ABSTRACT
Background. COVID-19 increase the risk of invasive pulmonary aspergillosis. However, the risk factors and fungal origin of COVID-19 associated pulmonary aspergillosis (CAPA) is not fully defined yet. We aim to identify the risk factors for CAPA in severe COVID-19 and evaluate association between fungal contamination within the air of negative pressure rooms and diagnosis of CAPAs. Methods. We performed a retrospective case-control study to identify risk factors for CAPA with 420 severe COVID-19 patients from March 2020 to January 2022 who admitted to a tertiary care hospital in South Korea. CAPA was defined with modified AspICU criteria. Control, matched by admission date and severity of COVID-19 at admission, was selected for each case. Air sampling and fungal culture was done on Jan 2022 with a microbial air sampler (MAS-100NT) at 11 spaces in the COVID-19 designated isolation ward including 9 negative pressure isolation rooms (IRs). A cross-sectional comparison between rooms with and without airborne fungal contamination was performed. Results. A total of 420 COVID-19 patients were hospitalized during the study period, and 51 patients were diagnosed with CAPA (prevalence 12.14%, incidence 6.26 per 1000 patient.day). Multivariate analysis showed that older age (odds ratio [OR] 1.051, 95% confidence intervals [CI] 1.006-1.009, p=0.025), mechanical ventilator use (OR 2.692, 95% CI 1.049-6.911, p=0.04), and lymphopenia (OR 4.353, 95% CI 1.727-10.975, p=0.02) were independent risk factors for CAPA. (Table 1, 2) Aspergillus spp. was identified within the air from 7 out of 11 spaces including 6 IRs and 1 doctors' room. (Figure 1). All 6 IRs with positive aspergillus culture were being occupied by patients at least 8 days. Among 6 patients, 3 had already been diagnosed with CAPA whereas the other 3 were not diagnosed with CAPA through the observation period. Among 4 patients in isolation rooms without airborne aspergillus contamination, one patient had been diagnosed as CAPA before air sampling. (Table 3). Conclusion. Association between CAPA and airborne aspergillus contamination within the negative pressure room could not be demonstrated in this study. Rather than environmental factors, patient factors such as older age, ventilator care, and lymphopenia were found to be associated with CAPA diagnosis.
ABSTRACT
Purpose - This paper examines the admissibility of restitution as the legal consequence where a contract is frustrated under the Law of Reform (Frustrated Contracts) Act 1943 in comparison with Korean Civil Code (KCC). In order to provide practical guidelines and advice regarding choice of and application of law for contracting parties in international trade, the paper comparatively evaluates requirements and the scope of restitution under the Act 1943 and KCC. Design/methodology - This paper executes a comparative study to analyze whether the parties may claim restitution of money paid or non-money benefit obtained before or after the time of discharge under English law and KCC. To achieve the purpose, it focuses on the identifying characteristics of each statute, thereby providing guidelines to overcome difficulties in legal application and interpretation as to restitution as the consequence of frustration. Findings - Under English law, the benefit may be restituted according to Art 1943 or the common law rule, mistake of fact or law. Under the KCC, restitution is considered based on the principle of the obligation to recover the original obtained regardless of the time when the benefit is conferred. Whilst Act 1943 does not require careful analysis of the grounds of restitution, requirements to justify restitution according to the principle of unjust enrichment, mistake of fact or law, and the KCC should be met. Meanwhile, the KCC may provide more opportunities to award restitution because it does not require the burden of proof related to the defendant's good faith, unlike the principle of unjust enrichment. Originality/value - Where the contract is frustrated by the effect of COVID-19, one legal issue is a consequence of frustration. Therefore, this paper analyzes requirements and the scope of restitution under English law as compared with the KCC in a timely manner. It provides contracting parties with practical guidelines and advice to reduce unpredictability when they choose the governing law in a contract.
ABSTRACT
Introduction: To prevent the spread of the COVID-19 pandemic, vaccinations have been authorized for emergency use and implemented worldwide. As with the others, COVID-19 vaccines are known to cause mild and transient side effects such as fever, myalgia, and fatigue, but severe and consistent adverse events have rarely been reported. We present a case of de novo glomerulonephritis after injection of COVID-19 mRNA vaccine, BNT162b2 (BioNTech, Pfizer, NY, USA). Case Description: A 48-year-old man with no past medical history was referred for suddenly and persistently worsening renal insufficiency for only a month and a half after the second dose injection of the vaccine. He presented with arthralgia and skin rash a week after the vaccination. Abdominal pain and diarrhea started two weeks later, and he was admitted to the hospital for enteritis treatment. Upon colonoscopy, multiple ulceration and petechiae suggestive of vasculitis were observed in the terminal ileum. While taking prednisolone for a few weeks the gastrointestinal symptoms improved, but the renal function continues to deteriorate. A kidney biopsy was performed for the rapid decline in renal function accompanying nephrotic-range proteinuria (urine protein to creatinine ratio 3389mg/gCr), and anti-neutrophil cytoplasmic autoantibody (ANCA)-negative pauci-immune crescentic glomerulonephritis was diagnosed. He started treatment with high-dose steroid pulse therapy and oral cyclophosphamide, and then gradually took steroid tapering, showing improvement in proteinuria and renal function over several weeks. Discussion(s): To date, several cases of glomerulonephritis suspected to be related to the COVID-19 vaccine have been reported. This is the first case report of ANCAnegative pauci-immune crescentic glomerulonephritis with extrarenal involvement after COVID-19 mRNA vaccine injection. It is difficult to find definite evidence to suspect or prove the causal relationship, except when there is a temporal association after vaccination or when the disease manifestations are unusual compared to well-known pathologic findings. Further in-depth studies are needed for de novo glomerulonephritis that occurs after vaccination and COVID-19 infection.