Candida spp. co-infection in COVID-19 patients with severe pneumonia: Prevalence study and associated risk factors.

BACKGROUND: Invasive fungal infections (IFI) are increasing in prevalence in recent years. In the last few months, the rise of COVID-19 patients has generated a new escalation in patients presenting opportunistic mycoses, mainly by Aspergillus. Candida infections are not being reported yet. OBJECTIVES: We aimed to determine the prevalence of systemic candidiasis in patients admitted to ICUs due to severe pneumonia secondary to SARS-CoV-2 infection and the existence of possible associated risk factors that led these patients to develop candidiasis. PATIENTS/METHODS: We designed a study including patients with a confirmed diagnosis of COVID-19. RESULTS: The prevalence of systemic candidiasis was 14.4%, and the main isolated species were C. albicans and C. parapsilosis. All patients that were tested positive for Candida spp. stayed longer in the ICU in comparison to patients who tested negative. Patients with candidiasis had higher MuLBSTA score and mortality rates and a worse radiological involvement. In our study, Candida spp. isolates were found in patients that were submitted to: tocilizumab, tocilizumab plus systemic steroids, interferon type 1ß and Lopinavir-Ritonavir. CONCLUSIONS: Results suggested a high prevalence of systemic candidiasis in severe COVID-19-associated pneumonia patients. Patients with Candidiasis had the worst clinical outcomes. Treatment with tocilizumab could potentialize the risk to develop systemic candidiasis.

Prevalence of opportunistic invasive aspergillosis in COVID-19 patients with severe pneumonia.

BACKGROUND: As the global coronavirus pandemic (COVID-19) spreads across the world, new clinical challenges emerge in the hospital landscape. Among these challenges, the increased risk of coinfections is a major threat to the patients. Although still in a low number, due to the short time of the pandemic, studies that identified a significant number of hospitalised patients with COVID-19 who developed secondary fungal infections that led to serious complications and even death have been published. OBJECTIVES: In this scenario, we aim to determine the prevalence of invasive fungal infections (IFIs) and describe possible associated risk factors in patients admitted due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. PATIENTS/METHODS: We designed an open prospective observational study at the Rey Juan Carlos University Hospital (Mostoles, Spain), during the period from February 1 to April 30, 2020. RESULTS: In this article, we reported seven patients with COVID-19-associated pulmonary aspergillosis (CAPA) who had a poor prognosis. Severely ill patients represent a high-risk group; therefore, we must actively investigate the possibility of aspergillosis in all of these patients. Larger cohort studies are needed to unravel the role of COVID-19 immunosuppressive therapy as a risk factor for aspergillosis. CONCLUSIONS: As the pandemic continues to spread across the world, further reports are needed to assess the frequency of emergent and highly resistant reemergent fungal infections during severe COVID-19. These coinfections are leading a significant number of patients with COVID-19 to death due to complications following the primary viral disease.

Determination of the dissolution rate of hazardous jarosites in different conditions using the shrinking core kinetic model.

The presence of hazardous jarosites causes a serious environmental problems, releasing potentially toxic elements, principally heavy metals such as Pb, As, Tl, Cr among others to the environment. Thus, the dissolution process of jarosites has to be monitored to assess the environmental impact. In the present work, the different hazardous jarosites were prepared, and characterized by analytical techniques (XRD, SEM, EDS, etc.), and the composition of jarosites was determined by induction-coupled plasma spectroscopy (ICP). Shrinking core kinetic model (SCKM) was employed to understand the stability of hazardous jarosites, studying a complete kinetic analysis of the jarosite dissolution process under different conditions (temperatures and pH). The results show that temperature has the highest effect on stability followed by pH, requiring extreme parameters for high dissolution. The batch experiments show that the results are in good agreement with the SCKM forming a solid layer as by-products. The chemical reaction, i.e. dissolution process performs through mostly controlling stage at extreme pH values and then moved to mass transport in the fluid layer. After analyzing the results, a kinetic equation has been proposed to describe adequately the dissolution process, and it predicts the lifetime of the hazardous jarosites.

Solid-phase distribution and mobility of thallium in mining-metallurgical residues: Environmental hazard implications.

Thallium (Tl) and its compounds are non-essential and highly toxic for living organisms, even at low concentrations. In this paper, we analyzed the presence and geochemical distribution of Tl in different mining-metallurgical and sediment samples collected from several mining zones of Mexico. A modified BCR sequential extraction procedure was also applied to the samples to investigate the geochemical behavior and potential environmental risk of Tl according to types of ore deposit and mineral processing method applied. Results revealed the presence of Tl in the majority of the mining-metallurgical samples, with labile concentrations reaching up to values of 184.4 mg kg-1, well above the environmental standards. A comparison of Tl partitioning in different samples showed that Tl was usually found associated with labile fractions instead of entrapped in the environmentally-passive residual fraction. Specifically, high levels of Tl were extracted from the exchangeable/acid-extractable and poorly-crystalline reducible fractions, suggesting its association with both soluble and amorphous Fe-Mn oxyhydroxides, respectively. Besides, Tl was also frequently found associated with the crystalline reducible fraction, presumably bonded to manganese oxides and jarosite-like minerals. Lastly, little amounts of Tl were extracted from the oxidizable fraction. Considering the fractionation of Tl in these mining-metallurgical samples, they may pose a significant environmental hazard. This study provides useful insights into the potential sources of Tl pollution in Mexico and emphasizes the need for further research to determine the extent of its impact and to develop effective remediation protocols to protect the environment from Tl toxicity.

Validity, Reliability, and Sensitivity of a Volleyball Intermittent Endurance Test.

PURPOSE: To analyze the concurrent and construct validity of a volleyball intermittent endurance test (VIET). The VIET's test-retest reliability and sensitivity to assess seasonal changes was also studied. METHODS: During the preseason, 71 volleyball players of different competitive levels took part in this study. All performed the VIET and a graded treadmill test with gas-exchange measurement (GXT). Thirty-one of the players performed an additional VIET to analyze the test-retest reliability. To test the VIET's sensitivity, 28 players repeated the VIET and GXT at the end of their season. RESULTS: Significant (P < .001) relationships between VIET distance and maximal oxygen uptake (r = .74) and GXT maximal speed (r = .78) were observed. There were no significant differences between the VIET performance test and retest (1542.1 ± 338.1 vs 1567.1 ± 358.2 m). Significant (P < .001) relationships and intraclass correlation coefficient (ICC) were found (r = .95, ICC = .96) for VIET performance. VIET performance increased significantly (P < .001) with player performance level and was sensitive to fitness changes across the season (1458.8 ± 343.5 vs 1581.1 ± 334.0 m, P < .01). CONCLUSIONS: The VIET may be considered a valid, reliable, and sensitive test to assess the aerobic endurance in volleyball players.

Hemorrhagic pericardial effusion as the debut of acquired hemophilia in a chronic lymphocytic leukemia patient: A case report, and a review of acquired hemophilia A-related hematological malignancies.

BACKGROUND: Acquired hemophilia A (AHA) is a rare bleeding disease caused by autoantibodies against factor VIII. Spontaneous bleeding symptoms usually affect the skin and muscle, while pericardial effusion is an extremely rare manifestation. In the elderly, anticoagulant treatment is frequent and bleeding symptoms are usually associated with this. CLINICAL FINDINGS: We report a hemorrhagic pericardial effusion as the AHA debut in a patient with untreated chronic lymphocytic leukemia and anticoagulated with apixaban for atrial fibrillation and chronic arterial ischemia. The patient was treated with recombinant activated factor VII to control the active bleeding and corticosteroids and cyclophosphamide to eradicate the inhibitor. In addition, a briefly review of hematological malignancies associated to acquired hemophilia was performed. PARTICULARITIES:: a) anticoagulant treatment may confuse the suspicion of AHA and its diagnosis; b) hemorrhagic pericardial effusion is an extremely rare presentation; c) bypassing agents raise the risk of thromboembolism; d) hematological malignancies rarely cause AHA (<20% of cases). CONCLUSION: A multidisciplinary team is needed to diagnose and manage AHA effectively. The use of anticoagulants may lead to the misdiagnosis of clinical symptoms. Chronic lymphocytic leukemia is one of the main causes of hematological malignancies associated. The specific treatment of CLL is still recommended in the event of active disease.

Sorption of As, Cd and Tl as influenced by industrial by-products applied to an acidic soil: equilibrium and kinetic experiments.

In situ stabilization of toxic elements in contaminated soils by the addition of amendments is being considered as an effective technique for remediation. In this paper, we performed both kinetics and equilibrium-based sorption experiments of three toxic elements (As, Cd and Tl) in soils amended with two by-products (phosphogypsum and sugar foam, rich in gypsum and calcium carbonate, respectively) to ascertain the feasibility of their application for improving the sorption capacity of As, Cd and Tl from the soil at 25, 35 and 50 degrees C. Kinetic studies indicated that the sorption follows a pseudo-second-order (PSO) kinetics and the sorption is a two-step diffusion process where both film and intraparticle diffusion played important roles in the sorption mechanisms of the elements. The Langmuir isotherms applied for sorption studies showed that the estimated maximum sorption capacity of the elements in control and amended soils decreased in the order of Cd>As>Tl. Using the thermodynamic equilibrium parameters obtained at different temperatures, the thermodynamic constants of sorption (DeltaG, DeltaH and DeltaS) were also evaluated, indicating spontaneous and endothermic nature of the process, except Tl which was exothermic. An optimal scaling procedure was undertaken to determine the relationships between the kinetic and equilibrium sorption parameters. By means of statistical analysis it was seen that these inter-parametric relationships are dependent on the element nature.