Diagnosis and Outcomes of Fungal Co-Infections in COVID-19 Infections: A Retrospective Study.

The SARS-CoV-2 pandemic has resulted in a public health emergency with unique complications such as the development of fungal co-infections. The diagnosis of fungal infections can be challenging due to confounding imaging studies and difficulty obtaining histopathology. In this retrospective study, 173 patients with COVID-19 receiving antifungal therapy due to concern for fungal co-infection were evaluated. Patient characteristics, clinical outcomes, and the utility of fungal biomarkers were then evaluated for continuation of antifungal therapy. Data were collected from the electronic health record (EPIC) and analyzed using SPSS (version. 28, IBM, Inc., Armonk, NY, USA) Data are presented as mean ± SD or percentages. A total of 56 COVID-19 patients were diagnosed with fungal co-infection and 117 COVID-19 + patients had no fungal infection. Significantly fewer female patients were in the fungal+ group compared to COVID-19 control patients (29% in fungal+ compared to 51% in controls p = 0.005). Fungal diagnostics were all significantly higher in fungal+ patients. These include 1,4-beta-D-glucan (BDG), fungal culture, and bronchoalveolar lavage galactomannan (BAL GM). Intensive care unit hospitalization, mechanical ventilation, and mortality in fungal+ patients with COVID-19 were significantly higher than in control patients. Finally, significantly more fungal+ patients received voriconazole, isavuconazonium, or amphotericin B therapies, whereas control patients received significantly more short-course fluconazole. COVID-19+ patients with fungal co-infection were significantly more likely to be in the ICU and mechanically ventilated, and they result in higher mortality compared to control COVID-19 patients. The use of fungal diagnostics markers were helpful for diagnosis.

Potential for sodium-glucose cotransporter-2 inhibitors in the management of metabolic syndrome: A systematic review and meta-analysis.

BACKGROUND: Landmark trials have established the benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2-Is) in cardiovascular disease including heart failure with reduced and preserved ejection fraction and renal diseases regardless of the presence of diabetes mellitus. However, studies evaluating the role of SGLT2-Is in metabolic syndrome (MetS) are limited. AIM: This study primarily aimed to evaluate the impact of SGLT2-Is on the components of MetS. METHODS: Two independent reviewers and an experienced librarian searched Medline, Scopus and the Cochrane central from inception to December 9, 2021 to identify placebo controlled randomized controlled trials that evaluated the impact of SGLT2-Is on the components of MetS as an endpoint. Pre- and post-treatment data of each component were obtained. A meta-analysis was performed using the RevMan (version 5.3; Copenhagen: The Nordic Cochrane Center, The Cochrane Collaboration). RESULTS: Treatment with SGLT2-Is resulted in a decrease in fasting plasma glucose (-18.07 mg/dL; 95%CI: -25.32 to -10.82), systolic blood pressure (-1.37 mmHg; 95%CI: -2.08 to -0.65), and waist circumference (-1.28 cm; 95%CI: -1.39 to -1.18) compared to placebo. The impact on high-density lipoprotein cholesterol was similar to placebo (0.01 mg/dL; 95%CI: -0.05 to 0.07). CONCLUSION: SGLT2-Is have a promising role in the management of MetS.

Virulent endocarditis due to Haemophilus parainfluenzae: A systematic review of the literature.

BACKGROUND: Haemophilus parainfluenzae (HPI) belongs to the HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium spp., Eikenella spp., and Kingella spp.) group of organisms. The HACEK group of organisms are a part of the oropharyngeal flora and can cause invasive opportunistic infection such infective endocarditis (IE) in hosts with compromised immunological barriers. AIM: To perform a 20-year systematic review of the literature characterizing the clinical presentation, epidemiology and prognosis of HPI IE. METHODS: We performed a systematic review of Medline, Pubmed, Scopus and Embase from 2000 to 2022 to identify all cases of HPI IE. RESULTS: Thirty-nine adult cases were identified. HPI IE was found to affect males slightly more than females and is common in patients with predisposing risk factors such as underlying valvular abnormalities. It mostly affected the mitral valve and had an indolent course; significantly sized vegetations (> 1 cm) developed in most cases. Central nervous system septic embolization was common. It had a favorable prognosis compared to staphylococcal and streptococcal IE. CONCLUSION: Clinicians should be attentive to the indolent course of HPI IE and the presence of predisposing risk factors in order to allow for timely management.

KMT5B is required for early motor development.

Disruptive variants in lysine methyl transferase 5B (KMT5B/SUV4-20H1) have been identified as likely-pathogenic among humans with neurodevelopmental phenotypes including motor deficits (i.e., hypotonia and motor delay). However, the role that this enzyme plays in early motor development is largely unknown. Using a Kmt5b gene trap mouse model, we assessed neuromuscular strength, skeletal muscle weight (i.e., muscle mass), neuromuscular junction (NMJ) structure, and myofiber type, size, and distribution. Tests were performed over developmental time (postnatal days 17 and 44) to represent postnatal versus adult structures in slow- and fast-twitch muscle types. Prior to the onset of puberty, slow-twitch muscle weight was significantly reduced in heterozygous compared to wild-type males but not females. At the young adult stage, we identified decreased neuromuscular strength, decreased skeletal muscle weights (both slow- and fast-twitch), increased NMJ fragmentation (in slow-twitch muscle), and smaller myofibers in both sexes. We conclude that Kmt5b haploinsufficiency results in a skeletal muscle developmental deficit causing reduced muscle mass and body weight.

Unusual Freshwater-Related Infections Caused by Haematospirillum jordaniae.

Freshwater-related infections can be caused by a broad range of pathogens, potentially leading to skin and soft tissue, pulmonary, gastrointestinal, or even systemic diseases. Haematospirillum jordaniae (H. jordaniae),a gram-negative, aerobic organism previously regarded solely as an environmental microbe, has been classified as a pathogen capable of causing human infection in the United States. There has been only one other case reported in the literature of H. jordaniae infection, and little is known about the pathogenesis.The presentation and progression of clinical symptoms in our cases indicate freshwater cutaneous injury as the most likely route of H. jordaniae infection. We present two cases of H. jordaniae infection in elderly males. Both patients had freshwater exposure and skin injury resulting in sepsis, cellulitis at the site of injury, and bacteremia. Additionally, one patient presented with an acute deep venous thrombosis. The diagnosis of H. jordaniae was confirmed using Sanger sequencing 16s ribosomal RNA data. Antimicrobial therapy included piperacillin-tazobactam, ceftazidime, and levofloxacin. Both patients recovered successfully. While clinical cases and literature involving the newly classified human pathogen H. jordaniae are still rare, it is crucial to recognize the potential emergence of environmental organisms, previously believed to be harmless, as human pathogens. In cases of bacteremia and cellulitis with recent freshwater exposure and injury, H. jordaniae infection should be considered as part of the differential diagnosis.

Human Papillomavirus Vaccination and Pap Smear Rates Among Burmese Refugee Girls in a Healthcare System in Omaha, Nebraska.

While human papilloma virus (HPV) vaccinations and Pap smear screenings are known to improve the survival rates and incidence of cervical cancer, refugee populations have traditionally been disadvantaged within this arena. Due to past and recent political issues in Myanmar, Burmese refugee women in Nebraska may be at particular risk due to their increasing numbers. This study examined 65 female Burmese refugees who were candidates for HPV vaccinations and 106 female Burmese refugees who could have received Pap smear screenings between 2010 and 2020. Of the 65 patients aged 11-26, 49.2% initiated the HPV vaccine series and 30.8% completed the series. In patients aged 13-17, 86.4% initiated the vaccine series and 54.6% completed the series. Of the 106 patients over 18 years of age, 32.1% had a Pap smear within the last 3 years. The need to improve HPV vaccine and Pap smear rates in refugee populations is clear. While focusing on the designated refugee exam may have improved HPV vaccine rates, it is important to examine gaps in knowledge with regards to attitudes surrounding HPV vaccines and Pap smears within the Burmese refugee population.

Morphology of the archaellar motor and associated cytoplasmic cone in Thermococcus kodakaraensis.

Archaeal swimming motility is driven by archaella: rotary motors attached to long extracellular filaments. The structure of these motors, and particularly how they are anchored in the absence of a peptidoglycan cell wall, is unknown. Here, we use electron cryotomography to visualize the archaellar basal body in vivo in Thermococcus kodakaraensis KOD1. Compared to the homologous bacterial type IV pilus (T4P), we observe structural similarities as well as several unique features. While the position of the cytoplasmic ATPase appears conserved, it is not braced by linkages that extend upward through the cell envelope as in the T4P, but rather by cytoplasmic components that attach it to a large conical frustum up to 500 nm in diameter at its base. In addition to anchoring the lophotrichous bundle of archaella, the conical frustum associates with chemosensory arrays and ribosome-excluding material and may function as a polar organizing center for the coccoid cells.