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Background Mucormycosis is a rare, invasive disease associated with high mortality rates, produced by opportunistic pathogens related to the Mucorales order and characterised by a diverse range of clinical forms; acute rhino-orbital-cerebral and pulmonary symptoms are the most reported ones. Objectives To report the experience of mucormycosis observed in a tertiary-care hospital in Mexico for 35 years. Methods This was a retrospective, descriptive and observational study on mucormycosis at a tertiary-care hospital in Mexico from January 1985 to December 2019. Demographic and clinical data and mycological and histopathological records were selected. Results Two hundred fourteen proven cases of mucormycosis for 35 years at a tertiary-care hospital in Mexico were included. Most of the cases were male patients with a median age of 45 years. The two most associated underlying diseases were diabetes mellitus (76.6%) and haematologic malignancy (15.4%). The three primary clinical forms were as follows: rhino-orbito-cerebral (75.9%), cutaneous (8.41%) and pulmonary (7.47%) mucormycosis. The most isolated agents were Rhizopus arrhizus (58.4%) and Lichtheimia corymbifera (12.3%). The overall therapeutic response was 58.5%, and the best response was observed with amphotericin B deoxycholate and surgical debridement. Conclusion Mucormycosis is an emerging disease, and its incidence has increased at our hospital over the years. In this study, the rhino-cerebral clinical type was the most frequent in patients with uncontrolled diabetes; the main aetiological agent was R. arrhizus. Early diagnosis, control of the underlying disease and prompt management may increase the survival rate.

Bloodstream infections due to bacteria are a highly consequential nosocomial occurrences and the organisms responsible for them are usually multidrug-resistant. The aims of this study were to describe the incidence of bacteremia caused by Gram-negative ESKAPE bacilli during the COVID-19 pandemic and characterize the clinical and microbiological findings including antimicrobial resistance. A total of 115 Gram-negative ESKAPE isolates were collected from patients with nosocomial bacteremia (18% of the total bacteremias) in a tertiary care center in Mexico City from February 2020 to January 2021. These isolates were more frequently derived from the Respiratory Diseases Ward (27), followed by the Neurosurgery (12), Intensive Care Unit (11), Internal Medicine (11), and Infectious Diseases Unit (7). The most frequently isolated bacteria were Acinetobacter baumannii (34%), followed by Klebsiella pneumoniae (28%), Pseudomonas aeruginosa (23%) and Enterobacter spp (16%). A. baumannii showed the highest levels of multidrug-resistance (100%), followed by K. pneumoniae (87%), Enterobacter spp (34%) and P. aeruginosa (20%). The blaCTX-M-15 and blaTEM-1 genes were identified in all beta-lactam-resistant K. pneumoniae (27), while blaTEM-1 was found in 84.6% (33/39) of A. baumannii isolates. The carbapenemase gene blaOXA-398 was predominant among carbapenem-resistant A. baumannii (74%, 29/39) and blaOXA-24was detected in four isolates. One P. aeruginosa isolate was blaVIM-2 gene carrier, while two K. pneumoniae and one Enterobacter spp were blaNDM gene carriers. Among colistin-resistant isolates mcr-1 gene was not detected. Clonal diversity was observed in K. pneumoniae, P. aeruginosa and Enterobacter spp. Two outbreaks caused by A. baumannii ST208 and ST369 were detected, both belonging to the clonal complex CC92 and IC2. A. baumannii was associated with a death rate of 72% (28/32), most of them (86%, 24/28) extensively drug-resistant or pandrug-resistant isolates, mainly in patients with COVID-19 (86%, 24/28) in the Respiratory Diseases Ward. A. baumannii isolates had a higher mortality rate (72%), which was higher in patients with COVID-19. There was no statistically significant association between the multidrug-resistant profile in Gram-negative ESKAPE bacilli and COVID-19 disease. The results point to the important role of multidrug-resistant Gram-negative ESKAPE bacteria causing bacteremia in nosocomial settings before and during the COVID-19 epidemic. Additionally, we were unable to identify a local impact of the COVID-19 pandemic on antimicrobial resistance rates, at least in the short term.

Introduction: Some patients with SARSCov-2 infection develop severe disease (SARS); however, the factors associated with severity are not yet fully understood. Some reports indicate that liver injury may be a poor prognostic factor. Aim: To identify the biochemical factors related to the development of SARS with mechanical ventilation (MV) requirement in patients with SARSCov-2 and COVID-19. Methods Type of study: Observational. Cohort study. Procedure: Data from COVID-19 patients were collected at admission time to a tertiary care center. Differential factors were identified between seriously ill SARS+MV patients versus stable patients without MV. Transformation to the natural logarithm of significant variables was performed and multiple linear regression was applied, then a predictive model of severity called AAD (Age-AST-D dimer) was constructed. Results: 166 patients were included, 114(68.7%) men, mean age 50.6±13.3 years-old, 27(16.3%) developed SARS+MV. In the comparative analysis between those with SARS+MV versus stable patients without MV we found significant raises of ALT (225.4±341.2 vs. 41.3±41.1; P=0.003), AST 325.3±382.4 vs. 52.8±47.1; P=0.001), LDH (764.6±401.9 vs. 461.0±185.6; P=0.001), D dimer (7765±9109 vs. 1871±4146; P=0.003), age (58.6±12.7 vs. 49.1±12.8; P=0-001). The results of the regression are shown in the Table, where model 3 was the one that best explained the development of SARS+MV; with these variables was constructed the model called AAD, where: [AAD= 3.896 + ln(age)x-0.218 + ln(AST)x-0.185 + ln(DD)x0.070], where a value ≤ 2.75 had sensitivity=0.797 and 1-specificity= 0.391, AUROC=0.74 (95%CI: 0.62-0.86; P

Aim. Coronavirus disease (COVID-19) ranges from mild clinical phenotypes to life-threatening conditions like severe acute respiratory syndrome (SARS). It has been suggested that early liver injury in these patients could be a risk factor for poor outcome. We aimed to identify early biochemical predictive factors related to severe disease development with intensive care requirements in patients with COVID-19. Methods. Data from COVID-19 patients were collected at admission time to our hospital. Differential biochemical factors were identified between seriously ill patients requiring intensive care unit (ICU) admission (ICU patients) versus stable patients without the need for ICU admission (non-ICU patients). Multiple linear regression was applied, then a predictive model of severity called Age-AST-D dimer (AAD) was constructed ( n = 166 ) and validated ( n = 170 ). Results. Derivation cohort: from 166 patients included, there were 27 (16.3%) ICU patients that showed higher levels of liver injury markers ( P < 0.01 ) compared with non-ICU patients: alanine aminotrasnferase (ALT) 225.4 ± 341.2 vs. 41.3 ± 41.1 , aspartate aminotransferase (AST) 325.3 ± 382.4 vs. 52.8 ± 47.1 , lactic dehydrogenase (LDH) 764.6 ± 401.9 vs. 461.0 ± 185.6 , D-dimer (DD) 7765 ± 9109 vs. 1871 ± 4146 , and age 58.6 ± 12.7 vs. 49.1 ± 12.8 . With these finding, a model called Age-AST-DD (AAD), with a cut-point of sensitivity = 0.797 and specificity = 0.391 , c − statistic = 0.74 ; 95%IC: 0.62-0.86, P < 0.001 ), to predict the risk of need admission to ICU ( OR = 5.8 ; 95% CI: 2.2-15.4, P = 0.001 ), was constructed. Validation cohort: in 170 different patients, the AAD model < 2.75 ( c − statistic = 0.80 (95% CI: 0.70-0.91, P < 0.001 ) adequately predicted the risk ( OR = 8.8 , 95% CI: 3.4-22.6, P < 0.001 ) to be admitted in the ICU (27 patients, 15.95%). Conclusions. The elevation of AST (a possible marker of early liver injury) along with DD and age efficiently predict early (at admission time) probability of ICU admission during the clinical course of COVID-19. The AAD model can improve the comprehensive management of COVID-19 patients, and it could be useful as a triage tool to early classify patients with a high risk of developing a severe clinical course of the disease.

Background and aim: Some patients with SARSCov-2 infection develop severe disease (SARS);however, the factors associated with severity are not yet fully understood. Some reports indicate that liver injury may be a poor prognostic factor. AIM: To identify the biochemical factors related to the development of SARS with mechanical ventilation (MV) requirement in patients with SARSCov-2 and COVID-19. Methods. Type of Study: Observational. Cohort study. Procedure: Data from COVID-19 patients were collected at admission time to a tertiary care center. Differential factors were identified between seriously ill SARS + MV patients versus stable patients without MV. Transformation to the natural logarithm of significant variables was performed and multiple linear regression was applied, then a predictive model of severity called AAD (Age-AST-D dimer) was constructed. Result(s): 166 patients were included, 114(68.7%) men, mean age 50.6 +/- 13.3 years-old, 27(16.3%) developed SARS + MV. In the comparative analysis between those with SARS + MV versus stable patients without MV we found significant raises of ALT (225.4 +/- 341.2 vs. 41.3 +/- 41.1;P = 0.003), AST 325.3 +/- 382.4 vs. 52.8 +/- 47.1;P = 0.001), LDH (764.6 +/- 401.9 vs. 461.0 +/- 185.6;P = 0.001), D dimer (7765 +/- 9109 vs. 1871 +/- 4146;P = 0.003), age (58.6 +/- 12.7 vs. 49.1 +/- 12.8;P = 0-001). The results of the regression are shown in the Table, where model 3 was the one that best explained the development of SARS + MV;with these variables was constructed the model called AAD, where: [AAD = 3.896 + ln(age)x-0.218 + ln(AST)x-0.185 + ln(DD)x0.070], where a value = 2.75 had sensitivity = 0.797 and 1-specificity = 0.391, AUROC = 0.74 (95%CI: 0.62-0.86;P 0.0001), to predict the risk of developing SARS + MV (OR = 5.8, 95%CI: 2.2-15.4;P = 0.001). Conclusion(s): Elevation of AST (probable marker of liver damage) is an important predictor of progression to SARS, together with elevation of D-dimer and age early (at admission) and efficiently predict which patients will potentially require MV. Conflicts of interest: The authors have no conflicts of interest to declare. [Formula presented] [Formula presented] Copyright © 2020

In this paper, the chemical composition, the main physicochemical properties, phase behavior and thermal stability of rambutan (Nephelium lappaceum L.) seed fat were studied. These results showed that the almond-like decorticated seed represents 6.1% of the wet weight fruit and is: 1.22% ash, 7.80% protein, 11.6% crude fiber, 46% carbohydrates, and 33.4% fat (d.b.). The main fatty acids in the drupe fat were 40.3% oleic, 34.5% arachidic, 6.1% palmitic, 7.1% stearic, 6.3% gondoic, and 2.9% behenic; the refraction, saponification and iodine values were 1.468, 186, and 47.0, respectively. The phase behavior analysis showed relatively simple crystallization and melting profiles: crystallization showed three well-differentiated groups of triglycerides around maximum peaks at +30.8, +15.6 and -18.1 degrees C; the fat-melting curve had a range between -14.5 and +51.8 degrees C with a fusion enthalpy of 124.3 J/g. The thermal stability analyzed in an inert atmosphere of N(2) and in a normal oxidizing atmosphere, showed that in the latter, fat decomposition begins at 237.3 degrees C and concludes at 529 degrees C, with three stages of decomposition. According to these results, rambutan seed fat has physicochemical and thermal characteristics that may become interesting for specific applications in several segments of the food industry.

Nine compounds were isolated and identified from the stem of Picramnia antidesma. Two of the isolated compounds: mayoside and saroside, which is new, are diastereoisomeric oxanthrones. The structure of saroside has been obtained on the basis of spectroscopic evidence. The absolute configuration of this diastereoisomeric pair has been determined by CD spectra, and that of saroside was further established by X-ray crystallographic analysis.

A new chrysophanol anthrone C-glycoside, named uveoside and four known compounds were isolated and identified from the chloroform extract of roots from Picramnia antidesma .

A new oxanthrone named mayoside was isolated from the roots of Picramnia hirsuta and the structure established by X-ray diffraction.