Responding to a school SARS-CoV-2 outbreak: Insights and policy implications emerging from the pandemic.

Background: The SARS-CoV-2 pandemic has affected also the school environment. Prolonged closures and the weakness of available data prevent a definitive answer to the question of school transmission. We report our experience of responding to COVID-19 cases in the school setting, presenting a case study of the management of an outbreak in a large school. Methods: The LHA/ASL Roma 1 has organized the School Units with a structure firmly rooted in the territory. At the local level, the District Unit mainly manages the relationship with schools, while the Hygiene and Public Health Service of the Prevention Department holds a coordinating and facilitating role. The HPHS carries out contact tracing activities facilitated by the schools, through the figure of the COVID-19 Contact Person, who is specifically trained to manage the preliminary stages of the reports. Results: Following several reports of COVID-19 suspect cases from two schools and, after a complex phase of contact tracing, it was possible to identify the major transmission chains. Furthermore, we performed a population-based screening on the entire school. Beyond the known transmission chains, for which quarantine was already in place, only five additional cases emerged, all asymptomatic, out of 1,231 swabs tested with RT-PCR. Conclusions: Our experience confirms that an active interaction between the school and the School Unit made it possible to quickly control a potentially dangerous outbreak. The large-scale screening test demonstrated the substantial absence of collateral transmission chains. Effective contact tracing allowed to set forth a successful response. Our model of intervention can be used to support public health protocols regarding school outbreaks.

Oxalosis y livedo reticularis / Oxalosis and Livedo Reticularis

La oxalosis es una enfermedad derivada del depósito de oxalato cálcico fuera del aparato urinario. Los lugares de depósito extrarrenales más frecuentes incluyen el hueso, el miocardio, la retina, los vasos sanguíneos y la piel, lo que da lugar a las manifestaciones clínicas de esta enfermedad. En la piel las alteraciones pueden deberse a la afectación de los vasos sanguíneos, lo que da lugar a la aparición de cuadros de livedo reticularis, acrocianosis, úlceras y gangrena. Presentamos el caso de una mujer de 60 años con historia de litiasis renal recidivante, que le llevó a una insuficiencia renal terminal que requirió hemodiálisis y posteriormente diálisis peritoneal. La paciente desarrolló de forma súbita la aparición de elementos cutáneos de color rojo-violáceo, dolorosos a la palpación compatibles con livedo reticularis que evolucionaron a úlceras. La biopsia cutánea reveló una vasculopatía por oxalato.En este artículo se describen las características de este raro proceso, su diagnóstico diferencial con la calcifilaxis y las alternativas terapéuticas (AU)

Oxalosis is a disease caused by the deposition of calcium oxalate in extrarenal tissues, most commonly bone, myocardium, retina, blood vessels, and skin, causing the clinical manifestations of the disease. Involvement of the blood vessels of the skin can give rise to livedo reticularis, acrocyanosis, ulcers, and gangrene. We present the case of a 60-year-old woman with a history of recurrent renal lithiasis that had led to terminal renal failure requiring hemodialysis and, subsequently, peritoneal dialysis. The patient developed tender red-violaceous skin discoloration of sudden onset, consistent with livedo reticularis; the lesions progressed to form ulcers. Skin biopsy revealed oxalate vasculopathy. In this article we describe the characteristics of this rare disorder, its differentiation from calciphylaxis, and the therapeutic options (AU)

Oxalosis and livedo reticularis.

Oxalosis is a disease caused by the deposition of calcium oxalate in extrarenal tissues, most commonly bone, myocardium, retina, blood vessels, and skin, causing the clinical manifestations of the disease. Involvement of the blood vessels of the skin can give rise to livedo reticularis, acrocyanosis, ulcers, and gangrene. We present the case of a 60-year-old woman with a history of recurrent renal lithiasis that had led to terminal renal failure requiring hemodialysis and, subsequently, peritoneal dialysis. The patient developed tender red-violaceous skin discoloration of sudden onset, consistent with livedo reticularis; the lesions progressed to form ulcers. Skin biopsy revealed oxalate vasculopathy. In this article we describe the characteristics of this rare disorder, its differentiation from calciphylaxis, and the therapeutic options.

Reclaimed wastewater quality enhancement by oxygen injection during transportation.

In-sewer treatments have been studied in sewer systems, but few have been carried out on reclaimed wastewater systems. A study of oxygen injection has been performed in a completely filled gravity pipe, 0.6 m in diameter and 62 km long, in cast iron with concrete inside coating, which is part of the reclaimed wastewater reuse scheme of Tenerife (Spain). A high pressure oxygen injection system was installed at 16.0 km from pipe inlet and a constant dosage of 30 mg/L O(2) has been injected during six months, under three different operational modes (low COD, 63 mg/L; high COD, 91 mg/L; and partially nitrified water). Oxygen has been consumed in nitrification and organic matter reduction. Generally, nitrification is clearly favored instead of the organic matter oxidation. Nitrification occurs, in general, with nitrite accumulation due to the presence of free ammonia above 1 mg/L. Denitrification is in all cases incomplete due to a limitation of easily biodegradable organic matter content, inhibiting the appearance of anaerobic conditions and sulfide generation. A notable reduction of organic matter parameters is achieved (TSS below 10 mg/L), which is significantly higher than that observed under the ordinary transport conditions without oxygen. This leads to a final cost reduction, and the oxygen injection system helps water reuse managers to maintain a final good water quality in the case of a treatment plant malfunction.

Nitrogen transformation of reclaimed wastewater in a pipeline by oxygen injection.

A study of oxygen injection was performed in a completely filled gravity pipe, which is part of the South Tenerife reclaimed wastewater reuse scheme (Spain), in order to inhibit the appearance of anaerobic conditions by a nitrification-denitrification process. The pipe was 0.6 m in diameter and 62 km long and made of cast iron with a concrete inner coating, A high-pressure oxygen injection system was installed at 16 km from the pipe inlet, where severe anaerobic conditions appear. Experiments on oxygen injection were carried out with three different concentrations (7, 15 and 30 mg l(-1) O2). In all experiments, oxygen dissolved properly after injection, and no gas escapes were detected during water transportation. Most oxygen was consumed in the nitrification process, due to the low COD/NH4-N ratio, leading to a maximum production of oxidized nitrogen compounds of 7.5 mg l(-1) NO(x)-N with the 30 mg l(-1) O2 dose. Nitrification occured with nitrite accumulation, attributed to the presence of free ammonia within the range 1.2-1.4 mg l(-). Once the oxygen had been consumed, an apparent half-order denitrification took place, with limitation of biodegradable organic matter. The anoxic conditions led to a complete inhibition of sulphide generation.

Hiperhidrosis severa como forma de presentación de la acromegalia / Acromegaly presenting with severe hiperhidrosis

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Ammonia removal in a deep reclaimed wastewater reservoir before agricultural reuse.

An experimental study has been carried out to determine the ammonia removal in a deep reclaimed wastewater reservoir of 50,000 m3. The reservoir is part of the Reuse System of Reclaimed Wastewater of South Tenerife (Spain). The study has been conducted under batch mode operation, in three different periods (winter, spring-summer and winter-spring), with an average storage time of 85 days. Vertical profiles of temperature, dissolved oxygen and pH were determined together with NH3-N, NO2-N and NO3-N concentrations at different points and different depths in the reservoir. Maximum removal efficiency was obtained during the winter periods, in absence of stratification and with good mixing conditions throughout the water column. During these periods, nitrification took place in some extension, favoring the ammonia removal. Average NH3-N concentrations in the reservoir were calculated and apparent first-order rate constants were determined for different stratification conditions. Although ammonia nitrogen could be used as nutrient in the agricultural reuse, its removal from reclaimed wastewater could be useful in order to diminish the chlorine needs for disinfection.