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The emergence of COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), triggered a global pandemic. Concurrently, reports of mucormycosis cases surged, particularly during the second wave in India. This study aims to investigate mortality factors in COVID-19-associated mucormycosis (CAM) cases, exploring clinical, demographic, and therapeutic variables across mostly Asian and partly African countries. A retrospective, cross-sectional analysis of CAM patients from 22 medical centers across eight countries was conducted, focusing on the first 3 months post-COVID-19 diagnosis. Data collected through the ID-IRI included demographics, comorbidities, treatments, and outcomes. A total of 162 CAM patients were included. The mean age was 54.29 ± 13.04 years, with 54% male. Diabetes mellitus (85%) was prevalent, and 91% had rhino-orbital-cerebral mucormycosis. Surgical debridement was performed in 84% of the cases. Mortality was 39%, with advanced age (hazard ratio [HR] = 1.06, [ P  < .001]), rituximab use (HR = 21.2, P  = .05), and diabetic ketoacidosis (HR = 3.58, P  = .009) identified as risk factors. The mortality risk increases by approximately 5.6% for each additional year of age. Surgical debridement based on organ involvement correlated with higher survival (HR = 8.81, P  < .001). The utilization of rituximab and diabetic ketoacidosis, along with advancing age, has been associated with an increased risk of mortality in CAM patients. A combination of antifungal treatment and surgical intervention has demonstrated a substantial improvement in survival outcomes. [ABSTRACT FROM AUTHOR]

Background: In severe COVID-19 cases, a hypercoagulable state may occur. Antiphospholipid syndrome-related auto-antibodies (APSRAs) contribute to coagulopathy, but their role in COVID-19 remains unclear. We aimed to investigate the prevalence of positive APSRAs and their effect on clinical outcomes in confirmed COVID-19 patients. Materials and Methods: In this cross-sectional study, severe hospitalized COVID-19 cases were enrolled. Demographic and clinical data were obtained from the day of admission. APSRAs including IgG and/or IgM anticardiolipin (aCL) and anti-ß2-glycoprotein1 (anti-ß2GP1) as well as lupus anticoagulant (LAC) were measured. Results: In this study, 54 severe COVID-19 cases with positive RT-PCR and chest CT scans were recruited. Positive APSRAs were found in 7 (12.9%) patients. Positive LAC was a more prevalent marker as compared to other tests (11.1%). The prevalence of positive aCL (IgM or IgG) and anti-ß2 GPI (IgM or IgG) w as 1.8% (in an elderly woman). Lower oxygen saturation was found in the positive APSRAs group as opposed to the negative APSRAs group (70.3±9 vs. 84.8±9.7%). The mortality rate in the positive APSRAs group was significantly higher relative to the negative APSRAs group (83.3% vs. 27.1%; Pvalue: 0.01). Likewise, the mechanical ventilation requirement in the positive group was also higher (50% vs. 27.1%, P-value: 0.28). Conclusion: This study indicated that LAC might be associated with critical cases and high mortality of COVID-19. Nonetheless, the mortality was not related to macrothrombotic incidence. [ABSTRACT FROM AUTHOR]

Introduction: Neuropsychological manifestations are increasingly reported in patients with COVID-19, but the subject is poorly understood and our knowledge about cognitive impairment is limited. This study aimed to investigate neuropsychological involvement of COVID-19 and its relation to laboratory data. Material and methods: This study was conducted among patients admitted to a tertiary medical center in Iran, in the period March 2020 to March 2021. Neuropsychiatric assessments were carried out by the Addenbrooke’s Cognitive Examination (ACE) test in all patients and interpreted by a specialist. It was performed using the Persian version of ACE in six domains consisting of attention, orientation, memory, language, visual perception and visuospatial skills. Laboratory data were assessed among all patients. Statistical analyses were performed using SPSS. Results: Among 114 patients with COVID-19, the mean age was 48.46 ±13.61 years, and the male/female ratio was 1.32. The mean values of some abnormal laboratory data were: erythrocyte sedimentation rate (ESR) 57.2 ±29.8, C-reactive protein (CRP) 81.7 ±59.8 and D-dimer 459.3 ±395.4. Cognitive impairment was detected in 41 patients (63%). The mean score of ACE was 80.68 ±19.29. Statistical analysis showed correlations between total result of the ACE test and laboratory findings that were not statistically significant. Conclusions: In our study, no relation was found between laboratory test results and the overall cognitive examination score but statistical analysis showed a correlation between CRP and verbal fluency, between hemoglobin level and language and visuospatial domains, and also between total level of bilirubin and memory. These relations may suggest that we should follow the neurocognitive features in COVID-19 patients earlier. [ABSTRACT FROM AUTHOR]

Seeking to free us from the clutches of our self-made rigid conventions, postmodernism criticizes the metanarratives of modern times, while metafiction seems a better spokesman of it. New York Trilogy, Paul Auster's debut composition and a meta-detective novel, has secured its fame in the postmodern fiction. It uses and abuses the conventions of detective novel, and lays bare the conventions of objective historiography. In doing this, Auster has given a self-reflective and equally historical dimension to his oeuvre through the technique of "historiographic metafiction". Linda Hutcheon sees "historiographic metafiction" as a way to rewrite history in postmodern fiction. Postmodernism seeks to embrace a plurality of truths, and history is no longer monolithic and objective. Hutcheon contends that the postmodernist fiction is characterized by intense self-reflexivity and overtly parodic intertextuality. Utilizing historical accounts as intertextual effects, the writers of postmodernist fiction distrust in history. The present article will attempt to analyze New York Trilogy as a "historiographic metafiction". Firstly, and insofar as it is within the scope of the article, it will attempt to offer a critical analysis of "postmodernism", "metafiction", and "metaphysical detective fiction". Then, it will examine Auster's novel as a "historiographic metafiction" in the light of Hutcheon's theories. [ABSTRACT FROM AUTHOR]

Background: Mucormycosis is an aggressive opportunistic fungal infection that afflicts patients with severe underlying immunosuppression, uncontrolled hyperglycemia and/or ketoacidosis, iron overload, and occasionally healthy patients who are inoculated with fungal spores through traumatic injuries. The epidemiology of mucormycosis has changed after the COVID-19 pandemic, with mucormycosis becoming the most common and the fatal coinfection., Methods: In a retrospective, cross-sectional study, 82 hospitalized patients with a definite diagnosis of mucormycosis were reported from 2007 to 2021 in a referral, tertiary care center in Tehran, Iran., Results: The number of post-COVID cases increased 4.6 times per year, with 41.5% of patients admitted during the two years of the pandemic. Mucormycosis was more common in women (57.3%), and the most common underlying diseases were diabetes (43.7%), both COVID-19 and diabetes (23.2%), cancer (11%), rheumatic diseases (7.3%), COVID-19 without other underlying diseases (6.1%), and transplantation (4.9%). Rhino-orbito-cerebral Mucormycosis (54.9%) followed by Sino-orbital infection (23.2%) was the most common presentation. There was a significant relationship between the use of immunosuppressive agents and the development of Mucormycosis (P<0.005) The average mortality was 41.5%, but this ratio decreased to 35% during the pandemic era., Conclusion: The COVID-19 pandemic caused a 4.6-fold increase in the number of mucormycosis patients, and there was a significant relationship between hyperglycemia, corticosteroid use, and mucormycosis. The death rate during the COVID-19 pandemic has decreased by 6.5%, and during the COVID period, the interval between the arrival of a patient with mucormycosis and the start of the correct treatment was significantly decreased., (Copyright© 2023 Darazam et al. Published by Tehran University of Medical Sciences.)

In acute myeloid leukemia (AML), despite the acceptance of standard intensive chemotherapy as an optimal induction regimen for all age groups, in the elderly patients, the best treatment should meet the challenge of multiple factors like age, comorbidities, and cytogenetics, making them ineligible for standard induction chemotherapy. Using the current low-intensity therapies like decitabine, azacitidine, and low-dose cytarabine as a single arm, outcomes for these patients remain poor. As a histone deacetylase inhibitor valproic acid (VPA) exhibit anticancer activity by triggering apoptosis, the mechanism of which is not yet completely clarified. To explore the possible connection between VPA treatment and the Hippo pathway as an apoptosis stimulating route, we also explore the expression of major components of this pathway and for the first time we postulate a relationship between VPA treatment and cell death induction through RASSF1A expression induction. Furthermore, we demonstrate that autophagy inhibition by chloroquine (CQ) significantly augmented the cytotoxic effect of VPA on AML cells, especially in those with unfavorable and normal karyotype. Regarding that VPA and CQ are well-tolerated drugs and our presumptive results of usefulness of VPA + CQ in three cytogenetic risk groups of AML, this combinatorial therapy could represent an attractive treatment option for older AML patients unfit for intensive therapy.