Continuous air cleaning by filtration and UV-C treatment of airborne pathogens and particulate matter in indoor spaces

Since COVID-19 became a global pandemic, improving air quality has been increasingly important to mitigate the transmission of pathogenic aerosols. Air filters such as MERV filters have been widely used in heating, ventilation, and air conditioning (HVAC) systems to clean inlet air. In recent years, ultraviolet (UV) light has been used for decontamination and disinfection in various applications, including indoor air cleaning, e.g., upper-room ultraviolet germicidal irradiation (UVGI). There are a variety of air purification devices available in the market, with some incorporating UV technology. However, many of them are not formally tested and certified for their effectiveness in mitigating airborne pathogens and particulate matter. The research's objectives are to (1) evaluate, design, and upgrade an existing air filtration device (~2,200 CFM) with the addition of UV-C lamps;(2) test the effectiveness of the upgraded device in mitigating airborne pathogens (bacteria) and particulate matter (PM) in real scenario (poultry farm). The testing results of air quality are expressed in particular matter (PM) levels and colony-forming units (CFUs). The preliminary data showed that both MERV-8 & MERV 13 and UV-C lamps can inactivate up to 100% of airborne bacteria, and the device can remove over 95% of total PM after treatment in a ~150-layer room. © 2022 ASABE. All Rights Reserved.

CEREBRAL VENOUS THROMBOSIS DUE TO VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA AFTER A SECOND CHADOX1 NCOV-19 VACCINE DOSE

Background and aims: Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare side effect of the ChAdOx1 nCoV-19 COVID- 19 vaccine (AstraZeneca/Oxford) and often manifests as cerebral venous thrombosis (CVT). So far, CVT-VITT has only been reported after a first ChAdOx1 nCoV-19 dose. Methods: We report cases (March-December 2021) of CVT-VITT after a second ChAdOx1 nCoV-19 vaccine dose from an international CVTVITT registry. We classified certainty of VITT diagnosis using criteria of the United Kingdom Expert Haematology Panel. Results: Out of 124 CVT cases that developed after ChAdOx1 nCoV- 19 vaccination, 120 were after a first dose (61 definite, 20 probable, 10 possible and 29 unlikely VITT), and 4 after a second dose (1 definite, 1 probable, 1 possible and 1 unlikely VITT). None of the four patients had any symptoms after the first ChAdOx1 nCoV-19 dose. All cases had symptom onset between 1 and 6 days after the second vaccination, thrombocytopenia, and increased D-dimer levels. Anti-PF4 antibodies were positive in 2/3 tested cases. Two patients presented in a coma and died during admission. Conclusion: CVT-VITT can occur after a second dose of ChAdOx1 nCoV-19 vaccine, but was reported substantially less often after a second than after a first vaccine dose. In some cases, symptom onset of VITT may be more rapid after a second than after the first dose, although the small number of cases precludes firm conclusions.

DECOMPRESSIVE SURGERY IN CEREBRAL VENOUS SINUS THROMBOSIS WITH VACCINE-INDUCED IMMUNE THROMBOTIC THROMBOCYTOPENIA

Background and aims: Cerebral venous sinus thrombosis with thrombosis with thrombocytopenia syndrome (CVST-TTS) is a serious adverse drug reaction after adenoviral SARS-CoV-2 vaccinations. CVST-TTS patients may need decompressive surgery to avoid fatal brain herniation, but despite this intervention, many CVST-TTS patients die during the initial hospital admission. Here, we describe the characteristics and outcomes of CVST-TTS patients who underwent decompressive surgery and explore predictors of mortality in CVST-TTS patients. Methods: We used data from an ongoing international registry collecting data from patients who developed CVST within 28 days of SARS-CoV-2 vaccination, reported between 29 March and 9 December 2021. TTS was defined in accordance with the Brighton Collaboration case definition. Results: Out of 97 CVST-TTS patients, 29 (30%) underwent decompressive surgery. All operated patients had an intracerebral haemorrhage before the surgery. In-hospital mortality was 19/29 (66%) in the operated and 23/68 (34%) in the non-operated group. In the operated group, the highest mortality rate was among patients who were in coma before the surgery (14/15, 93% vs 4/12, 33% in those not in coma), had bilateral absence of the pupillary response (7/7, 100% vs 8/16, 50% in patients with uni/bilateral pupillary response) and platelet count <50 x103/μL (11/14, 79% vs 6/12, 50% in cases with a platelet count ≥50 x103/μL). Conclusion: Mortality rate of CVST-TTS patients who underwent decompressive surgery is extremely high. Among the operated patients, coma before the surgery, bilateral absence of the pupillary response, and platelet count <50 x103/μL were the predictors of mortality.

Reinvention of an academic anaesthesiology department during pandemic times: Lessons learnt and adapting to a “New normal”

Conditions created by the COVID-19 pandemic have impacted many aspects of medical practice. Responding to this crisis has required health systems to rapidly address a multitude of concerns, including workforce safety, staff redeployment, supply shortages and physical space restructuring. The pace of change created by new information and evolving conditions has proven challenging for traditionally-structured academic departments in medicine. Pandemic medicine requires a nimbleness in decision-making, clarity of communication and comprehensiveness of services that may demand a temporary rearrangement of leadership structure and clinical service delivery. Furthermore, the uncertain nature of a pandemic may require reinstitution and dissolution of services as demand sporadically either rises or falls. As the global medical community continues to respond to what may be multiple COVID-19 peaks stretching over months or years, it is important that approaches to preparation and management of the pandemic are shared to enable the identification of best practices and an effective response. With the availability of open access and free communication technologies, these strategies can be easily shared among the global anaesthesia community. The approach outlined here represents one way to organise leadership and streamline communication in order to reinvent an academic department to match the dynamic requirements of crisis conditions. We describe our experience in offering new services such as an airway team, COVID-19 simulation training and personal protective equipment testing, as well as our approach to evaluating the rapid flow of research findings related to SARS-CoV-2 and COVID-19. We summarise lessons learnt and our adaptation to what may be a “new normal” in anaesthesiology practice. © 2021 The Author(s).