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.

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Systemic amyloidosis is a life-threatening disorder with a poor prognosis. Accurate and early diagnosis of the condition is of paramount importance as early initiation of therapy improves the prognosis and survival rate. A 49-year-old gentleman presented with recurrent right exudative pleural effusion. Thoracocentesis revealed unexplained exudative pleural effusion. Pleuroscopy and pleural biopsy showed chronic inflammatory changes with no atypical cells. Echocardiography revealed global dilated cardiomyopathy with an ejection fraction (EF) of 35%. He also had nephrotic range proteinuria of 2.83g/dL. A cystoscopy examination was performed due to macroscopic haematuria, and the bladder biopsy revealed focal acellular eosinophilic material within the stroma. Salmon red staining and apple-green birefringence were noticed under polarizing microscopy, suggestive of amyloidosis. Serum protein electrophoresis revealed raised alpha 1 globulin and alpha 2 globulins which support the diagnosis of primary systemic amyloidosis. Unfortunately, the patient passed away before the initiation of treatment due to cardiogenic shock. Early and less invasive tests for diagnosing systemic amyloidosis, such as abdominal fat pad aspiration and salivary gland biopsy, can be done. Given its systemic nature, early complications screening may benefit patients whereby targeted treatment can be given.

Coronavirus disease 2019 (COVID-19) is highly contagious in symptomatic patients as it is thought to be transmitted through respiratory droplets. However, it is debatable whether asymptomatic COVID-19 patients are contagious due to lack of data. From 1 st March to 15 th April 2020, a total of 247 COVID-19 cases were admitted to Tengku Ampuan Afzan Hospital and 1010 close contacts were identified. We studied the epidemiological and clinical outcomes in asymptomatic subjects, as well as estimated the metrics of disease transmission between asymptomatic, symptomatic, and pneumonia subjects. From a total of 125 asymptomatic subjects, majority (n=116, 92.8%) remained asymptomatic upon discharge. Only 9 (7.2%) subjects developed mild symptoms after admission. Seven subjects had abnormal chest radiograph suggestive of pneumonia, and 22 subjects (17.6%) were found to have mild liver impairment. None of the asymptomatic subjects required oxygen support, inotropic support or ICU care during admission. Fifteen second generation COVID-19 cases were found transmitted from the asymptomatic group, with an attack rate of 3.9%, which was statistically significantly lower compared to the symptomatic (7.6%) or pneumonia groups (25.7%, p<0.001). In conclusion, asymptomatic COVID-19 patients show excellent clinical outcome. They are infectious but had a lower transmission risk compared with symptomatic or pneumonia patients.

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