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Purpose: Compared to nasopharyngeal/oropharyngeal swabs (N/OPS-VTM), non-invasive saliva samples have enormous potential for scalability and routine population screening of SARS-CoV-2. In this study, we investigate the efficacy of saliva samples relative to N/OPS-VTM for use as a direct source for RT-PCR based SARS-CoV-2 detection. Method(s): We collected paired nasopharyngeal/oropharyngeal swabs and saliva samples from suspected positive SARS-CoV-2 patients and tested using RT-PCR. We used generalized linear models to investigate factors that explain result agreement. Further, we used simulations to evaluate the effectiveness of saliva-based screening in restricting the spread of infection in a large campus such as an educational institution. Result(s): We observed a 75.4% agreement between saliva and N/OPS-VTM, that increased drastically to 83% in samples stored for less than three days. Such samples processed within two days of collection showed 74.5% test sensitivity. Our simulations suggest that a test with 75% sensitivity, but high daily capacity can be very effective in limiting the size of infection clusters in a workspace. Guided by these results, we successfully implemented a saliva-based screening in the Bangalore Life Sciences Cluster (BLiSC) campus. Conclusion(s): These results suggest that saliva may be a viable alternate source for SARS-CoV-2 surveillance if samples are processed immediately. Although saliva shows slightly lower sensitivity levels when compared to N/OPS-VTM, saliva collection is logistically advantageous. We strongly recommend the implementation of saliva-based screening strategies for large workplaces and in schools, as well as for population-level screening and routine surveillance as we learn to live with the SARS-CoV-2 virus.Copyright © 2023 Indian Association of Medical Microbiologists
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Background and Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) is a highly transmissible and pathogenic coronavirus that emerged in late 2019. Cycle threshold (Ct) value of real-time reverse transcription polymerase chain reaction (RT-PCR) assay inversely correlated with viral load and can provide an indirect method of quantifying the number of copies of viral RNA in the sample is not reported clinically. Hence, this study was undertaken to compare the Ct values of patients tested positive for SARS CoV-2 by RT-PCR with severity of illness, duration of hospital stay, and mortality. Materials and Methods: A retrospective study was conducted over a period of 6 months in a tertiary care hospital in Bangalore. All patients tested positive for SARS CoV-2 by RT-PCR and admitted in our hospital were included in the study. Details of the patients on the duration of hospital stay, age, presence of comorbidities, intubation, and mortality were collected. Results: The study comprised of 80 patients, 48 (60%) males and 32 (40%) females. The mean age of the study population was 38.38 years. Majority of patients 41.25% had Ct value between 25 and 30. Patients with lower Ct values were significant associated with increased duration of hospital stay and infected more than one person in family indicating higher probability of transmission of infection. Mortality showed significant association with patients of more than 60 years' age. Interpretation and Conclusions: The study shows possible association between Ct values of SARS-CoV-2 RT-PCR assay with the duration of hospitalization, infectivity, and mortality. Mention of Ct value along with the positive report could potentially be used to guide patient care management, infection control, and occupational health decisions.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first detected in December 2019, and shortly after pandemic has been declared by the World Health Organization (WHO) due to its unstoppable global spread. Considerable amount of effort has beenput around the World in order to develop a safe and effective vaccine against SARS-CoV-2. Inactivated and RNA vaccines have already passed phase three studies showing sufficient efficacy and safety, respectively. Nowadays, there is a noticeable dominance of SARS-CoV-2 variants with various mutations over the wild type SARS-CoV-2. However, there is no report showing the efficacy of these vaccines on these variants. This case study describes a thirty-eight-year-old male reported to be infected with SARS-CoV-2 alpha variant following two doses of inactive CoronaVac administration with a protective level of SARS-CoV-2 specific antibodies. The variant analysis of the virus reported to be positive for N501Y mutation.This is the first case in the literature demonstrating that inactive SARS-CoV-2 vaccine might have a lower efficacy on alpha variant.Copyright © 2022 Cenk Serhan Ozverel et al., published by Sciendo.
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Junior Physician Investigator Award Recipient Purpose of study Severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) is the causative agent of the Coronavirus disease 2019 (COVID-19) pandemic. Convalescent plasma obtained from recovered persons was used for previous respiratory pandemics. Convalescent plasma with severe acute respiratory disease coronavirus 2 (SARS-CoV-2) antibodies (CCP) was proposed as an option that may hold promise as treatment for COVID-19. Our aim was to retrospectively evaluate the efficacy of CCP treatment of patients with severe to life-threatening COVID-19 hospitalized at Montefiore Medical Center (MMC) in the Bronx, NY between April 13 to May 4, 2020. Methods used We administered CCP as part of the Mayo Clinic expanded access investigational new drug (IND) program for hospitalized patients. We compared the mortality and clinical outcome of 73 patients with COVID-19 who received 200 mL of CCP with a Spike protein IgG titer >=1:2,430 (median 1:47,385) within 72 hours of admission to 1:1 propensity score-matched controls. Matching criteria for controls were age, sex, body mass index, race, ethnicity, comorbidities, week of admission, oxygen requirement, D-dimer, lymphocyte counts, corticosteroids, and anticoagulation use (figure 1). We additionally measured Spike protein IgG and neutralizing antibody titer in CCP and pre- and post-transfusion Spike protein IgG, IgM and IgA titer in CCP recipients. The primary outcome was all-cause mortality at day 28 post-CCP. The secondary outcomes were improvement in oxygenation status or mortality at day 28 post-CCP. Exploratory outcomes were associations between pre-CCP SARS-CoV-2 antibody titers and mortality at day 28. Summary of results There was no difference in mortality or oxygenation between CCP recipients and controls at day 28. When stratified by age, compared to matched controls, CCP recipients < 65 years had 4-fold lower mortality and 4-fold lower deterioration in oxygenation or mortality at day 28 (figure 2, 3). There was no association between CCP IgG or neutralizing antibody titer and clinical outcome. For CCP recipients, pre-transfusion Spike protein IgG, IgM and IgA titers were associated with mortality at day 28 in univariate analyses but not in multivariable analyses. Pre-transfusion Spike protein IgG titer was significantly correlated with Ddimer and detected viral load measured by cycle threshold (Ct) value of nasopharyngeal SARS-CoV-2 reverse-transcriptase- polymerase-chain-reaction (figure 4). No adverse effects of CCP were observed. Conclusions We report that CCP administration within 72 hours of hospitalization demonstrated a possible signal of reduced mortality in patients < 65 years. Pre-transfusion IgG titer may be a proxy for disease severity that may be useful in identifying those who are more likely to respond to CCP. Data from controlled trials is needed to validate this finding and establish the effect of ageing on CCP efficacy. (Figure Presented).
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Introduction: The objective of this study is to investigate the relationship between Cycle Threshold (Ct) values and serum biomarkers in COVID-19 patients with Total Severity Score (TSS) on chest computed tomography (CT). Apart from this, this study also aims to explore the role of TSS, serum biomarkers and viral load in predicting the disease severity and clinical outcome of patients with COVID-19. Method(s): In this retrospective cross-sectional study, we included 213 confirmed COVID-19 patients from Hospital Sungai Buloh who conform to the inclusion criteria. A search was performed on the picture achieving and communication system (PACS) and Centricity UV to collect data on the clinical features, laboratory findings (the first one upon admission), epidemiological characteristics as well as the chest CT scans of the targeted group. To quantify the extent of COVID- 19 lung involvement in CT scan, TSS was applied. Data was collected and analysed using SPSS. Result(s): There were significant correlations between TSS of chest CT with four out of the six serum biomarkers studied, namely C-Reactive Protein (CRP), Neutrophil-Lymphocyte Ratio (NLR), creatinine and Lactate Dehydrogenase (LDH). There was an inverse relationship between TSS and Ct values. TSS, serum biomarkers (NLR, CRP, LDH and creatinine) as well as Ct value are good predictors of disease severity. Conclusion(s): TSS is a reliable scoring method to determine the severity of COVID-19 patients. Serum biomarkers which include NLR, CRP, LDH and creatinine are good predictors of disease severity and can be used for stratification of patients according to severity. Ct value is a valuable early indicator of disease severity.
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Background: Despite increased social vulnerability and barriers to care, there has been a paucity of data on SARS-CoV-2 incidence among key populations in sub-Saharan Africa. We seek to characterize active infections and define transmission dynamics of SARS-CoV-2 among people who inject drugs (PWID) and their sexual and injecting partners from Nairobi and the coastal region in Kenya. Method(s): This was a nested cross-sectional study of SARS-CoV-2 infection from April to July 2021 within a cohort study of assisted partner services for PWID in Kenya. A total of 1000 PWID and their partners (500 living with and 500 living without HIV) were recruited for SARS-CoV-2 antibody testing, of whom 440 were randomly selected to provide self-collected nasal swabs for real-time PCR testing. Whole genome sequencing (WGS) was completed on a limited subset of samples (N=23) with cycle threshold values 32.0. Phylogenetic tree construction and analysis was performed using the Nextstrain pipeline and compared with publicly available SARS-CoV-2 sequences from GenBank. Result(s): A total of 438 (99.5%) participants provided samples for SARS-CoV-2 PCR testing. Median age was 37 (IQR 32-42);128 (29.2%) were female;and 222 (50.7%) were living with HIV. The overall prevalence of SARS-CoV-2 infection identified by RT-PCR was 86 (19.6%). In univariate analyses, there was no increased relative risk of SARSCoV- 2 infection related to positive HIV status, frequenting an injection den, methadone treatment, unstable housing, report of any high-risk exposure, or having a sexual or injecting partner diagnosed with COVID-19 or who died from COVID-19 or flu-like illness. Eight samples were successfully sequenced via WGS and classified as WHO variants of concern: 3 Delta, 3 Alpha, and 2 Beta. Seven were classified into clades predominantly circulating in Kenya during 2021. Notably, two sequences were identical and matched identically to another Kenyan sequence, which is consistent with, though not indictive of, a transmission linkage. Conclusion(s): Overall, the risk of SARS-CoV-2 infection in this population of PWID and their partners was not significantly associated with risk factors related to injection drug use. At a genomic level, the SARS-CoV-2 strains in this study were consistent with contemporary Kenyan lineages circulating during the time and not unique to PWID. Prevention efforts, therefore, must also focus on marginalized groups for control given the substantial amount of mixing that likely occurs between populations.
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The recent studies have indicated the requisite of computed tomography scan analysis by radiologists extensively to find out the suspected patients of SARS-CoV-2 (COVID-19). The existing deep learning methods distribute one or more of the subsequent bottlenecks. Therefore, a straight forward method for detecting COVID-19 infection using real-world computed tomography scans is presented. The detection process consists of image processing techniques such as segmentation of lung parenchyma and extraction of effective texture features. The kernel-based support vector machine is employed over feature vectors for classification. The performance parameters of the proposed method are calculated and compared with the existing methodology on the same dataset. The classification results are found outperforming and the method is less probabilistic which can be further exploited for developing more realistic detection system.Copyright © 2023 Inderscience Enterprises Ltd.
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Background: Jails house vulnerable persons. Crowded conditions, restricted access to medical care, and limited resources facilitate infectious disease outbreaks, particularly for airborne, highly transmissible diseases like COVID-19 (C19). Wastewater-Based Surveillance (WBS) is a low-cost, highly sensitive, non-invasive method that can provide an early warning of C19 surges in communities. We examined the value of SARS-CoV-2 WBS for a mega-jail. Method(s): 28-week study period: 10/20/21- 5/5/22. Wastewater samples were collected x 25 weeks;SARS-CoV-2 RNA was measured using RT-qPCR. We sampled one manhole serving multiple housing units. C19 rapid test data on jail entrants were summarized daily by the jail;16 mass PCR screenings using selfcollected nasal swabs were conducted by the study team. Individual diagnostic tests were collated and analyzed on a weekly basis. Data were summarized by % of the tested jailed individuals found infected. The Spearman correlation coefficient between weekly SARS-CoV-2 RNA in wastewater and % of positive (pos) C19 diagnostic tests were calculated;we also used linear regression to assess the predictability between paired Ct values and weekly % of pos diagnostic tests. Result(s): Weekly WBS coupled with periodic mass testing of jailed individuals was feasible. The efficiency of gathering individual nasal swabs increased to 3 tests collected per minute through a CQI process. PCR signal strength for SARSCoV- 2 RNA in jail wastewater correlated with the % of jail residents tested who had C19. The mean RT-qPCR Cycle threshold (Ct) value was 35.2. Overall, 3.4% of nasal swabs were pos. A strong inverse correlation was observed between % nasal swab pos and WBS Ct value (Figure.) The Spearman correlation coefficient was r= 0.628;linear regression likewise showed a similar correlation. Conclusion(s): Weekly WBS results for C19 correlated with the proportion of C19 individual test results. WBS proved to be a practical strategy to surveil for C19 in this jail setting. We are developing means to identify exact source, by housing unit, of wastewater with positive signal. Future studies will explore WBS for Mpox and HIV in correctional facilities. HIV RNA can be found in wastewater specimens;whether WBS for HIV in congregate facilities is feasible remains an open question.
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Background: SARS-CoV-2 Omicron sublineages exhibit evolving escape to in vitro neutralization by monoclonal antibodies (mAbs), with an unclear impact on in vivo treatment response. Our aim is to assess the impact of SARS-Cov-2 variants on the decline of viral load (VL) after treatment with 3 different drugs approved in EU for the early treatment of patients with mild-moderate COVID-19. Method(s): Post-hoc analysis from MONET (EudraCT: 2021-004188-28), phase 4 open-label RCT to assess efficacy of 500 mg intravenous sotrovimab (SOT), 600 mg intramuscular tixagevimab/cilgavimab (TIX/CIL) and oral 5-days course of NMV/r 300/100 mg BID, in non-hospitalized high-risk patients (pts) with early COVID-19. Pts' features were analyzed as binary variables by Chi-squared test. SARS-Cov-2 VL in nasopharyngeal swabs was carried out at randomization (1d) and at day 7 (7d) by cycle threshold value (Ct). Variant sequencing was performed at 1d. Ct variation was assessed by mixed effect log-linear model including random intercept at pts' level, log of Ct as independent variable, time, arm, viral variant as dependent variables, and interaction between time and arm. Multiple comparisons were adjusted by Bonferroni. Result(s): Among the 320 pts included between 4 Mar and 16 Nov, 2022, 108 (33.75%) received NMV/r, 103 (32.19%) TIX/CIL, and 109 (34.06%) SOT. Main characteristics were balanced across arms. Most of the pts were infected either with BA.2 (N=194;60.63%) or BA.4/BA.5 (N=100;31.25%) (Fig1A). VL at 1d was similar across the arms. In contrast, mean 7d VL was significantly lower in pts receiving NMV/r than in those receiving TIX/ CIL or SOT (P< 0.001) No significant VL variation was observed between the mAb arms (Fig1B). The analysis of the impact of viral variants suggests that while VL was significantly affected by variants (P=0.034), the superior effect of NMV/r over mAbs was homogeneous across all variant groups (P=0.290 for interaction) (Fig1C). Conclusion(s): Our study provides for the first time strong in vivo evidence that, when used against Omicron lineages, NMV/r exerts a stronger antiviral effect than mAbs. These results confirm previous in vitro evidence suggesting that mAbs may not retain neutralizing activity against all Omicron sublineages and provide preliminary information on how to use VL variation as a surrogate marker of efficacy. Further studies are needed to investigate whether the superior virologic activity of NMV/r over mAbs is confirmed for newly emerging variants, including BQ.1.1 or XBB.
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Background: Omicron subvariants questioned the efficacy of the approved therapies for the early COVID-19. In vitro data show that remdesivir (RDV), molnupiravir (MLN), and nirmatrelvir/ritonavir (NMV/r) all retained activity against all sub-lineages, while poor neutralizing activity was observed for Sotrovimab (SOT) and Tixagevimab/cilgavimab (TIX/CIL). No data about the risk of clinical failure or even in vivo antiviral activity are available. Method(s): Single-center observational comparison study enrolling all consecutive patients (pts) seen for care with a confirmed SARS-CoV-2 Omicron diagnosis and who met the AIFA criteria for eligibility for treatment with RDV, MLN, NMV/r, TIX/CIL, or SOT. Treatment allocation was subject to drug availability, time from symptoms onset, and comorbidities. Nasopharyngeal swab (NPS) VL was measured on day 1 (D1) and D7 and was expressed by log2 cycle threshold (CT) scale. Comparisons between treatment groups were made by Chi-square, and Wilcoxon paired tests. Primary endpoint was D1-D7 VL variation. Potential decrease in VL and average treatment effect (ATE) were calculated from fitting marginal linear regression models weighted for calendar month of drug initiation, duration of symptoms, and immunodeficiency using NMV/r as the comparator trial arm. Result(s): A total of 971 pts received treatments (SOT 321, MLN 231, NMV/r 211, TIX/CIL 70, and RDV 138): female 457 (47%), median age 67 yrs (IQR 56-78), 93% vaccinated;12% with negative baseline serology. At D1, median time from symptoms onset was 3 days (IQR 2,4). 379 (39%) pts were infected with BA.1, 215 (22%) with BA.2, 372 with BA.4/5 (38%), and 5 with BQ.1 (0,5%). D1 mean viral load was 4.02 log2. Adjusted analysis (ATE) showed that NMV/r significantly reduced VL compared to all the other drugs in pts infected with all sublineages, (Fig.1A-B) while less evidence for a difference vs. TIX/CIL was seen in those infected with BA.2 (p=0.05) (Fig.1 C-D). Conclusion(s): In this analysis of in vivo early VL reductions, NMV/r appears to be the drug showing the greatest antiviral activity, regardless of the underlying subvariant, perhaps with the exception of TIX/CIL in people infected with BA.2 for which there was less evidence for a difference. In the Omicron era, due to the high prevalence of vaccinated people and in absence of clinical events, VL is one of the possible alternative endpoints which guarantees adequate statistical power. Fig 1 SARS-CoV-2 RNA levels at D1 and D7 in patients treated with Nirmatrelvir/ ritonavir, Sotrovimab, Molnupiravir, Remdesivir, and Tixagevimab/cilgavimab. Dot-plots showing the comparison of viral loads detected at D1 and D7 and the variation of RNA levels observed between the two time-points by intervention in (A) all patients treated with Nirmatrelvir/ritonavir (n=211), Sotrovimab (n=321), or Molnupiravir (n=231), or Remdesivir (n=138), or Tixagevimab/ cilgavimab (n=136);(C) patients with Omicron BA.2 infection treated with Nirmatrelvir/ritonavir (n=58), Sotrovimab (n=81), or Molnupiravir (n=21), or Remdesivir (n=37), or Tixagevimab/cilgavimab (n=18);(D) patients with Omicron BA.4/5 infection treated with Nirmatrelvir/ritonavir (n=102), Sotrovimab (n=92), or Molnupiravir (n=110), or Remdesivir (n=16), or Tixagevimab/cilgavimab (n=52). Viral RNA levels are expressed as log2 CT values. The horizontal dashed line represents the limit of detection (CT: 40.0), values >=40 are considered negative. Mean of log2 CT values, and SD are shown in the graph. Statistical analysis of the differences in viral loads by intervention as compared to Nirmatrelvir/ritonavir was performed by Mann-Whitney test. Potential decrease in VL and average treatment effect (ATE) were calculated from fitting marginal linear regression models weighted for calendar month of drug initiation, duration of symptoms, and immunodeficiency using NMV/r as the comparator trial arm. Results are shown (B) for patients infected with all Omicron sublineages and (D) for those infected with Omicron BA.2 sublineage.
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Objectives: The Panbio COVID-19 Ag Rapid Test Device (Panbio COVID-19 Ag, Abbott Rapid Diagnostics) is a lateral flow immunochromatographic assay targeting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleoprotein in nasopharyngeal specimens for the diagnosis of coronavirus disease 2019 (COVID-19). This study aimed to verify the performance of the Panbio COVID-19 Ag for implementation in clinical laboratories. Method(s): Sixty nasopharyngeal swab specimens (30 positive and 30 negative) dipped in transport medium, and COVID-19 was confirmed using real-time RT-PCR using Allplex SARS-CoV-2 assay (Seegene), were tested using the Panbio COVID-19 Ag. Reproducibility was evaluated using positive and negative control materials. Sensitivity and specificity were calculated based on the results of realtime RT-PCR as the standard test method. Result(s): Reproducibility was confirmed by the consistent results of repeated tests of the quality control materials. The overall sensitivity and specificity of Panbio COVID-19 Ag were 50.0% and 100.0%, respectively. Panbio COVID-19 Ag demonstrated high sensitivity (88.2%) in analyzing the detection limit cycle threshold (Ct) value of 26.67 provided by the manufacturer as a positive criterion, and the sensitivity was 100.0% for the positive criterion of Ct values <25, although it was less sensitive for Ct > 25. Conclusion(s): Considering the high sensitivity for positive samples with Ct values <25 and the rapid turnaround of results, Panbio COVID-19 Ag can be used in clinical laboratories to diagnose COVID-19 in limited settings. Copyright © 2023 Ewha Womans University College of Medicine and Ewha Medical Research Institute.
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Spontaneous pneumomediastinum (SPM) is a decisive complication reported to be associated with COVID-19. Here, we present a case of SPM in a COVID-19positive patient that was not caused by any iatrogenic or known reasons. At the time of admission, the patient was COVID-positive and distressed. He was immediately subjected to hematological and radiological investigations (chest X-ray, HRCT), which confirmed pneumomediastinum. The patient was hypoxic and hypotensive even after receiving ionotropic support. Considering the patient's critical condition, a mediastinal pigtail catheterization was performed instead of a thoracotomy, and the catheter was in situ for nine days. Arterial blood gas was monitored during the hospital stay, and supplementary oxygen therapy was provided accordingly. The patient subsequently recovered and was discharged. Hence, SPM in this COVID patient was treated by pigtail catheterization, and major surgical interventions were avoided.Copyright © 2023 LookUs Scientific. All rights reserved.
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Introduction: Zygomycetes consisting of Mucorales order is a group of fungal infections. These species cause life threatening opportunistic fungal infections mucormycosis. This infection is highly prevalent in immunocompromised. During the 2 nd wave of Covid 19 pandemic corticosteroid treatment was used which has been linked to development of Mucormycosis. In our tertiary care teaching hospital we saw that patients suffering from Covid-19 infections developed mucormycosis. We present these cases in our study. To study the clinical, demographical,and Laboratory parameters in Covid-19 patients with Mucormycosis. Material(s) and Method(s): Retrospective Study. All biopsy proven cases of Mucormycosis (which developed after Covid-19 infection) were included. Relevant Clinical Demographics and Laboratory data was retrieved from the available case sheets. The data was tabulated in Excel sheet and further reviewed. Result(s): A total of 22 patients were diagnosed as suffering from mucormycosis majority were unvaccinated. 11 patients out of 22 (50%) started manifesting mucormycosis within one week of COVID infection. All the patients who had only single comorbidity (22.72%) suffered from mild disease and patient who had more than one comorbidity suffered from moderate (27.27%) to severe (50%) COVID infection. Conclusion(s): It is suggested that patients with Covid-19 infection are at risk for development of opportunistic fungal infections like Mucormycosis. Hence the physicians who are involved in treating such patients must be mindful of the fact that mucormycosis can develop in them. Histopathology helps in establishing a concrete diagnosis of Mucormycosis.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Introduction: We aimed to characterize epidemiological and clinical characteristics of children and adolescents with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, and to evaluate relationship of cycle threshold value (CT value) of Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test (As surrogate marker of viral load) with patient age and severity of infection. Method(s): We retrospectively collected data of children and adolescents admitted in our center from April 2020 to July 2020 with positive RT-PCR test for SARS-CoV-2. Result(s): Total 62 children, with median (IQR) of age 96 (54-122) months and 39 adolescents with median (IQR) of age 19.5 (18.2-20) years were included. 56 (90%) children and 34 (87%) adolescents had history of SARS-CoV-2 positive cases in their family. Only nine (14%) children had associated risk factor for severe SARS-CoV-2 infection. Fever was the commonest symptom which was present in 24 (39%) children and 16 (41%) adolescents. Cough was present in 17 (27%) children and 10 (26%) adolescents. Diarrhea was found in 14 (23%) children and three (8%) adolescents. CT values of RT-PCR test were similar in children and adolescence (p = 0.48). However, asymptomatic children had higher CT values than symptomatic children (p = 0.01). Conclusion(s): Majority of children have asymptomatic or mild SARS-CoV-2 infection with similar CT values in children and adolescents.Copyright © 2022 by author(s).
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Aim: COVID-19 infection has affected the whole world. It has been speculated that the virus might hold on to angiotensin-converting enzyme 2 (ACE 2) surfaces of type 2 alveolar cells. ACE inhibitors and angiotensin receptor antagonists (ARBs) are essential antihypertensive and cardiac failure drugs in the guidelines. In this study, we aimed to find the effect of these drugs on clinical, laboratory courses, and outcomes of COVID-19 patients. Material(s) and Method(s): We included 109 patients in this study. There were 43 patients in the ACE/ARB group and 66 patients in the non-ACE/ARB group. The mean age was 60 years in the ACE/ARB group and 52 years old in the non-ACE/ARB group. Basal symptoms, hemogram, CRP, D-dimer, LDH, Ferritin, AST, duration of hospitalization, percentage of intensive care unit (ICU) need, length of stay in ICU were compared between the groups. Result(s): The mean age in the ACE/ARB group was higher than in the other group and was statistically significant (p=.027). The initial symptoms were not different. There were no differences between the laboratory results of the groups. The ICU need was higher in the patients who do not use the drug than in the users (p<.020). Discussion(s): ACE/ARB usage in COVID-19 patients did not worsen the course of the disease. However, ACE/ARB users before COVID-19 pandemic were taken to ICU at a low rate.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Introduction: Covid-19 results in a wide spectrum of illness ranging from asymptomatic, mild to severe respiratory disease and multi-organ involvement. Transplant recipients are at increased risk of severe Covid-19. The risk of transmission from a Covid-19 positive donor to recipient in kidney transplantation is unknown. National Health Service Blood and Transplant, UK recommended respiratory polymerase chain reaction (PCR) testing for all donors for Covid-19 and advice against organ donation if positive within the last 28 days. However, a recent amendment of guideline (www.odt.nhs.uk, POL304/3) supports organ donation from selected donors with positive or indeterminate SARS-CoV-2 PCR results. Method(s): We report two cases of kidney transplantation including one unvaccinated recipient where donors had tested SARS-CoV-2 PCR positive. Result(s): 1: Mrs A is a 38-year old Caucasian with end-stage kidney disease (ESKD) secondary to reflux nephropathy, established on haemodialysis (HD). She had declined Covid-19 vaccinations. The donor died of traumatic brain injury and he had a positive lateral flow test 3 weeks prior. The PCR test was positive. Decision was made to proceed with deceased donor kidney transplantation. She was high immunological risk with a HLA antibody calculated reaction frequency (CRF) of 79%, donor specific antibody negative. She was given Basiliximab induction followed by Tacrolimus, Mycophenolate Mofetil and steroids. Graft function was immediate and at 3 week post-transplant, she is well with excellent graft function and no evidence of Covid-19. 2: Mrs B is a 63-year old Asian with ESKD secondary to diabetes and hypertension. She was established on HD and fully vaccinated (three doses of Pfizer-BNT162b2 mRNA vaccine). The donor died of subarchnoid haemorrhage. He had a positive lateral flow test 15 days prior with flu-like symptoms. Respiratory PCR for SARS-CoV-2 was positive. The decision was to proceed with deceased donor transplantation. She was low immunological risk with a HLA antibody CRF of 0%. There were no peri-operative complications and she had immediate graft function. She had Basiliximab induction and was discharged on Tacrolimus and Mycophenolate mofetil with prednisolone withdrawn on day 7 (our low immunological risk protocol). At 3 week post-transplant, she is well with no evidence of Covid-19 and excellent graft function. Conclusion(s): We report 2 cases of kidney transplantation from Covid-19 positive donors in whom the cause of death was not Covid-19 pneumonia. Covid-19 status of the donor was discussed with the patients who both consented. Neither recipient developed Covid-19 in the early post-transplant period, despite being heavily immunosuppressed. Although there remains a theoretical risk, there are no reports of transmission of Covid-19 to kidney transplant recipients from positive donors. Prophylactic antivirals or monoclonal antibodies for the recipient post-transplant or spike antibody test to guide decision making are not currently recommended. We used clinical details of the donor and virology advice which accounts for PCR cycle threshold value to make a decision to transplant. The outcomes of 2 patients reported along with similar experience from other centres is encouraging and supports use of kidneys from selected SARS-CoV-2 positive deceased donors after obtaining virological advice and appropriate consent. No conflict of interestCopyright © 2023
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INTRODUCTION. Two-thirds of patients with COVID-19 developed smell and taste dysfunction, of whom half experienced improvement within the first month. After six months, 5-15% still suffered from significant olfactory dysfunction (OD). Before COVID-19, olfactory training (OT) was proved to be effective in patients with post-infectious OD. Therefore, the present study aimed to investigate the progress of olfactory recovery with and without OT in patients with long COVID-19. METHODS. Consecutive patients with long COVID-19 referred to the Flavour Clinic at Godstrup Regional Hospital, Denmark, were enrolled. The diagnostic set-up at the first visit and follow-up included smell and taste tests, questionnaires, ENT examination and instructions in OT. RESULTS. From January 2021 to April 2022, 52 patients were included due to long COVID-19-related OD. The majority of patients complained of distorted sensory quality, in particular, parosmia. Two-thirds of the patients reported a subjective improvement of their sense of smell and taste along with a significant decline in the negative impact on quality of life (p = 0.0001). Retesting at follow-up demonstrated a significant increase in smell scores (p = 0.023) where a minimal clinically important difference (MCID) in smell scores was found in 23% of patients. Full training compliance was significantly associated with the probability of MCID improvement (OR = 8.13;p = 0.04). CONCLUSIONS. The average effect of OT is modest;however, full training compliance was significantly associated with an increased probability of a clinically relevant olfactory improvement. FUNDING. none. TRIAL REGISTRATION. not relevant.Copyright © 2023, Almindelige Danske Laegeforening. All rights reserved.
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Objective This multicenter clinical evaluation analyzed the clinical performance of five fast nucleic acid detection systems for 2019-nCoV. Methods Clinical performance of the five fast nucleic acid detection reagents approved in China was evaluated in the present study. Fifty-seven throat swabs samples from COVID-19 patients and fifteen throat swabs samples from healthy people were collected from the First Affiliated Hospital of Zhejiang University school of Medicine, Tongji Hospital of Tongji Medical College of HUST, and National Institute of Viral Disease Control and Prevention of CDC to evaluate the positive coincidence rate, negative coincidence rate, total coincidence rate, the detection time and retest rate as well as the relation between positive intensity and positive coincidence rate of the five fast nucleic acid detection systems in November 2020. Results The positive coincidence rates of the five kits were 92.59% (50/54), 83.64% (46/55), 98.25% (56/57), 94.44% (51/54) and 98.18% (54/55);and the negative coincidence rates were 93.33% (14/15), 93.33% (14/15), 86.67% (13/15), 100% (14/14) and 93.33% (14/15);and the total coincidence rates were 92.75% (64/69), 85.71% (60/70), 95.83% (69/72), 94.20% (65/69) and 97.14% (68/70), respectively. The positive coincidence rate of the five kits reached 100% for the strong-positive (90/90) and medium-positive samples (84/84), but only 82.18% (83/101) for weak-positive samples (cycle threshold value>33), and the retest rate of two kits were 15.28% (11/72) and 12.50% (9/72), which were both higher than 10%. Total time from sample extraction to amplification was between 32.33-65.33 minutes for these five kits. Conclusion The five fast nucleic acid detection reagents have good performance and can be used as a supplement to routine nucleic acid detection reagents.Copyright © 2022 Chinese Journal of Laboratory Medicine. All rights reserved.
ABSTRACT
The ongoing COVID-19 pandemic reminded once again that microbiological diagnostic methods are irreplaceable in both diagnosing and detecting asymptomatic persons. At present, real-time reverse transcriptase polymerase chain reaction (RT-PCR) is the gold standard method for diagnosing COVID-19, but the test's accuracy varies in sample quality. Especially in the last stages of the disease, negative results of nasopharyngeal or oropharyngeal swab samples or rapid antigen tests do not necessarily mean that these patients do not carry the virus. Considering that a significant number of COVID-19 patients need intensive care and mechanical ventilation in the late period, which sample should be taken from where and when should be evaluated. Lower respiratory tract samples have a more significant chance of finding viral RNA than upper respiratory tract samples. Technical recommendations and the virological diagnostic methodologies and used in the intensive care unit of patients infected with SARS-CoV-2 are summarized in this article. We aimed to emphasize the need to get a sample from the right place at the right time for a reliable virological diagnosis.Copyright © 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.
ABSTRACT
Introduction: Real time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test, the gold standard test for Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) detection, is a tedious process and requires proficient workforce. Accurate and fast test results may permit more efficient use of protective and isolation resources and allow rapid therapeutic interventions. Aim(s): To evaluate the analytical performance characteristics of the Cepheid Xpert Xpress SARS-CoV-2 test, a rapid, automated molecular test for SARS-CoV-2 with gold standard RT-PCR test. Material(s) and Method(s): This retrospective cohort study was conducted in Virus Research and Diagnostic Laboratory (VRDL) in Department of Microbiology at GGS Medical College, Faridkot from January 2021-June 2021. A total of 100 nasopharyngeal samples, collected from clinically suspected Coronavirus Diseae-2019 (COVID-19) cases admitted at GGSMC during 1st January-30th June 2021 were tested both by Xpert assay and RT-PCR test simultaneously, taking RT-PCR as the gold standard test. The data was analysed by MedCalc statistical software version 19.6.4., and sensitivity, specificity, predictive values, likelihood ratios and the agreement between the two tests were calculated. Result(s): The mean age of the study participants was 46 years. Of these, 55 were males and 45 were females. The overall sample sensitivity and specificity of the Xpert assay were both 100% and there was perfect agreement across specimens, if authors, set a cut-off Cycle threshold-value (Ct-value) at 40 cycles for Xpert. Of 100 samples, 32 were positive for SARS-CoV-2 by either of the tests and 68 were negative. Xpert assay could detect 100% positive cases and RT-PCR test could detect 84.37% positive cases. Out of the 32 samples which were positive by Xpert assay, 5 (15.62%) samples had a Ct-value greater than 40. Conclusion(s): The Xpert assay found to be useful as a point-of-care test in acute scenario, where rapid and authentic diagnosis is essential, but do not have expertise and infrastructure to perform RT-PCR.Copyright © 2023 Journal of Clinical and Diagnostic Research. All rights reserved.