Silent superbug killers in a river near you how factory farms contaminate public water courses on three continents

Water downstream from factory farms harbours an invisible threat to people's health which could eclipse the COVID-19 crisis. The threat? Antibiotic Resistance Genes (ARGs) which are driving antimicrobial resistance the world's superbug crisis - projected to kill up to 10 million people annually by 2050. This publication reports the presence of ARGs in animal waste discharged from industrial farms into public waterways or onto soil (or crops) in four countries. Gauge community impact and sentiment regarding the issue was also highlighted. The water and sediment from public water courses connected to effluent discharges from 6-10 pig farms were tested in each of four countries (Canada, Spain, Thailand and the USA).

Probing environmental and tectonic changes underneath Mexico City with the urban seismic field

The sediments underneath Mexico City have unique mechanical properties that give rise to strong site effects. We investigated temporal changes in the seismic velocity at strong-motion and broadband seismic stations throughout Mexico City, including sites with different geologic characteristics ranging from city center locations situated on lacustrine clay to hillside locations on volcanic bedrock. We used autocorrelations of urban seismic noise, enhanced by waveform clustering, to extract subtle seismic velocity changes by coda wave interferometry. We observed and modeled seasonal, co- and post-seismic changes, as well as a long-term linear trend in seismic velocity. Seasonal variations can be explained by self-consistent models of thermoelastic and poroelastic changes in the subsurface shear wave velocity. Overall, sites on lacustrine clay-rich sediments appear to be more sensitive to seasonal surface temperature changes, whereas sites on alluvial and volcaniclastic sediments and on bedrock are sensitive to precipitation. The 2017 Mw 7.1 Puebla and 2020 Mw 7.4 Oaxaca earthquakes both caused a clear drop in seismic velocity, followed by a time-logarithmic recovery that may still be ongoing for the 2017 event at several sites or that may remain incomplete. The slope of the linear trend in seismic velocity is correlated with the downward vertical displacement of the ground measured by interferometric synthetic aperture radar, suggesting a causative relationship and supporting earlier studies on changes in the resonance frequency of sites in the Mexico City basin due to groundwater extraction. Our findings show how sensitively shallow seismic velocity and, in consequence, site effects react to environmental, tectonic and anthropogenic processes. They also demonstrate that urban strong-motion stations provide useful data for coda wave monitoring given sufficiently high-amplitude urban seismic noise.

Coronavirus infection and organizational changes in the clinical process in patients with non-muscle-invasive bladder carcinoma.

The spread of the aggressive disease caused by the novel respiratory syndrome coronavirus-2 (SARS-CoV-2) has had an impact not only on the health and psyche of people, but also on the state of health systems in different countries, by complicating the treatment and diagnostic process. These changes have affected patients with cancers to a greater extent. The diagnosis, treatment, and follow-up of patients are of particular scientific and practical interest when working in conditions of special anti-epidemic control. Objective. To assess the possibility of reducing the frequency of hospitalization of patients with non-muscle-invasive bladder carcinoma (NMIBC) during the Covid-19 period. Subjects and methods. Sixty-four patients with urinary tract malignancy, including 19 (29.7%) patients with low-and high-risk re-current NMIBC, were followed up in two clinics (Saint Petersburg, Russia) in March to October 2020. All the patients were oper-ated on;the patients at high risk for recurrence received a cycle of adjuvant BCG therapy. Methods for cytological examination of urine sediment and the biomarkers UBC and Cyfra 21-1 were used for special laboratory diagnosis;the server stations of both clinics were applied for telehealth consultations (TCs). Results. TCs were used to reduce hospitalization rates: after TCs, all the patients reported a reduction in transport costs and recovery time after hospitalization. TCs could protect the followed-up patients against COVID-19 infection, by observing the rules of clinical examination, and achieve maximum individualization of treatment. The authors refused to perform diagnostic operations for low-risk NMIBC and to use laboratory tests using urinary biomarkers. At the place of their residence, outpatients underwent urinalysis for several indicators, transmitting the result to the clinic's servers or through a monitoring system. Inpatient treatment was used only in cases of gross hematuria or after recording abnormal laboratory test results. Control cystoscopy detected no re-current tumor. Conclusion. During the spread of COVID-19, the periods of endoscopic examinations and control diagnostic operations can be post-poned, by replacing face-to-face consultations with TC monitoring. Outpatient laboratory and radiation examinations are indicat-ed in patients with new-onset gross hematuria or after combination treatment. Repeated operations, including diagnostic ones, should be performed in the case of multiple NMIBCs or after incomplete excision of the primary tumor.Copyright © 2021.

Preface

Climate change has led to the increase of heat exposure or natural hazard due to extreme weather. This anthropological climate change phenomenon has negatively altered the most fundamental natural resources for living organism: air, water, and soil. Air has been polluted and warming due to human activities. The quantity of freshwater keeps on depleting, while the ground water recharge intervened with chemical and biological contamination. The sustainability of soil as the natural planting media is under threat due to land use conversion and soil quality degradation. Water acidification and temperature increase have been proved to change the salinity of seawater. Those are the impact of the increasing greenhouse gas emission in the earth's atmosphere.The 8th International Conference on Climate Change (ICCC) aims to accommodate and to discuss the regional findings related the adaptation and mitigation strategies on climate change worldwide. The meaning to hold ICCC is getting more and more important. This conference can alert the creeping disaster. The contribution of all the participants, distinguished guests to this conference would make our world better and progress our scientific knowledge. Sharing the insight into the recent research and the cutting-edge technologies should enhance our ability and it might give us the breakthrough ideas on our sustainability under climate change. ICCC would be fruitful for every participant and be a great chance to approach the scientific solution for our common goals.Faculty of Agriculture of Sebelas Maret University, Surakarta, Indonesia is very proud to organize the 8th International Conference on Climate Change (ICCC). International Conference on Climate Change has been playing a significant contribution to formulate the strategies to cope with the emerged problems due to the climate change, as well as to support the sustainable development goal achievement. Sebelas Maret University has been seriously taking part to minimize the climate change impact, by promoting environment-friend programs, such as the green campus program and prohibiting the motor-vehicle to enter the campus every month. Sebelas Maret University also realizes that the responsibility of maintaining this earth should be by everyone. Each of us plays a significant contribution to minimize the global warming of this earth. That is why Faculty of Agriculture of Sebelas Maret University organize such events to discuss the findings related the earth-protection.We hope this conference will resulting into valuable recommendations in focusing and improving the natural resources management as well as improving the human's living efficiency to bring the greenhouse gas emission down. We need to produce alternative technologies as the climatic resilience strategies to overcome the key climate-change sensitive pathways, as well as to support the achievements some global goals in the Sustainable Development Goals (SDG). Accordingly, the topic of the 8th ICCC is "Environmental Management towards Sustainable Development Goals (SDGs) under the Changing Climate”.The 8th ICCC was organized by Faculty of Agriculture, Sebelas Maret University, Indonesia, in collaboration with Asian Institute of Technology, Thailand and The United Graduate School of Agricultural Sciences, Gifu University, Japan. The 8th ICCC was held at The Asian Institute of Technology Conference Center, Thailand from 17-18 November 2022. The 8th ICCC was conducted in the Hybrid method because travel restrictions are still enforced by some countries to prevent the spread of Covid-19. Besides, providing options for attending the 8th ICCC virtually is more comfortable for participants and presenters with limitedness of budgets.The 8th ICCC 2022 delivers great appreciation to Prof. Dr. Samanhudi, Dean of Faculty of Agriculture, Sebelas Maret University, Indonesia;Professor Dr. Shobhakar Dhakal, Vice President for Academic Affairs, Asian Institute of Technology, Thailand;and Prof. Dr. Ken Hiramatsu, Dean of United Graduate School of Agricultural Science, ifu University, Japan;for formal support to the conference.Gratitude presented to the invited speakers: Prof. Dr. Avishek Datta from Head of Department of Food, Agriculture, and Bioresources, Asian Institute of Technology, Thailand;Prof. Dr. Eric van Hullenbusch from Institut de Physique du Globe de Paris, France;Dr. Taku M. Saitoh from Gifu University, Japan;Dr. Jauhari Syamsiyah from Sebelas Maret University, Indonesia;and Dr. James MacGregor from Eco-Plannet, Canada.List of Committee of the 8th ICCC 202 is available in this Pdf.

WCN23-1206 Glomerulopathies Biobank in Uruguay. Description of the first 110 patients enrolled

Introduction: The incidence of glomerular diseases varies across different countries and criteria for kidney biopsy has changed over time. In Uruguay, glomerular diseases (GD) are a frequent cause of end stage kidney disease (ESKD) and renal replacement therapy with an annual incidence of 25.0 patients per million population according to data from the Uruguayan Dialysis Registry (UDR, year 2020). Since 1970, the Uruguayan Registry of Glomerulopathies has been recording the incidence, epidemiology and evolution of patients with GP in our country. In 2018, the Glomerulopathies Biobank (GB) began to operate including all patients with a native kidney biopsy performed at the Nephrology Department of the teaching hospital Hospital de Clinicas in Montevideo, Uruguay. The purpose of the BG is to record the phenotype (clinical and paraclinical) of patients with GD diagnosed by renal biopsy and at the same time store blood, urine, renal tissue and DNA samples. The aim of this report is to communicate the first 110 patients enrolled in the BG, which started in February 2018. Method(s): The BG protocol includes the collection of patronymic data, personal history, and clinical and paraclinical features of renal pathology. Plasma, urine and cell samples are stored for subsequent DNA extraction at the time of the kidney biopsy. In our country, all renal biopsies are performed by nephrologists. The Glomerular Biobank project is funded by the Nephrology Research Fund (School of Medicine, University of the Repubic) and was approved by the Ethics Committee of the Hospital de Clinicas and the Regulatory Verification Unit of the National Institute of Donation and Transplantation. The results are presented as mean and standard deviation (SD) for the continuous variables;and qualitative variables are described with percentages. Result(s): Patient recruitment began in February 2018 and we have recruited 110 patients. The mean age at the time of biopsy was 38.3+/-16.1 (min:16;max:78) years. Regarding sex distribution, the female sex slightly predominated (55.3%). Plasma creatinine was 2.1+/-1.45 mg/dL, proteinuria was 3.1+/-3.7 gr/dL and albuminaemia was 3.2+/-1.0 mg/dL. Microhaematuria was present in 61% of patients in the sediment study. Figure 1 shows the negative impact of the COVID 19 pandemic on the incidence of patients undergoing kidney biopsy. IgA nephropathy (13,8%)was the most frequent primary glomerular disease, followed by d focal and segmental glomerulosclerosis and membranous nephropathy. Consernig the glomerulopathies secondary to a systemic disease, the most frequent diagnosis was lupus nephritis (34,5%) followed by vasculitis, amyloidosis and diabetes. Conclusion(s): Having a prospective cohort of patients with glomerular disease, including reliable data and biological samples, will allow us to perform clinical and epidemiological analyses quickly and reliably in the future. The data and aliquots of biological material are available to any local nephrologist who proposes a hypothesis and has the approval of the corresponding ethics committee. The medium-term objective is to incorporate other national reference institutions in the care of patients with glomerular diseases. The data collected by the Glomerular Biobank will be a valuable input to the process of continuous improvement, and will serve as a basis for future nephrological research of excellence. No conflict of interestCopyright © 2023

Mapping the trophic state index of eastern lakes in China using an empirical model and Sentinel-2 imagery data

Lake eutrophication has become a critical environmental issue due to the global effects of anthropogenic activities and climate change, and has been comprehensively studied for many years. A series of models and indicators have been proposed to assess the trophic state of lakes. The trophic state index (TSI) is a synthetic index that integrates chlorophyll-a, water clarity, and total phosphorus and is widely used to evaluate the trophic state of aquatic environments. In this study, we collected in situ lake samples (N = 431) from typical lakes to match Sentinel-2 MultiSpectral Instrument (MSI) imagery data using the Case 2 Regional Coast Color processor. Then we developed a new empirical model, TSI = -34.04 x (band 4/band 5) - 1.114 x (band 1/band 4) + 97.376. This model is valid for all of China, with good performance and few errors (RMSE = 7.36;MAE = 6.25) for the validation dataset. Recognizing that over 94% of the Chinese population located along eastern watersheds and large lakes have competing water uses, and given the TSI model on the seasonal scales, we further estimated the mean TSI and trophic state in eastern Chinese lakes (> 100 km2) from 2019 to 2020. The results revealed that more lakes were eutrophic in autumn (94.28%) than in spring (> 77.14%), indicating a serious eutrophication of eastern lakes. Although the eastern lakes have been studied in more detail, this study found that eutrophication still has markedly negative impacts on lake ecosystems. In addition, no significant improvement was observed in spring, most likely due to the months of curfew/lockdown from January 2020 onwards due to COVID-19. This may be due to the enrichment of nutrients deposited in sediment or watershed soil, which can be characterized as "autochthonous sources" of lake eutrophication, over decades with high rates of economic development. This study demonstrates the applicability of Sentinel-2 MSI data to monitor lake eutrophication as well as the feasibility of blue/red and red/red edge combinations. The framework and TSI model used bands available on MSI sensors to develop a novel approach for generating historical eutrophication data for large-scale evaluation of and decision-making related aquatic environmental changes, even in poorly studied areas.

Persistent microscopic hematuria in IgA nephropathy and frequency of gross hematuria following SARS-CoV-2 mRNA vaccination

Introduction: There have been scattered reports of IgA nephropathy (IgAN) patients with gross hematuria and acute deterioration of urinary findings and kidney function following SARS-CoV-2 mRNA vaccination ("vaccination"). Recent case series studies have indicated a possible link between remission of urinary findings at the time of vaccination and subsequent appearance of gross hematuria. In this study, we aimed to determine whether the remission status of pre-vaccination urinary findings is associated with gross hematuria following vaccination in patients with already diagnosed IgAN. Method(s): Outpatients with IgAN who had been followed for at least 6 months after biopsy diagnosis were included. We analyzed the association between remission of microscopic hematuria (urine sediment <5/HPF) or proteinuria (<0.3 g/gCr) before vaccination and gross hematuria following vaccination. Remission of urinary findings was evaluated based on the criteria proposed by the Japanese Society of Nephrology in patients who had undergone at least three urine tests in the 6 months before the first vaccination. Result(s): A total of 372 patients with IgAN (mean age 53 years, 53 % female, eGFR 56 mL/min/1.73 m2) were included. The frequency of gross hematuria following vaccination was higher in 21/140 patients (15%) without remission of microscopic hematuria than in 4/232 patients (2%) with remission of microscopic hematuria prior to vaccination (p < 0.001). There was no association between remission of proteinuria before vaccination and gross hematuria following vaccination. After adjustment for potential confounders such as gender (female), age (<50 years), eGFR (>=60 mL/min/1.73m2), histories of tonsillectomy and corticosteroid therapy, non-remission of microscopic hematuria was still associated with gross hematuria following vaccination (OR 6.97, p < 0.001). Conclusion(s): Patients with IgAN who have not achieved remission of microscopic hematuria prior to vaccination are at higher relative risk of gross hematuria following vaccination regardless of treatment history for IgAN. No conflict of interestCopyright © 2023

Positive Matrix Factorization as Source Apportionment of Paddy Soil Heavy Metals in Black Shale Areas in Western Zhejiang Province, China

The source apportionment of pollutants is the key to preventing and controlling the pollution caused by heavy metals in soils. The aim of this study was to investigate the main sources of heavy metals in the soils of black shale areas in western Zhejiang, China. Based on geostatistical spatial analysis, this research employed positive matrix factorization (PMF) for the source apportionment of heavy metals in paddy soil. The results showed that contaminated arable soils were concentrated in the western and southern study areas. At least five major sources of heavy metals were screened in this study: natural sources (39.66%), traffic emissions (32.85%), industrial emissions (9.23%), agricultural activities (9.17%), and mining (9.10%). To be specific, Cd was mainly from mining;As originated from agricultural inputs such as fertilizers and pesticides;and Hg, as an industrial pollutant, was transported by atmospheric deposition in the study area. The accumulation of Pb, Zn, and Cu was mainly influenced by natural sources and anthropogenic sources, i.e., traffic emissions, while that of Cr and Ni was controlled by natural sources.

RENAL FLARE IN ADOLESCENTS WITH LUPUS NEPHRITIS RECEIVED COVID-19 mRNA VACCINE

Introduction: Patients with systemic lupus erythematosus (SLE) are at increased risk of the Coronavirus disease 2019 (COVID-19), whereas vaccines against the COVID-19 increase type I interferon and may trigger SLE flares. Lupus nephritis (LN) is common in adolescents with SLE and usually more severe than in adults. The incidence and severity of renal flare among these patients following COVID-19 mRNA vaccination are limited. Method(s): Adolescents, aged 12-18 years, with SLE and ever biopsy-proven lupus nephritis who had renal remission were prospectively studied following the COVID-19 (BNT162b2) mRNA vaccination. Renal remission was defined as having stable renal function and normal urinalysis at recruitment. SLE disease activity index 2000 (SLEDAI-2K) scores during the last 3 months prior to the vaccination were reviewed, and compared to SLEDAI-2K scores at 1, and 3 months after two-dose primary series. Renal flare included new onset significant proteinuria, abnormal urine sediment, and/or significant increased serum creatinine. Result(s): 35 adolescents (female 88.6%), with mean age of 15.4 +/-1.6 years, were included. Median (IQR) duration of SLE was 41.4 (18.9, 70.4) months. LN included class II (2, 5.7%) class III (2, 5.7%), class IV (12, 34.3%) class V (7, 20.0%), and class III/IV + V (10, 28.6%). Median daily dose of prednisolone prior to vaccination was 5 (2.5, 5) mg. SLEDAI-2K scores at pre-vaccination, 1-, and 3-months post vaccination were not significantly different [2 (0.25,4), 2 (0, 4) and 2 (0, 4);p=0.06). Three (8.6%) patients had renal flare within 3 months post vaccination. One had mild microscopic hematuria and mild proteinuria but improved after increased prednisolone to 0.5 mg/kg/day. Two patients had severe renal flare with biopsy proven LN class IV (1 with class V and 1 with thrombotic microangiopathy). Moreover, one patient developed COVID-19 at 2 months post vaccination without renal flare. Conclusion(s): Within 3 months post COVID-19 mRNA vaccine in adolescents with remission of LN, incidence of renal flare was 8.6%. Renal flare could be severe and required increasing immunomodulatory treatment. Larger population and longer follow-up are needed. No conflict of interestCopyright © 2023

GIS-based spatial distribution analysis of water quality assessment using water pollution index of Yamuna river at Delhi

Pollution is one of the leading risk factors for the deterioration of the environment, mankind's poor health, and endangerment of the plant kingdom. The exploration of water pollution levels through a new remote sensing model "Water Pollution Index” makes this study unique, which is derived from the weighted overlay technique using land surface temperature, Chlorophyll Index, NCAI, and backscattering values from Sentinel 1, Sentinel 2, and Landsat 8 data sets. This chapter is concerned with the qualitative study of water pollution of the Yamuna river stretch, Delhi. To substantiate the results, sources are taken from different published papers and ground surveys. The objective is to define the pollution level and its contributing factors, algae blooming, sewage debris, coronavirus disease 2019 (COVID-19) shutdown impact, and rain in different seasons for two consecutive years, 2019 and 2020. A noticeable difference is found in the annual result indicating less pollution in 2020 especially in premonsoon data compared to 2019. © 2023 Elsevier Inc. All rights reserved.

Quaternary ammonium compounds of emerging concern: Classification, occurrence, fate, toxicity and antimicrobial resistance.

Amplified hygiene and precautionary measures are of utmost importance to control the spread of COVID-19 and future infection; however, these changes in practice are projected to trigger a rise in the purchase, utilisation and hence, discharge of many disinfectants into the environment. While alcohol-based, hydrogen peroxide-based, and chlorine-based compounds have been used widely, quaternary ammonium compounds (QACs) based disinfectants are of significant concern due to their overuse during this pandemic. This review presents the classification of disinfectants and their mechanism of action, focusing on QACs. Most importantly, the occurrence, fate, toxicity and antimicrobial resistance due to QACs are covered in this paper. Here we collated evidence from multiple studies and found rising trends of concern, including an increase in the mass load of QACs at a wastewater treatment plant (WWTP) by 331% compared to before the COVID-19 pandemic, as well as an increases in the concentration of 62% in residential dust, resulting in high concentrations of QACs in human blood and breast milk and suggesting that these could be potential sources of persistent QACs in infants. In addition to increased toxicity to human and aquatic life, increased use of QACs and accelerated use of antibiotics and antimicrobials during the COVID-19 pandemic could multiply the threat to antimicrobial resistance.

Post COVID-19 infection associated IgA vasculitis

Background/Purpose: IgA vasculitis is the most common vasculitis affecting children. Vasculitis can be associated with the inflammatory process following infections, involving single or multiple organs. COVID-19 associated vasculitides have been reported variously, mostly Kawasaki-like features, livedo reticularis and rarely cutaneous small vessels vasculitis. Recently, there have been reports of IgA vasculitis following COVID-19 infection in children, although data among Asians are scarce. Method(s): Case report Results: We herein report a case of a previously healthy 6-year- old Thai boy with history of COVID-19 infection 4 weeks earlier, with only mild upper respiratory tract symptoms treated by a 5 day-course of favipiravir and supportive medication. He presented with rash over both lower limbs with difficulty to bear weight for a week. He denied fever, abdominal pain, nausea, vomiting, or any abnormal urinary symptoms. Physical examination revealed palpable purpura distributed on both lower legs with pain in his left foot and difficulty in bearing weight. His blood pressure was unremarkable for age at 97/67 mmHg. The initial investigations showed complete blood count with white cell count of 8.9 x 103/muL (neutrophils 47.3% and lymphocytes 42.4%), hemoglobin of 13.6 g/dL, which had no anemia for his age and platelet count of 297 x 103/muL. His urinalysis showed 2-3 red blood cells and 0-1 white blood cells per high power field without proteinuria and normal renal function. The erythrocyte sediment rate was 11 mm/hr and c-reactive protein was 3.9 mg/L, which were in normal range. He was diagnosed as IgA vasculitis and non-steroidal anti-inflammatory drug was prescribed to alleviate arthralgia of left foot. A week later, he revisited due to pain and swelling at his left scrotum. He was diagnosed as orchitis, one of the clinical manifestations of IgA vasculitis that can occur in boys. He had ongoing palpable purpura on the legs but pain at the left foot subsided. He then received oral prednisolone for the indication of orchitis at the dosage of 1 mg/kg/day with subsequent tapering for total duration of 3 weeks. All of his symptoms completely resolved. Conclusion(s): We present the interesting case of a Thai boy clinically diagnosed with IgA vasculitis following COVID-19 infection, having the clinical manifestations of palpable purpura, arthralgia, and orchitis. There are very limited data about post COVID-19- associated IgA vasculitis in children, especially in the Asian population. We would like to highlight this condition for physicians and to raise the awareness in the COVID-19 era.

Autoimmune hemolytic anemia following SARS-COV- 2 vaccine in SLE nephritis with coexistent thymoma, complicated by severe COVID-19 infection

Background: We report a 40-year- old female with co-existent lupus nephritis and thymoma who developed severe lupus flare (worsening nephritis, new onset hemolytic anemia) following SARS-CoV- 2 vaccine. Case: This 40 year old female has had stable lupus nephritis (LN) while maintained on mycophenolate mofetil and hydroxychloroquine for several years. A co-existent thymoma was likewise stable and did not require any added therapy apart from the management of the LN. She received the first dose of inactivated vaccine for SARS-CoV- 2 without event. Two weeks following the second dose, she developed Coombs positive hemolytic anemia (hemoglobin 64 g/L) with leukopenia (WBC 2.3 x 109/L), worsening nephritis (3+ proteinuria with uPCR 1.0, active urine sediments), hypocomplementemia, and elevated anti-dsDNA. She received methylprednisolone pulse therapy then maintained on prednisone 40mg/day with clinical improvement. Two weeks thereafter, she was admitted due to severe COVID-19 pneumonia accompanied by severe anemia requiring blood transfusion;she received a regimen of bevacizumab, dexamethasone, and remdesivir and was discharged recovered, without overt sequelae at the time of this report. Discussion(s): Vaccines are highly effective in reducing hospitalization and death attributable to SARS-CoV- 2 infection. There are concerns however regarding autoimmune disease flares following SARS-CoV- 2 vaccine, reported to occur in about 4% patients with autoimmune disorders. It is also possible that this patient's reaction may have been further aggravated by the co-existent thymoma. While there was apparent sub-optimal protection of the vaccine against moderate to severe COVID-19 infection in this patient, it may be conjectured that her significant recovery and response to the anti-viral combined with immunosuppressive regimen may be due to the high dose steroid treatment given for the post-vaccine autoimmune reaction.

An unusual presentation of malignant Invasive Mucinous Adenocarcinoma of Lung mimicking Pulmonary Renal syndrome

Background: A 54-year- old male presented to our centre with a chronic non-productive cough and breathlessness. Recent history of COVID treated and resolved few months back. He had a history of brain surgery performed five years back but details not known. Physical examination revealed no oedema and bilateral coarse creps with bronchiolar breathing. Laboratory findings indicated neutrophilic leucocytosis, elevated inflammatory markers, with elevated troponin I and D dimers. Urine analysis suggested microscopic haematuria with sediments. While 24 hour quantification revealed sub nephrotic proteinuria. As auto immune workup and vasculitis profile was negative and patient has not improved in spite of standard of therapy hence we went ahead with CT-Chest indicating ground-glass opacities in bilateral lung parenchyma and prominent interlobular/intralobular septal thickening. Then Bronchoscopy done which revealed the blood-stained secretions in the main stem bronchi and diffuse alveolar haemorrhage in bilateral bronchial segments indicating an inflammatory study, while tuberculosis diagnostic panel and infective bio fire panel in BAL was negative. Meanwhile, his repeat BAL culture suggested Carbapenem resistant Acinetobacter baumannii complex infection. As the patient did not respond to the standard of care for vasculitis. Probability considered was a small vessel vasculitis (namely Granulomatous polyangiitis) was considered due to lung manifestation involving upper respiratory tract with epistaxis, neutrophilic leucocytosis, elevated acute reactive protein, and renal manifestation including microscopic haematuria and proteinuria. However he responded poorly to conventional standard of treatment including pulse steroids and IVIG. Hence after MDT discussion we proceeded with lung biopsy which showed linear cores of lung tissue infiltrated by a malignant neoplasm and acinar pattern suggesting Invasive mucinous adenocarcinoma. Hence we went ahead with the biopsy diagnosis for the treatment plan. As he was to be started on chemotherapy, but he suddenly collapsed and went into hypotension, bradycardia, and cardiac arrest. In spite of high supports and post 4 cycles of CPR, was unable to revive and sadly succumbed to his illness. Discussion(s): In this rare case, the original diagnosis pointed to the pulmonary-renal syndrome, an autoimmune disease characterized by diffuse pulmonary haemorrhage and glomerulonephritis. However, negative autoimmune antibodies and vasculitis profile along with lung biopsy results indicated an unusual case of malignant lung adenocarcinoma presented with pulmonary renal syndrome. Conclusion(s): In cases suggesting pulmonary-renal syndromes, if autoimmune work up is negative and response is suboptimal relook the diagnosis.

Integrated network of the ECMU (physical, chemical and morphological urine examination) of the Azienda USL Toscana Sud Est

INTRODUCTION Following the Sars-Cov2 pandemic of the last 2 years, telemedicine has become fundamental for the territorial assistance of patients and the consultation of professionals among them to carry out assistance services in a very complex territory such as that of the Azienda USL Toscana Sud Est (TSE). Currently, the middleware, on the network, allows for the integration of all data from the physical, chemical and morphological urine examination (ECMU), allowing the transmission of data and images between computer-connected laboratories. This work illustrates the organizational architecture of an analytical integration network managed in telemedicine and teleconsulting applied to the ECMU and consisting of all the laboratories of the Azienda TSE. MATERIALS AND METHODS The integrated network of the ECMU includes the territorial laboratories of the Azienda TSE, such as the hub centers of Arezzo, Grosseto, Nottola and Campostaggia with the spoke centers of Cortona, Bibbiena, Sansepolcro, Valdarno, Massa Marittima, Orbetello, Pitigliano, Abbadia San Salvatore , Castel del Piano. The instrumentation used by the laboratories is Aution Max 4030 (Menarini) and Pochet Chem UA for the chemical-physical examination, Sedimax Contrust (Menarini) and the Director Web (Menarini) management software. RESULTS The integrated network of the ECMU consists of all the Azienda TSE laboratories, which are connected to each other electronically through the middleware Director Web, which allows the sharing of rules, chemical-physical analysis data and images of the urinary sediment. Through the Director Web management software it is possible, in fact, for hub laboratories not only to consult and validate the ECMU carried out by the spoke centers in the area, but to receive and give "second opinion" advice between the network laboratories. CONCLUSIONS The use of the same analytical systems and the middleware system common throughout the Azienda TSE allows to obtain harmonized and standardized results throughout the territory with shared criteria in the integrated network of the ECMU, in fact, the collaboration of specialists is indirectly promoted with time much faster diagnosis and a less rigid and leaner organization of work, uniform throughout the territory.

The impact of disposable mask waste pollution in peat soil

The abundance of plastic waste in Indonesia has increased due to the contribution of disposable masks waste during the COVID-19 pandemic. The improper waste management causes the habit of dumping waste in the soil system to still frequently occur. The secondary microplastics from disposable mask waste has the potential to damage soil quality and soil capillary water. Therefore, this study was conducted with the aim of understanding the effects of disposable mask waste in peat soil. The research was conducted by setting up 3 reactors containing peat soil with disposable mask waste buried in it and some plants being grown on it. For 45 days, observations and samples were taken, both filtrate water and soil for analysis. The analysis results showed significant changes in soil properties with changes in the concentration of inorganic matter, organic matter, porosity, bulk density, and water content. Further research needs to be done to see the effects of disposable mask waste in the soil system in real conditions where several confounding variables cannot be controlled.

Has the "Covid-19" lockdown an impact on beach faunal communities? The central Atlantic coast of Morocco as a case study.

The restrictions related to the COVID-19 pandemic have led to a global hiatus in anthropogenic activities; several scientists have utilized this unique opportunity to assess the human impact on biological systems. In this study, the study describes for a period of five years (2018-2022) how the faunal community have been affected by human disturbances, as well as the effect of the "anthropause" period driven by the COVID-19 lockdown. The results confirmed human disturbances on faunal communities related to coastal urbanization. It was found that the "anthropause" period showed the highest values of abundance and biomass, hence the "COVID-19 lockdown" allowed recovery of faunal communities. The findings highlight the impact of human disturbances and that the community showed resilience. Overall, the authorities must perform restrictive measures aiming to mitigate the impact of anthropogenic activities in the study area including the banning of off-road and recreational vehicles, carrying out efficient cleaning and grooming operations, monitoring the severe harvesting of edible species, as well as penalizing the disposal of anthropogenic waste and sewage discharge from the touristic facilities. Likewise, management actions such as the temporal beach closures and the regular surveillance could be advantageous to provide a more sustainable exploitation of sandy beaches.

ACUTE INTERSTITIAL NEPHRITIS AS A PRIMARY PRESENTATION OF CANDIDA INFECTIVE ENDOCARDITIS

Introduction: Acute Interstitial Nephritis (AIN) is an important cause of Acute Kidney Injury (AKI), and infections are the second most common etiology, after the drugs. However, AIN following fungal infections is rare. We describe two cases of AIN, which on the investigation turn out to be candidemia following fungal infective endocarditis. Methods: CASE 1: A 65-year-old man with hypertension and diabetes without diabetic or hypertensive retinopathy and prior normal renal function, presented to us with vague abdominal pain with steadily creeping creatinine to 2mg/dl within 2 weeks, and urine showed no albuminuria and sediments. There was no history of any specific drug intake. His hematological and other parameters were normal. Blood and urine cultures were sterile. He underwent a renal biopsy which revealed acute interstitial nephritis (Figure 1). He was started on prednisolone at 1mg/kg/day for 1-week following which he had a rapidly worsening azotemia requiring hemodialysis. Steroids were stopped. Repeat blood cultures were sent which grew candida albicans resistant to flucytosine. Re-evaluation of the fundus revealed macular infarct in the right eye with vitreoretinitis in the left eye suggestive of endophthalmitis. PET CT showed increased FDG uptake in both kidneys suggestive of pyelonephritis. Trans-esophageal echocardiography (TEE) showed aortic valve vegetations. He was treated with antifungals for 3 months. He was dialysis-dependent for 2 weeks. He gradually regained normal renal function 3 weeks after starting anti-fungal agents. CASE 2: A 57-years-old man with diabetic, hypertensive, and no diabetic retinopathy had severe covid pneumonia in June 2021 requiring oxygen and tocilizumab 80 mg for 4 days, recovered with normal renal function. He presented to us 1 month later with unexplained non-oliguric severe AKI requiring dialysis, with bland urine sediments. Renal biopsy showed lymphocytic infiltrates in the interstitium suggestive of AIN (Figure 2). Blood cultures were sterile, but serum beta-D-glucan was elevated at 333 pg/ml. He was Initiated on 1mg/kg of prednisolone, on the presumption of drug-induced AIN. Simultaneously workup for systemic infection revealed mitral anterior leaflet endocarditis. He was initiated on anti-fungal therapy on the advice of an infectious disease specialist and the steroid was stopped. He continued to be dialysis-dependent after 6 weeks, despite anti-fungal agents. Results: [Formula presented] Conclusions: AIN contributes a significant proportion of cases in unexplained AKI. Prompt evaluation with a renal biopsy is warranted. Acute interstitial nephritis particularly due to candidemia can be oligosymptomatic as seen in our two cases. Since steroids have a significant role in treating early AIN, a dedicated search for underlying silent endocarditis and candidemia is advisable before initiating steroid therapy. Ophthalmic fundus evaluation, TEE, and repeat blood culture may be necessary to identify hidden candidemia. We recommend an evaluation to exclude fungal endocarditis in patients with AIN who present with minimal or no symptoms and no definitive cause for AIN is present. No conflict of interest

Fecal indicator bacteria levels at a marine beach before, during, and after the COVID-19 shutdown period and associations with decomposing seaweed and human presence.

Studies are limited that evaluate seaweed as a source of bacteria to beach waters. The objective of the current study was to evaluate whether seaweed, along with humans and other animals, could be the cause of beach advisories due to elevated levels of enterococci. The monitoring period occurred a year prior to and through the COVID-19 beach shutdown period, which provided a unique opportunity to evaluate bacteria levels during prolonged periods without recreational activity. Samples of water, sediment, and seaweed were measured for enterococci by culture and qPCR, in addition to microbial source tracking by qPCR of fecal bacteria markers from humans, dogs, and birds. During periods of elevated enterococci levels in water, these analyses were supplemented by chemical source tracking of human-associated excretion markers (caffeine, sucralose, acetaminophen, ibuprofen, and naproxen). Results show that enterococci with elevated levels of human fecal markers persist in the seaweed and sediment and are the likely contributor to elevated levels of bacteria to the nearshore waters. During the shutdown period the elevated levels of enterococci in the sediment were isolated to the seaweed stranding areas. During periods when the beaches were open, enterococci were distributed more uniformly in sediment across the supratidal and intertidal zones. It is hypothesized from this study that human foot traffic may be responsible for the spread of enterococci throughout these areas. Overall, this study found high levels of enterococci in decomposing seaweed supporting the hypothesis that decomposing seaweed provides an additional substrate for enterococci to grow.

Prompt Diagnosis and Intervention of Oxalate Nephropathy to Salvage Kidney Function

Hyperoxaluria can be primary due to defective glyoxylate metabolism leading to hepatic oxalate overproduction or secondary due to increased intestinal oxalate absorption. Oxalate nephropathy is the deposition of calcium oxalate crystals leading to tubular injury, interstitial fibrosis, and AKI or CKD. This describes three cases of renal oxalosis. First is a 60 year old male with stroke, hypertension, diabetes who presented with AKI of 4.5 mg/dL from 1.6 that rose to 11 mg/dL. Serologies for glomerulonephritis and paraproteinemia were negative. Biopsy showed tubular oxalate crystal deposition with tubular injury and interstitial nephritis. His renal failure required dialysis. Second is a 58 year old female with gastric bypass surgery who presented for edema and AKI from 1.3 to 3.6 mg/dL. Serologies were also negative. Biopsy showed interstitial nephritis with tubular calcium oxalate deposition. She was started on prednisone 60 mg. Creatinine stabilized to 2.2 mg/dL, not requiring dialysis. Third is a 82 year old male with obesity and sarcoma of the scalp treated with pembrolizumab who presented with dyspnea, edema and an AKI from 1 to 8.6 mg/dL. Urine sediment was bland with negative serologies. Differential included AIN due to pembrolizumab. Patient was started on high dose prednisone and biopsy showed interstitial nephritis and calcium oxalate crystal deposition. Patient endorsed taking frequent vitamin C as prophylaxis for Covid. Creatinine stabilized to 2.9 mg/dL not on dialysis. Classic etiologies of hyperoxaluria include dietary oxalate from ascorbic acid and fat malabsorption from gastric bypass surgery. Treatment includes increased fluid intake, oral calcium supplements and low oxalate diet. Oxalate nephropathy remains an under recognized cause of kidney failure, as such, early biopsy and intervention are necessary. (Figure Presented)