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Cutaneous infections by nontuberculous mycobacteria (NTM) are not usual but their relative importance has changed during the last few years and still further changes are expected. This study comprised 13 patients from whom NTM were recovered from skin biopsy specimens, sinus exudates or cutaneous abscesses. All samples were processed according to standard methods, and the isolates were identified by biochemical testing. Skin biopsy specimens, when available, were processed for histopathological study. The clinical records of the patients were reviewed, and the relevant clinical, microbiological and epidemiological data collected. The clinical manifestations were noted to be relatively nonspecific and consisted of draining sinuses, abscesses, ulcers and nodules with multicentric or sporotrichoid patterns. Tissue culture isolated Mycobacterium fortuitum complex in nine patients, M. avium in three, and M. marinum in one. In the nine patients studied by histopathology, various patterns were observed. These included dermo-hypodermal abscesses, suppurative granulomas, tuberculoid granulomas and granulomas with a perifollicular distribution. Cutaneous lesions can thus be the first and the only sign of NTM disease, and culture still remains the definitive diagnostic procedure.

Merck & Co, Inc.

The overcrowding of Emergency Departments (EDs) is a well-known problem that has been analyzed on multiple occasions. Queuing theory and simulation have been applied extensively to specific ED situations, such as staff planning, waiting time reduction and capacity investment. However, there are remaining problems in the EDs that need more study. One of them is the ambulance diversion, which may cause a delay in the treatment of urgent patients therefore jeopardizing their welfare. Since ED are complex system and setting the diversion state in EDs is a subjective decision, a detailed modeling and analysis of cause and effects of such a decision is beneficial. In this research, we build a case-study and analyze the impact of diversion policies in various performance measures of the ED through a designed experiment using a discrete-event simulation model.

Chronic urticaria (CU) has a widespread spectrum on causal or exacerbating factors, clinical manifestations, therapeutic response and quality of life affectation. Registries are useful tools in several real-life diagnosis and management approach. We aimed to evaluate the characteristics of CU patients living in Latin America through an original cross-sectional registry with data entered by regional allergologists. Results Three hundred patients were included, being 72% female, with median age of 36 years (1–85) and 20 months of CU median evolution time. The cause of CU was reported as unknown in 72% of them. Thirty-nine percent of suspected cases presented positive serology for Mycoplasma, positive autologous serum skin test (ASST) was reported in 47%, and occasional presence of thyroid or antinuclear autoantibodies and parasites. The impact of pruritus in their quality of life was moderate to severe in 60% of patients, with almost 3 out of four patients having partial or lack of urticaria control with anti-histamines. Conclusions Our registry provides retrospective data on the real-life assistance of a large number of patients from the region. Continuous search for associated conditions and better treatment possibilities are needed, in order to control the significant impact on quality of life and the length of disease.

BackgroundSARS-CoV-2 is believed to have emerged from an animal reservoir as a zoonotic pathogen. Over the course of the current pandemic, evidence has mounted that infected humans can transmit the virus to animals including household pets, however the frequency of and risk factors for this transmission remain unclear. We carried out a community-based study of pets in households with one or more confirmed SARS-CoV-2 case among the human residents, and report here on interim findings from sampling of dogs.MethodsData collection included a survey of human and animal demographic and clinical variables, features of their shared environment, and human-animal contact; blood collection from animals for serology for anti-SARS-CoV-2 antibodies; and nasopharyngeal sampling for PCR testing for SARS-CoV-2.ResultsSampling consisted of 67 dogs from 46 households. Nasopharyngeal PCR testing results were available for 58 dogs, and serological testing results were available for 51. Clinical signs consistent with COVID-19 were reported in 14 dogs (23.7%, 95% CI 0.13, 0.35), and SARS-CoV-2 antibody testing using viral receptor binding domain ELISA was positive in 22 dogs (43.1%, 95% CI 0.30, 0.57). All PCR tests of nasopharyngeal swabs were negative. Survey respondents commonly reported close human-animal contact, and the majority of households were aware of and adopted measures to mitigate human-to-animal transmission of SARS-CoV-2 following diagnosis. While no statistically significant associations were detected between human-animal contact variables and either seropositivity or COVID-19 like illness in dogs, positive trends were found for sharing beds with humans and the number of SARS-CoV-2 positive humans in the corresponding household. Reported measures taken by the household to mitigate transmission showed a protective trend, and COVID-19 like illness in a dog was positively associated with seropositivity in that dog.DiscussionThese data indicate that human-to-animal transmission of SARS-CoV-2 in households is common, in a study population characterized by close human-animal contact. They also indicate that infected pets often manifest signs of COVID-like illness. While nasopoharyngeal sampling of dogs in this study has not to date demonstrated positive PCR results, this could be due to delays in sampling. Household members reported taking precautions to protect pets from SARS-CoV-2 infection, indicating an opportunity for further measures to reduce transmission of SARS-CoV-2 between people and animals sharing households.

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