33Understanding the particle size distribution in the air and patterns of environmental 34 contamination of SARS-CoV-2 is essential for infection prevention policies. We aimed to 35 detect SARS-CoV-2 surface and air contamination and study associated patient-level factors. 36 245 surface samples were collected from 30 airborne infection isolation rooms of COVID-19 37 patients, and air sampling was conducted in 3 rooms. 38Air sampling detected SARS-CoV-2 PCR-positive particles of sizes >4 µm and 1-4 µm in 39 two rooms, which warrants further study of the airborne transmission potential of SARS-40 CoV-2. 56.7% of rooms had at least one environmental surface contaminated. High touch 41 surface contamination was shown in ten (66.7%) out of 15 patients in the first week of illness, 42 and three (20%) beyond the first week of illness (p = 0.010). 43All rights reserved. No reuse allowed without permission.
An 86-year-old Caucasian woman presented with a 2-day history of a painful swelling in the left upper thigh anteriorly. She also gave a recent history of recurrent urinary tract infection associated with macroscopic haematuria, against a background of a long-term indwelling catheter for complete urinary incontinence. She denied any change in bowel habit and her weight had also been stable. Her past history included a hysterectomy, dynamic hip screw insertion for fractured right neck of femur and coronary artery disease. On examination she was apyrexial with no signs of anaemia, jaundice or lymphadenopathy. The left thigh swelling was confirmed to be an abscess. Abdominal and rectal examinations were unremarkable. The abscess was subsequently incised and drained. A substantial amount of pus was released. Culture of the pus yielded Proteus and Escherichia coli. Unfortunately the left thigh wound failed to heal up completely resulting in a constantly discharging sinus (Figure 1). A sonogram was then performed which revealed a fistulous track passing closely to the left greater trochanter and then superiorly projected over the left iliac wing. It then tracked medially towards the spine and particularly towards a small staghorn-like calculus on the left side. At no time was contrast seen to spill intra-abdominally (Figure 2). A subsequent computed tomography scan demonstrated that the fistulous track lay anterior to the neck of femur and passed superiorly in front of the hip joint before entering the iliacus muscle compartment retroperitoneally. The contrast then tracked superiorly until it reached the iliac crest. It continued superomedially and retroperitoneally towards the lower pole of the left kidney which contained a staghorn-like calculus. Contrast was also seen in the bladder (Figure 3). The patient did not have intravenous pyelography. A diethylene triamine pentaacetic acid (DTPA) renogram was carried out which confirmed that the patient had a non-functioning left kidney but good function of the right kidney. This woman subsequently underwent a left nephrectomy through a midline incision. The left kidney was shrunken and tethered retroperitoneally, and was associated with a well-defined fistulous track. The track was opened and curetted and an associated abscess cavity involving iliacus muscle drained. Histology of the kidney confirmed chronic pyelonephritis with scarring and presence of calculus in the dilated pelvicalyceal system. The patient made a straightforward postoperative recovery. At follow-up 3 months postoperatively, the thigh sinus had healed completely and the patient was asymptomatic.
Volume 2(2): 3-3 forward down the subintimal plane is high. Declaration of Competing Interests:
BackgroundNovel outcome measures selecting a reduced joint count for ultrasonography can be highly responsive in demonstrating the improvement in joint inflammation seen in rheumatoid arthritis (RA) patients on treatment [1].ObjectivesTo determine whether the use of the novel methods can translate into smaller sample sizes for subject recruitment into RA clinical trials. Results from the existing methods are used for comparison.Methods24 RA patients with treatment starts or escalation had clinical and ultrasound joint assessment at baseline and 3 months. The novel methods select joints based on (A) ultrasound joint findings (i.e. Individualized Ultrasound (IUS) method) or (B) a composite of ultrasound and clinical joint findings (i.e. Individualized Composite Ultrasound (ICUS) method). In contrast, the existing methods utilize pre-determined joint sites for ultrasonography. Scores at the relevant joints per patient are summed up to obtain the total inflammatory score (TIS). The effect size (ES) was measured as the mean change of the TIS divided by the standard deviation of the change in the TIS. Sample sizes were calculated from confidence intervals (CIs) on ES that reflect uncertainty in estimating ES. For a given CI on ES, sample sizes are computed as the minimum number of patients required to provide ≥80% power at α =0.05 for rejecting the null hypothesis (defined as no difference in the 3-month mean change in TIS comparing novel versus existing methods).ResultsBased on the 95% CI analysis, sample sizes using existing joint assessment methods in conjunction with the 12-joint approach ranged from 10 to 234. The corresponding sample sizes using the ICUS method with the 12-joint approach ranged from 7 to 39, and using the IUS method with the 12-joint approach ranged from 6 to 37. The corresponding sample sizes using the ICUS method with the 7-joint approach ranged from 6 to 24, and using the IUS method with the 7-joint approach ranged from 6 to 35.Table 1.Summary statistics for novel versus existing methods on 3-month change in scoresMethod/ApproachSample Estimates95% CI Mean 3-month change in TISSD of change in TISEffect SizePost-hoc Sample SizeEffect SizeSample Size ICUS/7-joint0.610.541.1390.61, 1.646, 24ICUS/12-joint0.870.910.96110.46, 1.437, 39IUS/7-joint0.660.670.99110.49, 1.476, 35IUS/12-joint0.910.940.97110.47, 1.456, 37Existing/7-joint0.100.290.3470-0.07, 0.7516, –1Existing/12-joint0.220.350.63680.18, 1.0610, 234CI: Confidence Interval; SD: Standard Deviation. 1Interval contains zero which corresponds to the null hypothesis, so upper limit cannot be calculated.ConclusionsOur findings strongly suggest that novel ultrasound joint selection methods result in smaller sample size requirements compared to existing methods, and provide justification for larger studies to confirm these observations.References Tan YK et al. Novel Ultrasound Joint Selection Methods Using a Reduced Joint Number Demonstrate Inflammatory Improvement when Compared to Existing Methods and Disease Activity Score at 28 Joints. J Rheumat...
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