Detoxification of areca nut acid hydrolysate and production of xylitol by Candida tropicalis (MTCC 6192).

Areca nut husk is the most promising alternative source of low-cost raw materials because it contains a considerable amount of five-carbon monosaccharide sugar in the form of xylose. This polymeric sugar can be isolated and transformed into a value-added chemical using fermentation. To extract sugars from areca nut husk fibers, preliminary pretreatment, such as dilute acid hydrolysis (H2SO4), was performed. The hemicellulosic hydrolysate of areca nut husk can produce xylitol through fermentation, but toxic components inhibit the growth of microorganisms. To overcome this, a series of detoxification treatments, including pH adjustment, activated charcoal, and ion exchange resin, were carried out to reduce the concentration of inhibitors in the hydrolysate. This study reports a remarkable 99% removal of inhibitors in the hemicellulosic hydrolysate. Subsequently, a fermentation process using Candida tropicalis (MTCC6192) was executed with the detoxified hemicellulosic hydrolysate of areca nut husk, yielding an optimum xylitol yield of 0.66 g/g. This study concludes that detoxification techniques like pH adjustment, activated charcoal, and ion exchange resins are the most economical and effective methods for eliminating toxic compounds in hemicellulosic hydrolysates. Therefore, the medium derived after detoxification from areca nut hydrolysate may be considered to have significant potential for xylitol production.

Single-Pore versus Dual-Pore Bipyridine-Based Covalent-Organic Frameworks: An Insight into the Heterogeneous Catalytic Activity for Selective CH Functionalization.

Exponential growth in the field of covalent-organic frameworks (COFs) is emanating from the direct correlation between designing principles and desired properties. The comparison of catalytic activity between single-pore and dual-pore COFs is of importance to establish structure-function relationship. Herein, the synthesis of imine-linked dual-pore [(BPyDC)]x % -ETTA COFs (x = 0%, 25%, 50%, 75%, 100%) with controllable bipyridine content is fulfilled by three-component condensation of 4,4',4″,4'″-(ethene-1,1,2,2-tetrayl)tetraaniline (ETTA), 4,4'-biphenyldialdehyde, and 2,2'-bipyridyl-5,5'-dialdehyde in different stoichiometric ratio. The strong coordination of bipyridine moieties of [(BPyDC)]x % -ETTA COFs with palladium imparts efficient catalytic active sites for selective functionalization of sp2 CH bond to CX (X = Br, Cl) or CO bonds in good yield. To broaden the scope of regioselective CH functionalization, a wide range of electronically and sterically substituted substrates under optimized catalytic condition are investigated. A comparison of the catalytic activity of palladium decorated dual-pore frameworks with single-pore imine-linked Pd(II) @ Py-2,2'-BPyDC framework  is undertaken. The finding of this work provides a sporadic example of chelation-assisted CH functionalization and disclosed an in-depth comparison of the relationship between superior catalytic activity and core properties of rationally designed imine linked frameworks.

Post coronavirus disease-2019 vaccination Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating disorder of the peripheral nerve. Different variants of GBS can produce a wide array of symptoms among which motor weakness, areflexia without bladder-bowel involvement are commonly encountered. ChAdOx1 nCoV-19 is a recombinant Corona Virus Vaccine and it is incorporated into India's coronavirus disease-2019 (COVID-19) vaccination program. Few rare instances of serious neurological complications have been reported following COVID-19 vaccination. Our case received 2 dose of COVID-19 vaccine. After receiving 1st dose he had rapid onset of ascending paralysis without any sensory and bladder bowel involvement. He received Intra Venous Immuno Globulin and Injection prednisolone for 5 days. Following that his lower limb weakness resolved rapidly but there was no improvement in upper limb weakness. Nerve conduction study showed demyelinating etiology and along with clinical features, it was appeared to be a case of GBS. However, more evidence is needed before establishing the causal relationship between COVID-19 vaccines and GBS.

Acute kidney injury with consumption of raw gall bladder of Indian carp fish (Labeo rohita): A single center study from India.

AIM: This retrospective study examined the clinical presentation and outcome of all patients who presented with acute kidney injury (AKI) following consumption of uncooked fish gallbladder as folk medicine. METHODS: We reviewed all cases admitted at our institute between 1 January 1997 and 31 December 2016 following ingestion of fish gallbladder (Indian carp/Labeo rohita). RESULTS: A total 32 of patients were included, with a male: female ratio of 3:1 and mean age 44.34 ± 13.33 years. The mean number of gall bladder consumed was 4.59 ± 4.75. All 32 patients presented with hepatic and renal failure. The mean duration of onset of symptoms following ingestion was 6.47 ± 2.84 h. At the time of admission, urine output was 187.9 ± 141 mL/24 h, serum creatinine 11.66 ± 2.50 mg/dL, serum bilirubin 6.14 ± 3.91 mg/dL, serum glutamate-pyruvate transaminase (SGPT) 687 ± 458 IU/L and serum glutamic oxaloacetic transaminase (SGOT) 188 ± 181 IU/L. All but one patient required haemodialysis. Twenty-seven patients were discharged with recovering acute kidney injury while five patients died. Mean duration of hospital stay was 12.94 ± 8.31 days. Mean number of haemodialysis sessions received by patients was 4.59 ± 3.12. Interval between consumption and onset of symptoms, serum bilirubin and SGPT were found to be significantly different between those who survived and died. CONCLUSION: Acute kidney injury associated with ingestion of raw fish gallbladder is associated with significant morbidity and mortality.

Formulation, optimization, hemocompatibility and pharmacokinetic evaluation of PLGA nanoparticles containing paclitaxel.

OBJECTIVE: Paclitaxel (PTX)-loaded polymer (Poly(lactic-co-glycolic acid), PLGA)-based nanoformulation was developed with the objective of formulating cremophor EL-free nanoformulation intended for intravenous use. SIGNIFICANCE: The polymeric PTX nanoparticles free from the cremophor EL will help in eliminating the shortcomings of the existing delivery system as cremophor EL causes serious allergic reactions to the subjects after intravenous use. METHODS AND RESULTS: Paclitaxel-loaded nanoparticles were formulated by nanoprecipitation method. The diminutive nanoparticles (143.2 nm) with uniform size throughout (polydispersity index, 0.115) and high entrapment efficiency (95.34%) were obtained by employing the Box-Behnken design for the optimization of the formulation with the aid of desirability approach-based numerical optimization technique. Optimized levels for each factor viz. polymer concentration (X1), amount of organic solvent (X2), and surfactant concentration (X3) were 0.23%, 5 ml %, and 1.13%, respectively. The results of the hemocompatibility studies confirmed the safety of PLGA-based nanoparticles for intravenous administration. Pharmacokinetic evaluations confirmed the longer retention of PTX in systemic circulation. CONCLUSION: In a nutshell, the developed polymeric nanoparticle formulation of PTX precludes the inadequacy of existing PTX formulation and can be considered as superior alternative carrier system of the same.

Investigation of the Anticancer Activity of Coordination-Driven Self-AssembledTwo-Dimensional Ruthenium Metalla-Rectangle.

Coordination-driven self-assembly is an effective synthetic tool for the construction of spatially and electronically tunable supramolecular coordination complexes (SCCs), which are useful in various applications. Herein, we report the synthesis of a two-dimensional discrete metalla-rectangle [(η6-p-cymene)4Ru4(C6H2O4)2(2)2](CF3SO3)4 (3) by the reaction of a dinuclear half-sandwich ruthenium (II) complex [Ru2(η6-p-cymene)2(C6H2O4)Cl2] (1) and bis-pyridyl amide linker (2) in the presence of AgO3SCF3. This cationic ruthenium metalla-rectangle (3) has been isolated as its triflate salt and characterized by analytical techniques including elemental analysis, Fourier-transform infrared spectroscopy (FT-IR), proton nuclear magnetic resonance spectroscopy (1H-NMR), carbon nuclear magnetic resonance spectroscopy (13C-NMR), 1H-1H correlation spectroscopy (COSY), 1H-1H nuclear Overhauser effect spectroscopy (NOESY), diffusion ordered spectroscopy (DOSY), and high-resolution electrospray ionization mass spectrometry (HR-ESI-MS). Significantly, the 2D cationic ruthenium metalla-rectangle showed better anticancer activity towards three different cell lines (A549, Caki-1 and Lovo) as compared with the parent ruthenium complex (1) and the commercially used drug, cisplatin.

Development, optimization, and in vitro characterization of dasatinib-loaded PEG functionalized chitosan capped gold nanoparticles using Box-Behnken experimental design.

OBJECTIVE: The purpose of this research study was to develop, optimize, and characterize dasatinib loaded polyethylene glycol (PEG) stabilized chitosan capped gold nanoparticles (DSB-PEG-Ch-GNPs). METHODS: Gold (III) chloride hydrate was reduced with chitosan and the resulting nanoparticles were coated with thiol-terminated PEG and loaded with dasatinib (DSB). Plackett-Burman design (PBD) followed by Box-Behnken experimental design (BBD) were employed to optimize the process parameters. Polynomial equations, contour, and 3D response surface plots were generated to relate the factors and responses. The optimized DSB-PEG-Ch-GNPs were characterized by FTIR, XRD, HR-SEM, EDX, TEM, SAED, AFM, DLS, and ZP. RESULTS: The results of the optimized DSB-PEG-Ch-GNPs showed particle size (PS) of 24.39 ± 1.82 nm, apparent drug content (ADC) of 72.06 ± 0.86%, and zeta potential (ZP) of -13.91 ± 1.21 mV. The responses observed and the predicted values of the optimized process were found to be close. The shape and surface morphology studies showed that the resulting DSB-PEG-Ch-GNPs were spherical and smooth. The stability and in vitro drug release studies confirmed that the optimized formulation was stable at different conditions of storage and exhibited a sustained drug release of the drug of up to 76% in 48 h and followed Korsmeyer-Peppas release kinetic model. CONCLUSIONS: A process for preparing gold nanoparticles using chitosan, anchoring PEG to the particle surface, and entrapping dasatinib in the chitosan-PEG surface corona was optimized.

Development and optimization of locust bean gum and sodium alginate interpenetrating polymeric network of capecitabine.

OBJECTIVE: The objective of the study was to develop interpenetrating polymeric network (IPN) of capecitabine (CAP) using natural polymers locust bean gum (LBG) and sodium alginate (NaAlg). SIGNIFICANCE: The IPN microbeads were optimized by Box-Behnken Design (BBD) to provide anticipated particle size with good drug entrapment efficiency. The comparative dissolution profile of IPN microbeads of CAP with the marketed preparation proved an excellent sustained drug delivery vehicle. METHODS: Ionotropic gelation method utilizing metal ion calcium (Ca2+) as a cross-linker was used to prepare IPN microbeads. The optimization study was done by response surface methodology based Box-Behnken Design. The effect of the factors on the responses of optimized batch was exhibited through response surface and contour plots. The optimized batch was analyzed for particle size, % drug entrapment, pharmacokinetic study, in vitro drug release study and further characterized by FTIR, XRD, and SEM. To study the water uptake capacity and hydrodynamic activity of the polymers, swelling studies and viscosity measurement were performed, respectively. RESULTS: The particle size and % drug entrapment of the optimized batch was 494.37 ± 1.4 µm and 81.39 ± 2.9%, respectively, closer to the value predicted by Minitab 17 software. The in vitro drug release study showed sustained release of 92% for 12 h and followed anomalous drug release pattern. The derived pharmacokinetic parameters of optimized batch showed improved results than pure CAP. CONCLUSION: Thus, the formed IPN microbeads of CAP proved to be an effective extended drug delivery vehicle for the water soluble antineoplastic drug.

The reverse dorsal metacarpal artery flap in finger reconstruction: A reliable choice.

BACKGROUND: The finger skin and soft-tissue defects are reconstructive challenges due to their nature and the intricate extensor apparatus and flexors it protects. The reverse dorsal metacarpal artery (RDMA) is a time-tested option for the reconstruction of the same. MATERIALS AND METHODS: A total of 14 cases of RDMA flap for finger defects involving proximal to distal phalanx were performed. Thirteen of these patients were male and one patient female and the most common mode of injury was occupational in nature followed by road traffic accident. The overall appearance was assessed for the flap and the donor site. The associated injuries and the range of motion were noted. RESULTS: All but one flap survived completely. One patient had partial distal flap loss, which was tackled with split-thickness skin grafting. The flap size varied from 3.5 cm × 1.5 cm to 9 cm × 2 cm with mean of 6.64 cm × 1.72 cm. The mean age of the patients was 33.4 years. All the patients had acceptable aesthesis. The donor site had no complications and healed with linear scar. CONCLUSIONS: RDMA flap is a reliable flap for finger defects reconstruction. The range of movement mainly depends on the associated injury rather than flap transfer alone and to prove this we require doing analysis of range of movement in patients with flap done alone or with associated injuries.

Screening of ionically crosslinked chitosan-tripolyphosphate microspheres using Plackett-Burman factorial design for the treatment of intrapocket infections.

OBJECTIVE: Application of Plackett-Burman factorial design to investigate the effect of processing factors in the fabrication of ionically crosslinked chitosan-tripolyphosphate (CS-TPP) microspheres. SIGNIFICANCE: Microspheres were screened and optimized to provide maximum process yield (PY), encapsulation efficiency (EE), and time for 80% drug release (T80%) and minimum burst and particles size (PS), for successful application in periodontitis. METHODS: Processing factors viz. method of preparation (MOP), CS, TPP, crosslinking time (CT), agitation (AS), and drying technique (DT) were selected. Solid state characterization was performed by Fourier-Transform infrared (FTIR), differential scanning calorimetry (DSC), X-ray diffraction (XRD), and scanning electron microscopy (SEM). Mucoadhesion, cytocompatibility, and stability of microspheres were also evaluated. RESULTS: Pareto analysis and analysis of variance, screened most significantly (p < .05) impacting process factors on selected responses. The optimized microspheres demonstrated: o/w emulsification method, CS (2.5%), TPP (5%), CT (120 min), AS (2000 rpm), and DT (freeze-dried), and provided PY- 95.67%, PS- 168.45%, EEOZ- 85.56%, EEDX- 91.34%, BOZ- 15.26%, BDX- 12.91%, TOZ- 47.09 and TDX- 67.95 minutes. FTIR illustrated compatibility between excipients and complexation of CS and TPP. XRD and DSC showed loss of crystallinity of entrapped drugs in microspheres. Biphasic drug release was observed for four days with non-Fickian kinetics. Furthermore, microspheres exhibited good mucoadhesivity (82.51%), antimicrobial activity against Staphylococcus aureus and Escherichia coli, cytocompatibility for L929 cells, and long-term stability. CONCLUSIONS: Therefore, CS-TPP microspheres were found mucoadhesive, safe, stable and provided controlled and prolonged release of drugs. These properties confirmed its high potential and applicability in chronic periodontitis.

P. vivax Malaria presenting as Thrombotic Microangiopathy.

INTRODUCTION: Acute kidney injury (AKI) is reported to occur in patients with falciparum malaria but not uncommon with vivax malaria. AKI, anemia, thrombocytopenia and jaundice is a recurrent finding in severe malaria and can mimic as thrombotic microangiopathy (TMA). Relationship of malaria with TMA is unclear till date however evidences suggest their association. METHODS & MATERIAL: We reviewed our electronic database to evaluate relationship of malaria with TMA, of cases of malaria, jaundice and AKI. RESULTS: 4 patients found to have P. vivax malaria and histopathologically confirmed TMA. All had fever, oliguria, jaundice at presentation. The time between onset of symptoms and admission ranged from 7 to 14 days. All had parasitemia at presentation so were treated with Artesuanate. Hemodialysis and Plasmapheresis was done in all patients. On follow-up all patients recovered and asymptomatic urinary abnormality persisting in one patient. CONCLUSION: High index of suspicion should be kept for TMA in a patient who has nonrecovering AKI with persistent anemia and thrombocytopenia even after clinical and laboratory evidences of recovery from malaria, as response to plasmapheresis seems excellent in this subset of malarial AKI. There could be a pathogenetic link between P.vivax and TMA though yet to be confirmed in larger studies.

The p38-MSK1 signaling cascade influences cytokine production through CREB and C/EBP factors in human neutrophils.

Neutrophils influence innate and adaptative immunity by generating numerous cytokines and chemokines whose regulation largely depends on transcriptional activators such as NF-κB and C/EBP factors. In this study, we describe the critical involvement of CREB transcription factors (CREB1 and activating transcription factor-1) in this functional response as well as relevant upstream signaling components. Neutrophil stimulation with LPS or TNF led to the phosphorylation, DNA binding activity, and chemokine promoter association of CREB1 and activating transcription factor-1. These responses occurred downstream of the p38-MSK1 signaling axis, as did the phosphorylation and promoter association of another bZIP factor, C/EBPß. Conversely, inhibition of RSK1 failed to alter the phosphorylation of either CREB1 or C/EBPß in neutrophils. From a more functional standpoint, the inhibition of p38 MAPK or MSK1 interfered with cytokine generation in neutrophils. Likewise, overexpression of a dominant-negative CREB1 mutant (K-CREB) or of a point mutant (S133A) resulted in a decreased ability of human neutrophil-like PLB-985 cells to generate inflammatory cytokines (CXCL8, CCL3, CCL4, and TNF-α). Collectively, our data show the involvement of CREB1 in neutrophil cytokine production, the key role of its S133 residue, important upstream signaling events, and the parallel activation of another bZIP factor. These are all potential molecular targets that could be exploited in the context of several chronic inflammatory diseases that prominently feature neutrophils and their products.

Bifunctional Metal-Organic Nanoballs Featuring Lewis Acidic and Basic Sites as a New Platform for One-Pot Tandem Catalysis.

The design and synthesis of polyhedra using coordination-driven self-assembly has been an intriguing research area for synthetic chemists. Metal-organic polyhedra are a class of intricate molecular architectures that have garnered significant attention in the literature due to their diverse structures and potential applications. Hereby, we report Cu-MOP, a bifunctional metal-organic cuboctahedra built using 2,6-dimethylpyridine-3,5-dicarboxylic acid and copper acetate at room temperature. The presence of both Lewis basic pyridine groups and Lewis acidic copper sites imparts catalytic activity to Cu-MOP for the tandem one-pot deacetalization-Knoevenagel/Henry reactions. The effect of solvent system and time duration on the yields of the reactions was studied, and the results illustrate the promising potential of these metal-organic cuboctahedra, also known as nanoballs for applications in catalysis.

Xylitol Production by Candida tropicalis from Areca Nut Husk Enzymatic Hydrolysate and Crystallization.

Lignocellulosic biomasses are extensively used by researchers to produce a variety of renewable bioproducts. This research described an environment-friendly technique of xylitol production by an adapted strain of Candida tropicalis from areca nut hemicellulosic hydrolysate, produced through enzymatic hydrolysis. To enhance the activity of xylanase enzymes, lime and acid pretreatment was conducted to make biomass more amenable for saccharification. To improve the efficiency of enzymatic hydrolysis, saccharification parameters like xylanase enzyme loading were varied. Results exposed that the highest yield (g/g) of reducing sugar, about 90%, 83%, and 15%, were achieved for acid-treated husk (ATH), lime-treated husk (LTH), and raw husk (RH) at an enzyme loading of 15.0 IU/g. Hydrolysis was conducted at a substrate loading of 2% (w/V) at 30 °C, 100 rpm agitation, for 12 h hydrolysis time at pH 4.5 to 5.0. Subsequently, fermentation of xylose-rich hemicellulose hydrolysate was conducted with pentose utilizing the yeast Candida tropicalis to produce xylitol. The optimum concentration of xylitol was obtained at about 2.47 g/L, 3.83 g/L, and 5.88 g/L, with yields of approximately 71.02%, 76.78%, and 79.68% for raw fermentative hydrolysate (RFH), acid-treated fermentative hydrolysate (ATFH), and lime-treated fermentative gydrolysate (LTFH), respectively. Purification and crystallization were also conducted to separate xylitol crystals, followed by characterization like X-ray diffraction (XRD) and scanning electron microscopy (SEM) analysis. Results obtained from crystallization were auspicious, and about 85% pure xylitol crystal was obtained.

Large-Scale Synthesis of Covalent Organic Frameworks: Challenges and Opportunities.

Connecting organic building blocks by covalent bonds to design porous crystalline networks has led to covalent organic frameworks (COFs), consequently transferring the flexibility of dynamic linkages from discrete architectures to extended structures. By virtue of the library of organic building blocks and the diversity of dynamic linkages and topologies, COFs have emerged as a novel field of organic materials that propose a platform for tailor-made complex structural design. Progress over the past two decades in the design, synthesis, and functional exploration of COFs in diverse applications successively established these frameworks in materials chemistry. The large-scale synthesis of COFs with uniform structures and properties is of profound importance for commercialization and industrial applications; however, this is in its infancy at present. An innovative designing and synthetic approaches have paved novel ways to address future hurdles. This review article highlights the fundamental of COFs, including designing principles, coupling reactions, topologies, structural diversity, synthetic strategies, characterization, growth mechanism, and activation aspects of COFs. Finally, the major challenges and future trends for large-scale COF fabrication are outlined.

Radiological Lung Sequelae of Severe COVID-19: A Retrospective Observational Study From a Dedicated COVID Centre of Eastern India.

BACKGROUND: The pulmonary sequelae of severe COVID-19 infection are yet to be fully defined. The authors undertook this study to find out the proportion of severe COVID-19 patients having fibrosis-like lung sequelae during a medium-term follow-up period. MATERIALS AND METHODS: This was a retrospective observational study from a dedicated COVID centre of Eastern India. Severe COVID-19 patients who had undergone chest computerized tomography (CT) during the acute phase of illness and at least one follow-up CT with a gap of minimum two months between the two scans were included in the study. RESULT: A total of 39 patients who had recovered from severe COVID-19 pneumonia and presented to the pulmonary medicine OPD in the months of July and August 2021 were included. Patients with pre-existing lung disease (n-4), mild to moderate (n-11), and due to unavailability of CT scan (n-2) were excluded. A total of 22 patients (thirteen males, nine females) were thus included for analysis. Follow-up scans were performed with a mean of 2.5 months after the onset of the disease. Out of 22 patients, only one patient's follow-up scan was normal. Predominant fibrotic-like features were present in six (27.2%) patients, though some evidence of fibrosis-like changes were seen in 20 out of 22 (90.9%) patients. The remaining 15 (68.2%) patients with abnormal scans had predominant non-fibrotic changes like ground-glass opacities (GGOs), consolidation, cavity, or nodule. The most common presenting symptoms at the follow-up examination were dyspnoea (81.8%), cough (54.1%) followed by fatigue in 40.9% of patients. CONCLUSION: This study concluded that most of the severe COVID-19 patients have some residual radiological findings during medium-term follow-up. Fibrotic-like lesions are present in almost all patients but most of them get resolved with time. True fibrotic features like honeycombing are rarely seen as residual lung sequelae.

State-of-the-Art Mixed Matrix Membranes (MMMs).

The performance of most polymer membranes suffers from the trade-off relationship between permeability and selectivity [...].

Clinical characteristics, treatment outcomes and factors associated with severe illness in 813 COVID-19 patients admitted in a tertiary care hospital of eastern India.

INTRODUCTION: This retrospective observational study has been designed to identify clinical characteristics, treatment outcomes and factors associated with severe illness in 813 COVID-19 patients hospitalised in an Indian tertiary care hospital. MATERIAL AND METHODS: This was a retrospective analysis of patient admitted between 1st July to 15th Aug 2020 with COVID-19 infections. Logistic regression was performed to explore the association of clinical characteristics and laboratory parameters with the risk of severe disease and mortality. The statistical significance level was set at 0.05 (two-tailed). RESULTS: Out of 813 study patients, 630 (77.50%) patients were categorised with mild to moderate while 183 (22.50%) patients as severe Covid infection. Mortality was significantly higher in severe Covid patients as compared to mild moderate cases (66.21% vs. 10.31%. p<0.0001. Patients with severe infection were significantly more likely to have diabetes hypertension, chronic kidney disease (CKD) and had significantly higher Neutrophil count, serum creatinine, C-reactive protein (CRP), ferritin, D-Dimer and decreased haemoglobin, lymphocyte and serum calcium than patients with mild-moderate infection. In Multivariate analy-sis, age more than 60 years [AOR: 2.114, 95% CI (1.05-4.254), 0.036], NLR more than 3.3 [AOR: 1.082, 95% CI (1.030-1.137), 0.002] and D-Dimer >1 µg/mL [AOR: 2.999 (1.464- 6.146),0.003] were found significantly associated with severe disease (p < 0.05). Factors associated with mortality were age more than 60 years, presence of breathlessness, severe disease or presence of chronic kidney disease. CONCLUSIONS: Factors like elderly age (age > 60 years), elevated NRL, CRP, D-Dimer and serum ferritin were associated with sig-nificantly higher risk to develop severe COVID-19 infections. Elderly, and patients with CKD were associated with worse outcome.

Impact of COVID-19-associated Mucormycosis in Kidney Transplant Recipients: A Multicenter Cohort Study.

BACKGROUND: COVID-19-associated mucormycosis (CAM) is a recently emerging entity. There is a lack of reports of CAM in organ transplant recipients. METHODS: We conducted a multicenter (n = 18) retrospective research in India during November 2020 to July 2021. The purpose of this study was to explore the clinical spectrum, outcome and risk factors for mortality of CAM in kidney transplant recipients (KTRs). RESULTS: The incidence of CAM was 4.4% (61/1382 COVID-19-positive KTRs) with 26.2% mortality. The median age of the cohort was 45 (38-54) y. Twenty (32%) were not hospitalized and 14 (22.9%) were on room air during COVID-19. The proportion of postdischarge CAM was 59.1%, while concurrent CAM was reported in 40.9%. The presentation of CAM was 91.8% rhino-orbital-cerebral mucormycosis and 8.2% pulmonary with 19.6% and 100% mortality, respectively. In the univariable analysis, older age, obesity, difficulty of breathing, high-flow oxygen requirement, and delay in starting therapy were significantly associated with mortality. In the multivariable logistic regression analysis, patients requiring high-flow oxygen therapy [odds ratio (95% confidence interval) = 9.3 (1.6-51); P = 0.01] and obesity [odds ratio (95% confidence interval) = 5.2 (1-28); P = 0.05] was associated with mortality. The median follow-up of the study was 60 (35-60) d. CONCLUSIONS: We describe the largest case series of CAM in KTRs. Morality in pulmonary CAM is extremely high. Severe COVID-19 pose extra risk for the development of CAM and associated mortality. Our report will help in better understanding the conundrum and management of CAM.