Evolucion De La Epidemiologia De La Enfermedad Celiaca E Impacto De La Covid19. Resultados Preliminares Del Plan Nacional De Enfermedad Celiaca-Ciberehd

Introduccion: Se ha reportado que tanto la prevalencia como la incidencia de la enfermedad celiaca (EC) estan aumentando a nivel mundial. Este aumento podria ser atribuido a infecciones viricas como desencadenante de la EC, entre otros factores. La COVID-19 ha impactado de lleno en la realizacion del estudio de prevalencia del Plan Nacional de EC promovido por el CIBERHED. Se ha sugerido que SARS-CoV-2, que penetra por via digestiva, podria desencadenar brotes de EC. Objetivos: 1) Evaluar la prevalencia actual de EC en comparacion con la de la cohorte 2004-2009. 2) Evaluar el impacto de la COVID-19 en la prevalencia actual de EC. Metodos: Desde enero 2021 hasta la actualidad se han incluido 1886 individuos de entre 1 y 90 anos atendidos por cirugia menor en los 6 hospitales participantes (Hospitales Universitarios (HU) Mutua Terrassa- Sant Joan de Deu, HU Virgen del Rocio, HU Central de Asturias, HU Galdakao-Cruces y HU Fundacion Jimenez Diaz) (calculo muestral: 5.300). La inclusion se realiza ajustada por edad y sexo a la piramide poblacional. Se determinan Ac. antitransglutaminasa (tTGA) y en los casos positivos se confirma el diagnostico segun guias de consenso. Se reporta la prevalencia serologica (tTGA > 7 U/ml) mas los casos prevalentes previamente diagnosticados. La relacion entre COVID19, registrada mediante cuestionario, y los casos positivos (tTGA > 7 U/mL y tTGA zona gris 2-7 U/mL) se ha evaluado mediante prueba exacta de Fisher. Resultados: Se han detectado 11 sujetos con serologia positiva y 2 pacientes con diagnostico previo de EC;prevalencia 6,89 x 1.000, IC95% 3,68-11,76. En comparacion con la prevalencia de la cohorte (2004-2007), 5,67 x 1.000, no existen diferencias significativas. Se han detectado 3 casos con serologia tTGA positiva y COVID-19 sobre un total de 335 pacientes infectados y 8 casos con serologia tTGA positiva sin COVID-19 sobre un total de 1.547 individuos no infectados (p = 0,4247). Tampoco se ha encontrado relacion entre COVID-19 y valores de serologia en la zona gris. Conclusiones: No se detecta un incremento de la prevalencia de EC en las ultimas dos decadas en nuestro medio. La infeccion por COVID19 no ha tenido impacto en la aparicion de nuevos casos de la enfermedad.Copyright © 2023 Elsevier Espana, S.L.U. Todos los derechos reservados.

Analysis of COVID-19 clusters involving vertical transmission in residential buildings in Hong Kong.

Multiple clusters of coronavirus disease 2019 (COVID-19) in Hong Kong have involved vertical transmissions in residential buildings, wherein the flats of confirmed cases were often vertically aligned. Data on the buildings and cases associated with 19 such clusters were retrieved and compared with the corresponding data on the entirety of Hong Kong. Vertical transmissions usually occurred in old high-rise buildings with small flat areas and low estate prices during winter. In addition, infection occurred frequently among the elderly and among upstairs neighbours of index cases. Virus-laden aerosols may have been transmitted between flats mostly via shared drainpipes, and the vertical distribution of the confirmed cases in a building varied by its drainage system design. For buildings with their entire drainpipes installed indoors, both the upstairs and downstairs neighbours of the index case flats could be infected. By comparison, buildings with their drainage stacks installed outdoors had lower infection risks and demonstrated a clearer pattern of vertical transmission: most infected cases resided upstairs from the index case flats, indicating that the virus spread could be dominated by the stack effect. This study provides valuable data and analysis for developing epidemic control strategies for residential buildings. Electronic Supplementary Material ESM: The Appendix is available in the online version of this article at 10.1007/s12273-022-0929-5.

Massive empyema due to Lactococcus garvieae

Introduction Lactococcus garvieae, a zoonotic pathogen, may rarely infect humans through the consumption of fish. Documented manifestations of L. garvieae infection in humans include infective endocarditis, prosthetic joint infections, liver abscesses, peritoneal dialysis-associated peritonitis, osteomyelitis, meningitis, infective spondylodiscitis, acalculous cholecystitis, and urinary tract infection. Case report An 87-year-old female was hospitalized for coffee-ground emesis secondary to acute gastritis after eating cooked fish. One week after her discharge, she developed new-onset confusion and was returned to the hospital. Chest computed tomography revealed total consolidation of the left lung and a multiloculated left pleural effusion. The patient required intubation and direct admission to the intensive care unit. Pleural fluid and blood cultures grew L. garvieae, which was susceptible to ceftriaxone, penicillin, and vancomycin. Despite intensive antibiotic therapy and supportive care for thirteen days, the patient remained in irreversibl e shock, and the family opted for comfort care. Conclusions Heretofore unreported, this case demonstrates that L. garvieae can cause bronchopneumonia and empyema. Copyright © GERMS 2022.

CFD Numerical Simulation in Building Drainage Stacks as an Infection Pathway of COVID-19.

Being aware of global pandemics, this research focused on the potential infection routes in building drainage systems. Case studies have found that dysfunctional building drainage systems not only failed to block contaminants but also potentially became a route for the spreading of viruses. Several fluid simulations in pipelines were conducted in this research using COMSOL Multiphysics. In particular, virus transmission from one patient's room to other uninfected residential units through pipelines was visualized. A 12-story building, which is commonly seen in the local area, was designed as a simulation model to visualize the transmission and analyze its hazards. Furthermore, five environmental factors were filtered out for discussion: distance, time span, pressure, initial concentration, and environment temperature. By manipulating these factors, the relationship between the factors and the behavior of the contaminant could be explored. In addition, a simulation with a different pipeline arrangement was included to observe the virus diffusion behavior under different scenarios. The visualized simulation concluded that the contaminant would spread through the drainage system and arrive at the neighboring four floors within an hour under the circumstances of a 12-story building with broken seals and constant pressure and contaminant supply on the seventh floor. Meanwhile, the whole building would be exposed to infection risks by the continuous virus spreading through a drainage system. Distance, time span, and pressure were considered critical factors that affected indoor contamination in the system. On the other hand, initial concentration and environmental temperature did not have significant roles. Visualizing the behavior of viruses provides a glimpse of what happens behind walls, paving the way for recognizing the importance of maintaining functional drainage systems for individuals' health.

Dasatinib Related Pleural Effusions: Real-World Experience in a District General Hospital

Dasatinib, a second-generation BCRABL1 tyrosine kinase inhibitor (TKI), is an approved treatment for chronic myeloid leukaemia, both as first-line therapy and following imatinib intolerance or resistance. It is generally well tolerated, however, dasatinib has been associated with a higher risk for pleural effusions. Frequency, risk factors and outcomes of this significant side effect were analysed in the phase 3 DASISION and 034/Dose-optimization trials. Annual risk of 5%-15% was reported. Drug-related pleural effusion occurred in 28%-33% of patients in a minimum of 5-year follow-up period. One major risk factor was advanced age. We therefore reviewed a cohort of 34 patients treated with dasatinib between 2016 and 2021, to determine 'real-world' data of this toxicity. Case notes, pathology results and radiological reports were analysed. We identified 12 (35%) cases of pleural effusions. Eight (66%) cases were male. The median average age of patients with and without drug-related pleural effusion were 59.5 years (range: 31-91 years) and 54.5 years (range: 20-88 years) respectively. Cardiovascular and respiratory comorbidities were noted in eight patients (66.6%) with pleural effusion (ischaemic heart disease, hypertension, lung cancer, COVID, peripheral vascular disease and hyperlipidaemia) and nine patients (41%) without pleural effusion (prior non-TKI pleural effusion, hypertension, asthma, congenital heart defect, COPD and atrial fibrillation). Nine cases (75%) of those with pleural effusion were non-smokers. Lymphocytosis was not noted in any of those 12 cases of drug-related pleural effusion. Ten cases (83%) were on dasatinib 100 mg daily when pleural effusion was diagnosed, one was on 50 mg daily and the other was on 20 mg daily. Pleural effusion occurred after a median of 36 months (range: 6-108 months). Nine cases (75%) were mild to moderate in severity-Common Terminology Criteria for Adverse Events (CTCAE ) grade 1-2, two were grade 3 and one was grade 4. Two required no intervention, three required only medical intervention (steroid+/-antibiotics), three required pleural tap and three required pleural drain. One required VATS procedure with talc pleurodesis. The patient with grade 1 pleural effusion required no treatment change. One required dose reduction of dasatinib without interruption. One required temporary interruption but restarted on the same dose. Six required temporary interruption of dasatinib followed by dose reduction to 50 mg daily. Two of these subsequently recurred on lower dose dasatinib and were then switched to an alternative TKI (bosutinib and imatinib). Two required temporary TKI interruption and were restarted on a different TKI (nilotinib). One case of pleural effusion persisted and the patient was kept off TKI treatment. Although the numbers are too small for statistically robust analysis, we have observed several trends which may help to guide patient counselling and selection. Pleural effusion has an incidence of 35% in our local population. Risk factors were cardiovascular and respiratory comorbidities, advanced age and male sex. Smoking status and lymphocytosis did not appear to be risk factors in our cohort, where they have been in other reports. Most effusions were mild to moderate in severity and could usually be managed by steroid+/-pleural tap+/-drain. Most patients required temporary interruption of their dasatinib but were successfully able to restart at a lower dose without recurrence..

Occurrence and decay of SARS-CoV-2 in community sewage drainage systems.

The rapid spread of the coronavirus disease (COVID-19) pandemic in over 200 countries poses a substantial threat to human health. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, can be discharged with feces into the drainage system. However, a comprehensive understanding of the occurrence, presence, and potential transmission of SARS-CoV-2 in sewers, especially in community sewers, is still lacking. This study investigated the virus occurrence by viral nucleic acid testing in vent stacks, septic tanks, and the main sewer outlets of community where confirmed patients had lived during the outbreak of the epidemic in Wuhan, China. The results indicated that the risk of long-term emission of SARS-CoV-2 to the environment via vent stacks of buildings was low after confirmed patients were hospitalized. SARS-CoV-2 were mainly detected in the liquid phase, as opposed to being detected in aerosols, and its RNA in the sewage of septic tanks could be detected for only four days after confirmed patients were hospitalized. The surveillance of SARS-CoV-2 in sewage could be a sensitive indicator for the possible presence of asymptomatic patients in the community, though the viral concentration could be diluted more than 10 times, depending on the sampling site, as indicated by the Escherichia coli (E. coli) test. The comprehensive investigation of the community sewage drainage system is helpful to understand the occurrence characteristics of SARS-CoV-2 in sewage after excretion with feces and the feasibility of sewage surveillance for COVID-19 pandemic monitoring.

Pneumomediastinum in the COVID-19 era: to drain or not to drain

Introduction: Although quite uncommon in the pre-COVID-19 era, pneumomediastinum has been increasingly reported in COVID-19 cases complicating the management and prognosis of these patients. The aim of this study is to present the current experience on COVID-19 associated pneumomediastinum and to propose a management algorithm based on the existing literature. Method: A search strategy focused on electronic databases (Medline, Embase, Google Scholar) was performed. Main search keywords were pneumomediastinum and COVID-19-related keywords. Eligible studies were included without strict limitations on type of study, type of publication, language, or date. Results: Several reports of pneumomediastinum management in the context of COVID-19 infection have been reported. An initial diagnostic approach with computed tomography scan is recommended for all patients with increased oxygen requirements and suspicious chest X ray. In stable, non-intubated patients, pneumomediastinum can be initially monitored, whereas in the event of progressing air accumulation and cardiorespiratory compromise, a subxiphoid drain alone may preserve the cardiopulmonary reserve. In cases with coexisting pneumothorax and pneumomediastinum, a pleural drain should be prioritised and a subxiphoid drain should be reserved for cases not responding to initial treatment. In surgical emphysema cases, conservative management, especially in non-intubated patients, is suggested, while coexisting pneumothorax as described above. For refractory surgical emphysema cases, subcutaneous drain or subxiphoid drain- in presence of pneumomediastinum- might be required. Conclusions: In air space complications such as pneumomediastinum, surgical emphysema and pneumothorax, a proposed treatment algorithm can be applied aiming to improve the outcomes of these complicated COVID-19 patients.

High attack rate in a Tong Lau house outbreak of COVID-19 with subdivided units in Hong Kong.

Poor housing conditions are known to be associated with infectious diseases such as high Coronavirus disease 2019 (COVID-19) incidences. Transmission causes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in poor housing conditions can be complex. An understanding of the exact mechanism of transmission can help to pinpoint contributing environmental issues. Here, we investigated a Hong Kong COVID-19 outbreak in early 2021 in four traditional Tong Lau houses with subdivided units. There are more than 80 subdivided units of less than 20 m2 floor area each on average. With a total of 34 confirmed COVID-19 cases, the outbreak had an attack rate of 25.4%, being one of the highest attack rates observed in Hong Kong, and ranked among the highest attack rates in reported outbreaks internationally. Tracer gas leakage and decay measurements were performed in the drainage system and in the subdivided units to determine the transport of infectious aerosols by the owner-modified sophisticated wastewater drainage pipe networks and the poor ventilation conditions in some subdivided units. The results show that the outbreak was probably due to multiple transmission routes, i.e. by the drainage pipe spread of stack aerosols, which is enhanced by poor ventilation in the subdivided units.

Spread of SARS-CoV-2 aerosols via two connected drainage stacks in a high-rise housing outbreak of COVID-19.

Vertical transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) along a vertical column of flats has been documented in several outbreaks of coronavirus disease 2019 (COVID-19) in Guangdong and Hong Kong. We describe an outbreak in Luk Chuen House, involving two vertical columns of flats associated with an unusually connected two-stack drainage system, in which nine individuals from seven households were infected. The index case resided in Flat 812 (8th floor, Unit 12), two flats (813, 817) on its opposite side reported one case each (i.e., a horizontal sub-cluster). All other flats with infected residents were vertically associated, forming a vertical sub-cluster. We injected tracer gas (SF6) into drainage stacks via toilet or balcony of Flat 812, monitored gas concentrations in roof vent, toilet, façade, and living room in four of the seven flats with infected residents and four flats with no infected residents. The measured gas concentration distributions agreed with the observed distribution of affected flats. Aerosols leaking into drainage stacks may generate the vertical sub-cluster, whereas airflow across the corridor probably caused the horizontal sub-cluster. Sequencing and phylogenetic analyses also revealed a common point-source. The findings provided additional evidence of probable roles of drainage systems in SARS-CoV-2 transmission.

Aerosol transmission of SARS-CoV-2 due to the chimney effect in two high-rise housing drainage stacks.

Stack aerosols are generated within vertical building drainage stacks during the discharge of wastewater containing feces and exhaled mucus from toilets and washbasins. Fifteen stack aerosol-related outbreaks of coronavirus disease 2019 (COVID-19) in high-rise buildings have been observed in Hong Kong and Guangzhou. Currently, we investigated two such outbreaks of COVID-19 in Hong Kong, identified the probable role of chimney effect-induced airflow in a building drainage system in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We injected tracer gas (SF6) into the drainage stacks via the water closet of the index case and monitored tracer gas concentrations in the bathrooms and along the facades of infected and non-infected flats and in roof vents. The air temperature, humidity, and pressure in vertical stacks were also monitored. The measured tracer gas distribution agreed with the observed distribution of the infected cases. Phylogenetic analysis of the SARS-CoV-2 genome sequences demonstrated clonal spread from a point source in cases along the same vertical column. The stack air pressure and temperature distributions suggested that stack aerosols can spread to indoors through pipe leaks which provide direct evidence for the long-range aerosol transmission of SARS-CoV-2 through drainage pipes via the chimney effect.

Numerical investigation on the transmission and dispersion of aerosols in a 7-stories building drainage system.

In previous reports, the positive SARS-CoV-2 nucleic acid was detected in the fecal samples from confirmed pneumonia patients, suggesting a high probability of the fecal-oral transmission. To date, however, the role played by the drainage system of a high-rise building in the virus transmission is not clear and especially studies on the dynamics mechanism behind is scarce. From this point of view, the present work carries out a computational fluid dynamics (CFD) modeling to investigate the effects of the water seal effectiveness of the floor drain, the negative/positive pressures (P 1 , P 2 ) in the bathroom, temperature differential (ΔT), outside wind velocity (v), the piping fittings and the negative pressure at the cowl (P 3 ) on the transmission of the virus-laden aerosol particles in a drainage system of a typical 7-storeys residential building. The CFD models are first validated by the previous experiments in literature. Numerical results imply that the drainage system might play an essential role to the virus transmission. Then, results indicate that, the leakage risk of the aerosol particles via the floor drain with inefficient water-seal (UFD) mainly exists at the upper floors above the neutral pressure level (NPL). Besides, the negative and positive pressures at the bathroom can enhance and reduce the exposure risk of aerosol particles from the corresponding UFD, respectively. The ΔT increasing does not modify the location of the NPL. Moreover, the exposure risk of aerosol particles can be effectively avoided by the well water-sealed floor drains and/or the presence of a proper negative pressure at the cowl on the top floor. Finally, based on the CFD results, several protection suggestions on the drainage system and human activities are provided.

Modified Closed Chest Drainage System for Safe Anaesthesia in Patients with COVID-19 Suspicion.

An emergency operation was planned for a patient who developed pneumothorax, subcutaneous emphysema and pneumomediastinum, which was thought to develop secondary to acute diverticulitis. Polymerase chain reaction (PCR) test for coronavirus disease 2019 (COVID-19) diagnosis could not be performed before the operation. In COVID-19 infection, it has been reported that pneumonia, pneumomediastinum and subcutaneous emphysema could be seen in thoracic computed tomography (CT) scan in addition to classic ground-glass opacities. In this study, a modified closed chest drainage system (CCDS) is presented to prevent COVID-19 aerosolisation in a patient undergoing intraoperative tube thoracostomy.

Quantifying the risk of indoor drainage system in multi-unit apartment building as a transmission route of SARS-CoV-2.

The COVID-19 pandemic has had a profound impact on human society. The isolation of SARS-CoV-2 from patients' feces on human cell line raised concerns of possible transmission through human feces including exposure to aerosols generated by toilet flushing and through the indoor drainage system. Currently, routes of transmission, other than the close contact droplet transmission, are still not well understood. A quantitative microbial risk assessment was conducted to estimate the health risks associated with two aerosol exposure scenarios: 1) toilet flushing, and 2) faulty connection of a floor drain with the building's main sewer pipe. SARS-CoV-2 data were collected from the emerging literature. The infectivity of the virus in feces was estimated based on a range of assumption between viral genome equivalence and infectious unit. The human exposure dose was calculated using Monte Carlo simulation of viral concentrations in aerosols under each scenario and human breathing rates. The probability of COVID-19 illness was generated using the dose-response model for SARS-CoV-1, a close relative of SARS-CoV-2, that was responsible for the SARS outbreak in 2003. The results indicate the median risks of developing COVID-19 for a single day exposure is 1.11 × 10-10 and 3.52 × 10-11 for toilet flushing and faulty drain scenario, respectively. The worst case scenario predicted the high end of COVID-19 risk for the toilet flushing scenario was 5.78 × 10-4 (at 95th percentile). The infectious viral loads in human feces are the most sensitive input parameter and contribute significantly to model uncertainty.