Airborne SARS-CoV-2 RNA excretion by patients with COVID-19 on different oxygen-delivery systems: a prospective observational study.

BACKGROUND: Concerns persist regarding the risk of airborne SARS-CoV-2 transmission by patients with COVID-19 on various modalities of oxygen therapy, such as high-flow nasal cannula (HFNC). AIM: We aimed to compare the presence of airborne RNA in air samples between groups of patients with COVID-19 on different oxygen-delivery systems. We also explored factors that were associated with SARS-CoV-2 RNA positivity in air samples. RESULTS: Air samples were positive for SARS-CoV-2 RNA in three of 39 patients (8%) on HFNC, 0 of 13 (0%) on masks, versus five of 20 (25%) on nasal cannula. Odds ratio for air sample positivity was 0.52 (95% confidence interval (CI) 0.11-2.34) when comparing HFNC vs non-HFNC group, and 5.78 (1.24-27.01) for nasal cannula vs non-nasal cannula group. Patients with positive air samples in comparison with those with negative air samples were sampled earlier after symptoms onset (median: 7 vs 10 days; P=0.04) and had lower Ct values of diagnostic nasopharyngeal samples (median: 22 vs 26; P=0.02). CONCLUSIONS: Air sample positivity was not related to oxygen support device but to viral load. These data suggest that the use of personal protection equipment should be based on risk management according to viral load rather than oxygen support device.

[An older woman with dextrocardia and shortness of breath]. / Een oudere vrouw met dextrocardie en kortademigheid.

A 73-year-old woman, who had a history of chronic sinusitis, presented to the emergency department with shortness of breath. Additional imaging demonstrated situs inversus totalis and multiple bronchiectases. The clinical triad of sinusitis, situs inversus totalis and bronchiectasis is often characteristic of Kartagener's syndrome, a subset of primary ciliary dyskinesia.

Recurrent acute pulmonary oedema after aortic and mitral valve surgery due to trachea malacia and obstructive sleep apnoea syndrome.

In this report we describe a patient with recurrent episodes of acute pulmonary oedema after aortic and mitral valve surgery. The first episode of pulmonary oedema was caused by mitral valve dysfunction. The second episode of pulmonary oedema was not clearly associated with a mitral valve problem, but reoperation was performed in the absence of another explanation. After the third episode of acute pulmonary oedema occurred, the diagnosis of obstructive sleep apnoea syndrome (OSAS) was considered and confirmed. After starting treatment with continuous positive airway pressure (CPAP) during his sleep the patient had no further episodes of acute respiratory failure. Our case demonstrates that acute pulmonary oedema after cardiothoracic surgery can be caused or at least be precipitated by OSAS and should be suspected in patients with unexplained episodes of (recurrent) pulmonary oedema. (Neth Heart J 2008;16:310-2.).

Arterial stiffness, endothelial function and microcirculatory reactivity in healthy young males.

Large (C1) and small (C2) arterial stiffness has been suggested to parallel endothelial reactivity and has led researchers to suggest parameters of arterial stiffness may be alternative measures to brachial sonographic assessments of flow-mediated dilatation (FMD). However, past studies comparing these measures can be criticized. In addition to %FMD responses, we recorded concurrent hyperaemic responses of the microcirculation and both were compared with C1 and C2. Twenty-nine subjects 18-30 years of age were investigated. Radial blood pressure was recorded with a tonometer. Pulse waveform analysis was performed to calculate C1 and C2. These were compared with %FMD responses and responses of finger flux measured by laser Doppler fluxmetry (LDF); pulsatile finger volume measured by photoplethysmography (PPG); and palm skin temperature measured by infrared thermography (Tpalm) (i.e. microcirculatory responses). Responses were determined as % changes from control. We only found weak relationships between C1 and %FMD (r=0.4, P=0.04); C2 and %PPG (r=0.38, P=0.07); and C2 and %LDFdorsal (r=-0.38; P=0.04). Responses of %FMD weakly parallel those of C1. Neither C2 nor C1 are viable indicators of endothelial or microcirculatory reactivity (i.e. hyperaemic or venous constriction) in healthy, resting young males. These findings refute the claims that C1 and C2 are substitute measures to sonographic assessments of brachial FMD.

[Diagnostic image (116). A man with acute exanthema. Epstein-Barr virus infection]. / Diagnose in beeld (116). Een man met acuut exantheem. Ziekte van Pfeiffer.

A 19-year-old man presented with a rash, several days after antibiotic therapy for pharyngitis. Such a rash is highly suggestive of an acute viral infection; Epstein-Barr virus infection was confirmed serologically.