The estimated risk of SARS-CoV- 2 infection via cornea transplant in Canada.

In late 2019 the respiratory illness, Corona Virus Disease-19 caused by the SARS-CoV-2 virus emerged in China and quickly spread to other countries. The primary mode of transmission is person-to-person via respiratory droplets. SARS-CoV-2 has been identified in conjunctiva. Transmission by cornea transplant has not been reported but is theoretically possible. We aimed to estimate the possible risk of transmission in Canada via cornea transplant during the first wave of the pandemic, and the potential risk reduction from testing decedents. We constructed a deterministic model in which the risk of transmission was estimated as the product of three proportions: decedents with SARS-CoV-2 infection, corneas that are NAT positive, and NAT positive corneas presumed to transmit. Risk was estimated according to 3 scenarios: most likely, optimistic and pessimistic. At the peak of the first wave of the pandemic risk was estimated to be 1 in 63,031 cornea transplants in Canada but could be as low as 1 in 175,821 or as high as 1 in 10,129. It would take 16 years at the peak infection of the first wave of the pandemic to observe 1 transmission. Testing would reduce the risk of 1 in 63,031 to 1 in 210,104 assuming 70% test sensitivity. The theoretical risk of SARS-CoV-2 transmission by cornea transplant is extremely low and decedent testing is unlikely to be beneficial.

Procedure-related serious adverse events among home hemodialysis patients: a quality assurance perspective.

BACKGROUND: There has been resurgent interest in home hemodialysis (HD) in recent years because of the reported benefits and its excellent safety record. However, the potential for adverse events, including potentially catastrophic ones, exists when patients are performing HD in their homes without supervision. There is a lack of literature on this important topic. STUDY DESIGN: Quality improvement report. SETTING & PARTICIPANTS: We present the experience of 2 adult home HD programs in Canada from 2001 to 2012, including a total of 190 patients and approximately 500 patient-years of treatments. QUALITY IMPROVEMENT PLAN: We retrospectively reviewed all life-threatening adverse events occurring in our programs and re-examined our approach to patient training, retraining, and safety monitoring. RESULTS: We report 1 death and 6 potentially fatal adverse events, yielding a crude rate of 0.060 events/1,000 dialysis treatments. Six of 7 events involved significant blood loss (including 1 exsanguination); 5 of 7 events involved human error with lapses in protocol adherence. Because such events are rare, evaluation of specific intervention strategies will require much longer follow-up. LIMITATIONS: Retrospective identification of cases. A specific quality improvement initiative was not undertaken. CONCLUSIONS: Life-threatening adverse events in home HD are uncommon; however, when one does occur, this should prompt review of home HD-related policies and procedures to make this therapy even safer.

Agonal sequences in 14 filmed hangings with comments on the role of the type of suspension, ischemic habituation, and ethanol intoxication on the timing of agonal responses.

The Working Group on Human Asphyxia has analyzed 14 filmed hangings: 9 autoerotic accidents, 4 suicides, and 1 homicide. The following sequence of agonal responses was observed: rapid loss of consciousness in 10 ± 3 seconds, mild generalized convulsions in 14 ± 3 seconds, decerebrate rigidity in 19 ± 5 seconds, beginning of deep rhythmic abdominal respiratory movements in 19 ± 5 seconds, decorticate rigidity in 38 ± 15 seconds, loss of muscle tone in 1 minute 17 seconds ± 25 seconds, end of deep abdominal respiratory movements in 1 minute 51 seconds ± 30 seconds, and last muscle movement in 4 minutes 12 seconds ± 2 minutes 29 seconds. The type of suspension and ethanol intoxication does not seem to influence the timing of the agonal responses, whereas ischemic habituation in autoerotic practitioner might decelerate the late responses to hanging.