The Prevalence and Clinical Implications of Rectal SARS-CoV-2 Shedding in Danish COVID-19 Patients and the General Population.

Background: SARS-CoV-2 has resulted in a global pandemic since its outbreak in Wuhan, 2019. Virus transmission primarily occurs through close contact, respiratory droplets, and aerosol particles. However, since SARS-CoV-2 has been detected in fecal and rectal samples from infected individuals, the fecal-oral route has been suggested as another potential route of transmission. This study aimed to investigate the prevalence and clinical implications of rectal SARS-CoV-2 shedding in Danish COVID-19 patients. Methods: Hospitalized and non-hospitalized adults and children who were recently tested with a pharyngeal COVID-19 test, were included in the study. A rectal swab was collected from all participants. Hospitalized adults and COVID-19 positive children were followed with both pharyngeal and rectal swabs until two consecutive negative results were obtained. RT-qPCR targeting the envelope gene was used to detect SARS-CoV-2 in the samples. Demographic, medical, and biochemical information was obtained through questionnaires and medical records. Results: Twenty-eight of 52 (53.8%) COVID-19 positive adults and children were positive for SARS-CoV-2 in rectal swabs. Seven of the rectal positive participants were followed for more than 6 days. Two of these (28.6%) continued to test positive in their rectal swabs for up to 29 days after the pharyngeal swabs had turned negative. Hospitalized rectal positive and rectal negative adults were comparable regarding demographic, medical, and biochemical information. Furthermore, no difference was observed in the severity of the disease among the two groups. Conclusions: We provided evidence of rectal SARS-CoV-2 shedding in Danish COVID-19 patients. The clinical importance of rectal SARS-CoV-2 shedding appears to be minimal.

Cholecystectomy for uncomplicated gallbladder stones does not follow evidence-based recommendations.

INTRODUCTION: The introduction of laparoscopic cholecystectomy was followed by a steep increase in the cholecystectomy rate, which has remained on an unchanged, high level. The main indication for cholecystectomy in Denmark in cases with uncomplicated gallbladder stones is socially debilitating pain. The objective of the present study was to investigate whether the indication "socially debilitating pain" was reported in the patient's file when he or she was referred to surgery. METHODS: Hospital files for all patients referred to surgical evaluation for uncomplicated gallbladder stones from Odense University Hospital's service area (approximately 449,000 inhabitants) within a one-year period (2014) were reviewed. RESULTS: Among 1,003 eligible patients, a total of 516 met the inclusion criteria, 407 (78.9%) of whom underwent elective cholecystectomy. For only 89 (21.9%) of these 407 patients, the indication of socially debilitating pain was described in the patient files. CONCLUSIONS: Our results may represent overtreatment and/or incorrect selection of patients suitable for surgery. More and larger prospective cohort studies are warranted to elucidate the indications for cholecystectomy in uncomplicated gallbladder stones. FUNDING: none. TRIAL REGISTRATION: not relevant.

Temporal weights in the level discrimination of time-varying sounds.

To determine how listeners weight different portions of the signal when integrating level information, they were presented with 1-s noise samples the levels of which randomly changed every 100 ms by repeatedly, and independently, drawing from a normal distribution. A given stimulus could be derived from one of two such distributions, a decibel apart, and listeners had to classify each sound as belonging to the "soft" or "loud" group. Subsequently, logistic regression analyses were used to determine to what extent each of the ten temporal segments contributed to the overall judgment. In Experiment 1, a nonoptimal weighting strategy was found that emphasized the beginning, and, to a lesser extent, the ending of the sounds. When listeners received trial-by-trial feedback, however, they approached equal weighting of all stimulus components. In Experiment 2, a spectral change was introduced in the middle of the stimulus sequence, changing from low-pass to high-pass noise, and vice versa. The temporal location of the stimulus change was strongly weighted, much as a new onset. These findings are not accounted for by current models of loudness or intensity discrimination, but are consistent with the idea that temporal weighting in loudness judgments is driven by salient events.