similarities shared with most vertebrate hemoglobins, hemoglobin from the reindeer shows significant differences with respect to the effect of both organic phosphates and chloride anions. 3. The limited effect of temperature on oxygen binding (delta H = -4 kcal/mol O2) could be regarded as an interesting case of molecular adaptation to extreme environmental conditions.