Acute respiratory distress syndrome is a common complication of severe viral pneumonia, such as influenza and COVID‐19, that requires critical care including ventilatory support, use of ...corticosteroids and other adjunctive therapies to arrest the attendant massive airways inflammation. Although recommended for the treatment of viral pneumonia, steroid therapy appears to be a double‐edged sword, predisposing patients to secondary bacterial and invasive fungal infections (IFIs) whereby impacting morbidity and mortality. Mucormycosis is a fungal emergency with a highly aggressive tendency for contiguous spread, associated with a poor prognosis if not promptly diagnosed and managed. Classically, uncontrolled diabetes mellitus (DM) and other immunosuppressive conditions including corticosteroid therapy are known risk factors for mucormycosis. Upon the background lung pathology, immune dysfunction and corticosteroid therapy, patients with severe viral pneumonia are likely to develop IFIs like aspergillosis and mucormycosis. Notably, the combination of steroid therapy and DM can augment immunosuppression and hyperglycaemia, increasing the risk of mucormycosis in a susceptible individual. Here, we report a case of sinonasal mucormycosis in a 44‐year‐old woman with hyperglycaemia secondary to poorly controlled diabetes following dexamethasone therapy on a background of influenza pneumonia and review 15 available literatures on reported cases of influenza and COVID‐19 associated mucormycosis.
One major issue with MED-TVC systems, a widely used thermal-based desalination technology, is their high energy consumption and carbon emissions. This underscores the importance of optimising and ...integrating these thermal-based desalination technologies with sustainable energy systems to utilize their waste heat and enhance the performance of these plants effectively. This research aimed to optimize and address the environmental challenges of MED-TVC desalination plants in areas with insufficient sunlight, unstable weather conditions, and limited economic resources. To this end, a model of an electric heater for generating thermal energy coupled with an optimized MED-TVC desalination plant was proposed. The MED-TVC section was optimized by incorporating an additional ejector in the final stage of MED-TVC demonstrating an increase of over 11 % in evacuating non-condensable gases from the last effect and increasing the product water by up to 14.89 %. Regarding the design of the electric heating elements used in electric heaters, the use of one-plus-two U-tubes with helical baffles was more efficient than multi-layer U-tubes with segmental baffles as improved the pressure loss of the thermal fluid by 25 % and increased the heat transfer coefficient of the heating elements to 18 %. The power section was also equipped with an off-grid system to provide the necessary power for the equipment of the proposed model. In the economic analysis of employing a parabolic trough solar collector and electric heaters, not only were the direct costs of the electric heaters almost equal to just 40 % of the direct costs of the parabolic trough solar collector approach but also the required thermal fluid was 50 % of the solar case.
In case of wireless sensor networks (WSNs) the sensed data which are collected by the ordinary senor nodes will have to be forwarded to the sink node (Base Station) in order to be accessible by the ...remote users. The location of the sink could significantly affect the energy dissipation and throughput of the network. This paper aims to investigate an optimal location for the sink node in such a way that the sum of distances from all the sensor nodes to the sink node is minimized. In an effort to place the sink node within the network our algorithm finds the geometric median of all the location associated with the sensor nodes. In a discrete set of points, the geometric median could be defined as the location which basically minimizes the sum of distances to all the points. Performance evaluation reveals that the proposed location for the sink node extends the network lifetime comparing with other possible location within the network field.
There is a poor understanding about the prevalence and characteristics of secondary bacterial and fungal infections among Coronavirus diseases 2019 (COVID-19) superinfection in hospitalized patients.
...Four hundred COVID-19-proven patients were enrolled in this study. Nasal swabs for molecular assay (Real-time PCR) and sputum samples for further microbiological assays were collected. Following a broad-spectrum search, a meta-analysis was performed using StatsDirect software (version 2.7.9) according to the DerSimonian and Laird method applying the random-effects models.
spp. (21.5%) and
spp
(16.7%) had the highest prevalence of bacterial coinfection among the COVID-19 patients, while
spp. had the lowest prevalence (4.2%). Among fungal coinfections,
was the most prevalent (6.7%), and
spp. was the lowest (2%). Males, elderly patients, patients with a history of underlying diseases and drug use, patients who showed acute clinical symptoms, and patients with a prolonged hospital stay had a higher incidence of secondary infections (P-value <0.05). The pooled prevalence for bacterial and fungal coinfections was 33.52% (95% CI: 18.12 to 50.98; I
: 99.4%; P-value: <0.0001).
We suggest designing additional research with a larger target population and diagnostic molecular analyses to depict a more realistic view of the coinfection status.
Occurrence of non-
(NCAC) species that are associated with elevated MIC values and therapeutic failures are increasing. As a result, timely and accurate means of identification to the species level ...is becoming an essential part of diagnostic practices in clinical settings. In this study, 301 clinically isolated yeast strains recovered from various anatomical sites Blood (
= 145), other sites (
= 156) were used to assess the accuracy and practicality of API 20C AUX and 21-plex PCR compared to MALDI-TOF MS and large subunit rDNA (LSU rDNA). MALDI-TOF MS correctly identified 98.33% of yeast isolates, 100% of top five
species, 95.7% of rare yeast species, while 1.3% of isolates were misidentified. API 20C AUX correctly identified 83.7% of yeast isolates, 97.2% of top five
species, 61.8% of rare yeast species, while 16.2% of yeast isolates were misidentified. The 21-plex PCR, accurately identified 87.3% of yeast isolates, 100% of top five
species, 72% of rare yeast species, but it misidentified 1.3% of rare yeast species while 9.9% of whole yeast isolates were not identified. The combination of rapidity of 21-plex PCR and comprehensiveness of API 20C AUX, led to correct identification of 92% of included yeast isolates. Due to expensiveness of MALDI-TOF MS and sequencing, this combination strategy could be the most accurate and inexpensive alternative identification strategy for developing countries. Moreover, by the advent and development of cost-effective, reliable, and rapid PCR machines that cost 130 US dollars, 21-plex could be integrated in routine laboratories of developing and resource-limited countries to specifically identify 95% causative agents of yeast-related infections in human. Databases of MALDI-TOF MS, API 20C AUX, and the number of target species identified by 21-plex require further improvement to keep up with the diverse spectrum of yeast species.
Non-
albicans Candida
species and other rare yeasts have emerged as major opportunistic pathogens in fungal infections. Identification of opportunistic yeasts in developing countries is mainly ...performed by phenotypic assay, which are time-consuming and prone to errors. The aim of the present study was to evaluate PCR-RFLP as a routinely used identification technique for the most clinically important
Candida
species in Iran and make a comparison with a novel multiplex PCR, called 21-plex PCR. One hundred and seventy-three yeast isolates from clinical sources were selected and identified with sequence analysis of the D1/D2 domains of rDNA (LSU rDNA) sequencing as the gold standard method. The results were compared with those obtained by PCR-RFLP using
MspI
restriction enzyme and the 21-plex PCR. PCR-RFLP correctly identified 93.4% of common pathogenic
Candida
species (
C. albicans
,
C. glabrata
,
C. parapsilosis
,
C. tropicalis
, and
P. kudriavsevii
(=
C. krusei
)) and was able to identify 45.5% of isolates of the uncommon yeast species compared to the D1/D2 rDNA sequencing. Compared with PCR-RFLP, all common
Candida
species and 72.7% of uncommon yeast species were correctly identified by the 21-plex PCR. The application of the 21-plex PCR assay as a non-sequence-based molecular method for the identification of common and rare yeasts can reduce turnaround time and costs for the identification of clinically important yeasts and can be applied in resource-limited settings.
Given the increasing incidence of yeast infections and the presence of drug-resistant isolates, accurate identification of the pathogenic yeasts is essential for the management of yeast infections. ...In this review, we tried to introduce the routine and novel techniques applied for yeast identification. Laboratory identification methods of pathogenic yeast are classified into three categories; I. conventional methods, including microscopical and culture-base methods II. biochemical/physiological-processes methods III. molecular methods. While conventional and biochemical methods require more precautions and are not specific in some cases, molecular diagnostic methods are the optimum tools for diagnosing pathogenic yeasts in a short time with high accuracy and specificity, and having various methods that cover different purposes, and affordable costs for researchers. Nucleotide sequencing is a reference or gold standard for identifying pathogenic yeasts. Since it is an expensive method, it is not widely used in developing countries. However, novel identification techniques are constantly updated, and we recommend further studies in this field. The results of this study will guide researchers in finding more accurate diagnostic method(s) for their studies in a short period of time.
Candidemia is a major cause of morbidity and mortality among patients receiving immunosuppressive therapy and those hospitalized with serious underlying diseases. Here, we investigated the ...epidemiological, clinical, and mycological features of candidemia in Tehran, Iran.
A prospective observational study of all patients diagnosed with candidemia was performed at two referral teaching hospitals in Tehran, Iran, from February to December 2018. Demographic characteristics, underlying diseases, risk factors, clinical symptoms, and laboratory analyses of candidemic patients with positive culture were mined.
isolates were molecularly identified by sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2). The antifungal susceptibility testing for fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, caspofungin, micafungin, and anidulafungin against the isolates was performed using CLSI broth microdilution reference method (M27-A3).
A total of 89 episodes were identified, with an incidence of 2.1 episodes/1000 admissions. The common underling disease were malignancy (46%), renal failure/dialysis (44%), and hypertension (40%). The overall crude mortality was 47%.
(44%) was the most frequent causative agent, followed by
(21%),
complex (15%),
(11%), and
(3.5%). All the isolates were susceptible to amphotericin B. The activity of all four azoles was low against
species, especially
.
The increase in non-
species with reduced susceptibility to antifungal drugs might be alarming in high-risk patients. Therefore, accurate knowledge of predisposing factors and epidemiological patterns in candidemia are effective steps for managing and decreasing the mortality rate in candidemia.
is the most common
species (sp.) isolated from fungal infections. Azole resistance in
species has been considerably increased in the last decades. Given the toxicity of the antimicrobial drugs, ...resistance to antifungal agents, and drug interactions, the identification of new antifungal agents seems essential. In this study, we assessed the antifungal effects of biogenic selenium nanoparticles on
and determined the expression of
and
genes.
Selenium nanoparticles were synthesized with
sp. MSH-1. The ultrastructure of selenium nanoparticles was evaluated with a transmission electron microscope. The antifungal susceptibility test was performed according to the modified Clinical and Laboratory Standards Institute M27-A3 standard protocol. The expression levels of the
and
genes were analyzed using the quantitative real-time polymerase chain reaction (PCR) assay.
The azole-resistant
and wild type
strains were inhibited by 100 and 70 µg/mL of selenium nanoparticle concentrations, respectively. The expression of
and
genes was significantly down-regulated in these selenium nanoparticle concentrations.
As the findings indicated, selenium nanoparticles had an appropriate antifungal activity against fluconazole-resistant and -susceptible
strains. Accordingly, these nanoparticles reduced the expression of
and
genes associated with azole resistance. Further studies are needed to investigate the synergistic effects of selenium nanoparticles using other antifungal drugs.
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