Environmental house calls can reduce symptoms of chemical intolerance: a demonstration of personalized exposure medicine.

AIM: The goals of this investigation were to 1) identify and measure exposures inside homes of individuals with chemical intolerance (CI), 2) provide guidance for reducing these exposures, and 3) determine whether our environmental house calls (EHCs) intervention could reduce both symptoms and measured levels of indoor air contaminants. BACKGROUND: CI is an international public health and clinical concern, but few resources are available to address patients' often disabling symptoms. Numerous studies show that levels of indoor air pollutants can be two to five (or more) times higher than outdoor levels. Fragranced consumer products, including cleaning supplies, air fresheners, and personal care products, are symptom triggers commonly reported by susceptible individuals. METHODS: A team of professionals trained and led by a physician/industrial hygienist and a certified indoor air quality specialist conducted a series of 5 structured EHCs in 37 homes of patients reporting CI. RESULTS: We report three case studies demonstrating that an appropriately structured home intervention can teach occupants how to reduce indoor air exposures and associated symptoms. Symptom improvement, documented using the Quick Environmental Exposure and Sensitivity Inventory Symptom Star, corresponded with the reduction of indoor air volatile organic compounds, most notably fragrances. These results provide a deeper dive into 3 of the 37 cases described previously in Perales et al. (2022). DISCUSSION: We address the long-standing dilemma that worldwide reports of fragrance sensitivity have not previously been confirmed by human or animal challenge studies. Our ancient immune systems' 'first responders', mast cells, which evolved 500 million years ago, can be sensitized by synthetic organic chemicals whose production and use have grown exponentially since World War II. We propose that these chemicals, which include now-ubiquitous fragrances, trigger mast cell degranulation and inflammatory mediator release in the olfactory-limbic tract, thus altering cerebral blood flow and impairing mood, memory, and concentration (often referred to as 'brain fog'). The time has come to translate these research findings into clinical and public health practice.

Moisture buffering and mould growth characteristics of naturally ventilated lime plastered houses.

Lime plaster is a sustainable building material that can be an effective passive cooling strategy. The moisture buffering quality of lime causes adsorption and desorption of moisture which moderates the indoor relative humidity. Its vapour permeability is also influential in moisture transfer across the building envelope. Lime plaster also has a self-healing quality which prevents the formation of inner cracks. Moreover, its strength increases with time leading to a longer life span. In old structures, an important function is the breathability of ceilings and walls. Hence, it is often used in conservation projects where it improves the appearance and durability of old buildings. Often organic additives employed to impart certain qualities to the lime mortar/plaster led to mould growth. Mould growth degrades indoor air quality, and the occupant health is compromised. To avoid mould-related problems, it is necessary to understand the behaviour of lime plaster with respect to the indoor relative humidity and surface moisture content. This paper focuses on the hygrothermal performance of lime plaster in naturally ventilated residential spaces. Surveys were carried out in 45 traditional buildings in Ahmedabad in India with measurements of ambient variables, such as temperature, relative humidity, wall moisture content, etc. The mould growth patterns of these spaces are related to the measured variables and wall characteristics. Hygrothermal simulations of some spaces were also carried out to observe the moisture buffering of lime plaster. Experimental observations were then compared to simulation results to see if the predictions of the hygrothermal models were realistic.

The causes of air movement in hidden indoor micro-environments: measurements in historic bookshelves.

The use of ventilation holes in small micro-environments has been proposed by the National Trust as a mechanism to improve the environmental conditions of moisture and temperature within bookshelves. At one National Trust historic property, this mechanism has been used to encourage air movement behind books as a possible strategy to reduce the risk of mould growth. It is believed that including ventilation holes as a passive design solution to promote airflow within micro-environments could prevent decay from occurring in the archives of historic buildings. This paper investigates the mechanisms that cause airflow behind bookshelves using field measurements in three National Trust historic libraries. The measurements indicate that small but measurable velocities, up to 4 cm/s, can be passively generated behind bookshelves. Air movement in such confined micro-environments is probably caused by a combination of natural convection, caused by temperature differences between the walls and the interior and the exterior of the bookshelf, and forced convection due to drafts in the surrounding environment. While in some cases one mechanism prevailed, both mechanisms may be present simultaneously in most cases. Further research is needed to clarify how surface temperature drives air motion behind shelves.

Antifungal activity mechanisms of venturicidin A against Botrytis cinerea contributes to the control of gray mould.

BACKGROUND: Gray mould caused by Botrytis cinerea, an airborne phytopathogenic pathogen, infects many economically important fruits and vegetables. Secondary metabolic products of microorganisms are potential resources for developing fungicide alternatives. Venturicidin A (VentA) is produced by a biocontrol strain Streptomyces pratensis S10. Although a broad spectrum of antifungal activity has been reported for VentA, little is known about its antifungal mechanisms against B. cinerea. RESULTS: Venturicidin A exhibited a strong hyphal inhibition of B. cinerea with an EC50 (effective concentration causing 50% growth inhibition) value of 1.08 µg mL-1 on PDA medium. Different concentrations of VentA inhibited spore germination with an inhibition rate of 49-86%. Venturicidin A also displayed protective and curative activity against the development of B. cinerea infection on tomato fruit, reducing disease incidence by ≈28-78%. Additionally, VentA effectively reduced the disease index and lesion length of gray mould on tomato plant. Meanwhile, VentA downregulated the expression levels of six genes related to pathogenicity in B. cinerea. As observed by scanning electron microscopy, B. cinerea spores and hyphae are abnormal after treatment with VentA. Propidium iodide staining revealed that VentA destroyed cell membrane integrity, causing cytoplasmic leakage. Furthermore, VentA induced accumulation of reactive oxygen species and upregulated the genes encoding subunits for NADPH oxidase in B. cinerea. CONCLUSION: This study indicated that VentA displayed strong inhibitory activity against B. cinerea and effectively reduced gray mould disease. Thus, VentA has the potential to manage gray mould caused by B. cinerea. © 2024 Society of Chemical Industry.

Experimental validation of a novel hybrid Equilibrium Slime Mould Optimization for solar photovoltaic system.

Maximizing Power Point Tracking (MPPT) is an essential technique in photovoltaic (PV) systems that guarantees the highest potential conversion of sunlight energy under any irradiance changes. Efficient and reliable MPPT technique is a challenge faced by researchers due to factors such as fluctuations in irradiance and the presence of partial shading. This paper introduced a novel hybrid Equilibrium Slime Mould Optimization (ESMO) MPPT-based algorithm combining the advantages of two recent algorithms, Slime Mould Optimization (SMO) and Equilibrium Optimizer (EO). The ESMO algorithm is compared with highly efficient MPPT-based techniques such as SMO, EO, Particle Swarm Optimization (PSO), Grey Wolf Optimization (GWO), and Whale Optimization Algorithm (WOA), both under a Simulink environment and a real-time experimental laboratory setup using a Dspace1104 controller and PV emulator. The comparison focuses on performance under several irradiance cases, including instant irradiance change, partial shading, complex partial shading, and dynamic partial shading. The key advantage of ESMO is the fact that it has a single tunable parameter, which makes implementation much easier and, at the same time, reduces the computational resources that are required by the control system. Extensive testing proves the superiority of ESMO over all other techniques, the average efficiency of which is 99.98% under all conditions. Additionally, ESMO provides fast average tracking times of 244 ms under simulation experiments and 200 ms for real-time experiments. These results show that ESMO can be very important for future implementation in large-scale solar PV systems.

Application of X-Ray Computed Tomography to Identify Defects in Lost Wax Ceramic Moulds for Precision Casting of Turbine Blades.

This article presents the results of testing the suitability of X-ray computed tomography for the quality control of the casting moulds used for producing turbine blades. The research was focused on the analysis of cross-sectional images, spatial models and the porosity of moulds using a Phoenix L 450 microtomograph. The research material consisted of samples from three mixtures of ceramic materials and binders intended for producing casting moulds using the lost wax method. Various configurations of filling materials (Molochite and quartz flours) and binder (Remasol, Ludox PX 30 and hydrolysed ethyl silicate) mixtures were considered. X-ray computed tomography enabled the detection of a number of defects in the ceramic mass related to the distribution of mass components, porosity concentration and defects resulting from the specificity of the mould production. It was found that casting mould quality control on cross-sectional tomographic images is faster and as accurate as the analysis of three-dimensional models and allows for the detection of a whole range of ceramic defects, but the usefulness of the images is greatest only when the cross-sections are taken at an appropriate angle relative to the object being examined.

Green mould contamination of Pleurotus pulmonarius cultivation in Malaysia: Unravelling causal agents and water source as critical factors.

Green mould contamination causes a significant challenge to mushroom growers in Malaysia leading to reduced yields and economic losses in the widely cultivated and marketed edible grey oyster mushroom, Pleurotus pulmanorius. This study aimed to identify the causal agents of green mould contaminants and determine the critical points in the cultivation process in the farm that contribute to green mould contamination. Samples of mushroom substrate (sawdust), spawn substrate (corn), environmental sources and tools were collected at different stages of mushroom cultivation. As results, the causal agents of green mould contamination were identified as Trichoderma pleuroti, T. harzianum and T. ghanese. Prior to steam pasteurisation and after steam pasteurisation, the spawn substrate and mushroom substrate were found to be free of Trichoderma. However, Trichoderma was detected in water, air within the production house and on cleaning tools. This findings suggests that water could serve as the source of green mould introduction in mushroom farms, while cultivation practices such as watering and scratching during the harvesting cycle may contribute to adverse green mould. Understanding these critical points and causal agents provides information to mitigate the green mould contamination throughout the grey oyster mushroom cultivation process.

Knee Osteoarthritis SCAENet: Adaptive Knee Osteoarthritis Severity Assessment Using Spatial Separable Convolution with Attention-Based Ensemble Networks with Hybrid Optimization Strategy.

Osteoarthritis (OA) of the knee is a chronic state that significantly lowers the quality of life for its patients. Early detection and lifetime monitoring of the progression of OA are necessary for preventive therapy. In the course of therapy, the Kellgren and Lawrence (KL) assessment model categorizes the rigidity of OA. Deep techniques have recently been used to increase the precision and effectiveness of OA severity assessments. The training process is compromised by low-confidence samples, which are less accurate than normal ones. In this work, a deep learning-based knee osteoarthritis severity assessment model is recommended to accurately identify the condition in patients. The phases of the designed model are data collection, feature extraction, and prediction. At first, the images are generally gathered from online resources. The gathered images are given into the feature extraction phase. A new model is implemented to predict knee osteoarthritis named Spatial Separable Convolution with Attention-based Ensemble Networks (SCAENet), which includes feature extraction, stacked target-based feature pool generation, and knee osteoarthritis prediction. The feature extraction is done using ResNet, Visual Geometry Group (VGG16), and DenseNet. The stacked target-based feature pool is obtained from the SCAENet. Hence, the stacked target-based feature pool is obtained by the Hybridization of Equilibrium Slime Mould with Bald Eagle Search Optimization (HESM-BESO). Here, the knee osteoarthritis's severity prediction is performed using the dimensional convolutional neural network (1DCNN) technique. The designed SCAENet model is validated with other conventional methods to show high performance.

Structural behaviour and construction of a monumental ice structure.

This paper investigates the use of ice-based materials combined with Fiber-Reinforced Polymer (FRP) to enhance the bending capacity of ice sculptures. Through three-point bending tests and ABAQUS simulations, the study analyses the mechanical behaviour of GFRP and cellulose ice, both separately and together. The results show that FRP improves tensile resistance while cellulose ice adds mass and ductility. An ABAQUS simulation with a layered shell partially captures the mechanical behaviour but has limitations in modelling beyond the elastic phase due to assumptions of perfect connection and material failure. Applied to a monumental sculpture by artist KAWS, incorporating a steel framework, GFRP mould, and ice-based material, the study confirms the potential of combining FRP and cellulose ice to achieve improved structural performance in ice-based sculptures.

Study on the Effect of Sooty Mould Disease in Tea Plants.

Sooty mould (SM) disease affects the growth, development and metabolism of plants and reduces the commodity and economic value of crops. SM disease is one of the important leaf diseases in tea plants. Nonetheless, studies on the effect of SM disease in tea plants are rare. Herein, we found that SM disease disrupted the cell morphology and structure and reduced the contents of caffeine, theanine, and catechins in the mature leaves of tea plants. Transcriptome analysis revealed that SM disease inhibited the biosynthesis of lignin, chlorophyll, catechin, caffeine, and theanine and affected the plant-pathogen interactions in the mature leaves of tea plants by downregulating gene expression. In addition, two fungal isolates, MTzyqA and MTzyqB, were obtained from the mature leaves of diseased tea plants. These strains were identified as Cladosporium pseudocladosporioides by mulitgene phylogenetic analysis, and they grew epiphytically on the leaves of tea plants. The biocontrol bacteria JT68, ZGT5, and BX1 had obvious inhibitory effect on MTzyqA and MTzyqB. These results provide a basis for understanding the effect of SM disease in tea plants.

Interaction of Capnodium alfenasii with extrafloral nectaries of Azadirachta indica.

Sooty moulds are saprophytic epiphytic fungi that grow mostly on insect secretions, but they can also be associated with plant secretions. In this study, we aimed to describe de interaction of Capnodium alfenasii sooty mould with the extrafloral shoot nectaries of Azadirachta indica. Anatomical and histochemical studies were carried out on serial sections of extrafloral shoot nectaries of A. indica without and with C. alfenasii infestation. The total soluble sugar content of the secreted nectar was determined, and the conidial germination of the fungus in distilled water and in dextrose and nectar solutions was evaluated. The shoot nectaries of A. indica are elongated structures that occur in pairs near the base of the petiole. The exuded nectar contains an average of 534.8 µg of total soluble sugars per µL of nectar and provides ideal conditions for conidial germination and fungal growth. C. alfenasii hyphae grow on the nectary, penetrate through breaks in the cuticle, travel under the cuticle and penetrate the secretory tissue by inter- and intracellular routes. The present report is the first to describe the interaction of C. alfenasii with the A. indica nectary, including the penetration of hyphae into nectariferous tissues and the plant defence mechanisms.

Enhanced Multi-Strategy Slime Mould Algorithm for Global Optimization Problems.

In order to further improve performance of the Slime Mould Algorithm, the Enhanced Multi-Strategy Slime Mould Algorithm (EMSMA) is proposed in this paper. There are three main modifications to SMA. Firstly, a leader covariance learning strategy is proposed to replace the anisotropic search operator in SMA to ensure that the agents can evolve in a better direction during the optimization process. Secondly, the best agent is further modified with an improved non-monopoly search mechanism to boost the algorithm's exploitation and exploration capabilities. Finally, a random differential restart mechanism is developed to assist SMA in escaping from local optimality and increasing population diversity when it is stalled. The impacts of three strategies are discussed, and the performance of EMSMA is evaluated on the CEC2017 suite and CEC2022 test suite. The numerical and statistical results show that EMSMA has excellent performance on both test suites and is superior to the SMA variants such as DTSMA, ISMA, AOSMA, LSMA, ESMA, and MSMA in terms of convergence accuracy, convergence speed, and stability.

Implementing high-dose rate surface mould brachytherapy for carcinoma of eyelid: a practical approach and weekly review.

Surface mould brachytherapy is a conformal radiotherapy technique that can deliver high dose to the target while sparing nearby normal structures, Here, we aim to describe the procedurals details for high-dose rate (HDR) surface mould brachytherapy in sebaceous carcinoma of eyelid in a 54-year old lady. She was hesitant for surgery and any form of invasive intervention like interstitial brachytherapy. So, she was treated with surface mould HDR brachytherapy to a total dose of 52 Gy in 13 fractions at a dose of 4 Gy per fraction delivered twice daily using Iridium-192 isotope with no acute side effects. She was evaluated on a weekly basis for any radiation side effects and now she is disease-free for 6 months post-treatment with only mild dry eye. A detailed step-by-step procedure of surface mould technique, simulation procedure, dose prescription, planning, plan evaluation and treatment has been described in this paper. Surface mould HDR brachytherapy can be safely used as organ preserving modality of treatment for eyelid carcinoma.

Twenty Years in EUCAST Anti-Fungal Susceptibility Testing: Progress & Remaining Challenges.

Since its inception in 2002, the EUCAST Antifungal Susceptibility Testing Subcommittee (AFST) has developed and refined susceptibility testing methods for yeast, moulds and dermatophytes, and established epidemiological cut-off values and breakpoints for antifungals. For yeast, three challenges have been addressed. Interpretation of trailing growth in fluconazole susceptibility testing, which has been proven without impact on efficacy if below the 50% endpoint. Variability in rezafungin MIC testing due to laboratory conditions, which has been solved by the addition of Tween 20 to the growth medium in E.Def 7.4. And third, interpretation of MICs for rare yeast with no breakpoints, where recommendations have been established for MIC-based clinical advice. For moulds, refinements include the validation of spectrophotometer reading for A. fumigatus to facilitate objective MIC determination, and for dermatophytes the establishment of a microdilution method with automated reading and a selective medium to minimise the risk of contaminations. Recent initiatives involve development and validation of agar-based screening assays for detection of potential azole and echinocandin resistance in A. fumigatus and Aspergillus species, respectively, and of terbinafine resistance in Trichophyton species. Moreover, the development of a EUCAST guidance document for molecular resistance testing represents an advancement, particularly for identifying target gene alterations associated with resistance. In summary, EUCAST AFST continues to play a pivotal role in standardizing AFST and facilitating accurate interpretation of susceptibility data for clinical decision-making. Adoption of EUCAST breakpoints for commercial test methods, however, requires thorough validation to ensure concordance with EUCAST reference testing species-specific MIC distributions.

Design and optimization of a castability test for copper alloys applied to plaster moulds.

The paper deals with the design and execution of the test of the castability into preheated plaster moulds. Castability is an important parameter for the evaluation of foundry alloys. When the metal does not run, it usually causes an irreparable defect in the casting. Therefore, it is necessary to verify this technological property correctly for different types of moulds. The castability test for plaster moulds and bronze is not defined, therefore The Vertical Bar Test was adopted, subsequently modified, and applied to plaster moulds. The models are made of wax and the plaster moulds are made according to the manufacturer's prescription and heated to a predetermined temperature. Copper alloy specifically CuSn10 was selected as the alloy to be investigated. The aim of the experiment is to correctly set up and observe the parameters and the method of performing the castability test using gravity casting technology in plaster moulds. It is assumed, as the casting temperature increases, the run-in length of the metal alloy will increase. An important goal is to obtain relevant results, as many variables affect the progress of the test and so there is a risk of error. Due to the time-consuming nature of producing a real disposable model and mould, any failure to succeed would have an economic impact on the foundry, affecting the price of castings. The new method for evaluating castability in plaster moulds can be applied to other types of alloys when temperature changes occur.

Boosting prairie dog optimizer for optimal planning of multiple wind turbine and photovoltaic distributed generators in distribution networks considering different dynamic load models.

Deploying distributed generators (DGs) supplied by renewable energy resources poses a significant challenge for efficient power grid operation. The proper sizing and placement of DGs, specifically photovoltaics (PVs) and wind turbines (WTs), remain crucial due to the uncertain characteristics of renewable energy. To overcome these challenges, this study explores an enhanced version of a meta-heuristic technique called the prairie dog optimizer (PDO). The modified prairie dogs optimizer (mPDO) incorporates a novel exploration phase inspired by the slime mold algorithm (SMA) food approach. The mPDO algorithm is proposed to analyze the substantial effects of different dynamic load characteristics on the performance of the distribution networks and the designing of the PV-based and WT-based DGs. The optimization problem incorporates various operational constraints to mitigate energy loss in the distribution networks. Further, the study addresses uncertainties related to the random characteristics of PV and WT power outputs by employing appropriate probability distributions. The mPDO algorithm is evaluated using cec2020 benchmark suit test functions and rigorous statistical analysis to mathematically measure its success rate and efficacy while considering different type of optimization problems. The developed mPDO algorithm is applied to incorporate both PV and WT units, individually and simultaneously, into the IEEE 69-bus distribution network. This is achieved considering residential, commercial, industrial, and mixed time-varying voltage-dependent load demands. The efficacy of the modified algorithm is demonstrated using the standard benchmark functions, and a comparative analysis is conducted with the original PDO and other well-known algorithms, utilizing various statistical metrics. The numerical findings emphasize the significant influence of load type and time-varying generation in DG planning. Moreover, the mPDO algorithm beats the alternatives and improves distributed generators' technical advantages across all examined scenarios.

A novel contaminant in museums? A cross-sectional study on xerophilic Aspergillus growth in climate-controlled repositories.

In the last decade, extensive fungal growth has developed in Danish museums parallel to climate change, challenging occupational health and heritage preservation. The growth was unexpected as the museums strived to control relative humidity below 60 %, and it should exceed 75 % to risk growth. A Danish case study found xerophilic Aspergillus species able to grow at low relative humidity in a museum repository. This cross-sectional study aimed to examine whether xerophilic growth from Aspergillus section Restricti has become a novel contaminant nationally distributed in Danish museum repositories striving to control relative humidity according to international environmental recommendations for heritage collections. The study examined The National Museum of Denmark and eight large State Recognized museums distributed throughout Denmark. It was based on 600 swab and tape-lift samples and 60 MAS100-Eco and filter air samples analyzed for fungi with cultivation and morphological identification, Big-Dye-Sanger sequencing, CaM-Nanopore and ITS-Illumina amplicon sequencing. The study showed growth from seven xerophilic Aspergillus species: A. conicus, A. domesticus, A. glabripes, A. halophilicus, A. magnivesiculatus, A. penicilloides, A. vitricola, of which three are new to Denmark, and 13 xerotolerant Aspergillus species. There was no growth from other fungal species. The multiple detection approach provided a broad characterization; however, there was variance in the detected species depending on the analysis approach. Cultivation and Big-Dye Sanger sequencing showed the highest Aspergillus diversity, detecting 17 species; CaM-Nanopore amplicon sequencing detected 12 species; and ITS-illumina amplicon sequencing detected two species but the highest overall diversity. Cultivation, followed by Big-Dye Sanger and CaM-amplicon sequencing, proved the highest compliance. The study concluded that xerophilic Aspergillus growth is nationally distributed and suggests species from Aspergillus section Restricti as a novel contaminant in climate-controlled museum repositories. To safeguard occupational health and heritage preservation research in sustainable solutions, avoiding xerophilic growth in museum collections is most important.

Sequential breakdown of the Cf-9 leaf mould resistance locus in tomato by Fulvia fulva.

Leaf mould, caused by Fulvia fulva, is a devastating disease of tomato plants. In many commercial tomato cultivars, resistance to this disease is governed by the Cf-9 locus, which encodes five paralogous receptor-like proteins. Two of these proteins confer resistance: Cf-9C recognises the previously identified F. fulva effector Avr9 and provides resistance during all plant growth stages, while Cf-9B recognises the yet-unidentified F. fulva effector Avr9B and provides mature plant resistance only. In recent years, F. fulva strains have emerged that can overcome the Cf-9 locus, with Cf-9C circumvented through Avr9 deletion. To understand how Cf-9B is circumvented, we set out to identify Avr9B. Comparative genomics, transient expression assays and gene complementation experiments were used to identify Avr9B, while gene sequencing was used to assess Avr9B allelic variation across a world-wide strain collection. A strict correlation between Avr9 deletion and resistance-breaking mutations in Avr9B was observed in strains recently collected from Cf-9 cultivars, whereas Avr9 deletion but no mutations in Avr9B were observed in older strains. This research showcases how F. fulva has evolved to sequentially break down the Cf-9 locus and stresses the urgent need for commercial tomato cultivars that carry novel, stacked resistance genes active against this pathogen.

The cytosolic form of dual localized BolA family protein Bol3 is important for adaptation to iron starvation in Aspergillus fumigatus.

Aspergillus fumigatus is the predominant mould pathogen for humans. Adaption to host-imposed iron limitation has previously been demonstrated to be essential for its virulence. [2Fe-2S] clusters are crucial as cofactors of several metabolic pathways and mediate cytosolic/nuclear iron sensing in fungi including A. fumigatus. [2Fe-2S] cluster trafficking has been shown to involve BolA family proteins in both mitochondria and the cytosol/nucleus. Interestingly, both A. fumigatus homologues, termed Bol1 and Bol3, possess mitochondrial targeting sequences, suggesting the lack of cytosolic/nuclear versions. Here, we show by the combination of mutational, proteomic and fluorescence microscopic analyses that expression of the Bol3 encoding gene leads to dual localization of gene products to mitochondria and the cytosol/nucleus via alternative translation initiation downstream of the mitochondrial targeting sequence, which appears to be highly conserved in various Aspergillus species. Lack of either mitochondrial Bol1 or Bol3 was phenotypically inconspicuous while lack of cytosolic/nuclear Bol3 impaired growth during iron limitation but not iron sensing which indicates a particular importance of [2Fe-2S] cluster trafficking during iron limitation. Remarkably, cytosolic/nuclear Bol3 differs from the mitochondrial version only by N-terminal acetylation, a finding that was only possible by mutational hypothesis testing.

Prevalence of co-existent COVID-19-associated pulmonary aspergillosis (CAPA) and its impact on early mortality in patients with COVID-19-associated pulmonary mucormycosis (CAPM).

BACKGROUND: Data on mixed mould infection with COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19-associated pulmonary mucormycosis (CAPM) are sparse. OBJECTIVES: To ascertain the prevalence of co-existent CAPA in CAPM (mixed mould infection) and whether mixed mould infection is associated with early mortality (≤7 days of diagnosis). METHODS: We retrospectively analysed the data collected from 25 centres across India on COVID-19-associated mucormycosis. We included only CAPM and excluded subjects with disseminated or rhino-orbital mucormycosis. We defined co-existent CAPA if a respiratory specimen showed septate hyphae on smear, histopathology or culture grew Aspergillus spp. We also compare the demography, predisposing factors, severity of COVID-19, and management of CAPM patients with and without CAPA. Using a case-control design, we assess whether mixed mould infection (primary exposure) were associated with early mortality in CAPM. RESULTS: We included 105 patients with CAPM. The prevalence of mixed mould infection was 20% (21/105). Patients with mixed mould infection experienced early mortality (9/21 [42.9%] vs. 15/84 [17.9%]; p = 0.02) and poorer survival at 6 weeks (7/21 [33.3] vs. 46/77 [59.7%]; p = 0.03) than CAPM alone. On imaging, consolidation was more commonly encountered with mixed mould infections than CAPM. Co-existent CAPA (odds ratio [95% confidence interval], 19.1 [2.62-139.1]) was independently associated with early mortality in CAPM after adjusting for hypoxemia during COVID-19 and other factors. CONCLUSION: Coinfection of CAPA and CAPM was not uncommon in our CAPM patients and portends a worse prognosis. Prospective studies from different countries are required to know the impact of mixed mould infection.