The 11th edition of Harrison's Principles of Internal Medicine welcomes Anthony Fauci to its editorial staff, in addition to more than 85 new contributors. While the organization of the book is similar to previous editions, major emphasis has been placed on disorders that affect multiple organ systems. Important advances in genetics, immunology, and oncology are emphasized. Many chapters of the book have been rewritten and describe major advances in internal medicine. Subjects that received only a paragraph or two of attention in previous editions are now covered in entire chapters. Among the chapters that have been extensively revised are the chapters on infections in the compromised host, on skin rashes in infections, on many of the viral infections, including cytomegalovirus and Epstein-Barr virus, on sexually transmitted diseases, on diabetes mellitus, on disorders of bone and mineral metabolism, and on lymphadenopathy and splenomegaly. The major revisions in these chapters and many

Harrison's Principles of Internal Medicine

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Antiseptics and disinfectants are extensively used in hospitals and other health care settings for a variety of topical and hard-surface applications A wide variety of active chemical agents (biocides) are found in these products, many of which have been used for hundreds of years, including alcohols, phenols, iodine, and chlorine Most of these active agents demonstrate broad-spectrum antimicrobial activity; however, little is known about the mode of action of these agents in comparison to antibiotics This review considers what is known about the mode of action and spectrum of activity of antiseptics and disinfectants The widespread use of these products has prompted some speculation on the development of microbial resistance, in particular whether antibiotic resistance is induced by antiseptics or disinfectants Known mechanisms of microbial resistance (both intrinsic and acquired) to biocides are reviewed, with emphasis on the clinical implications of these reports

/pdf/antiseptics-and-disinfectants-activity-action-and-resistance-4s72yz0ujj.pdf

Antiseptics and Disinfectants: Activity, Action, and Resistance

The American Society for Testing and Materials (ASTM) is an independent organization devoted to the development of standards.

American Society for Testing and Materials

Infectious Diseases Society of America.

Scope of Coverage. Microbial Agents and Their Transmission. Risk Assessment Paradigms. Conducting the Hazard Identification. Analytical Methods for Developing Occurrence and Exposure Databases. Exposure Assessment. Conducting the Dose-Response Assessment. Conducting the Risk Characterization. Compendium of Data. Index.

Quantitative Microbial Risk Assessment

SARS-CoV-2 in wastewater: State of the knowledge and research needs.

Worldwide annually there are 1.7 million deaths from diarrheal diseases and 1.5 million deaths from respiratory infections ([56][1]). Viruses cause an estimated 60% of human infections, and most common illnesses are produced by respiratory and enteric viruses ([7][2], [49][3]). Unlike bacterial

https://courses.washington.edu/eh451/articles/fomites.pdf

Significance of Fomites in the Spread of Respiratory and Enteric Viral Disease

Publisher Summary This chapter highlights how the current understanding of the mechanisms and factors influencing virus adsorption can be used to interpret and control virus behavior in the environment. An understanding of factors controlling the interaction has already led to new and improved methods for the concentration of viruses from water, and their isolation from the environment. It is evident that not all viruses behave alike toward a solid under identical conditions. Under most natural conditions viruses with a low isoelectric point appear to be more poorly adsorbed to most solid surfaces. This must be taken into consideration when evaluating concentration or treatment systems which involve adsorption. This phenomenon is also important in determining the transport of viruses in the environment. Certain enteric viruses appear to adsorb less readily to soils and aquatic sediments than others. Thus their potential transport to groundwater may be greater and they may be less likely to settle in surface waters. To take into consideration these differences in virus behavior, it is perhaps best to use viruses with widely varying isoelectric points or marked differences in hydrophobicity to evaluate the extremes in virus interaction with a given surface which could occur.

Applied and Theoretical Aspects of Virus Adsorption to Surfaces

Polymerase chain reaction (PCR) methodologies for detection of pathogens in environmental samples are currently available. However, positive amplification products for any set of primers only signal that the appropriate target nucleic acid sequences were present in the sample. The presence of the amplification products does not imply that the target organisms were viable. Here we show that PCR will detect nonviable cells, as long as intact target nucleic acid sequences are available. In an environmental water sample, nucleic acids degraded quickly and were not detectable by PCR after 3 weeks even when stored at 4 degrees C. However, these data show that there is a window of opportunity for PCR analyses to result in false positives with respect to viable cells. We further show that care must be taken in the way samples are stored for future PCR amplifications and that filter sterilization of media is not acceptable for long-term preservation of samples for PCR.

Charles P. Gerba

Papers

Quantitative Microbial Risk Assessment

SARS-CoV-2 in wastewater: State of the knowledge and research needs.

Significance of Fomites in the Spread of Respiratory and Enteric Viral Disease

Applied and Theoretical Aspects of Virus Adsorption to Surfaces

Polymerase chain reaction detection of nonviable bacterial pathogens.