Should chest compressions be considered an aerosol-generating procedure? A literature review in response to recent guidelines on personal protective equipment for patients with suspected COVID-19.

There is disagreement between international guidelines on the level of personal protective equipment (PPE) required for chest compressions for patients with suspected COVID-19. This discrepancy centres on whether they are considered to be an aerosol-generating procedure (AGP), thus requiring airborne protection to prevent transmission to healthcare workers (HCWs). The need to don higher-level PPE has to be weighed against the resulting delay to emergency treatment.We performed a literature search on this topic which found eight relevant studies. All were observational with low patient numbers and multiple confounding factors, but describe cases of acute respiratory infection transmission during chest compressions. One systematic review concluded that chest compressions were not an AGP. Two simulated studies (released as preprints) potentially demonstrate aerosol generation. Given that there is evidence for infection transmission during chest compressions, we conclude that a precautionary approach with appropriate PPE is necessary to protect HCW from contracting a potentially fatal infection.

Successful treatment of maternal listeria monocytogenes bacteremia in the first trimester of pregnancy: A case report and literature review.

OBJECTIVE: To report detailed clinical history and management of maternal listeria infection in the first trimester. CASE REPORT: A 34-year-old woman at 11 gestational weeks was infected by Listeria monocytogenes with clinical symptoms of acute onset of a fever with subsequent headache and neck stiffness, and was treated with intravenous ampicillin at 2 g every 4 h for 3 weeks. A healthy, unaffected male baby was delivered at term. Histopathologic examination of the placenta did not reveal any chorioamnionitis, granulomas, microabscesses or vasculitis. The neonate developed well without any neurologic compromise at a six-week postnatal follow-up visit. CONCLUSION: A favorable outcome of maternal listeria infection in the first trimester may be anticipated. Besides, intravenous ampicillin with or without gentamicin should be a reasonable treatment option for maternal listeria infection in the first trimester.

Analysis of gene regulation in rabbit corneal epithelial cells induced by ultraviolet radiation.

Ultraviolet (UV)-induced cataracts are becoming a major environmental health concern because of the possible decrease in the stratospheric ozone layer. Experiments were designed to isolate gene(s) affected by UV irradiation in rabbit cornea tissues using fluorescent differential display-reverse transcription-polymerase chain reaction (FDDRT-PCR). The epithelial cells were grown in standard medium for 2 or 4 hours post treatment. Cornea epithelial cells were irradiated with UVB for 20 minutes. RNA was extracted and amplified by reverse transcriptase-polymerase chain reaction using poly A+ specific anchoring primers and random arbitrary primers. Polyacrylamide gel electrophoresis revealed several differentially expressed genes in untreated versus UV irradiated cells. Complimentary DNA (cDNA) fragments resulting from fluorescent differentially expressed mRNAs were eluted from the gel and re-amplified. The re-amplified PCR products were cloned directly into the PCR-TRAP cloning system. These data showed that FDDRT-PCR is a useful technique to elucidate UV-regulated gene expressions. Future experiments will involve sequence analysis of cloned inserts. The identification of these genes through sequence analysis could lead to a better understanding of cataract formation via DNA damage and mechanisms of prevention.

The effects of sub-solar levels of UV-A and UV-B on rabbit corneal and lens epithelial cells.

The purpose of this work was to establish whether exposing cultured rabbit corneal and lens epithelial cells to ultraviolet radiation equivalent to several hours under the sun would damage the cells. Confluent rabbit corneal epithelial cells were irradiated with broadband UV-A or UV-B, and confluent lens epithelial cells were irradiated with broadband UV-A. The maximum dose of UV-A was 6.3 J cm(-2) and that of UV-B was 0.60 J cm(-2). Damage to corneal epithelial cell was studied using the terminal deoxynucleotidyl transferase mediated dUTP-X nick end labeling (TUNEL) assay and damage to lens epithelial cell was studied using the single cell gel electrophoresis (comet) assay and trypan blue exclusion assay. Lipid peroxidation was assayed using the thiobarbituric acid reaction. Both UV-B and UV-A induced cell death in corneal epithelial cells with different latent periods. UV-A damage included cell death, decreased viability and increased lipid peroxidation of lens epithelial cell. In addition, UV irradiation of the corneal and lens epithelial cells decreased the activity of catalase to thirty to fifty percent of its original value, while the activities of glutathione peroxidase and superoxide dismutase did not decrease within experimental error. Thus, even sub-solar UV radiation can cause irreversible damage to corneal and lens epithelial cells.