Hot Tub Research Articles

Legionnaires' Disease Outbreak Associated With a Hot Tub Display at the North Carolina Mountain State Fair, September 2019.

On September 23, 2019, the North Carolina Division of Public Health identified a legionellosis increase in western North Carolina; most patients had recently attended the North Carolina Mountain State Fair. We conducted a source investigation. Cases were fair attendees with laboratory-confirmed legionellosis and symptom onset within 2 to 14 days (Legionnaires' disease) or ≤3 days (Pontiac fever). We conducted a case-control study matching cases to non-ill fair attendees as control participants and an environmental investigation, and we performed laboratory testing (Legionella bacteria culture and polymerase chain reaction) of 27 environmental samples from fairgrounds and hot tubs and 14 specimens from case patients. We used multivariable unconditional logistic regression models to calculate adjusted odds ratios for potential Legionella exposure sources and risk factors. Of 136 people identified with fair-associated legionellosis, 98 (72%) were hospitalized and 4 (3%) died. Case patients were more likely than control participants to report walking by hot tub displays (adjusted odds ratio = 10.0; 95% CI, 4.2-24.1). Complete hot tub water treatment records were not kept, precluding evaluation of water maintenance conducted on display hot tubs. Legionella pneumophila sequence types (STs) were consistent among 10 typed clinical specimens (ST224) but distinct from the only positive environmental sample from the fair (ST7 and ST8). Hot tub displays were identified as the most likely outbreak source, making this the largest hot tub-associated Legionnaires' disease outbreak worldwide. Following the investigation, the North Carolina Division of Public Health and the Centers for Disease Control and Prevention released guidance on mitigating risk of Legionella exposure from hot tub displays. Results highlight the importance of properly maintaining equipment that aerosolizes water, including hot tubs intended for display purposes only.

West Coast Weather

West Coast Weather Grace Kearney (bio) We had not spoken in months when you invited me to your baptism—your "bapti-Zoom"—and I heard myself saying, "Yes, of course," as I have to all your rebirths. The ceremony took place in a backyard pool in Berkeley, befitting, to my mind, the ill-defined character of the church to which you now belonged. ("When a church has a podcast and a professionally designed website but no denomination listed, it's Evangelical," my sister in divinity school told me, foretelling your repeated attempts to bring me into its fold.) The video quality was poor, which was too bad, as I wanted to hear which Bible verse you had chosen to read. I heard only the splash, and the faint sound of applause. I had angled my camera so that you could see, though you did not look, the wall behind me, where the painting you made me five years ago still hangs. Inspired by The Phantom Tollbooth, it shows a little boy driving an open-roofed car down a road lined with palms, their trunks wavy and distorted, like driving in a dream. ________ When we found the Enterprise on Escondido Road closed on Sundays, we downloaded a car-sharing app and with a few taps secured a shiny red car, available immediately on the other side of campus. It was our junior year of college and we were prone to shortcuts. Plus, it was a convertible, and nothing is more Spring Break or Road Trip or Route 1 than a red convertible. Prone, too, to the idea of Platonic forms. We had both been reading Plato's Republic when we met, high on our own intellect like so many college freshmen before us. While the trappings of reality surrounded us—the election of a Dorm President, the mad scramble for friend groups—we closed the door and sat cross-legged on my thin mattress and decided the Real lay elsewhere. We answered each other's questions with questions. You drew diagrams. Whenever a third party entered the room, the difference was obvious: men spoke at us, and we spoke to each other. There was only one solution, we joked, platonically. We went to parties only to observe and debrief on the stumbling walk home. On Halloween, we went to Sig Ki with everyone else but [End Page 45] wore white bedsheets over our heads, sexless and bodiless, eyes and ears only. As we peeled onto 280 North, the wind was merciless. For the sake of Spring Break we kept the roof down, but it was too cold when night fell and we realized the roof was stuck. The wind blew our voices back into our mouths, wiped the sheen from our faces. Not long after, the front left tire blew out. You were driving and I was annoyed by your carelessness, though of course it was not your fault. But hadn't this happened to your own car last month? You didn't answer. You were annoyed, too, because now Angelo would be asleep by the time we got there. He was, and so was everyone else, laid out in sleeping bags on the wooden deck. You crawled into his, and I lay out my own. Harbin Hot Springs, according to the website, was a hot spring retreat and workshop center. According to its patrons, it was a nudist camp. This was something your Angelo was into, and you were talked into, and I accepted as a detour on our trip. There was a recommended order for the array of heated pools: tepid bathtub water, standard hot tub water, icy pool water, and a boiling pot with clay walls, where I sat and let blackness hover on the edges of my vision. Time passed in a dizzy blur of bodies. I didn't see you for most of the day, until I wandered into the communal pantry and there you were, eating chocolate chips and raspberries. "Have you ever done this?" I asked, and pressed a chocolate chip into the pocket of a raspberry. "No, but it's perfect," you said. You shared my food kleptomania. That first year together...

Molecular Identification, Isolation, Morphologic and Serologic of Acanthamoeba sp. Throw the Ovary of Sprague-Dawley Rats.

<b>Background and Objective:</b> Typically, free-living amoebae, members of the genus <i>Acanthamoeba</i> can exist in a range of biological niches, such as fresh and brackish water, filters for heating, soil, airborne dust, ventilation, in addition to air conditioning, as well as pools and hot tubs. On rare occasions, these can be linked to infections of the central nervous system in both people in addition to animals. This study aimed to identify the cause of rats' death by isolating and identifying <i>Acanthamoeba</i> sp., from the ovary of Sprague-Dawley rats. <b>Materials and Methods:</b> An amoeba was identified and cultured from the ovary of Sprague-Dawley rats that succumbed to an amoebic illness. Considering culture attributes, growth shape and immunofluorescence measures, <i>Acanthamoeba</i> sp., was determined as the infecting amoeba. <b>Results:</b> <i>Acanthamoeba</i> sp., the contaminating single adaptable cell, was discovered. Furthermore, by sequencing a symptomatic part of the atomic little subunit ribosomal RNA gene to recognize the one-celled critter as <i>Acanthamoeba</i> sp., <b>Conclusion:</b> An <i>Acanthamoeba</i> strain was demonstrated that has a wide range of genotypes and is capable of infecting people and other species can also infect rats fatally.

Associations of household factors, hot water temperature, and chlorine residual with Legionella occurrence in single-family homes in New Jersey

Only 4 % of reported Legionnaires' disease (LD) cases are outbreak-associated and the remaining 96 % are sporadic, for which no known source of Legionella is identified. Although outbreaks of LD are linked to cooling towers, decorative fountains, spas and hot tubs, and other sources, the drivers of sporadic LD are less known. Residential premise plumbing is likely an important source of aerosol exposure and there are unique features of premise plumbing which could lead to proliferation of Legionella. A sampling study of Legionella in single-family homes was undertaken in NJ from 2020 to 2021 which included a household characteristic survey and collection of hot water temperature and chlorine residual during sampling. A total of 94 homeowners residing in owner-occupied, single-family units with individual hot water systems were recruited to participate through two mechanisms (1) Legionnaire's disease case-patients and (2) non-case volunteers from each NJ county. Among the 94 single-family homes sampled, 15 % had least one sample positive for Legionella by culture and 57 % had at least one sample with detection of Legionella DNA markers by PCR. Chlorine residual, hot water temperature, and season were independently associated with increased detection of Legionella in home water samples. There was limited or inconsistent evidence of the role of household characteristic factors in Legionella detection. This study identified season, insufficient chlorine residual and hot water temperature as risk factors for Legionella detection in single-family homes. Findings from this work can promote additional partnership between public health and water utilities in improving chlorine residuals in residential communities and educating homeowners on best practices for home water management.

America: What Time is Love?

America:What Time is Love? Satori Good (bio) Dude she's spawning. Hide the spade!" "Which one?" "Hurry she's right behind—" "Which one!" I yell, spamming A. The Skeleton King's spine morphs into a serpent that wraps around Stalker24's throat. "Alecto!" Shit. I scroll through my inventory and chuck the spade, but it's too late. Alecto, with her owl eyes and snake arms, is impossible to beat. She possesses the king's body, hoists the spade with ease, and whacks me over the head. ERINYES WIN. I shove my desk in frustration. A mixture of apple cider vinegar, dish soap, and dead gnats splashes on the floor. I soak it up with a pair of boxers. "I told you to hide the spade," says Stalker24 when I reenter the chat. "We were so close—" "Another round?" It's 2:45. "I should shower before work." "Marcel, you're so boring," he says. Stalker24 likes my name, and never forgets it either. His is something Jag. Jaguar. "Jagdish, not everyone owns a crypto empire." "Offer still stands. You move to Delhi, and we play Fight of Furies every day. No work!" "Cap." "No cap." I shut the laptop because he gets on my last nerve, lounging in his Sultanpur luxury farmhouse while I can barely afford boots that adhere to the TSA Personal Appearance Standard. [End Page 59] He's sweet though, Stalker24. I strip off my hoodie and start the shower. If I wanted to abandon my bleary-eyed life in this shitty suburban condo, Jagdish's farmhouse would be my first stop. We'd hang Halloween fairy lights around his hot tub. Mix Fireball with Angry Orchards and watch the Survivor fiftieth anniversary special. Talk about our favorite band, the Kopyright Liberation Front, and their money-burning and sheep-killing stunts in the name of anarchy and art. But Jagdish built his life online. I built mine with food stamps and job interviews. I'm no sugar baby. _______ As a kid I had nine career plans. Environmental biologist for the EPA. Architectural engineer. Truck driver. Bar bouncer. Anthropologist, sociologist, Buffalo Wild Wings manager. Museum curator. Professor in African American Studies, which I went to school for, until there were no job openings and my cousin who worked concessions at the Charlotte Douglas Airport suggested I do transportation security. I keep the job for Macy's college fund. Macy is the best mistake I ever made. On weekends when I have custody, we attend a sailing club where she teaches me TikTok dances and different types of knots. She knows over fifty dances. Fourteen knots! On my way to work, I text her good morning and stop at Shell for coffee and a piss. The bathroom lock gets jammed and the front desker has to navigate being faded and using power tools to release a blue-poloed Black dude from Windex-flavored prison. I'm fifteen minutes late. Val glares at me from the metal detectors, and I half jog to the X-ray machine. "We're low on bins," says Poppy, a marine vet. "Who's stealing them?" I shrug and spray sanitizer on the belt. "You watch the news?" she says. "Nah." "It's gonna be crowded today," says Poppy. "Cr-ow-ded. Almost called in." "You and everyone else." [End Page 60] We're missing five people. The other checkpoint agents, Denzel and Maria and Kaleb, huddle near Val's desk. I intend to ask more questions, but the trickle of passengers becomes a line for the 5 a.m. flights. I get in X-ray flow, analyzing the sunset-orange images of bags and shoes and laptops. I love it. We break life down to its bare essentials, the few things we need to survive. My scans are rarely interrupted, apart from the occasional too-big sunscreen bottles and biscuit packages from forgotten flights. "Hold up." The words escape before I can think. "What?" Poppy says. We stare at the backpack scan. A Hydroflask, a wallet, several transparent wads of cloth. And a human skull. It's too early for Halloween. "What's this?" I say, but Poppy's...

Surveillance of Legionella pneumophila: Detection in Public Swimming Pool Environment.

The bacterium Legionella pneumophila is a ubiquitous microorganism naturally present in water environments. The actual presence of this opportunistic premise plumbing pathogen in recreational swimming pools and hot tubs in the northwestern part of Croatia has not been investigated. This study aimed to analyze the presence of the opportunistic pathogen L. pneumophila in public swimming pool water in Primorje-Gorski Kotar County (N = 4587) over a four-year period (2018-2021). Additionally, the second aim was to investigate the connection between the presence of L. pneumophila and pool water physicochemical parameters using mathematical predictive models. The presence of L. pneumophila was detected in six pool samples. Five positive samples were found in the water of indoor hot tubs filled with fresh water, and one positive sample in an outdoor recreational saltwater pool. A predictive mathematical model showed the simultaneous influence of chemical parameters dominated by the temperature in saltwater and freshwater pools, as well as the significant influence of free residual chlorine and trihalomethanes. Our results pointed out that keeping all physicochemical parameters in perfect harmony is necessary to reach the best disinfection procedure and to avoid the optimum conditions for L. pneumophila occurrence.

Two Cases of Legionnaires’ disease following exposure to a hot tub at a private residence – Ontario, 2021

On September 10, 2021, the Haliburton, Kawartha, Pine Ridge District Health Unit in Ontario, Canada, received a case report of Legionella pneumophila serogroup 1 in a patient (case 1) hospitalized for pneumonia. A second case (case 2) within the same household was also identified. Case 1 was laboratory diagnosed by urine antigen testing, whereas case 2 was diagnosed by PCR and culture from a respiratory specimen collected from case 2, both at Public Health Ontario Laboratory, Ontario, Canada. Cases were linked by household and both cases were exposed via a newly purchased but previously used hot tub. Samples from the hot tub were culture positive when tested at PHO’s Laboratory. Given a respiratory culture isolate was available, together with an environmental isolate from the hot tub, sequence based typing was undertaken. Having both a clinical and an environmental culture isolate is essential for molecular investigations. The sequence type for the clinical isolate was the same as the environmental isolate, providing additional evidence that the hot tub was the source of infection for both cases.

The Drinking Water and Swimming Pool Disinfectant Trichloroisocyanuric Acid Causes Chlorination Stress Enhancing Solar UV-Induced Inflammatory Gene Expression in AP-1 Transgenic SKH-1 Luciferase Reporter Mouse Skin.

Freshwater sanitation and disinfection using a variety of chemical entities as chlorination agents is an essential public health intervention ensuring water safety for populations at a global scale. Recently, we have published our observation that the small molecule oxidant, innate immune factor and chlorination agent HOCl antagonize inflammation and photocarcinogenesis in murine skin exposed topically to environmentally relevant concentrations of HOCl. Chlorinated isocyanuric acid derivatives (including the chloramines trichloroisocyanuric acid [TCIC] and dichloroisocyanuric acid [DCIC]) are used worldwide as alternate chlorination agents serving as HOCl precursor and stabilizer compounds ensuring sustained release in aqueous environments including public water systems, recreational pools and residential hot tubs. Here, for the first time, we have examined the cutaneous TCIC-induced transcriptional stress response (in both an organotypic epidermal model and in AP-1 luciferase reporter SKH-1 mouse skin), also examining molecular consequences of subsequent treatment with solar ultraviolet (UV) radiation. Taken together, our findings indicate that cutaneous delivery of TCIC significantly enhances UV-induced inflammation (as profiled at the gene expression level), suggesting a heretofore unrecognized potential to exacerbate UV-induced functional and structural cutaneous changes. These observations deserve further molecular investigations in the context of TCIC-based freshwater disinfection with health implications for populations worldwide.

(In)visible moderation: A digital ethnography of marginalized users and content moderation on Twitch and Reddit

Research suggests that marginalized social media users face disproportionate content moderation and removal. However, when content is removed or accounts suspended, the processes governing content moderation are largely invisible, making assessing content moderation bias difficult. To study this bias, we conducted a digital ethnography of marginalized users on Reddit’s /r/FTM subreddit and Twitch’s “Just Chatting” and “Pools, Hot Tubs, and Beaches” categories, observing content moderation visibility in real time. We found that on Reddit, a text-based platform, platform tools make content moderation practices invisible to users, but moderators make their practices visible through communication with users. Yet on Twitch, a live chat and streaming platform, content moderation practices are visible in channel live chats, “unban appeal” streams, and “back from my ban” streams. Our ethnography shows how content moderation visibility differs in important ways between social media platforms, harming those who must see offensive content, and at other times, allowing for increased platform accountability.

Screen-printed Electrodes with Stable Solid-state Reference Electrode for Oxidation-reduction Potential (ORP) Measurement Applications

ORP is defined as the electromotive force between a noble metal electrode and a reference electrode when immersed in solution [1]. The electrochemical setup typically involves a platinum wire as a working electrode (sometimes gold, rarely silver) and a well-controlled reference electrode. When these electrodes are immersed together into a solution, an electron migration is produced between the working electrode and the solution. Depending on the nature of the species diluted, the working electrode loses electrons if the media is an oxidant, so the potential measured becomes positive. If the media is reductive, the working electrode gains electrons, and the resulting potential will be negative. Voltage is measured between both electrodes (working and reference electrode), so the ORP value is usually given in millivolts.ORP provides valuable information because it is a measure of sanitizer activity and water quality, due to the changes in ORP being associated with the existence of contaminants or biological activity. ORP measurements are also useful in several major industrial applications where maintaining potential in a production stage under control is a critical parameter or when it is necessary to assure the quality of water. Examples include cyanide oxidation or chrome reduction in wastewater treatment of metal-plating industry residues, bleach production and bleaching of paper, biological growth control in cooling towers and water quality monitoring in swimming pools, hot tubs, spas, or aquafarming.Screen-printed electrodes (SPEs) offer several interesting advantages in industrial applications such as point-of-care testing, usability, and a wide range of possible customizable setups. However, most SPEs include a pseudo-reference electrode fabricated with silver or silver/silver chloride. Since the KCl electrolyte is absent, this pseudo-reference electrode is exposed to media implying that the reference electrode is not under control, especially in aggressive media. In this publication, an SPE with a platinum paste working electrode and a controlled solid-state reference electrode is presented. Several experiments are included to show that these platforms offer ORP monitoring in household, industrial or laboratory applications.

The acute effects of passive heating on endothelial function, muscle microvascular oxygen delivery, and expression of serum HSP90α.

Passive heating has been a therapeutic tool used to elevate core temperature and induce increases in cardiac output, blood flow, and shear stress. We aimed to determine the effects of a single bout of passive heating on endothelial function and serum heat shock protein 90α (HSP90α) levels in young, healthy subjects. 8 healthy subjects were recruited to participate in one bout of whole-body passive heating via immersion in a 40°C hot tub to maintain a 1°C increase in rectal temperature for 60min. Twenty-four hours after heating, shear-rate corrected endothelium-dependent dilation increased (pre: 0.004±0.002%SRAUC; post: 0.006±0.003%SRAUC; p=0.034) but serum [HSP90α] was not changed (pre: 36.7±10.3ng/mL; post: 40.6±15.9ng/mL; p=0.39). Neither resting muscle O2 utilization (pre: 0.17±0.11mL O2 min-1 (100g)-1; post: 0.14±0.09mL O2 min-1 (100g)-1); p=0.28) nor mean arterial pressure (pre: 74±11mmHg; post: 73±11mmHg; p=0.79) were influenced by the heating intervention. Finally, time to peak after cuff release was significantly delayed for % O2 sat (TTPpre=39±8.9s and TTPpost=43.5±8.2s; p=0.007) and deoxy-[heme] (TTPpre=41.3±18.1s and TTPpost=51.4±16.3s; p=0.018), with no effect on oxy-[heme] (p=0.19) and total-[heme] (p=0.41). One bout of passive heating improved endothelium-dependent dilation 24h later in young, healthy subjects. This data suggests that passive heat treatments may provide a simple intervention for improving vascular health.

Investigation of a cluster of rapidly growing mycobacteria infections associated with joint replacement surgery in a Kentucky hospital, 2013–2014 with 8-year follow-up

We describe the investigation of a nosocomial outbreak of rapidly growing mycobacteria (RGM) infections and the results of mitigation efforts after 8 years. A cluster of RGM cases in a Kentucky hospital in 2013 prompted an investigation into RGM surgical site infections following joint replacement surgery. A case-control study was conducted to identify risk factors. Eight cases were identified, 5 caused by M. wolinskyi and 3 by M. goodii. The case-control study showed the presence of a particular nurse in the operating room was significantly associated with infection. Environmental sampling at the nurse's home identified an outdoor hot tub as the likely source of M. wolinskyi, confirmed by pulsed-field gel electrophoresis and whole genome sequencing. The hot tub reservoir was eliminated, and hospital policies were revised to correct infection control lapses. No new cases of RGM infections have been identified as of 2021. Breaches in infection control practices at multiple levels may have led to a chain of infection from a nurse's hot tub to surgical sites via indirect person-to-person transmission from a colonized health care worker (HCW). The multifactorial nature of the outbreak's cause highlights the importance of overlapping or redundant layers of protection preventing patient harm. Future investigations of RGM outbreaks should consider the potential role of colonized HCWs as a transmission vector.

Never Feed Birds in the Hot Tub! A Case of Bird-Fancier's Lung

A 50-year-old female non-smoker with a past medical history of rheumatoid arthritis and asthma presented to the pulmonology clinic with a chief complaint of acute on chronic exertional dyspnea for 6 months. The patient was discharged from the hospital 2 weeks prior and was given the diagnosis of acute hypoxemic respiratory failure secondary to asthma exacerbation. She was discharged with a 7-day course of prednisone, which temporarily improved her dyspnea, and an outpatient referral was placed.

Environmental surveillance of Legionella in tourist facilities of the Balearic Islands, Spain, 2006 to 2010 and 2015 to 2018.

BackgroundLegionnaires’ disease is a respiratory illness often associated with hotels and travel. Spain is a major tourist destination and one of the European countries with most cases of Legionnaires’ disease , both community- and travel-associated. However, the prevalence of Legionella in tourist facilities is unknown.AimThe present investigation aimed to survey the tourist facilities in the Balearic Islands, Spain, for Legionella prevalence.MethodsWe visited tourist facilities in the Balearic Islands in two different periods (2006–2010 and 2015–2018) and took water samples following national and international guidelines. Legionella was investigated by culture methods following international standards (ISO 11731:1998).ResultsWe evaluated 13,472 samples from 465 facilities. Bacteria of the Legionella genus were detected in 65.4% of the surveyed facilities. Contamination of the facilities was significantly higher during the second decade (54.5 vs 78.6%). The most frequent colonisers were L. pneumophila serogroup 2–14. We detected the pathogen in 15.9% and 6.9% of hot and cold water distribution systems samples, respectively. The Legionella contamination rate in cold water systems samples was higher when free chlorine levels were < 0.2 mg/L and at > 25 °C temperatures, while in the hot water systems samples, the contamination rate was higher at < 50 °C. Of the samples from hot tubs, 10.9% were contaminated.Conclusion Legionella prevalence in hotels in the Balearic Islands was high but the contamination rates depended on the installations. Corrective measures are still needed to improve Legionella control.

Severe acute necrotising Community Acquired Pneumonia with Pyopneumothorax due to Pseudomonas aeruginosa in a healthy young girl

Aim: We report this case to acknowledge the presence of multi drug resistant Pseudomonas aeruginosa in the community setting, which transpired in a young female, without any known comorbidity or exposure risk.&#x0D; Background: Pseudomonas aeruginosa is an extremely unusual pathogen in community acquired pneumonia (CAP), especially in previously healthy young adults. Immune status, underlying lung disease and possible exposures like hot tub use, should always be ruled out. There have been reports of bacterial aetiology being next common after Tuberculosis for Pyopneumothorax, but ours is the first case to report P.aeruginosa as a cause of CAP and pyopneumothorax in an absolutely healthy young adult.&#x0D; Case description: A young female, developed Pneumonia from the community setting which grew a nosocomial organism. Complications involved cavity formation and Pyopneumothorax, which required Intercostal Drainage (ICD) and extensive intravenous antibiotics. Immediate and appropriate management is life saving.&#x0D; Conclusion: CAP due to heinous organisms like Pseudomonas aeruginosa should be suspected in any patient who presents with a rapidly progressive course, even in the absence of risk factors and exposures. In cases of Pleural effusion or Pneumothorax or both, ICD drain should be inserted. Broad spectrum antibiotic coverage especially in hemodynamically unstable patients should be initiated immediately, followed by antibiotic stewardship protocols.&#x0D; Clinical significance: We would like to emphasize the importance of acquiring cultures from respiratory site, for early initiation/switching of appropriate antibiotics. Also Pseudomonas being an ominous organism yields a finer prognosis only when treated with appropriate anti-pseudomonal antibiotics.

"Hot Tubbing" of Expert Witnesses: Experiences in Other Jurisdictions and Expected Issues at the Tax Court of Canada

Practice Note no. 22, dated March 11, 2019, sets out the procedure for the "hot tubbing" of expert witnesses at the Tax Court of Canada. The practice note directs judges to convene a pretrial expert panel before the experts are examined concurrently at trial. In this article, the author reviews the benefits and perceived shortcomings of hot tubbing reported in other jurisdictions that permit the practice, explains the Tax Court procedure, and discusses issues that are expected to arise in Tax Court cases. The author argues in favour of hot tubbing and suggests revision of the practice note to incorporate approaches that could conserve judicial resources while enhancing the quality of expert evidence.

ЛЕГЕНЕВИЙ СИНДРОМ «ГАРЯЧОЇ ВАННИ»

HOT TUB LUNG Y. O. Dziublyk Abstract This review deals with current approaches to etiology, pathogenesis, clinical features and diagnostics of hot tub lung. The aim of the report is to extend the knowledge of practicing physicians in the area of interstitial lung diseases considering possible role of environmental exposures. Hot tub lung is a granulomatous lung disease, resulted in hyperreactive response of immune system to airborne exposure with nontuberculous mycobacteria (NTM). ATS diagnostic criteria for hot tub lung include the sub-acute onset of respiratory symptoms associated with hot tub exposure, positive mycobacterial cultures from respiratory and water samples, and characteristic radiographic findings. Treatment of this condition rests on avoidance of exposure with bacterial antigens and a trial of corticosteroid therapy. Better understanding of this pathology would help physician with sometimes difficult differential diagnosis of interstitial lung diseases. Key words: hot tub lung, nontuberculous mycobacteria, hypersensitivity pneumonitis. Ukr. Pulmonol. J. 2022;30(1):25–29.

Hiding Spot

Hiding Spot Caroline Kim (bio) It was a good hiding spot. Too good. Mrs. Lee stood in her closet with her hands on her hips, squeezing her eyes shut, telling herself to “think, think.” She could almost see it, see herself folding tissue paper around her wedding rings, pushing them down into a blue velvet pouch that also held her wedding pearls and a white jade ring passed down from her mother. Yes, she could almost even feel herself pulling the yellow drawstring tightly closed and putting it all . . . where? In a box? Under something? In something? Scornfully, she remembered congratulating herself for picking such a good hiding spot because no one would think to look there. She felt like a character in a folktale, an old fool, tripped up by her own cleverness. It was only three months ago that she had hidden her jewelry, in the days before she and Mr. Lee went on a cruise to Alaska. They weren’t the vacationing type, but one day while Mr. Lee was reading the Chosun Ilbo online, he saw an ad for a cruise line offering incredible deals. “It’ll feel like we’re losing money if we don’t go,” he said. The only catch was that the cruise left in just a few days from Seattle. No problem. Isn’t this why they’d retired from their dry-cleaning business the year before? They certainly didn’t have to worry about anyone missing them. Not a single person would be affected if they left at a moment’s notice. So they flew from Atlanta to San Francisco to Seattle and spent a week in a tiny, closet-sized room with no windows, disembarking in the mornings to take other, smaller boats out to where they took pictures of melting glaciers and smelly, wild-looking sled dogs. Mr. Lee couldn’t sleep because of the nonstop humming of the ship which Mrs. Lee hardly noticed. While he spent hours lying in their tiny room watching Korean dramas and reading newspapers on his laptop, Mrs. Lee sat out on the top deck watching people brave the chilly air to swim in the pools or sit in the foamy waters of the hot tub, which Mr. Lee called “people soup.” The only good parts were the entertainment and the profligate amount of food on the ship, which Mrs. Lee found unnerving though it did not stop her nor Mr. Lee from stuffing themselves at all hours of the day and night. When they returned home, Mrs. Lee didn’t look for her rings right away. But on the evening they were invited to a dol by the Chois, whose plump grandson was turning one, Mrs. Lee discovered she couldn’t remember where she’d hidden her rings. At first she didn’t worry. Her memory had just turned shy, refusing to reveal what she needed to know when she was too focused on it. This had happened to [End Page 134] her her whole life. Thinking too much about one thing made it flee instead of getting it nailed down. She figured the pouch would turn up eventually when she was looking for something else. But now there was an urgency. She needed to find her rings because Ken had showed up the night before, with a girl, no less. Ken, the son she hadn’t seen for two years. ________ Mrs. Lee moved quietly through the house because Ken and the girl were still sleeping. Mr. Lee was at the YMCA getting in his laps before the pool became crowded. Their new house was a lot smaller than their last; they had downsized a year back after taking a good long look at their finances. But the two of them were fine in a small bungalow with just the two bedrooms, the larger one for sleeping, the smaller one as Mrs. Lee’s craft room, where Ken and his girl were now sleeping. She kept a bookcase of yarn and a sewing machine on a desk in there, a comfortable chair where she knit hats and blankets, sewed baby-sized quilts for her church to donate. But there...

English

When it comes to natural medicine, the use of water or hydrotherapy is as old as humankind. Hydrotherapy is also known as water therapy, pool therapy, balneotherapy and aquatic therapy. Water as a treatment aid was used in various parts of Rome, Greece, Egypt, China and Japan in the ancient period. Water therapy means using water for medicinal purposes like hot tubs, cold water treatments, ice packs, steam vapours, saunas, mineral springs, hot springs, wet towel applications, water exercises, and water massages. Therefore, the use of water at different temperatures and in different forms provides various effects on several systems of the body. Great results of hydrotherapy were experienced by people in physical functioning, energy, sleep, cognitive function, ability to work and participation in daily life. Based on the available data and literature this review propounds that water therapy has an empirical evidence-based outcome on various systems of the body. KEY WORDS Natural Medicine, Hydrotherapy, Empirical Evidence-Based, Various Systems.

Antigen avoidance and outcome of nonfibrotic and fibrotic hypersensitivity pneumonitis.

BackgroundHypersensitivity pneumonitis (HP) is classified into nonfibrotic and fibrotic phenotypes. Patients with nonfibrotic HP often experience recurrence and develop fibrosis, whereas those with fibrotic HP have a poor prognosis. Although antigen avoidance has long been the first line of treatment for HP, its impact on prognosis has been poorly reported.MethodsMedical records of 121 patients with HP diagnosed by new diagnostic criteria of American Thoracic Society/Japanese Respiratory Society/Asociación Latinoamericana del Tórax (ATS/JRS/ALAT) guidelines and treated at our institution in Saitama, Japan, were retrospectively analysed. HP was classified into nonfibrotic and fibrotic phenotypes and six HP subtypes: summer-type, bird-related, home-related and occupational HP, humidifier lung, and hot tub lung. Achievement of reduced exposure to inciting agents was divided into complete antigen avoidance (CAA) and incomplete antigen avoidance (IAA) by HP subtype.ResultsOf the 74 patients with nonfibrotic HP, 30 achieved CAA and experienced no recurrence or development of fibrosis. In the remaining 44 patients with IAA, 24 (54.5%) experienced recurrence and/or development of fibrosis. The all-cause 5-year mortality rate in the 47 patients with fibrotic HP was 47.8%. Negative prognostic factors of HP-related mortality in these patients were <50% lymphocytes in bronchoalveolar lavage (BAL) and honeycombing. Multivariate analysis showed a tendency for IAA to be related to poorer survival (hazard ratio 3.452, 95% CI 0.964–12.359, p=0.057).ConclusionsIn the patients with nonfibrotic HP, CAA resulted in no recurrence or development of fibrosis and longer survival. In the patients with fibrotic HP, <50% lymphocytes in BAL and honeycombing were negative prognostic factors for mortality.