Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission

BACKGROUND AND OBJECTIVES

Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role.

METHODS

This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2.

RESULTS

From December 5 to December 17, 21 patients and 44 healthcare workers (HCWs) developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among HCWs, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%; p = 0.005). Three days before the first positive case was detected, two extractor fans were found to be defective, affecting the ventilation of three rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered.

CONCLUSION

The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.

Brote nosocomial de COVID-19 en una planta de medicina interna: probable transmisión aérea

Antecedentes y objetivos

A pesar de los datos cada vez mayores que respaldan la importancia de la transmisión aérea en la infección por el SARS-CoV-2, en la inmensa mayoría de los brotes nosocomiales descritos de COVID-19 no se ha considerado relevante. El objetivo de este estudio consiste en describir un brote nosocomial de infección por el SARS-CoV-2 cuyas características indican que la transmisión por aerosoles desempeñó un papel importante.

Métodos

Se trata de un análisis descriptivo de un brote nosocomial de infección por el SARS-CoV-2 en una planta de medicina interna que tuvo lugar en diciembre de 2020. Todos los casos se confirmaron mediante una PCR positiva para SARS-CoV-2.

Resultados

Entre el 5 y el 17 de diciembre, 21 pacientes y 44 profesionales sanitarios contrajeron una infección nosocomial por el SARS-CoV-2. De los 65 casos, 51 (78,5%) se diagnosticaron entre el 6 y el 9 de diciembre. La tasa de afectación en los pacientes fue del 80,8%. Entre los profesionales sanitarios, la tasa fue mayor en los que habían trabajado al menos una jornada laboral completa en la planta (56,3%) que en los que habían estado ocasionalmente en ella (25,8%; p = 0,005). Tres días antes de detectar el primer caso positivo se identificó una avería en 2 extractores de aire, que afectó a la ventilación de 3 habitaciones. Dieciséis casos cursaron de forma asintomática, 48 manifestaron síntomas leves y 2 precisaron ingreso en la unidad de cuidados intensivos. Todos los casos se recuperaron finalmente.

Conclusiones

La elevada tasa de afectación, la naturaleza explosiva del brote y la coincidencia en el tiempo con la avería de los extractores de aire en algunas habitaciones de la planta indican que la transmisión aérea desempeñó un papel fundamental en el desarrollo del brote.

Effect of horizontal wave barriers on ground vibration propagation

The aim of this article is to introduce a method to mitigate ground surface vibration through a flexural plate coupled to the ground and acting as a horizontal wave barrier. Using the thin plate hypothesis, two flexural plates are coupled to the ground, the first plate being the excited plate and the second plate the horizontal wave barrier. For instance, the first plate may represent a slab track and be excited by the tramway wheels. A solution to the problem can be found using a spatial two-dimensional Fourier transform of the elastodynamics equation for the ground and a modal decomposition for the flexural plate vibration. The authors show that vibration is substantially mitigated by the horizontal wave barrier and depends on its thickness and width. When the top surface wavelength becomes smaller than twice the plate width, the horizontal wave barrier acts as a wave barrier in the frequency range of interest, i.e., from 20 Hz.

Ground cross-modal impedance as a tool for analyzing ground/plate interaction and ground wave propagation

An analytical approach is investigated to model ground-plate interaction based on modal decomposition and the two-dimensional Fourier transform. A finite rectangular plate subjected to flexural vibration is coupled with the ground and modeled with the Kirchhoff hypothesis. A Navier equation represents the stratified ground, assumed infinite in the x- and y-directions and free at the top surface. To obtain an analytical solution, modal decomposition is applied to the structure and a Fourier Transform is applied to the ground. The result is a new tool for analyzing ground-plate interaction to resolve this problem: ground cross-modal impedance. It allows quantifying the added-stiffness, added-mass, and added-damping from the ground to the structure. Similarity with the parallel acoustic problem is highlighted. A comparison between the theory and the experiment shows good matching. Finally, specific cases are investigated, notably the influence of layer depth on plate vibration.

Medication use in a dual pathology program: Observational study

Introduction

Polyfarmacy is frequent in patients with dual diagnosis.

Aims

To quantify the number and describe the treatments prescribed in a cohort of outpatients with dual diagnosis.

Material and methods

A descriptive and transversal study was performed. Patients with dual diagnosis treated at an Outpatient Drug Treatment Center from January 2005 to December 2009 were included. Data from demographic, clinical and therapeutical variables were gathered once. The instruments used for the diagnosis were EuropASI y SCID-I. The number and type of prescript drugs were related with protocol variables.

Results

The study sample included 80 patients (71,6% men, average age 37,2 ± 9). Psychotic disorders (46.8%) and cocaine dependence/abuse (34.6%) were the most frequent comorbid psychiatric illnesses found. 40.8% of patients were polydrug users. The mean of prescript drugs was 3,06 ± 1,4 and only 14% of patients were on monotherapy. The frequency of drugs prescribed was: 68,4% antidepressant, 63,3% antipsychotic, 55,7% antiepileptic and 36,7% anxiolytic drugs. Older patients ( > 45years) took a major number of prescripted drugs (3,88 ± 1,1). Patients with psychotic disorders took the 43.9% of drugs prescripted (p = 0,042). Patients with benzodiazepine abuse took higher number of prescription drugs (5 ± 1,4;p = 0,003) compared with patients with other dependence or abuse.

Conclusions

Patients with dual diagnosis take high quantity of drugs. Older patients, diagnosis of psychosis and benzodiacepine abuse were related with polydrug prescription. Quantification of medication is recommended for treatment optimisation and avoiding yatrogenic.

Differential protein expression profiling by iTRAQ-2DLC-MS/MS of human bladder cancer EJ138 cells transfected with the metastasis suppressor KiSS-1 gene

e16043

Background: The use of isobaric tags for relative and absolute quantization (iTRAQ) followed by multidimensional liquid chromatography (LC) and tandem mass spectrometry (MS/MS) analysis is emerging as a powerful methodology for biomarker and drug target discovery. KiSS-1 is a metastasis suppressor gene reported to be involved in the progression of several solid neoplasias. The loss of KiSS-1 expression has been shown to be inversely correlated with increasing tumor stage and poor overall survival in bladder tumors. In order to identify the molecular pathways associated with the metastasis suppressor role of KiSS-1 in bladder cancer, we carried out a proteome discovery analysis using an iTRAQ approach. Methods: Bladder cancer cells (EJ138) were transiently transfected with a vector encompassing the full length KiSS-1 gene. Protein extracts collected after 24h and 48h transfection were fractionated, digested with trypsin and treated with iTRAQ reagents. The labelled peptides were separated through Strong Cation Exchange (SCX) and Reversed Phase LC and analysed by MALDI TOF/TOF MS. Several software packages were utilized for data analysis: ProteinPilot, Protein Center for gene ontology (GO) analysis and Ingenuity Pathway. Results: Comparative analysis among transfected, mock and empty vector exposed cells have identified more than 800 proteins with high confidence (>99%), showing high correlation rates among replicates (>70%). The involvement of the identified proteins in biological networks has served to characterize molecular pathways associated with KiSS-1 expression and to select critical candidates for validation analyses by Western Blot using independent transfected replicates. As part of complementary clinical validation strategies, inmunohistochemical analyses performed in metastatic bladder tumours spotted onto tissue microarrays (n = 175) have revealed the role of KiSS-1, ezrin and filamin in bladder cancer progression. Conclusions: Our proteomic study not only has served to reveal molecular mechanisms associated with the metastasis suppressor role of KiSS-1 in bladder cancer, but also to identify novel potential metastatic biomarkers for patients affected with bladder tumors.

No significant financial relationships to disclose.

Are the olive oil and other dietary lipids related to cancer? Experimental evidence

There is a wealth of evidence supporting the relationship between dietary lipids and cancer, particularly those of the breast, colon and rectum and prostate. The main support comes from the international correlational studies and, especially, from experimental ones. The evidence from human analytical studies is less consistent because of several conflicting findings, probably due to methodological issues. Experimentally, it has been clearly demonstrated that quantity and type of dietary lipids as well as the particular critical phases of the carcinogenesis in which they act, are the essential factors in this relationship. Thus, whereas high dietary intake of n-6 polyunsaturated fatty acids (PUFA), primarily LA, and saturated fat has tumor-enhancing effects, long chain n-3 PUFA, CLA and GLA have inhibitory effects. Monounsaturated fatty acids (MUFA), mainly OA, present in high quantities in olive oil, seem to be protective although some inconsistent results have been reported. Bioactive compounds of virgin olive oil may also account for the protective effect of this oil, which is the main source of fat in the Mediterranean diet. Experimental studies have also provided evidence of several putative mechanisms of action of dietary lipids on cancer. Lipids can influence the hormonal status, modify cell membranes structure and function, cell signalling transduction pathways and gene expression, and modulate the function of the immune system. Although further studies are needed to evaluate and verify these mechanisms in humans, based on the multiple ways dietary lipids can act, they may have an important influence on tumorigenesis.

Body temperature and response to thrombolytic therapy in acute ischaemic stroke

OBJECTIVE

To determine the relationship between body temperature (BT), arterial recanalization, functional outcome, and hemorrhagic transformation (HT) of cerebral infarction in patients treated with i.v. tissue plasminogen activator (tPA).

METHODS

We studied 254 patients treated with tPA within 3 h from stroke onset. National Institute of Health Stroke Scale score, BT, and transcranial Doppler ultrasound (n = 99) on admission and at 24 h were recorded. Hypodensity volume and HT were evaluated on CT at 24-36 h. Poor outcome (Rankin Scale > 2) was evaluated at 3 months.

RESULTS

Arterial recanalization at 24 h was found in 70.7% of patients, HT in 24.8% (symptomatic in 4.7%) and poor outcome in 44.1%. Baseline BT was not associated with greater stroke severity at admission or at 24 h, HT or poor outcome. However, BT at 24 h correlated to stroke severity (P < 0.001) and hypodensity volume (P < 0.001) at 24 h, and was higher in patients who did not recanalize (P = 0.001), had symptomatic HT (P = 0.063) and poor outcome (P < 0.001). The adjusted odds ratio of poor outcome for patients with BT at 24 h > or = 37 degrees C was 2.56 (1.19-5.50, P = 0.016).

CONCLUSION

Body temperature > or =37 degrees C at 24 h, but not at baseline, is associated with a lack of recanalization, greater hypodensity volume and worse outcome in stroke patients treated with tPA.

A health promotion programme in Adventist and non-Adventist women based on Pender's model: A pilot study

OBJECTIVE

In the last decades, the epidemiological and demographic transition in Chile has resulted in a considerable increase in diet-related non-communicable chronic diseases. The aim of this study was to determine the impact of a health promotion programme (HPP) on behaviour in terms of the dimensions of the health-promoting lifestyle profile (HPLP) based on Pender's model. Pender based his research on the development of a model that explains, predicts and modifies forms of behaviour that promote health; an HPP based on this model may achieve positive changes that promote a healthy lifestyle.

STUDY DESIGN

This was a comparative study and the participants were Seventh-Day Adventist Church women (SDAW) and non-Seventh-Day Adventist Church women (NSDAW) aged 20-45 years from the urban area of Villarrica, Ninth Region of Chile. From a population of 300 women (150 SDAW and 150 NSDAW), a random sample of 18 SDAW and 18 NSDAW was chosen. Both groups were comparable in age and socio-economic status. An HPP was undertaken for both groups between April and September 2002. The response rate was 100%.

METHODS

The overall score and the scores for the six dimensions of the HPLP (self-actualization, health responsibility, exercise, nutrition, interpersonal support and stress management) were measured in the pre- and post-test periods. Statistical analysis was performed using the Sign test and Wilcoxon's test. Data were processed using the statistical analysis system.

RESULTS

In both groups, the median scores increased significantly between the pre- and post-test periods for the overall HPLP score and the scores of the six dimensions. When comparing the median scores in SDAW with NSDAW, only the score for nutrition was significantly higher in SDAW than NSDAW in both the pre-test (P<0.0001) and post-test (P<0.0005) periods.

CONCLUSIONS

These findings demonstrate that an HPP based on Pender's model improves behaviour related to a health-promoting lifestyle in both groups, but more so for the NASDW.

Perceptions of women living with coronary heart disease: a pilot investigation

This qualitative study describes how forty-one perimenopausal and postmenopausal women with coronary heart disease (CHD) perceive their illness experience. Five focus groups were conducted by a professional facilitator at two community hospitals in New Jersey. All data were collected and analyzed based on the grounded theory approach. Findings indicate that participants often failed to recognize the significance of risk factors and symptoms, and even denied the presence of disease following diagnosis and treatment. Consequences of illness centered on women's efforts to maintain control over their health and their lives. Findings also indicate that there is a gap between the desire for knowledge and the ability to access and assimilate information in key areas regarding CHD and personal health behaviors. The insights provided by these women have several implications for future research and contribute valuable information related to the needs of this population.

"How do you feel?" Self-Reported Health as an Indicator of Current Physical and Mental Health Status

Self-reported health can serve as a reliable indicator of an individual's physical health status and future morbidity and mortality. Although patients are commonly asked "How do you feel?" they are rarely asked to rate their health on a continuum of excellent to poor. This question can be helpful in ascertaining the need for further assessment or referral.

Nursing Home Residents' Perceptions of the Quality of Their Care

This pilot study employed qualitative interviews to assess nursing home residents' perceptions of their "best" and "worst" experiences in the nursing home. Findings suggest residents are least satisfied with the care provided by nurse aides, and most satisfied with that provided by professional staff members. The quality of interpersonal relationships with staff was the basis for the majority of both residents' best and worst experiences. Qualitative analyses identified specific "adaptive responses" that were associated with how residents interpreted and responded to negative experiences with care.

STATE OF THE ART in Geropsychiatric Nursing

1. Almost 1 million people in the United States were 65 years or older in 1989. This group is anticipated to more than double, increasing to over 68 million by the year 2050. 2. Evidence from a range of studies suggests that older persons are at risk for ongoing disability as a result of the underuse of mental health services. 3. Continuing advances in our understanding of mental disorders of the elderly--particularly with respect to management and treatment--point to the necessity of ongoing continuing education for nurses practicing in all sites that serve older persons.

Psychological morale and job satisfaction among homecare workers who care for persons with AIDS

This paper reports the findings of a study of 103 home care workers who have cared for PWAs. It investigated degree of "exposure" to AIDS cases, perception of risk of occupational contagion, client/worker relationships, attitudes toward homosexuality and drug abuse and other work related factors for their relationship with psychological morale and job satisfaction. Multivariate analyses found sociodemographic characteristics and physical health to be the strongest predictors of morale. The quality of client/worker relationships and risk perception were the strongest predictors of job satisfaction. These findings, and that of the relative lack of importance of exposure to AIDS cases and attitudes toward the risk groups in accounting for job satisfaction, are discussed in terms of qualitative data collected from respondents during informal small group discussions.

Comorbidity, age, and hospital use among elderly Medicare patients

This article reports the findings of a retrospective study of elderly Medicare patients (N = 8,915) discharged from New York City hospitals prior to the implementation of the Medicare Prospective Payment System in New York State. Its purpose was to investigate physical comorbidity, mental comorbidity, age, and other factors for their relationship with hospital use. Study findings suggest that age, as used in the diagnosis-related group (DRG) classification scheme, is less powerful than comorbidity as a predictor of hospital use. Dementia, which is not recognized as a valid comorbid condition by the DRG system, was also found to be positively associated with use.

Institutional loyalty and job satisfaction among nurse aides in nursing homes

The high rate of turnover among nurse aides employed in nursing homes has been associated with the low job status and the poor job benefits accorded workers. However, this is not always the case. Competitive benefit packages and limited labor market opportunities increase the likelihood that nurse aides in some nursing homes may stay on the job despite their dissatisfaction with it. The present study investigated "institutional loyalty," an attitudinal proxy for job turnover, among 219 nurse aides for its relationship to a number of job-related factors. Somewhat unexpectedly, the quality of the social environment of the nursing home was found to be as important as attitudes toward job benefits in accounting for institutional loyalty.

[Generalized scleroderma and angioaccesses for hemodialysis]

Considering the manifold difficulties present in renal insufficiency: economical as much as those created by reinterventions in order to keep the angioacceses viable, the use of Quinton's double lumen catheter is proposed in generalized scleroderma, obliteration of several angioaccesses, absence of distal bed in left upper limb, and dry skin in a patient with chronic renal insufficiency.

Mental health and older women

Currently it is estimated that up to 25 percent of the elderly manifest symptoms of mental disorder. The recognition of the seriousness of the problem has lead to a growing body of research in the field of geriatric mental health. This paper presents an overview of early gerontological studies of life satisfaction and morale of older persons and of the two most prevalent mental health problems of the aged, depression and dementia. Mental health service delivery and utilization issues are also considered.

Illness-engendered poverty among the elderly

This paper presents an overview of the economic situation of elderly women in the United States. Its focus is on "illness-engendered poverty," a type of poverty that results from the inadequacies of Medicare coverage of long-term care and the subsequent need of many elderly to "spend down" into poverty in order to qualify for means-tested, publicly financed health and social programs. The consequences of Medicaid eligibility requirements and system incentives on the economic and social well-being of older women and their families are discussed.

Lipid accumulation in jejunal and colonic mucosa following chronic cholestyramine (Questran) feeding

The hypolipidemic agent, cholestyramine (Questran), when fed to rats inhibits intestinal absorption of cholesterol and triglycerides and causes significant epithelial cell damage in both small and large intestine. In this study, we report significant accumulation of lipids in the mucosal layer of both jejunum and colon in rats administered 2% cholestyramine for a four-week period, when compared to a control group maintained on regular chow. The total lipid increment with cholestyramine was 4.7-fold in the jejunum and 3.7-fold in the colon. The triglyceride fraction increased substantially in the small but not the large intestine. Relative phospholipid levels decreased in the treated jejunum but not in the colon. The biochemical data were reflected in morphological evidence of lipid-laden enterocytes obtained by light and transmission electron microscopy. Since cholestyramine has been shown to sequester 99.8% of micellar phospholipid in vitro, it is concluded that the presence of cholestyramine in the intestinal lumen may interfere with phospholipid availability for chylomicron synthesis and serosal lipid exit from the epithelium. This unusual deposition of lipid within the mucosal layer may also be correlated with the known cocarcinogenic effect of this resin in experimentally induced intestinal cancer.

Morphological disruption of colonic mucosa by free or cholestyramine-bound bile acids

In order to assess the effects of free or resin-bound bile acids on colonic topography, adult rats were surgically provided with an indwelling infusion catheter in the proximal cecum, which exited at the neck behind the head. Conscious, unrestrained rats were allowed chow ad libitum and were administered 1 ml of an infusion mixture twice daily for five days. The infusion mixtures included either carrier saline, 100 mg cholestyramine, 165 mumol mixed bile acids, or the bile acids bound to cholestyramine. Additional groups of rats were fed defined diets with and without 2% cholestyramine. Compared to fed controls, colonic infusions of saline had little effect on colon topography. Infusions of 100 mg of cholestyramine in saline twice each day did cause some apparent damage to surface morphology of the colon, but not to the extent observed during feeding of the resin as 2% of the diet. In contrast, extensive surface damage of the colon was observed by twice daily infusions of either 165 mumol of an equimolar mixture of cholic, deoxycholic, and chenodeoxycholic acids, or by the bile acids mixed previously with the ion-exchange resin. The data suggest that topographical damage of the colon observed during feeding of bile acid-sequestering resins is in large part due to increased concentrations of either bound or unbound bile acids in the large bowel.

Ultrastructural modifications of intestinal and colonic mucosa induced by free or bound bile acids

There is substantial evidence that bile acids may enhance the colon tumorigenesis induced by chemical carcinogens and that agents stimulating increased bile acid excretion may show similar promoting or enhancing activity. To test the premise that these agents might modify topographical ultrastructure of the small intestine and colon in the absence of carcinogens, rats were fed for 6 weeks on chemically defined diets containing 2% levels of three commercial bile acid sequestrants or 15% levels of wheat brain, cellulose, pectin, or alfalfa. Major qualitative and quantitative deviations from normal morphology were observed with each of the three sequestrants. Similar but less dramatic modifications occurred with diets containing alfalfa or pectin, both of which either "bind" bile acids in vitro or result in increased bile acid excretion. Bran and cellulose which neither "bind" bile acids nor increase their fecal excretion, were without significant effects on intestinal or colonic morphology. The morphological deviations observed with bile acid sequestrants were shown to be a direct response to free or bound bile acids by comparing the morphological modifications resulting from daily intracolonic infusions of free bile acids, sequestrant-bound bile acids, or the sequestrant alone.