Interpreting Air Cleaner Performance Data

The global COVID-19 pandemic has prompted widespread demand for air cleaning technologies aimed at reducing risks of airborne pathogen transmission inside buildings. The commercial landscape for air cleaning devices is complex, ranging from conventional technologies such as high-efficiency fibrous-media filters and ultraviolet germicidal irradiation (UVGI) to a wide variety of electronic air cleaning technologies such as plasma generators, hydroxyl radical generators, ionizers, photocatalytic oxidizers and others. This article demonstrates some frequently prevalent issues in electronic air cleaner performance testing and reporting and proposes a path forward to meet research needs and improve test methods that could reduce the current uncertainty about the performance of electronic air cleaning technologies. It also provides tools to support practitioners and consumers in their decision-making regarding air cleaning technologies. Copyright 2022 ASHRAE.

Persistent impairment in peripheral but not cerebral vascular function in young healthy adults with long-term symptoms from covid-19

Vascular dysfunction and inflammation are precursors to cardiovascular disease (CVD). Notably, young adults who were symptomatic from COVID-19 during the acute phase of illness (within 4 weeks from diagnosis) have shown to exhibit peripheral vascular dysfunction. Importantly, many young adults report persistent symptoms from COVID-19 for several months, including cognitive difficulties. However, it remains unknown whether vascular dysfunction persists beyond the acute phase of COVID-19 in symptomatic young adults. We tested the hypothesis that peripheral and cerebral vascular function would be blunted in symptomatic (SYM) young adults who are beyond 4 weeks from a COVID-19 diagnosis, compared to asymptomatic adults (ASYM). Since COVID-19 causes inflammation that may negatively impact vascular function, we also hypothesized that serum hsCRP would be elevated in SYM compared to ASYM. We studied 15 otherwise healthy adults (age = 23 ± 1 years;mean ± SE) with a positive lab diagnosis of COVID-19. Eight were SYM (14 ± 1 weeks from diagnosis) while seven were ASYM (13 ± 2 weeks from diagnosis) at time of testing. Brachial artery flow-mediated dilation (FMD;duplex Doppler ultrasound) was performed, and macroand microvascular function were quantified as FMD% and peak blood velocity after cuff release, respectively. Cerebral vasomotor reactivity (CVMR) was quantified as percent increase in middle cerebral artery blood velocity (transcranial Doppler ultrasound) to rebreathing induced hypercapnia. Serum hsCRP level was measured. FMD was lower in SYM (3.81 ± 0.60%) compared to ASYM (7.10 ± 0.94%, P = 0.010). Likewise, peak blood velocity after cuff release was lower in SYM (47 ± 3 cm/s vs. ASYM: 65 ± 8 cm/s, P = 0.037). However, CVMR was not different between the two groups (P = 0.91). Serum hsCRP was higher in SYM (3.4 ± 1.0 mg/L vs. ASYM: 0.7 ± 0.1 mg/L, P = 0.036). These preliminary results indicate that peripheral macro-and microvascular function remain blunted beyond the acute phase in young adults with persistent symptoms from COVID-19, whereas cerebral vascular function appears unaffected. The extent to which this sustained vascular impairment and elevated hsCRP contributes to increased CVD risk in these otherwise healthy young adults remains to be determined.

Upadacitinib associated pneumocystis jirovecii pneumonia

Introduction:Upadacitinib is a new oral janus kinase (JAK) inhibitor that has been approved to treat rheumatoid arthritis. JAK inhibitors carry a black box warning for their association with severe infections especially when used in combination with other immunosuppressants. Although there is a strong association, there are very few reports of Pneumocystis jirovecii pneumonia (PJP) caused by upadacitinib. We describe a case of PJP due to upadacitinib use in rheumatoid arthritis. Case presentation: A 44-year-old woman with a history of rheumatoid arthritis presented with 2 weeks of dyspnea, dry cough and fever after recently starting upadacitinib. She was noted to be tachypneic, tachycardic and hypoxemic on admission. Initial laboratory tests were within normal limits and lactate dehydrogenase was 304. Respiratory viral panel and reverse transcription-polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 were negative. Computerized tomography of the chest revealed diffuse multi-focal ground glass and consolidative opacities. The patient's respiratory status rapidly deteriorated, requiring admission to medical intensive care unit where she was initiated on invasive mechanical ventilation. A 1,3-beta-D-glucan serology test was positive and PJP polymerase chain reaction in bronchoalveolar lavage was positive. She was started on intravenous trimethoprim-sulfamethoxazole 400mg three times a day and intravenous methylprednisolone 500mg twice a day for three days. Her oxygen requirements rapidly improved and she was extubated on day 4 of admission. The patient was discharged without a supplemental oxygen requirement to complete a course of oral trimethoprim-sulfamethoxazole and prednisone. Discussion:JAK inhibitors are increasingly used for the treatment of rheumatoid arthritis and other autoimmune diseases. Other less selective JAK inhibitors such as tofacitinib and baricitinib have been associated with PJP in rheumatoid arthritis. Upadacitinib is a selective JAK1 inhibitor which is thought to give it an improved side effect profile compared to other less selective JAK inhibitors. This represents one of the first cases of PJP associated with the use of upadacitinib, a selective JAK1 inhibitor. PJP should be included in the differential diagnosis of patients treated with upadacitinib who present with fever, hypoxemia and pulmonary infiltrates. Awareness of this disease and its manifestations are critical to appropriate diagnostic evaluation and timely treatment.