Diabetes Mellitus Type 2 as a Risk Factor and Outcome Modifier for Cryptococcosis in HIV Negative, Non-transplant Patients, a Propensity Score Match Analysis

Cryptococcosis is an opportunistic fungal infection of worldwide distribution with significant associated morbidity and mortality. HIV, organ transplantation, malignancy, cirrhosis, sarcoidosis, and immunosuppressive medications are established risk factors for cryptococcosis. Type 2 diabetes mellitus (DM2) has been hypothesized as a risk factor and an outcome modifier for cryptococcosis. We aimed to compare outcomes among HIV-negative, non-transplant (NHNT) patients with and without DM2. We queried a global research network to identify NHNT patients (n = 3280). We performed a propensity score-matched (PSM) analysis comparing clinical outcomes among cryptococcosis patients by DM status. We also characterize adults with cryptococcosis and DM2 as the only risk factor. After PSM, NHNT patients with DM2 were more likely to develop cognitive dysfunction [9% vs. 6%, OR 1.6; 95% CI (1.1–2.3); P = 0.01] but had similar mortality, hospitalization, ICU, and stroke risk after acquiring cryptococcosis when compared to NHNT patients without DM2. Pulmonary cryptococcosis was the most common site of infection. Among 44 cryptococcosis patients with DM2 as the only identifiable risk factor for disease, the annual incidence of cryptococcosis was 0.001%, with a prevalence of 0.002%. DM2 is associated with increased cognitive dysfunction risk in NHNT patients with cryptococcosis. It is rare for DM2 to be the only identified risk factor for developing cryptococcosis. Kidney disease, hyperglycemia, and immune dysfunction can increase the risk of cryptococcosis in patients with DM2

Multiblock Copolymers by Thiol Addition Across Norbornene

Multiblock copolymers, composed of different combinations and number of blocks, offer appreciable opportunities for new advanced materials. However, exploring this parameter space using traditional block copolymer synthetic techniques, such as living polymerization of sequential blocks, is time-consuming and requires stringent conditions. Using thiol addition across norbornene chemistry, we demonstrate a simple synthetic approach to multiblock copolymers that produces either random or alternating architectures, depending on the choice of reactants. Past reports have highlighted the challenges associated with using thiol–ene chemistry for polymer–polymer conjugation; however, using norbornene as the “ene” yielded multiblock copolymers at least four or five blocks. Preparation of new multiblock copolymers containing two or three block chemistries highlights the versatility of this new approach. These materials were thermally stable and showed microphase separation according to characterization by DSC, SAXS, and AFM. This chemical platform offers a facile and efficient route to exploring the many possibilities of multiblock copolymers

Characteristics and Outcomes of Cryptococcosis among Patients with and without COVID-19

The effect of COVID-19 on the risk and prognosis of cryptococcosis is unclear. We compared the characteristics and outcomes of cryptococcosis in patients with and without COVID-19. Patients 18 years and older with cryptococcosis were identified from TriNetX and separated into two cohorts based on a diagnosis of COVID-19 within 3 months of the index diagnosis of cryptococcosis. Differences examined between groups included comorbidities, immunosuppressive medications, ED visits, hospitalizations, ICU admissions, mechanical ventilation, and deaths. The propensity score matching was performed based on demographics and comorbidities. Of the 6998 patients with cryptococcosis included, 4.4% (n = 306) had COVID-19 prior to cryptococcosis. Mortality was higher in patients with COVID-19 compared to those without COVID-19 (14% vs. 11%, p = 0.032). Additionally, those with COVID-19 were older (55.2 ± 14.4 vs. 51.9 ± 15.2 years, p < 0.001) with higher rates of transplant (29% vs. 13%, p < 0.001), neoplastic disease (37% vs. 21%, p < 0.001), chronic kidney disease (42% vs. 18%, p < 0.001), or diabetes (35% vs. 19%, p < 0.001) but not HIV (30% vs. 31%, p = 0.618). Glucocorticoid use was more common in those with COVID-19 (52% vs. 27%, p < 0.001). More patients with COVID-19 required ED visits (29% vs. 23%, p = 0.025) and ICU admission (18% vs. 11%, p < 0.001). After propensity score matching, patients with COVID-19 had higher rates of neoplastic disease, heart failure, chronic kidney disease, and glucocorticoid use but did not experience worse outcomes compared to those without COVID-19. Patients with COVID-19 who developed cryptococcosis had independently higher rates of comorbidities and glucocorticoid use but similar outcomes, including death, versus those without COVID-19

Cryptococcosis among hospitalised patients with COVID‐19: A multicentre research network study

It is unclear if there is an association between COVID-19 and cryptococcosis. Therefore, this study aimed to describe the clinical features, risk factors, and outcomes associated with cryptococcosis in hospitalised patients with COVID-19. The objectives of this study were to determine the incidence of and examine factors associated with cryptococcosis after a diagnosis of COVID-19. We used TriNetX to identify and sort patients 18 years and older hospitalised with COVID-19 into two cohorts based on the presence or absence of a diagnosis of cryptococcosis following diagnosis of COVID-19. Outcomes of interest included the incidence of cryptococcosis following the diagnosis of COVID-19 as well as the proportion of patients in each group who had underlying comorbidities, received immunomodulatory therapy, required ICU admission or mechanical ventilation (MV), or died. Propensity score matching was used to adjust for confounding. Among 212,479 hospitalised patients with COVID-19, 65 developed cryptococcosis. The incidence of cryptococcosis following COVID-19 was 0.022%. Patients with cryptococcosis were more likely to be male and have underlying comorbidities. Among cases, 32% were people with HIV. Patients with cryptococcosis were more likely to have received tocilizumab (p < .0001) or baricitinib (p < .0001), but not dexamethasone (p = .0840). ICU admission (38% vs 29%), MV (23% vs 11%), and mortality (36% vs 14%) were significantly higher among patients with cryptococcosis. Mortality remained elevated after adjusted propensity score matching. Cryptococcosis occurred most often in hospitalised patients with COVID-19 who had traditional risk factors, comparable to findings in patients without COVID-19. Cryptococcosis was associated with increased ICU admission, MV, and mortality

Desempenho produtivo de vacas leiteiras alimentadas com silagem pré-seca de alfafa adicionada de inoculante microbiano Performance of lactating dairy cows fed alfalfa haylage with microbial inoculant

Objetivou-se, com o presente estudo, avaliar os efeitos da inoculação microbiana da silagem pré-seca de alfafa sobre o consumo de matéria seca, a produção e composição do leite de vacas da raça Holandesa, multíparas, com 135 ± 16,4 dias de lactação, distribuídas em delineamento em reversão simples com seqüência balanceada ("cross-over"), com dois períodos sucessivos. Os tratamentos corresponderam à silagem pré-seca de alfafa (50,0% de MS e 16,5% de PB) controle ou inoculada com o produto Silobac® (Lactobacillus plantarum e Pediococcus pentosaceus). Cada período experimental teve duração de 21 dias, sendo os cinco últimos dias destinados à coleta de dados. Não se observou efeito da inoculação sobre o CMS (inoculada = 17,8 vs. controle = 17,8 kg/animal/dia), a produção de leite corrigida para 4,0% de gordura (21,0 vs. 20,4 kg/dia), produção de leite (23,0 vs. 22,4 kg/dia), porcentagem de gordura (3,46 vs. 3,47%), proteína (2,96 vs. 2,93%), lactose (4,64 vs. 4,67%), sólidos totais (11,9 vs. 11,9%) e sólidos desengordurados (8,49 vs. 8,48%), CCS (5,43 vs. 5,16 log cel/10³/mL), NUL (11,7 vs. 12,1 mg/dl), acidez (15,9 vs. 16,4ºD), densidade (1030,1 vs. 1030,0) e crioscopia (-0,529 vs. -0,531ºH).<br>The objective of this study was to evaluate the effects of feeding alfalfa haylage with microbial inoculat on dry matter intake, milk yield and composition in Holstein cows, at 135 ± 16.4 days in milk. A cross-over design with two periods of sampling was used. Treatments were alfalfa haylage (50.0% DM and 16.5% CP) control or microbially inoculated with Silobac® product (Lactobacillus plantarum and Pediococcus pentosaceus). Each experimental period extended for twenty-one days, the last five used for data collection. The inoculation did not influence DMI (inoculated = 17.8 vs. control = 17.8 kg/animal/day), 4%FCM (21.0 vs. 20.4 kg/day), milk yield (23.0 vs. 22.4 kg/day), fat (3.46 vs. 3.47%), protein (2.96 vs. 2.93%), lactose (4.64 vs. 4.67%), total solids (11.9 vs. 11.9%) and fat free solids percentage (8.49 vs. 8.48%), SCC (5.43 vs. 5.16 log cell/10³/mL), MUN (11.7 vs. 12.1 mg/dl), acidity (15.9 vs. 16.4ºD), density (1030.1 vs. 1030.0) and cryoscopic index (-0.529 vs. -0.531ºH)

Additional file 1: of Biomarkers of endothelial dysfunction predict sepsis mortality in young infants: a matched case-control study

Table S1. Blood culture isolates from bacteremic infants. Bacterial isolates from blood cultures obtained by venipuncture on admission of septic young infants age < 59 days to a pediatric facility in Sylhet, Bangladesh. (DOCX 16 kb