Pilgrim Experience and Revisit Intention Post COVID-19: An Exploratory Study of Amarnath Holy Shrine in Jammu and Kashmir, India

The present preliminary study seeks to explore the pilgrim tourist experience and their revisit intentions post-COVID pandemic. Data were collected at the Amarnath Holy Shrine in Jammu and Kashmir, India, using a combination of primary and secondary sources, including seven in-depth semi-structured telephone interviews with pilgrims using the snowball sampling technique. Five main themes were found regarding revisiting intentions, including ease of registration, safety and security, health facilities, accommodation facilities, food and beverage services, and connectivity of the destinations. The study highlights that despite COVID-19, most respondents agree to return to visit the holy Amarnath Cave as they felt that they would not be affected by COVID-19 in the future. This research has implications for tourists' safety and security concerns at religious sites, including highlighting the need for proper infrastructure development to enhance the sustainability of religious destinations. Regarding social impacts, the local administration must make efforts to carry out the pilgrimage in a sustainable way post-COVID-19, following new procedures to ensure the safety and health of the tourist and the local community. The Shrine board and Local administration must formally implement these standards via formal Standards of Procedure (SOP). © 2022 International Journal of Religious Tourism and Pilgrimage.

Coronavirus pandemic: An opportunity to study the anthropogenic impact on micro-climate conditions and CaCO3 crystal morphology in the Nerja Cave (SE Spain).

Following the declaration of the COVID-19 pandemic, the Spanish Government restricted non-essential movements of all citizens and closed all public spaces, such as the Nerja Cave, until May 31, 2020. This particular condition of the closure of the cave provided a unique opportunity to study the micro-climate conditions and carbonate precipitation in this tourist cave without the presence of visitors. Our results show the significant effect of visitors on the air isotopic signature of the cave and on the genesis of the extensive dissolution features affecting the carbonate crystals formed in the tourist sector of the cave, alerting us to the possible corrosion of the speleothems located there. The movement of visitors within the cave also favours the mobilisation of aerial fungi and bacterial spores and their subsequent sedimentation simultaneously with the abiotic precipitation of carbonates from the drip water. The traces of these biotic elements could be the origin of the micro-perforations previously described in the carbonate crystals formed in the tourist galleries of the cave, but they are subsequently enlarged due to abiotic dissolution of the carbonates through these weaker zones.

Speleomycology of Air in Stopica Cave (Serbia).

Fungi can colonize organic matter present in subterranean sites and have a significant role as dwellers in different microniches of cave habitats. In order to analyze the content of airborne fungal propagules in different parts of "Stopica Cave," a touristic site in Serbia, air sampling was carried out in three seasons during 2020, prior to and during the onset of COVID-19 pandemic. Culturable mycobiota was identified using both microscopic techniques and ITS region/BenA gene barcoding, while multivariate analyses were employed to establish the link between fungal taxa and different environmental factors. The maximal measured fungal propagule concentrations were recorded during spring sampling which were based on fungal propagule concentration categories; the cave environment matches the category V. A total of 29 fungal isolates were identified, while Aspergillus, Cladosporium, Fusarium, Lecanicillium, Mucor, and Penicillium were the most diverse genera. According to the trophic mode, most of the isolated fungal species were pathotrophs (75.86%), but when regarding ecological guilds, the most dominant were undefined saprobes and animal pathogens (41.38% for each). Show caves are especially vulnerable to human impacts, and the fungal propagules' concentration within the caves could be good indices for the level of ecological disturbance.

Scheduling Closure Periods Is Not an Effective Management Strategy to Reduce Lampenflora in Show Caves

The conversion of wild caves into tourist sites poses serious threats to the conservation of subterranean environments. Among them, the extensive growth of photosynthetic biofilms induced by artificial lighting—the so-called lampenflora—is of particular concern for cave managers. The identification of cost-effective management actions controlling the growth of lampenflora is therefore required to preserve the environmental and touristic values of show caves. By taking advantage of the closure period imposed to contain the COVID-19 pandemic, we tested whether 6 months of cave closure could be an effective strategy to reduce the concentration of photosynthetic biofilms on speleothems in four geographically close Italian show caves. We compared the concentration of the three main microorganism groups composing lampenflora, i.e., cyanobacteria, diatoms, and green algae, measured in September 2020 with values recorded 6 months after the closure, in May 2021. Although slight variations have been observed across the different sampling sessions, we did not detect any significant effect of the closure period on the overall concentration values of lampenflora. Also, we recorded no significant differences in lampenflora concentration after 4 months of regular tourist use, in September 2021. Our results suggest that management practices based on regulating visits to show caves are not effective strategies to reduce lampenflora. Therefore, management practices aiming at a sustainable use of show caves should focus on the active removal of photosynthetic biofilms.

A Pipeline for the Implementation of Immersive Experience in Cultural Heritage Sites in Sicily

Modern digital technologies allow potentially to explore Cultural Heritage sites in immersive virtual environments. This is surely an advantage for the users that can better experiment and understand a specific site, also before a real visit. This specific approach has gained increasing attention during the extreme conditions of the recent COVID-19 pandemic. In this work, we present the processes that lead to the implementation of an immersive app for different kinds of low and high-cost devices, which have been attained in the context of the 3dLab-Sicilia project. 3dLab-Sicilia’s main objective is to sponsor the creation, development, and validation of a sustainable infrastructure that interconnects three main Sicilian centres specialized in augmented and virtual reality. The project gives great importance to the cultural heritage, as well as to the tourism-related areas. Despite the presentation of the case study of the Santa Maria La Vetere church, the process of the final app implementation guided by the general pipeline here presented is general and can be applied to other cultural heritage sites. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

LUNG CAVITY: A RARE FINDING IN COVID-19

SESSION TITLE: Post-COVID-19 Infection Complications SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Chest CT features in COVID-19 pneumonia include scattered ground-glass infiltrates in milder cases to confluent ground-glass change, dense consolidation, and crazy paving in the critically ill. However, cavitary lesions are uncommon in these patients. We present a case of lung cavity in a patient who had recent COVID-19 pneumonia. CASE PRESENTATION: A 33-year-old male diagnosed with COVID-19 four weeks ago presented with hemoptysis and exertional dyspnea. He had pleuritic chest pain without fever, night sweats, weight loss, skin rashes, hematemesis, or epistaxis. He had COVID-19 in Brazil, where he had received dexamethasone, hydroxychloroquine, ivermectin, colchicine, azithromycin, and rivaroxaban. The last dose of rivaroxaban was three days prior to the presentation. He had no history of travel to caves or exposure to birds or animals. His past medical history included hypertension, diabetes, and bariatric surgery. He had no history of smoking or IV drug use. He had moved from Brazil to the United States six years ago and worked as an interpreter. Physical examination was notable for stable vitals with O2 sat of 99%. Systemic examinations were unremarkable. Blood work including CBC, platelet count, PT/INR was within normal limits. COVID-19 testing (PCR) was negative. A chest CT revealed bilateral scattered ground-glass opacities with central cavitation in the left lower lobe concerning for septic pulmonary emboli. HIV 1/2, ANA, rheumatoid factor, and Quantiferon TB gold were negative. Blood cultures showed no growth. An echocardiogram was negative for any vegetations. Bronchoalveolar lavage from the left lower lobe was negative for AFB and gram staining. Sputum cultures, fungal cultures, and NAAT for Mycobacterium tuberculosis were negative, as was the cytology. He was started on amoxicillin-clavulanic acid during his hospital stay. He did not experience any recurrence of hemoptysis and was discharged home. The subsequent follow-up chest CT scans showed resolving cavitation at one month and a complete resolution of the cavity at 3 months. DISCUSSION: Cavitary lung lesions are usually related to fungal, mycobacterial, autoimmune, parasitic, thrombotic, or neoplastic etiologies. While not often seen in patients with viral pneumonia, lung cavitation can rarely occur in COVID-19. Mycobacterium tuberculosis and Nocardia were suspected given the history of being an immigrant and a recent trip to Brazil. As these tests were negative and the lung cavity resolved over a few months with conservative treatment, the etiology of the cavity was attributed to a late presentation of COVID-19 pneumonia. CONCLUSIONS: COVID-19 has variable complications which are still to be explored. The lung cavity in a COVID patient is an under-recognized entity. This case report highlights the need for further studies to determine the cause of cavitation, which could be related to COVID infection or its treatment. Reference #1: Selvaraj V, Dapaah-Afriyie K Lung cavitation due to COVID-19 pneumonia. BMJ Case Reports CP 2020;13:e237245. Reference #2: Chen Y, Chen W, Zhou J, Sun C, Lei Y. Large pulmonary cavity in COVID-19 cured patient case report. Ann Palliat Med 2021;10(5):5786-5791. doi: 10.21037/apm-20-452 Reference #3: Zoumot, Z., Bonilla, MF., Wahla, A.S. et al. Pulmonary cavitation: an under-recognized late complication of severe COVID-19 lung disease. BMC Pulm Med 21, 24 (2021). https://doi.org/10.1186/s12890-020-01379-1 DISCLOSURES: no disclosure on file for Raul Davaro;No relevant relationships by Susant Gurung No relevant relationships by Bijay Khanal No relevant relationships by Anil Phuyal No relevant relationships by Kamal Pokhrel No relevant relationships by REGINA SHRESTHA No relevant relationships by Mithil Gowda Suresh

INVASIVE PULMONARY FUSARIOSIS WITH SUPERIMPOSED HISTOPLASMOSIS IN AN IMMUNOCOMPETENT HOST

SESSION TITLE: Complicated Chest Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Fusarium species (FS) are large filamentous fungi widely distributed in soil and plants that are well-known to cause human infections ranging from superficial to disseminated predominantly depending on the host's immune system. Histoplasma capsulatum (HC), on the other hand, is a dimorphic fungus found in soil contaminated with bird or bat droppings, such as caves, where most infections are asymptomatic or self-limited. We present a case of an immunocompetent patient who developed long-term pulmonary sequelae after a co-infection pneumonia with FS and HC. CASE PRESENTATION: 47-year-old man, non-smoker with history of Myasthenia Gravis presents to the emergency department with worsening shortness of breath and sporadic episodes of fever over the course of 3 weeks. The patient claimed to have gone cave-exploring and worked as an air-condition technician. During the previous three years, he reports progressive dyspnea on exertion, fatigue, and a constant dry cough that required multiple hospitalizations which was treated as Myasthenic Crisis. Clinical exam was remarkable for diffuse rales on bilateral lungs with a resting hypoxia of 82-84%. Laboratories showed elevated inflammatory markers with no leukocytosis or neutropenia. Chest-x-ray revealed increased pulmonary markings and chest CT demonstrated diffuse bilateral ground-glass opacities with septal thickening and innumerable millimetric pulmonary nodules of unclear distribution. Extensive infectious, immunologic, and rheumatologic workup were negative. He underwent a bronchoscopy with broncho-alveolar lavage (BAL) which showed FS and HC on cytology. Therefore, intravenous liposomal Amphotericin B was given for 2 weeks followed by a long-course of oral Voriconazole resulting in marked improvement of symptoms, yet he remained with limited physical activity due to exertional hypoxia of less than 80%. Pulmonary function tests revealed mixed obstructive-restrictive disease. DISCUSSION: To our knowledge, this case represents a novel and rare presentation of invasive pulmonary fusariosis with superimposed histoplasmosis in an immunocompetent host. Our patient had environmental exposure for years with subsequent chronic and progressive respiratory symptoms, however, with no evidence of immunosuppression. Imaging findings were non-specific which difficulted the diagnosis. Nonetheless, the patient was given directed antifungal therapy as a result of the BAL's histopathologic findings with improvement of symptoms. CONCLUSIONS: Regardless of the immunologic status, invasive fungal pneumonia should be considered in patients with prolonged environmental exposure and non-specific chest imaging abnormalities. Reference #1: Chae, S. Y., Park, H. M., Oh, T. H., Lee, J. E., Lee, H., Jeong, W. G., & Kim, Y.-H. (2020). Fusarium species causing invasive fungal pneumonia in an immunocompetent patient: a case report. Journal of International Medical Research. https://doi.org/10.1177/0300060520976475. Retrieved March 18, 2022. Reference #2: Kauffman, C. A. (2022). Diagnosis and treatment of pulmonary histoplasmosis. In Bogorodskaya, M. (Ed.), UpToDate. Retrieved March 18, 2022, from https://www.uptodate.com/contents/diagnosis-and-treatment-of-pulmonary-histoplasmosis. Reference #3: Poignon, C., Blaize, M., Vezinet, C., Lampros, A., Monsel, A., & Fekkar, A. (2020). Invasive pulmonary fusariosis in an immunocompetent critically ill patient with severe COVID-19. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 26(11), 1582–1584. https://doi.org/10.1016/j.cmi.2020.06.026. Retrieved March 18, 2022. DISCLOSURES: No relevant relationships by Juan Adams-Chahin No relevant relationships by Jorge Barletta Farias No relevant relationships by Gabriel Galindez De Jesus No relevant relationships by Camille Gonzalez Morales No relevant relationships by manuel hernandez No rele ant relationships by Enrique Leal No relevant relationships by Arelis Morales Malavé No relevant relationships by Ruth Santos Rodriguez

Absence of visitors during lockdown reveals natural variation in carbon dioxide level in the Glowworm Cave, Waitomo, New Zealand

Waitomo Glowworm Cave is a highly visited cave where the highlight is viewing the bioluminescence display of a large colony of glowworms. Anthropogenic carbon dioxide build-up in the cave is prevented by management of chimney-effect ventilation aided by a network of microclimate sensors. A cave door prevents ventilation under drying conditions and promotes it when necessary to clear CO2 and when inflowing air has high relative humidity. A COVID-19-related nationwide “lockdown” in New Zealand from March 2020 resulted in neither staff nor visitors being present in the cave for 60 days, and provided an opportunity to assess the natural microclimate of the cave, especially the natural variation in partial pressure of carbon dioxide (pCO2). In addition, comparison to the previous year showed that the presence of people in the cave increased the cave temperatures but the effect was short-lived due to cave ventilation. During the period of lockdown, the daily increase of carbon dioxide partial pressure (pCO2) due to visitors was absent. When the cave door remained sealed, pCO2 varied and tended to lie at levels above that of the external atmosphere (410 ppm). Notably, rain events raised pCO2 by up to 200 ppm (v/v), which appeared to be sourced from both stream water and drip water. These natural CO2 sources rarely reached the levels associated with cave visitation. The results support current management practices that use door control to enhance cave ventilation when people are in the cave or when natural conditions (high stream levels and high drip-water levels) promote CO2 outgassing into the cave. Suppressing ventilation outside of those times reduces the risk of introducing dry air that could desiccate the glowworms. © 2022, Societa Speleologica Italiana. All rights reserved.

A Case Study for the Design and Implementation of Immersive Experiences in Support of Sicilian Cultural Heritage

Virtual Reality (VR) is a robust tool for sponsoring Cultural Heritage sites. It enables immersive experiences in which the user can enjoy the cultural assets virtually, behaving as he/she would do in the real world. The covid-19 pandemic has shed light on the importance of using VR in cultural heritage, showing advantages for the users that can visit the site safely through specific devices. In this work, we present the processes that lead to the creation of an immersive app that makes explorable a famous cultural asset in Sicily, the church of SS. Crocifisso al Calvario. The application creation process will be described in each of its parts, beginning from the digital acquisition of the cultural asset to the development of the user interface. The application is provided for three different VR devices: smartphones equipped with cardboards, headsets, and CAVE. The paper is supported by the 3DLab-Sicilia project, whose main objective is to sponsor the creation, development, and validation of a sustainable infrastructure that interconnects three main Sicilian centres specialized in augmented and virtual reality. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Central Nervous System Tuberculosis with SARS-CoV-2 Infection: A Short Case-series from Sri Lanka

Objective: To report a series of patients with clinical and imaging findings suggestive of central nervous system (CNS) Tuberculosis (TB) and active or recent SARS-CoV-2 infection presenting to a single tertiary care center within a two-month period. Background: A presumptive diagnosis of CNS TB is made in the setting of relevant clinical and epidemiologic factors together with typical radiographic findings. Immunosuppression is clearly associated with reactivation or re-infection of TB, although triggers leading to a reactivation are unclear. It is postulated that the SARS-CoV-2 infection suppresses the host innate and adaptive immunity. Design/Methods: NA Results: Three patients with suspected and one with confirmed CNS TB were identified. Patient one presented with a history of fever and altered sensorium for one-week. Concurrent SARS-CoV-2 infection was confirmed. CT-brain showed an obstructive hydrocephalus and an External Ventricular Drain was placed. Cerebrospinal fluid (CSF) nucleic acid amplification test (NAAT) for TB was positive. Patients 2-4 were diabetic and had SARS-CoV-2 infection identified concurrently or in the preceding two weeks. They presented with a history of headache & diplopia of two weeks duration. Examination revealed multiple cranial nerve palsies. The common MRI features were contrast enhancement & soft tissue thickening in the cavernous sinus wall. Patient two had multiple tuberculomas, patient three had orbital apex involvement and patient four had Meckel's cave thickening. CSF analysis revealed elevated proteins without cells and NAAT for TB was negative. All patients were started on anti-TB chemoprophylaxis with corticosteroids. Conclusions: Given the potential immunomodulatory role of SARS-CoV-2, we hypothesize that the viral infection acted as a trigger for the reactivation of TB in the CNS. In addition, three out of four of our patients had cavernous sinus wall involvement which is an unusual finding in CNS TB.

Coronavirus and Paramyxovirus Shedding by Bats in a Cave and Buildings in Ethiopia.

Bats are important hosts of zoonotic viruses with pandemic potential, including filoviruses, MERS-Coronavirus (CoV), SARS-CoV -1, and likely SARS-CoV-2. Viral infection and transmission among wildlife are dependent on a combination of factors that include host ecology and immunology, life history traits, roosting habitats, biogeography, and external stressors. Between 2016 and 2018, four species of insectivorous bats from a readily accessed roadside cave and buildings in Ethiopia were sampled and tested for viruses using consensus PCR assays for five viral families/genera. Previously identified and novel coronaviruses and paramyxoviruses were identified in 99 of the 589 sampled bats. Bats sampled from the cave site were more likely to test positive for a CoV than bats sampled from buildings; viral shedding was more common in the wet season; and rectal swabs were the most common sample type to test positive. A previously undescribed alphacoronavirus was detected in two bat species from different taxonomic families, sampling interfaces, geographic locations, and years. These findings expand knowledge of the range and diversity of coronaviruses and paramyxoviruses in insectivorous bats in Ethiopia and reinforce that an improved understanding of viral diversity and species-specific shedding dynamics is important for designing informed zoonotic disease surveillance and spillover risk reduction efforts.

The world's future: A question of art and health

Art has shown its resilient nature throughout prehistoric and modern human history, from extreme climate challenges to worsening microbial threats against species' health. From the cave paintings scattered across three continents, Europe, Latin America and Asia, to the digitization of culture that characterizes the modern creative industry, art has continued to remind us that existential risks are better addressed through co-habitational thinking/caring. This short essay makes a case for art resilience amid the pandemic that has shown no sign of surrendering to human intervention as planetary multispecies life braces for a more precarious climate emergency in years to come.

Ecological surveillance of bat coronaviruses in Sarawak, Malaysian Borneo.

OBJECTIVE: Coronaviruses (CoVs) are natural commensals of bats. Two subgenera, namely Sarbecoviruses and Merbecoviruses have a high zoonotic potential and have been associated with three separate spillover events in the past 2 decades, making surveillance of bat-CoVs crucial for the prevention of the next epidemic. The study was aimed to elucidate the presence of coronavirus in fresh bat guano sampled from Wind Cave Nature Reserve (WCNR) in Sarawak, Malaysian Borneo. Samples collected were placed into viral transport medium, transported on ice within the collection day, and preserved at - 80 °C. Nucleic acid was extracted using the column method and screened using consensus PCR primers targeting the RNA-dependent RNA polymerase (RdRp) gene. Amplicons were sequenced bidirectionally using the Sanger method. Phylogenetic tree with maximum-likelihood bootstrap and Bayesian posterior probability were constructed. RESULTS: CoV-RNA was detected in ten specimens (47.6%, n = 21). Six alphacoronavirus and four betacoronaviruses were identified. The bat-CoVs can be phylogenetically grouped into four novel clades which are closely related to Decacovirus-1 and Decacovirus-2, Sarbecovirus, and an unclassified CoV. CoVs lineages unique to the Island of Borneo were discovered in Sarawak, Malaysia, with one of them closely related to Sarbecovirus. All of them are distant from currently known human coronaviruses.

Full Genome of batCoV/MinFul/2018/SriLanka, a Novel Alpha-Coronavirus Detected in Miniopterus fuliginosus, Sri Lanka.

Coronaviruses (CoV) are divided into the genera α-CoVs, ß-CoVs, γ-CoVs and δ-CoVs. Of these, α-CoVs and ß-CoVs are solely capable of causing infections in humans, resulting in mild to severe respiratory symptoms. Bats have been identified as natural reservoir hosts for CoVs belonging to these two genera. Consequently, research on bat populations, CoV prevalence in bats and genetic characterization of bat CoVs is of special interest to investigate the potential transmission risks. We present the genome sequence of a novel α-CoV strain detected in rectal swab samples of Miniopterus fuliginosus bats from a colony in the Wavul Galge cave (Koslanda, Sri Lanka). The novel strain is highly similar to Miniopterus bat coronavirus 1, an α-CoV located in the subgenus of Minunacoviruses. Phylogenetic reconstruction revealed a high identity of the novel strain to other α-CoVs derived from Miniopterus bats, while human-pathogenic α-CoV strains like HCoV-229E and HCoV-NL63 were more distantly related. Comparison with selected bat-related and human-pathogenic strains of the ß-CoV genus showed low identities of ~40%. Analyses of the different genes on nucleotide and amino acid level revealed that the non-structural ORF1a/1b are more conserved among α-CoVs and ß-CoVs, while there are higher variations in the structural proteins known to be important for host specificity. The novel strain was named batCoV/MinFul/2018/SriLanka and had a prevalence of 50% (66/130) in rectal swab samples and 58% (61/104) in feces samples that were collected from Miniopterus bats in Wavul Galge cave. Based on the differences between strain batCoV/MinFul/2018/SriLanka and human-pathogenic α-CoVs and ß-CoVs, we conclude that there is a rather low transmission risk to humans. Further studies in the Wavul Galge cave and at other locations in Sri Lanka will give more detailed information about the prevalence of this virus.

Pentahelix management model for the development of cave geo-ecotourism in Ngestirejo, Tanjungsari district, Gunungkidul Regency, DIY, Indonesia

Tritis cave ngestirejo, tanjungsari located in the area of Inclusive international geopark gunungsewu. There are thousands of cave which is located in the landscape of natural karst gunungsewu. Historically, the caves were used as ancient human Habitation, hiding place, and as a place of meditation. Due to the recent development of tourism, the cave has become an exclusive tourism potential. Tritis ngestirejo cave has its own uniqueness and attraction from morphology, biodiversity, and legends that make it one of the tourists destination that applies ecotourism principles. Ecotourism is one of the development of sustainable tourism that emphasizes aspects of nature conservation and community welfare. This research aims to develop touristict object in tune with the local wisdom. This qualitative research using pentahelix management models. Primary data collection through observation, focus group discussion, interviews and in-depth interviews. Secondary data were obtained from various sources (documents, articles, journals). Results of this research shows that the village ngestirejo has a completed potential source to become attractive cave geo-ecotourism. Pentahelix synergy that is the community, government, stakeholders are built. However, there are obstacles, especially those related to climate factors and global conditions (pandemic covid-19). © 2021 American Institute of Physics Inc.. All rights reserved.

Retrosigmoid Craniectomy and Suprameatal Drilling-3-Dimensionally Printed Microneurosurgical Simulation: 2-Dimensional Operative Video.

Neurosurgical training is being challenged by rigorous work-hour restrictions and the COVID-19 pandemic.1 Now, more than ever, surgical simulation plays a pivotal role in resident education and psychomotor skill development. Three-dimensional (3D) printing technologies enable the construction of inexpensive, patient-specific, anatomically accurate physical models for a more convenient and realistic simulation of complex skull base approaches in a safe environment.2 All stages of the surgical procedure can be simulated, from positioning and exposure to deep microdissection, which has an unparalleled educational value. The complex approach-specific anatomy, narrow working angles, and pathoanatomic relationships can be readily explored from the surgeon's perspective or point of view.2,3 Furthermore, different thermoplastic polymers can be utilized to replicate the visual and tactile feedback of bone (cortical/cancellous), neurological, and vascular tissues.4 Retrosigmoid craniectomies are widely used in neurosurgery with various applications, including microvascular decompressions in patients with trigeminal neuralgia.5-7 Removal of the suprameatal tubercle (SMT) extends the retrosigmoid approach superiorly to the middle fossa and Meckel's cave, and anteriorly to the clivus.8,9 This maneuver may be necessary in patients with prominent SMTs obstructing the view of the trigeminal nerve and in patients with a more anterosuperior neurovascular conflict. This video illustrates a microsurgical training tool for learning and honing the technique of retrosigmoid craniectomy and suprameatal drilling using an affordable (29.00 USD) biomimetic 3D-printed simulator that closely recapitulates not only the anatomy but also the tactile feedback of drilling and manipulating neurological tissues (see Table and Graph 1; minute 07:11) as it happens at the time of surgery.

Detection of Alpha- and Betacoronaviruses in Miniopterus fuliginosus and Rousettus leschenaultii, two species of Sri Lankan Bats.

Bats are known to be potential reservoirs of numerous human-pathogenic viruses. They have been identified as natural hosts for coronaviruses, causing Severe Acute Respiratory Syndrome (SARS) in humans. Since the emergence of SARS-CoV-2 in 2019 interest in the prevalence of coronaviruses in bats was newly raised. In this study we investigated different bat species living in a sympatric colony in the Wavul Galge cave (Koslanda, Sri Lanka). In three field sessions (in 2018 and 2019), 395 bats were captured (Miniopterus, Rousettus, Hipposideros and Rhinolophus spp.) and either rectal swabs or fecal samples were collected. From these overall 396 rectal swab and fecal samples, the screening for coronaviruses with nested PCR resulted in 33 positive samples, 31 of which originated from Miniopterus fuliginosus and two from Rousettus leschenaultii. Sanger sequencing and phylogenetic analysis of the obtained 384-nt fragment of the RNA-dependent RNA polymerase revealed that the examined M. fuliginosus bats excrete alphacoronaviruses and the examined R. leschenaultii bats excrete betacoronaviruses. Despite the sympatric roosting habitat, the coronaviruses showed host specificity and seemed to be limited to one species. Our results represent an important basis to better understand the prevalence of coronaviruses in Sri Lankan bats and may provide a basis for pursuing studies on particular bat species of interest.

Risks posed by SARS-CoV-2 to North American bats during winter fieldwork.

The virus that causes COVID-19 likely evolved in a mammalian host, possibly Old-World bats, before adapting to humans, raising the question of whether reverse zoonotic transmission to bats is possible. Wildlife management agencies in North America are concerned that the activities they authorize could lead to transmission of SARS-CoV-2 to bats from humans. A rapid risk assessment conducted in April 2020 suggested that there was a small but significant possibility that SARS-CoV-2 could be transmitted from humans to bats during summer fieldwork, absent precautions. Subsequent challenge studies in a laboratory setting have shed new information on these risks, as has more detailed information on human epidemiology and transmission. This inquiry focuses on the risk to bats from winter fieldwork, specifically surveys of winter roosts and handling of bats to test for white-nose syndrome or other research needs. We use an aerosol transmission model, with parameter estimates both from the literature and from formal expert judgment, to estimate the risk to three species of North American bats, as a function of several factors. We find that risks of transmission are lower than in the previous assessment and are notably affected by chamber volume and local prevalence of COVID-19. Use of facemasks with high filtration efficiency or a negative COVID-19 test before field surveys can reduce zoonotic risk by 65 to 88%.

Characterization of the bioaerosol in a natural thermal cave and assessment of the risk of transmission of SARS-CoV-2 virus.

Thermal caves represent an environment characterized by unique chemical/physical properties, often used for treatment and care of musculoskeletal, respiratory, and skin diseases.However, these environments are poorly characterized for their physical and microbiological characteristics; furthermore, the recent pandemic caused by COVID-19 has highlighted the need to investigate the potential transmission scenario of SARS-CoV-2 virus in indoor environments where an in-depth analysis of the aerosol concentrations and dimensional distributions are essential to monitor the spread of the virus.This research work was carried out inside a natural cave located in Viterbo (Terme dei Papi, Italy) where a waterfall of sulfur-sulfate-bicarbonate-alkaline earth mineral thermal water creates a warm-humid environment with 100% humidity and 48 °C temperature. Characterization of the aerosol and bioaerosol was carried out to estimate the personal exposure to aerosol concentrations, as well as particle size distributions, and to give an indication of the native microbial load.The data obtained showed a predominance of particles with a diameter greater than 8 µm, associated with low ability of penetration in the human respiratory system. A low microbial load was also observed, with a prevalence of noncultivable strains generated by the aerosolization of the thermal waters.Finally, the estimation of SARS-CoV-2 infection risk by means of mathematical modeling revealed a low risk of transmission, with a decisive effect given by the mechanical ventilation system, which together with the adoption of social distancing measures makes the risk of infection extremely low.