Combination of mycological criteria: a better surrogate to identify COVID-19 associated pulmonary aspergillosis patients and evaluate prognosis?

Introduction: Diagnosis of COVID-19 associated pulmonary aspergillosis remains unclear especially in non-immunocompromised patients. The aim of this study was to evaluate seven mycological criteria and their combination in a large homogenous cohort of patients. Methods: All successive patients (n=176) hospitalized for COVID-19 requiring mechanical ventilation and who clinically worsened despite appropriate standard of care were included over a one-year period. Direct examination, culture, Aspergillus qPCR ( Af -qPCR) and galactomannan was performed on all respiratory samples (n=350). Serum galactomannan, ß-D-glucan and plasma Af -qPCR were also assessed. Criteria were analyzed alone or in combination in relation to mortality rate. Results: Mortality was significantly different in patients with 0, ≤2 and ≥3 positive criteria (logrank test, p=0.04) with death rate of 43.1, 58.1 and 76.4% respectively. Direct examination, plasma qPCR and serum galactomannan were associated with a 100% mortality rate. Bronchoalveolar lavage (BAL) galactomannan and positive respiratory sample culture were often found as isolated markers (28.1 and 34.1%) and poorly repeatable when a second sample was obtained. Aspergillus DNA was detected in 13.1% of samples (46/350) with significantly lower Cq when associated with at least one other criteria (30.2 vs 35.8) (p<0.001). Conclusion: Combination of markers and/or blood biomarkers and/or direct respiratory sample examination seems more likely to identify patients with CAPA. Af -qPCR may help identifying false positive results of BAL galactomannan testing and culture on respiratory samples while quantifying fungal burden accurately.

Utilization of Andong Leaf Extract (Cordyline fruticosa) as an Alternative for Coloring the Eggs of Intestinal Nematode

Microscopic examination is essential to find the type of worm that causes infection. Direct examination of worm eggs needs to use staining to distinguish between worm eggs and food residues that are not completely digested. The dyes commonly used are synthetic. The purpose of this study was to replace synthetic dyes with natural dyes with Andong (Cordyline Fruticosa) leaf juice. It can be used as an alternative or a substitute for dyes. This research method is descriptive, conducted at the Parasitology Laboratory of Poltekkes Kemenkes Pontianak. The population in this study was the juice of the leaves of Andong (Cordyline Fruticosa). The method of inspection is direct preparation with an object glass as is routinely done, but the dye is replaced with Andong leaf juice (Cordyline Fruticosa). The results showed that natural dye Andong leaf juice (Cordyline Fruticosa), gave a clear color to the absorption of intestinal nematode worm eggs as the test target. This study concludes that the juice of the leaves of Andong (Cordyline Fruticosa) with alcohol solvent can be used as an alternative dye for the examination of intestinal nematode worm eggs.

Crosslinking Multilayer Graphene by Gas Cluster Ion Bombardment

In this paper, we demonstrate a new, highly efficient method of crosslinking multilayer graphene, and create nanopores in it by its irradiation with low-energy argon cluster ions. Irradiation was performed by argon cluster ions with an acceleration energy E ≈ 30 keV, and total fluence of argon cluster ions ranging from 1 × 109 to 1 × 1014 ions/cm2. The results of the bombardment were observed by the direct examination of traces of argon-cluster penetration in multilayer graphene, using high-resolution transmission electron microscopy. Further image processing revealed an average pore diameter of approximately 3 nm, with the predominant size corresponding to 2 nm. We anticipate that a controlled cross-linking process in multilayer graphene can be achieved by appropriately varying irradiation energy, dose, and type of clusters. We believe that this method is very promising for modulating the properties of multilayer graphene, and opens new possibilities for creating three-dimensional nanomaterials.

Childhood Maltreatment Amplifies the Association Between Relationship Functioning and Depressive Symptoms Among Rural African American Couples

Despite considerable literature documenting associations between relationship functioning and depressive symptoms, there has been relatively little direct examination of this association among African American couples. Likewise, little research has investigated factors that may exacerbate this association. The current study addressed this gap by investigating longitudinal associations between relationship functioning and depressive symptoms among 344 rural African American couples and by examining whether experiences of childhood maltreatment (i.e., childhood physical neglect and childhood physical abuse) amplify this association. Results indicated relationship functioning and depressive symptoms were negatively associated, initially and over time, for both men and women. Additionally, childhood maltreatment moderated several of these associations, such that associations between relationship functioning and depressive symptoms were generally strongest for those reporting greater levels of childhood maltreatment. This pattern of results suggests that experiences of childhood maltreatment may amplify negative associations between adult relationship functioning and depressive symptoms among African American couples, providing further evidence that adverse family-of-origin experiences can contribute to negative consequences later in the life course.

LYING OF A PARTY IN THE ARBITRATION COURT AS A PROCEDURAL LEGAL FACT

The study puts forward the idea that the development of the principle of good faith in civil law should seriously affect the arbitration process and should make it unprofitable to lie in court. Among other things, we believe that it is possible to raise the question of using the legislator’s approach without the culpable occurrence of negative consequences of false assurances about circumstances in the conduct of entrepreneurial activity. The author also argues that there should be no deception of the court, because any decision based on a lie is not justice and is contrary to the rule of law. In a situation where deception does occur, there must be a mechanism to rectify the situation and level out the consequences of the deception. As a kind of substantiation of the above ideas, the author uses a reference to the principle of direct examination of evidence, which is enshrined in Articles 10 and 71 of the APC RF and obligates the court to directly examine and perceive all evidence in the case, including hearing explanations of persons involved in the case, testimony of witnesses, expert opinions, review written evidence, examine the physical evidence. Compliance with this principle guarantees the personal perception of the judges of the arbitration court of all evidence, which is probably one of the most significant guarantees of justice.

Onychomycosis in patients with diabetes mellitus: Etiology, clinical features, and treatment response

Background: Onychomycosis accounts for 30% of all superficial mycoses and 50% of all nail diseases. One of the most studied predisposing factors is diabetes mellitus, with a frequency of onychomycosis of 31.5% in these patients. Many show resistance to standard therapeutics and have “polypharmacy”, which represents a risk for pharmacological interactions. Objective: The objective was to assess the clinical response to therapy, evaluate with histopathology, direct examination with KOH and white-calcofluor, and culture the most frequent etiologic agents associated with the development of onychomycosis in patients with diabetes mellitus. Materials and Methods: A non-randomized, uncontrolled, open-ended, prospective cohort study was conducted on 46 patients with onychomycosis and diabetes mellitus. Treatment was assigned according to clinical findings and specific indications for treatment. Results: From the samples taken for direct examination with KOH and calcofluor-white, culture, and histopathological study, positive results were: 39 (84.1%) patients to the direct examination, 32 (69.6%) to the culture, 27 (65.2%) with a positive histopathological study, and 17 (54.86%) to the calcofluor-white. On clinical evaluation, we found no treatment response in 8 patients (20%), a partial response in 14 patients (25%), and a complete response in 18 patients (45%). Out of the 46 patients evaluated initially, 25 persisted with onychomycosis after six months of follow-up. Conclusion: The prevalence of onychomycosis is increasing and requires correct diagnosis since there are other non-fungal diseases of the nails that resemble onychomycosis. Presumably, the immunosuppression of diabetes, its systemic affection, and the foot abnormalities of a diabetic patient cause more nail dystrophy, an increased fungal load, and treatment resistance.

Case Report: Invasive Sinusitis due to Sporothrix Brasiliensis in a Renal Transplant Recipient

Sporotrichosis is usually a subcutaneous infection caused by thermodimorphic fungi of the genus Sporothrix. The disease occurs worldwide, but endemic areas are located in tropical and subtropical regions. The epidemiology of sporotrichosis in Brazil is peculiar because of the cat’s entry in the chain of transmission of this mycosis, associated with Sporothrix brasiliensis, the most virulent species in the genus. Sporothrix species sinusitis is unusual and may be underdiagnosed or confused with other fungal etiologies, like mucormycosis. We report a case of sinusitis due to a Sporothrix species in a 6-year renal transplant recipient. Direct examination of smears of exudate of the sinus specimen (aspirate, biopsy) revealed budding yeasts and cigar-shaped cells. Sporothrix was subsequently recovered from the patient’s exudate culture and identified as S. brasiliensis using species-specific polymerase chain reaction, and she was successfully treated with antifungal therapy. Her parents also developed the disease a week later, both only cutaneous involvement. Sporotrichosis sinusitis is a rare disease, even in immunocompromised patients. Diagnosis is crucial, and benefits from good epidemiological history.

Teledentistry as a Supportive Tool for Dentists in Pakistan

The current scenario of the COVID-19 pandemic has forced dentists to seek different options for delivering healthcare services other than the in-person direct examination in clinical practice. Teledentistry is one of the options for remote patient care and monitoring. Objective. The present survey was conducted to assess the knowledge and perception of the dentists in Pakistan regarding teledentistry as an emergent supportive tool. Materials and Methods. A self-administered, close-ended, and prevalidated survey questionnaire was used, comprising 21 questions, and distributed electronically via e-mail, WhatsApp, and Facebook Messenger to evaluate the knowledge and perception of dentists regarding teledentistry. The data collected was compiled in a systematic manner and analyzed in terms of frequency (yes/no). Results. Out of a total of 350 dentists, 325 responded to the questionnaire, and it was seen that 62.5% of them did not have knowledge about teledentistry prior to COVID-19. 65.8% of dentists considered the practice of teledentistry in nonpandemic situations in the future. Conclusion. In the present study, it was observed that most of the dental professionals had inadequate knowledge about teledentistry before COVID-19, but the awareness and perception regarding teledentistry were currently satisfactory among the dental professionals in Pakistan. This emerging trend gives a positive hope for the implementation of teledentistry in the healthcare setup of Pakistan in the near future, as it will prove to be beneficial for safe dental practice during times of pandemic and even after.

IDENTIFICATION OF MALASSEZIA SPECIES AND ITS ASSOCIATION WITH CLINICAL MANIFESTATIONS OF ATOPIC DERMATITIS

Introduction: Atopic dermatitis is a chronic, recurrent inflammatory skin disease that is characterized by an eczematous reaction. Few studies have investigated fungi in the pathogenesis of atopic dermatitis, however, there are different about distribution of Malassezia species. Objectives: To indentificate of Malassezia species and its asociation with clinical manifestations in Vietnamese atopic dermatitis patient. Methods: 178 patients who were diagnosed with atopic dermatitis and had a postitive direct examination of Malassezia at the National hospital of dermatology and venereology between July 2019 and June 2020. Specimens were taken with cellotape, then stained in 20% of potassium hydroxit combined with ParkerTM blue black ink. All patient who had postive test were cultured on SDA and mDixon. For fungal samples, we selected pure colonies with morphological characteristics of yeast as follows about 1cm in diameter, round, cream or milky in color, smooth and glossy to detect the species. Results: From the samples of atopic dermatitis patients, we cultured and idenfified 41 cases. 5 species were found, in which M. globosa was the most common species, accounting for 39%, followed by M. restricta (19.5%), M. dermatis (17.1%), M. furfur (17.1%) and M. sympodialis (2.4%). Conclusion: On the skin lesions of Vietnamese patients with atopic dermatitis, M. globosa was the most common species with 39.0%.