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Aim/Introduction: COVID-19 and the SARS-CoV-2 pandemic has been ongoing for 2 year and thromboembolic events have been described as a major complication at the time of the infection and as a mid-term event, even in patients on prophylactic anticoagulants.In this study we underline the importance of the pulmonary scintigraphy in the detection of early or mid terme thromboembolic events especially in subsegmental pulmonary arteries who could be missed by CT pulmonary angiography. Material(s) and Method(s): In our department we performed 12 pulmonary perfusion scintigraphy for patients presenting persisting respiratory symptoms (such as dyspnea, thoracic pain ) after covid-19 infection. Most of our patients were women (sex ratio 1,3) and the mean age was 55.4 yAfter intravenous injection of 148-222 MBq (4-6mCi) of 99mTc-macroaggregated albumin, SPECT imaging with low-dose CT was performed with the patient supine. Planar imaging was done in multiple projections (anterior and posterior;right anterior and posterior oblique;and left anterior and posterior oblique). The images were reconstructed in the transaxial, coronal, and sagittal views and were reviewed for perfusion defects. Modified PIOPED criteria were used to interpret the exams : The mismatched perfusion defects in this study were based on a mismatch between CT and scintigraphy images since we do not perform ventilation scans in our department. Result(s): On a median interval of 2 months after infection , Lung perfusion defects (of any type) were observed in 11 out of 12 subjects (92%). Patients with severe COVID-19 were not at higher risk of having mismatched perfusion defects than were patients with moderate COVID-19 and the interval between COVID-19-positive reports and scanning did not reduce the risk for mismatched perfusion defects.Mismatched perfusion defects were the commonest and were observed in 9 subjects (75%), suggestive of pulmonary embolism and leading to the instauration of curative anticoagulants. Conclusion(s): With these results, we aim to show that Lung perfusion scintigraphy can play an important role in the screening of such patients who may be at risk for developing pulmonary embolism as post-SARS-CoV-2 infection sequelae.
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Background Testing is a crucial tool in the pandemic response to identify and confirm COVID-19 in those who are symptomatic. The aim of the present study was to assess the negative predictive value (NPV) of COVID-19 Rapid Antigen Testing (RAT) according to the symptoms, test timing in relation to symptom onset and characteristics of the person. Methods We performed a prospective cohort study of patients attended the COVID-19 testing center at the university hospital of Monastir, between 23 November 2020 and 19 April 2021. In the first time we performed the COVID19 RAT. In the second time, if this result was negative we performed the reverse transcription polymerase chain reaction (rRT-PCR). The NPV was conducted with SPSS software, version 21.0. A logistic binary regression was performed to determine factors affected the NPV of COVID-19 RAT. A p value of < 0.05 was considered statistically significant. Results A total of 855 tests were performed, of which 807 were RAT and 467 rRT-PCR. Positive RAT test was found in 336 cases (39%). False negative RAT was noted in 87 cases (10.2%). The NPV of RAT was 83.6%. The NPV ranged between 80% and 88% for the following symptoms: fever, cough, myalgia, dyspnea, dizziness, asthenia, headache, myalgia, odynophagia, flu_rhume. It varied from 64.2 to 77.8 for Ageusia, Anosmia, Arthralgia, chest pain, thrill, digestive signs. The NPV was equivalent according to age and gender. The NPV varied from 80 to 100% if the test was applied between the first and the 5th day for the onset of symptoms. Beyond this duration, it decreased to 50%. A long period of symptom onset (>5 days) increased significantly the risk of false negative RAT (OR = 2.57 IC95%: [1.38-4.82], p = 0.003). Conclusions Many factors may affect the performance of COVID-19 Rapid Antigen Testing (RAT). In fact, negative RAT should be completed by a rRT-PCR according to the the type of symptoms and the time from illness onset. Key messages False negative RAT rate was high. Many factors must be taken into account in interpreting the RAT, in particular the type of symptoms and the time from illness onset.
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Background An outbreak of coronavirus disease 2019 (COVID-19) is becoming a public health emergency. Data are limited on the association between a prolonged viral shedding in patients with COVID-19 and having symptoms. We aimed to study the association between the presence of symptoms and recovery time of COVID-19 confirmed patients. Methods We conducted a prospective cohort study of COVID-19 patients admitted to the designated national COVID-19 center in Monastir, Tunisia from March to July 2020. Kaplan-Meier survival curve and Cox proportional hazards regression models were used to assess viral shedding in asymptomatic versus symptomatic patients with COVID-19. Results Among the 264 patients included in the study, symptoms such as anosmia, dry cough, and fatigue were reported by 34.4% (n = 75) of cases. The median time to RNA viral conversion was 24 days (IQR 18-36 days) for symptomatic patients versus 20 days (IQR 16-30 days) for asymptomatic patients. Having symptoms was significantly associated with a prolonged viral shedding (HR 0.600, 95% CI 0.401-0.897) (p = 0.013). Conclusions Our findings revealed that having symptoms delayed viral clearance among COVID-19 patients. Therefore, symptomatology should be taken into consideration in isolation strategy for infected patients. Key messages Having symptoms was associated with a delay in SARS-CoV-2 RNA clearance. The presence of symptoms should be taken into consideration for patient’s isolation strategy.
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Introduction: Health-care workers (HCWs) are at the frontline of response to coronavirus disease 2019 (COVID-19) and subsequently at higher risk of acquiring the disease. Objectives: We aimed to investigate SARS-CoV-2 risk factors among HCWs using a systematic review. Methods: A systematic review was carried out from January 2020 to 20th March 2021 on COVID-19 risk factors among HCWs in PubMed and Google Scholar. Medical subject headings (MeSH) were searched using Boolean operators “OR/AND”. The search terms were: (“coronavirus infection” OR “COVID-19” OR “SARS-CoV-2”) AND (“health personnel”) AND (“risk factors” OR “risk assessment”). We included in our review only papers published in peer-reviewed journals. Results: Twenty-one articles were included in this review. The main associated factors of COVID-19 infection among HCWs were personal protective equipment (PPE) shortage, exposure to infected patients mainly through working in high-risk departments, aerosol generating procedures, working overload, lack of knowledge on SARS-CoV-2 infection control and suboptimal hand hygiene. Our review showed a higher risk of infection among physicians compared with nurses and general services employees. Pre-existing medical conditions, age and male gender were also associated with COVID-19 infection among HCWs. Conclusion: Lack of PPE, exposure to infected patients, work overload, poor infection control, and preexisting medical conditions put HCWs at risk of COVID-19 infection. Identifying these factors is of paramount importance to develop sustainable measures that protect HCWs especially those with higher risk levels.