COVID-19-associated mucormycosis presenting to the Emergency Department-an observational study of 70 patients

BACKGROUND

Mucormycosis (MM) is a deadly opportunistic fungal infection and a large surge in COVID-19-associated mucormycosis (CAM) is occurring in India.

AIM

Our aim was to delineate the clinico-epidemiological profile and identify risk factors of CAM patients presenting to the Emergency Department (ED).

DESIGN

This was a retrospective, single-centre, observational study.

METHODS

We included patients who presented with clinical features or diagnosed MM and who were previously treated for COVID-19 in last 3 months of presentation (recent COVID-19) or currently being treated for COVID-19 (active COVID-19). Information regarding clinical features of CAM, possible risk factors, examination findings, diagnostic workup including imaging and treatment details were collected.

RESULTS

Seventy CAM patients (median age: 44.5 years, 60% males) with active (75.7%) or recent COVID-19 (24.3%) who presented to the ED in between 6 May 2021 and 1 June 2021, were included. A median duration of 20 days (interquartile range: 13.5-25) was present between the onset of COVID-19 symptoms and the onset of CAM symptoms. Ninety-three percent patients had at least one risk factor. Most common risk factors were diabetes mellitus (70%) and steroid use for COVID-19 disease (70%). After clinical, microbiological and radiological workup, final diagnosis of rhino-orbital CAM was made in most patients (68.6%). Systemic antifungals were started in the ED and urgent surgical debridement was planned.

CONCLUSION

COVID-19 infection along with its medical management have increased patient susceptibility to MM.

A phase I/II study of imatinib and docetaxel as neoadjuvant therapy in locally advanced breast cancer

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Background: Imatinib mestylate(Gleevec,G) is a tyrosine kinase inhibitor of platelet derived growth factor receptor(PDGFR) and KIT(CD117). In breast cancer(BC),PDGFR signaling regulates tumor interstitial fluid pressure(IFP). PDGFR inhibition lowers IFP enhancing tumor drug delivery and chemo effect. KIT’s role in BC growth is unclear.PDGFR and KIT signal pathways regulate proliferation and cell cycle progression.Receptor blockade may enhance anti-tumor activity combined with chemo.This study evaluated tolerability,toxicity and efficacy of imatinib and docetaxel and treatment changes in biomarker expression and downstream mediators. Methods: Eligibility:Total 12 women, invasive LABC(T2–4,No-2,Mo)IHC + for KIT and/or PDGF, ECOG 0–2,bidimensional disease.Treatment:Assigned to 1of 3 G dose levels(400,600,800mg) taken daily 2 weeks then combined with D30mg/m2 IV weekly x3 Q28 days. Three completed G(400mg D) and protocol modified to G600 and 800mg dose for 1 week then combined with D30mg/m2 IV weekly x12. Tumor(T)measured pretreatment and at definitive surgery at conclusion of G+D.T biopsy done preG, postG and at end of G+D for tissue markers. Three treated G400, 5G600 and 4G800mg dose. Results: 12 patients median age 51 (range 39–62), ECOG PS O, 4 pre/8 post menopausal treated. Clinical pretreatment (C-PRx) tumor size (TS)median 6cm (range 3- 12cm).C-PRx node status 7cN0 and 5cN1.PRx x-ray TS median 4.5 cm (range 2.5–8.5cm). Response:OR 25% 1 near CR+2 PR(3/12) at 400 and 600mg dose levels.Two SD(G800mg),3 progressed/off study,2 withdrew/toxicity(G3 rash/edema and G4 N/V), 2 NR.Surgery:5PM and 7MRM. Toxicity:Non- hematologic:nausea(1G4/G400mg),vomiting(1G4/G600mg),diarrhea(1G3/G800mg),fatigue(2G3/G800mg),myalgia(1G3/G800mg),rash(1G3/G600m g) and hypophosphatemia (2G3/G600mg). Hematologic toxicity mild neutropenia/anemia G1/2.One hospitalized for G3 odonophagia/stomatitis,G800mg.Dose Delay:2 missed 1 week of D+G (G600mg),2 missed 2 weeks of D+G (1G600mg and 1G800mg). Conclusion: Imatinib and docetaxel in neoadjuvant LABC is feasible and tolerable with low G3/4 toxicity and acceptable activity.G400mg dose best tolerated. Tissue IHC and molecular profiles to be reported separately.

Incorporation of thiosemicarbazide in Amberlite IRC-50 for separation of astatine from alpha-irradiated bismuth oxide

A chelating resin was synthesized by incorporating thiosemicarbazide into Amberlite IRC-50, a weakly acidic polymer. Astatine radionuclides produced by alpha-irradiating bismuth oxide were separated using the newly synthesized chelating resin. The resin showed high selectivity for astatine. The adsorbed astatine was recovered using 0.1M EDTA at pH approximately 10.

Application of tracer packet technique for multielemental uptake studies on the inorganic ion exchanger zirconium vanadate

The conception of tracer packet was first started with the irradiation of a thick cobalt target with 16O, 7Li and 12C beams, consecutively. This produced carrier-free radiotracers of Mn, Cu, Zn, Ga, Ge, As and Se. These elements are adjacent members in the periodic table and are of nutritional importance. Another 'tracer packet', which was subsequently designed, was of heavy and toxic metals. A gold target irradiated with medium energy 7Li and 12C produced 197Hg, 200Tl, 200Pb, 204Bi, 204Po. The uptake of these elements has been studied using two different ion exchangers, one of inorganic origin and the other of chelating type.

Radiochemical separation of carrier-free 204,206 Bi from alpha-irradiated thallium oxide target

Alpha activation of Tl(2)O(3) target results in the formation of carrier-free 204,206 Bi. Two different radiochemical methods were used for the separation of bismuth radionuclides from the target matrix. A very high separation factor was achieved using liquid-liquid extraction (LLX) method with methyl isobutyl ketone (MIBK)-HCl system. Solid-liquid exchange adsorption was carried out using a novel inorganic ion exchanger, zirconium vanadate from HCl medium. The separation was found to be maximum around pH 2.

Non-significance of rhizosphere degradation during phytoremediation of MTBE

Methyl tertiary butyl ether (MTBE) is a gasoline additive associated with groundwater pollution at gas station sites. Previous research on poplar trees in hydroponic systems suggests that phytovolatilization is an effective mechanism for phytoremediation of MTBE (Rubin and Ramaswami, 2001), but the potential for microbial degradation of MTBE in the rhizosphere of trees had not been assessed. MTBE had largely been considered recalcitrant to microbial processes, but recent fieldwork suggests rapid biodegradation may occur in certain cases. This paper investigates the potential for rhizosphere degradation of MTBE at time frames relevant for phytoremediation. Three experiments were conducted at different levels of aggregation to examine possible degradation of MTBE by rhizosphere microorganisms that had been acclimated to low levels of MTBE for 6 weeks. MTBE soil die-away studies, conducted with both poplar trees and fescue grass, found no significant differences between MTBE concentration in vegetated and unvegetated soils over a two-week attenuation period. Closed chamber tests comparing hydroponic and rhizospheric poplar tree systems also showed essentially complete recovery of MTBE mass in both systems, suggesting an absence of degradation. Finally, rhizosphere microbes tested in aerated bioreactors were found to be thriving and metabolizing root materials, but did not show measurable degradation of MTBE. In all tests, the MTBE degradation product, Tert Butyl Alcohol (TBA), was not detected. The insignificance of MTBE degradation by rhizosphere microorganisms suggests that plant processes be the primary focus of further research on MTBE phytoremediation.

Alternative radiochemical heavy ion activation methods for the production and separation of thallium radionuclides

Heavy ion activation of natural gold foil with a 7Li beam results in the formation of carrier-free 199-201Pb radionuclides along with their corresponding decay products, 199-201Tl, in the matrix. At 49 MeV projectile energy, the production of 199Tl through its precursor 199Pb is maximal, while that of other. thallium radionuclides is minimal. Another way for the direct production of carrier-free thallium radionuclides is to irradiate natural platinum foil with a 7Li beam; on this case, production of 199Tl is maximal at 43 MeV projectile energy. The carrier-free thallium radionuclides have been separated from the bulk target matrix gold and platinum by liquid-liquid extraction using trioctylamine as a liquid anion exchanger.

Separation of 48V and 48,49Cr in 7Li irradiated Sc2O3 target by liquid-liquid extraction

A radiochemical heavy ion activation procedure was carried out for the simultaneous production of carrier-free 48V and 48,49Cr in 7Li ion irradiated Sc2O3 target, followed by the separation of the individual radio-elements in pure form through liquid-liquid extraction using liquid cation exchanger, di-(2-ehtylhexyl) phosphoric acid. Liquid anion exchanger, trioctylamine, was used to obtain extractants from aqueous acid solutions under different experimental conditions.

Separation of carrier-free 181Re produced in 16O-irradiated thulium target

Heavy ion activation of natural Tm2O3 with 90 MeV 16O beam results in the formation of carrier-free short-lived 181Ir and 181Os which ultimately decay out to 181Re in the matrix. The liquid cation exchanger, HDEHP, has effectively been utilized as an extractant for quantitative separation of bulk thulium target matrix from carrier-free rhenium radionuclide.

Batch-mixed iron treatment of high arsenic waters

This paper develops batch-mixed treatment with zero-valent iron as a point-of-use technology, appropriate for arsenic removal from water stored within rural homes in Bangladesh and West Bengal, India, where arsenic poisoning has affected an estimated 20 million people. Batch tests with iron yielded the following results: (1) High arsenic removal (>93%) was achieved from highly arsenated waters (2,000 microg/L) over short contact times (0.5-3h) with iron filings added at doses ranging from 2500 to 625 mg/L; (2) Most rapid arsenic removal was observed in head-space free systems with sulphates present in solution, while phosphate buffers were observed to inhibit arsenic removal by iron; (3) The arsenic removed from water was found to be strongly bound to the elemental iron filings, such that the treated water could be decanted and iron could be reused at least 100 times; (4) Some iron dissolved into water over the contact period, at concentrations ranging from 100 to 300 microg/L, which are within safe drinking water limits. These results indicate that, with appropriate assessment of water chemistry in the affected region, treatment with metallic iron followed by simple decantation can be used as a practical, in-home, point-of-use technique for reducing human exposure to arsenic in drinking water.

The potential for phytoremediation of MTBE

This paper examines the potential for phytoremediation of MTBE, a gasoline additive that has become a prevalent and persistent groundwater pollutant, due to its' non-sorbing and non-reactive nature in water. A novel experimental design is developed to measure plant uptake and transpiration of MTBE from hydroponic systems, separating these processes from passive volatilization of the chemical. Plant uptake experiments indicate 30% reduction in MTBE mass in water over a 1-week period by small poplar saplings, at both high (1600 ppb) and low (300 ppb) MTBE concentrations. Active plant uptake of MTBE was approximately double that achieved by passive volatilization through a balsa wood control. MTBE was detected in biomass at the 100-ppb level, confirming passage of MTBE through the plant. A mass balance indicated that MTBE was largely untransformed during transport through the small poplar saplings to air. The high degree of MTBE removal achieved by small plants over a short period of time indicates great potential for successful phytoremediation of subsurface MTBE plumes using poplar trees. The fraction of MTBE removed from the hydroponic systems correlated well with volume of water transpired by the plants; the correlation enabled computation of the MTBE transpiration stream concentration factor of approximately 1, an important parameter for the design of engineered MTBE phytoremediation systems.

Separation of carrier-free hafnium and lutetium radionuclides produced in 16O activated terbium metal target

Charged particle activation with approximately 88 MeV 16O7+ beam on natural terbium metal foil leads to the production of the short lived carrier-free radioisotopes 170,171Ta and their corresponding daughter products 170,171Hf and 170,171Lu in the target matrix. Liquid-liquid extraction with HDEHP diluted in cyclohexane was carried out for the separation of 170,171Hf and 170,171Lu from the bulk terbium in an aqueous HCl medium.

Separation of carrier-free ytterbium and thulium produced in 80 MeV 12C6+ irradiated gadolinium foil target by liquid-liquid extraction with HDEHP

Heavy ion activation of natural gadolinium foil with 80 MeV 12C6+ results in the formation of carrier-free ytterbium isotopes, 165,166,167Yb and their corresponding decay products, 165,166,167Tm, in the matrix. Carrier-free ytterbium and thulium isotopes have been separated quantitatively from the bulk target matrix gadolinium by employing di-(2-ethylhexyl)phosphoric acid (HDEHP) as a liquid cation exchanger.

Exploring the role of environmental factors in association and linkage studies

We analyzed some simulated data to assess the success of statistical methodologies to establish the role of the environmental factors (EF) and to identify associated and linked markers. We considered five replicates for each of the four studies, and, with the knowledge of the generating model, concentrated our analyses on chromosomes (CH) 1, 3, and 5. To determine the influence of EF and associated markers on the affection status (AS), we utilized chi-square tests for independence and recursive partitioning (via the CART software). To identify linked markers, we scanned the relevant chromosomes with nonparametric multipoint linkage (NPL) and transmission/disequilibrium tests. These analyses were performed on the whole data set as well as on subsets of individuals and families defined by exposure to EF. CART correctly selected the associated marker (D1G024) and EF1 for Study (ST) 1 and did not generate trees for the other studies. NPL identified the relevant regions on CH3 and CH5 but failed to do so for CH1, except in ST4. Stratifying families by exposure to EF1 did not consistently increase sensitivity of NPL to the relevant CH3 markers, but did help characterize the genetic heterogeneity and identify linked families.

Separation of carrier free 151,152Tb produced in 16O irradiated lanthanum oxide matrix

Charged particle activation of natural La2O3 with approximately 78.5 MeV 16O results in the formation of carrier free 151,152Tb isotopes in the matrix. The liquid cation exchanger, HDEHP, has effectively been utilised as an extractant in the quantitative separation of the activation products from the bulk target matrix of lanthanum oxide.