Comparison of one single-antigen assay and three multi-antigen SARS-CoV-2 IgG assays in Nigeria.

Objectives: Determining an accurate estimate of SARS-CoV-2 seroprevalence has been challenging in African countries where malaria and other pathogens are endemic. We compared the performance of one single-antigen assay and three multi-antigen SARS-CoV-2 IgG assays in a Nigerian population endemic for malaria. Methods: De-identified plasma specimens from SARS-CoV-2 RT-PCR positive, dried blood spot (DBS) SARS-CoV-2 RT-PCR positive, and pre-pandemic negatives were used to evaluate the performance of the four SARS-CoV-2 assays (Tetracore, SARS2MBA, RightSign, xMAP). Results: Results showed higher sensitivity with the multi-antigen (81% (Tetracore), 96% (SARS2MBA), 85% (xMAP)) versus the single-antigen (RightSign (64%)) SARS-CoV-2 assay. The overall specificities were 98% (Tetracore), 100% (SARS2MBA and RightSign), and 99% (xMAP). When stratified based on <15 days to ≥15 days post-RT-PCR confirmation, the sensitivities increased from 75% to 88.2% for Tetracore; from 93% to 100% for the SARS2MBA; from 58% to 73% for RightSign; and from 83% to 88% for xMAP. With DBS, there was no positive increase after 15-28 days for the three assays (Tetracore, SARS2MBA, and xMAP). Conclusion: Multi-antigen assays performed well in Nigeria, even with samples with known malaria reactivity, and might provide more accurate measures of COVID-19 seroprevalence and vaccine efficacy.

Andover diagnostic centre cardiac imaging workforce planning – implications of richards & GIRFT

ObjectiveHHFT response to Richard’s report & GIRFTMethodsThe Richards report, published in 2020 addressed the strain on diagnostic services in the context of the COVID-19 pandemic recommended Community diagnostic hubs should be established to take non-acute diagnostics away from acute hospital sites. Hampshire Hospitals Foundation Trust (HHFT) Cardiac CT team pivoted to install a CT scanner acquired from the non-installed Canon scanner base from the London Nightingale COVID-19 centre. This was a strategic move to set up vetted ‘cold’ Cardiac CT in a small community hospital, Andover War Memorial hospital.ResultsHHFT (serving a population of 600,000 patients), performed 393 CTCAs in 2021 with 43.5% performed at Andover. This allowed us to retire an older GE HD750 machine from service thus improving image quality and reducing patient dose. With interpretation aided by HeartFlow, we aim to reduce downstream diagnostic invasive coronary angiography. There were 0 adverse events from administration of GTN and IV Metoprolol. The community CTCA innovation has acted as a proof of concept and supported a business plan allowing HHFT to acquire regional approval to develop Andover Community Diagnostic Centre (ACDC).ConclusionStrategically responding to the disruption of a global pandemic and to the opportunity presented by acquiring the aforementioned CT scanner, HHFT pivoted to increase its throughput of COVID ‘cold’ non-acute Cardiac diagnostics. This innovation gave us resilience through the pandemic and has acted as proof of concept for performing community diagnostics, accelerating our business plans, as well as helping to make HHFT successful in its bid for Diagnostic Centre funding.

Performance of SARS-CoV-2 Antigens in a Multiplex Bead Assay for Integrated Serological Surveillance of Neglected Tropical and Other Diseases.

Serosurveillance can provide estimates of population-level exposure to infectious pathogens and has been used extensively during the COVID-19 pandemic. Simultaneous, serological testing for multiple pathogens can be done using bead-based immunoassays to add value to disease-specific serosurveys. We conducted a validation of four SARS-CoV-2 antigens-full-length spike protein, two receptor binding domain proteins, and the nucleocapsid protein-on our existing multiplex bead assay (MBA) for enteric diseases, malaria, and vaccine preventable diseases. After determining the optimal conditions for coupling the antigens to microsphere beads, the sensitivity and specificity of the assay were determined on two instruments (Luminex-200 and MAGPIX) when testing singly (monoplex) versus combined (multiplex). Sensitivity was assessed using plasma from 87 real-time reverse transcription polymerase chain reaction (rRT-PCR) positive persons collected in March-May of 2020 and ranged from 94.3% to 96.6% for the different testing conditions. Specificity was assessed using 98 plasma specimens collected prior to December 2019 and plasma from 19 rRT-PCR negative persons and ranged from 97.4% to 100%. The positive percent agreement was 93.8% to 97.9% using 48 specimens collected > 21 days post-symptom onset, while the negative percent agreement was ≥ 99% for all antigens. Test performance was similar using monoplex or multiplex testing. Integrating SARS-CoV-2 serology with other diseases of public health interest could add significant value to public health programs that have suffered severe programmatic setbacks during the COVID-19 pandemic.

Validation of xMAP SARS-CoV-2 Multi-Antigen IgG assay in Nigeria.

OBJECTIVE: There is a need for reliable serological assays to determine accurate estimates of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroprevalence. Most single target antigen assays have shown some limitations in Africa. To assess the performance of a multi-antigen assay, we evaluated a commercially available SARS-CoV-2 Multi-Antigen IgG assay for human coronavirus disease 2019 (COVID-19) in Nigeria. METHODS: Validation of the xMAP SARS-CoV-2 Multi-Antigen IgG assay was carried out using well-characterized SARS-CoV-2 reverse transcription polymerase chain reactive positive (97) and pre-COVID-19 pandemic (86) plasma panels. Cross-reactivity was assessed using pre-COVID-19 pandemic plasma specimens (213) from the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). RESULTS: The overall sensitivity of the xMAP SARS-CoV-2 Multi-Antigen IgG assay was 75.3% [95% CI: 65.8%- 82.8%] and specificity was 99.0% [95% CI: 96.8%- 99.7%]. The sensitivity estimate increased to 83.3% [95% CI: 70.4%- 91.3%] for specimens >14 days post-confirmation of diagnosis. However, using the NAIIS pre-pandemic specimens, the false positivity rate was 1.4% (3/213). CONCLUSIONS: Our results showed overall lower sensitivity and a comparable specificity with the manufacturer's validation. There appears to be less cross-reactivity with NAIIS pre-pandemic COVID-19 specimens using the xMAP SARS-CoV-2 Multi-Antigen IgG assay. In-country SARS-CoV-2 serology assay validation can help guide the best choice of assays in Africa.

The epidemiology of out-of-hospital cardiac arrest in Australia and New Zealand: A binational report from the Australasian Resuscitation Outcomes Consortium (Aus-ROC).

INTRODUCTION: The Australasian Resuscitation Outcomes Consortium (Aus-ROC) out-of-hospital cardiac arrest (OHCA) Epistry (Epidemiological Registry) now covers 100% of Australia and New Zealand (NZ). This study reports and compares the Utstein demographics, arrest characteristics and outcomes of OHCA patients across our region. METHODS: We included all OHCA cases throughout 2019 as submitted to the Epistry by the eight Australian and two NZ emergency medical services (EMS). We calculated crude and age-standardised incidence rates and performed a national and EMS regional comparison. RESULTS: We obtained data for 31,778 OHCA cases for 2019: 26,637 in Australia and 5,141 in NZ. Crude incidence was 107.9 per 100,000 person-years in Australia and 103.2/100,000 in NZ. Overall, the majority of OHCAs occurred in adults (96%), males (66%), private residences (76%), were unwitnessed (63%), of presumed medical aetiology (83%), and had an initial monitored rhythm of asystole (64%). In non-EMS-witnessed cases, 38% received bystander CPR and 2% received public defibrillation. Wide variation was seen between EMS regions for all OHCA demographics, arrest characteristics and outcomes. In patients who received an EMS-attempted resuscitation (13,664/31,778): 28% (range across EMS = 13.1% to 36.7%) had return of spontaneous circulation (ROSC) at hospital arrival and 13% (range across EMS = 9.9% to 20.7%) survived to hospital discharge/30-days. Survival in the Utstein comparator group (bystander-witnessed in shockable rhythm) varied across the EMS regions between 27.4% to 42.0%. CONCLUSION: OHCA across Australia and NZ has varied incidence, characteristics and survival. Understanding the variation in survival and modifiable predictors is key to informing strategies to improve outcomes.

COVID-19 ir dirbančių emigrant iškraustymas: medijų rėminimo analizė Keralos valstijoje, Indijoje

Migracija ir migrantų judėjimas yra pasaulinė tendencija, kurią įtakoja keletas veiksnių. Vienas iš jų, palengvinančių migrantų judėjimą, yra geresnių gyvenimo sąlygų ieškojimas. Viena iš labiausiai pažeidžiamų bendruomenių šiuo atžvilgiu yra migrantai, ypač besivystančiame pasaulyje, vykdantys migraciją iš vienos šalies į kitą. Darbo jėgos migracija yra reikšmingas nacionalinis reiškinys Indijoje, kai darbuotojai migruoja po valstijas, o tai palengvino tarpvalstybinis judėjimas. Neseniai kilęs pandemijos COVID-19 protrūkis kelia didžiausią iššūkį darbuotojams migrantams, kurie susiduria su perkėlimo problema dėl judėjimo ir visuomenės suvokimo ribojimo. Vienas iš svarbiausių dalyvių, palengvinančių viešąjį diskursą, yra žiniasklaida, kuri rėmėsi migrantų scenarijaus formavimu. Šiame straipsnyje analizuojama, kaip Indijos laikraštis vaizduoja Keralos darbuotojų migrantų sunkumus per žiniasklaidos rėminimą naudojabt kokybinę atvejų analizę. Tyrimas atskleidžia, kad žiniasklaidos rėmuose vaizduojama migruojančių darbuotojų padėtis pandemijos metu ir rezultatas gali būti naudingas imigrantų integracijos politikos kūrėjams.Alternate abstract: Migration and migrant movement are a global scenario, in which one of the main drivers, which facilitates migrant movement, is the search for better living conditions. One of the most vulnerable communities in this regard is migrant workers, especially in the developing world, who conduct cross-country migration. Labour migration is a significant national phenomenon in India in which the workers migrate across the states, which were facilitated by the interstate movement. The recent outbreak of pandemic COVID-19 poses the greatest challenge to the migrant workers who face the challenge of displacement due to the restriction of movement and public perception. One of the significant actors facilitating public discourse is the media, which explores the migrant scenario through framing. This article analyzes how the Indian newspaper portrays the plight of the migrant workers in Kerala through media framing using qualitative case analysis. The study reveals that the media frames portray the plight of the migrant workers during the pandemic situation, and the result could be helpful for policy developers on immigrant’s integration.

Next generation vaccine platform: polymersomes as stable nanocarriers for a highly immunogenic and durable SARS-CoV-2 spike protein subunit vaccine (preprint)

Multiple successful vaccines against SARS-CoV-2 are urgently needed to address the ongoing Covid-19 pandemic. In the present work, we describe a subunit vaccine based on the SARS-CoV-2 spike protein co-administered with CpG adjuvant. To enhance the immunogenicity of our formulation, both antigen and adjuvant were encapsulated with our proprietary artificial cell membrane (ACM) polymersome technology. Structurally, ACM polymersomes are self-assembling nanoscale vesicles made up of an amphiphilic block copolymer comprising of polybutadiene-b-polyethylene glycol and a cationic lipid 1,2-dioleoyl-3-trimethylammonium-propane. Functionally, ACM polymersomes serve as delivery vehicles that are efficiently taken up by dendritic cells, which are key initiators of the adaptive immune response. Two doses of our formulation elicit robust neutralizing titers in C57BL/6 mice that persist at least 40 days. Furthermore, we confirm the presence of memory CD4+ and CD8+ T cells that produce Th1 cytokines. This study is an important step towards the development of an efficacious vaccine in humans.

Olfactory Training for Postviral Olfactory Dysfunction: Systematic Review and Meta-analysis.

OBJECTIVE: Olfactory dysfunction is a common problem that is most frequently attributed to upper respiratory infection. Postviral olfactory dysfunction (PVOD) can be prolonged and clinically challenging to treat. Olfactory training (OT) has demonstrated potential benefit for patients with nonspecific olfactory dysfunction. We sought to evaluate the efficacy of OT specifically for PVOD by pooled analysis of the existing evidence. DATA SOURCES: PubMed, Embase, and Web of Science. REVIEW METHODS: Following PRISMA guidelines, PubMed, Embase, and Web of Science databases were queried and abstracts screened independently by 2 investigators. We included studies evaluating the efficacy of OT for PVOD and excluded studies evaluating pharmacologic interventions or olfactory loss from other causes. RESULTS: Of the initial 1981 abstracts reviewed, 16 full-text articles were included. Sniffin' Sticks olfactory testing results were reported in 15 (93%) studies as threshold (T), discrimination (D), and identification (I) subscores and TDI total scores. All studies reported clinically significant results after OT, defined as a score improvement of TDI >5.5. Four studies were included in the meta-analysis, in which pooled estimates revealed that patients with PVOD who received OT had a 2.77 (95% confidence interval, 1.67-4.58) higher odds of achieving a clinically important difference in TDI scores compared to controls. CONCLUSION: Meta-analysis of existing data demonstrates clinically significant improvements in PVOD associated with OT. Variability exists among OT protocols and may benefit from further optimization. Existing data supports the use of OT for the treatment of existing and newly emerging cases of PVOD.