Point-of-Care Testing of COVID-19: Current Status, Clinical Impact, and Future Therapeutic Perspectives

The effective management of the coronavirus disease 2019 (COVID-19) pandemic depends on the bedrock of rapid and accurate testing to enable promptness in quarantining, contact tracing, epidemiologic characterization, evaluating vaccine response, and strategic decision-making. In this context, point-of-care (POC) tests are of utmost importance as they facilitate rapid and decentralized testing without much instrumentation and technical expertise. The review describes the current status of POC COVID-19 testing in three broad categories: molecular, antigen, and antibody. The advantages, limitations, and adaption of each of the three types of POC tests are discussed while highlighting their clinical impact in real-world settings. The role of POC testing for COVID-19 screening, diagnosis, and surveillance has been highlighted, focusing on recent advances in the field. The difference between POC and at-home tests is discussed while elaborating on the necessity for the latter. A spotlight on the impact of variants on the performance of COVID-19 tests is provided. The clinical impact of POC testing in hospitals with regard to improving therapeutic options, patient flow, enhancing the infection control measures, and early recruitment of patients into clinical trials is discussed. Finally, the future perspectives that will aid the research community in the development of POC tests for COVID-19 or any infectious disease, in general, are presented. Overall, we believe this review can benefit the research community as it (i) presents a comprehensive understanding of current COVID-19 POC testing methods (ii) highlights features required to transform the current tests developed during the past year as POC diagnostics, and (iii) provides insights to address the unmet challenges in the field. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

DISSEMINATED MULTIFOCAL MUCORMYCOSIS TREATED WITH A COMBINATION ANTIFUNGAL REGIMEN

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Rhinocerebral mucormycosis is a fatal infection in poorly controlled diabetic patients with a history of diabetic ketoacidosis (DKA). DKA blunts neutrophil chemotaxis, phagocytosis and boosts serum iron, a mucor nutrient. It spreads to the brain via the hematogenous or contiguous spread [1]. We present a case of disseminated rhinocerebral mucormycosis in a diabetic patient on treatment with a combination antifungal regimen CASE PRESENTATION: A 22-year-old poorly controlled diabetic with a hemoglobin A1c of 14.1% was admitted to an outside hospital for a week of chest pain, dyspnea, fever, and dry cough with recently diagnosed coronavirus disease 2019. She was treated for DKA. Four days later, she developed a new-onset right-sided vision loss, ptosis, areflexic pupil, eye abduction loss, and bloody nasal mucus drainage. Computed tomography (CT) of the chest was normal. CT angiogram (CTA) of the head and neck showed occlusion of the right ophthalmic artery and the superior ophthalmic vein. Magnetic resonance imaging (MRI) showed subacute right frontal infarct and chronic sinusitis. An oral exam disclosed a large hard palate necrotic area, which on biopsy culture grew Rhizopus oryzae (Figure A-B). She was transferred to our facility for further surgical debridement. On arrival, she was placed on high-dose liposomal amphotericin (LAmB) and euglycemic control. A cerebral angiogram revealed right internal carotid artery occlusion. MRI showed right cavernous sinus thrombosis, right ophthalmic artery mycotic aneurysm, paranasal sinusitis with right sphenoid fungal sinusitis extending into gyri rectus, and watershed infarcts in the right middle and anterior cerebral artery territories (Figure C1). Neurosurgery deferred surgical debridement. Later caspofungin and deferasirox were added adjunctively for two weeks with surgical debridements and a week of hyperbaric oxygen, after which MRI findings improved (Figure C2). She is clinically improving on LAmB and caspofungin DISCUSSION: Combination regimens are ineffective in neutropenic or cancer patients [2,3]. LAmB and deferasirox with or without an echinocandin/posaconazole have been effective in diabetics with intracranial lesions [2]. Combination regimen efficacy has been observed in diabetic mice and anecdotal case reports [3,4]. This is due to prompt recovery of neutrophil function and loss of glucose-regulated protein78 mediated Rhizopus angioinvasion once acidosis and hyperglycemia are corrected [5] CONCLUSIONS: To improve diabetic patient outcomes, a timely diagnosis, prompt reversal of DKA and hyperglycemia, along with surgical debridement and antifungal therapy, are of immense importance. Combination antifungal therapy may benefit cases where complete surgical debridement is not achievable REFERENCE #1: Mallis A, Mastronikolis SN, Naxakis SS, Papadas AT. Rhinocerebral mucormycosis: an update. Eur Rev Med Pharmacol Sci. 2010;14(11):987-92 DISCLOSURES: No relevant relationships by Mohammed Alnijoumi, source=Web Response No relevant relationships by Phillip Beck, source=Web Response No relevant relationships by Paragkumar Patel, source=Web Response No relevant relationships by SACHIN PATIL, source=Web Response No relevant relationships by Deepthi Rao, source=Web Response No relevant relationships by Hariharan Regunath, source=Web Response No relevant relationships by Blaine Winterton, source=Web Response

Evidence-Based Recommender System for a COVID-19 Publication Analytics Service

The rapid growth of COVID-19 publications has driven clinical researchers and healthcare professionals in pursuit to reduce the knowledge gap on reliable information for effective pandemic solutions. The manual task of retrieving high-quality publications based on the evidence pyramid levels, however, presents a major bottleneck in researchers' workflows. In this paper, we propose an "evidence-based" recommender system namely, KnowCOVID-19 that utilizes an edge computing service to integrate recommender modules for data analytics using end-user thin-clients. The edge computing service features chatbot-based web interface that handles a given COVID-19 publication dataset using two recommender system modules: (i) evidence-based filtering that observes domain specific topics across the literature and classifies the filtered information according to a clinical category, and (ii) social filtering that allows diverse experts with similar objectives to collaborate via a "social plane" to jointly find answers to critical clinical questions to fight the pandemic. We compare the Domain-specific Topic Model (DSTM) used in our evidence-based filtering with state-of-the-art models considering the CORD-19 dataset (a COVID-19 publication archive) and show improved generalization effectiveness as well as knowledge pattern query effectiveness. In addition, we conduct a comparison study between a manual literature review process and the KnowCOVID-19 augmented process, and evaluate the benefits of our information retrieval techniques over important queries provided by COVID-19 clinical experts.