Clinical influence of multiplex polymerase chain reaction routine uses in urgent pediatric admissions.

BACKGROUND: The coronavirus disease 2019 outbreak has prompted some hospitals to implement screening tests upon admission since 2020. FilmArray® Respiratory 2.1 Panel (FilmArray) is a multiplex polymerase chain reaction (PCR) test with high sensitivity and specificity for detecting respiratory pathogens. We aimed to assess the clinical influence of the routine use of FilmArray for pediatric patients, including those without symptoms suggestive of an infection. METHODS: We conducted a single-center retrospective observational study, which investigated patients aged ≤15 years who underwent FilmArray on admission in 2021. We collected the patients' epidemiological information, symptoms, and FilmArray results from their electronic health records. RESULTS: A positive result was observed in 58.6% of patients admitted to the general ward or intensive care unit (ICU) but only in 1.5% of patients in the neonatal ward. Among the patients admitted to the general ward or ICU who tested positive, 93.3% had symptoms suggestive of infections, 44.6% had a sick contact before admission, and 70.5% had siblings. However, 62 (28.2%) out of 220 patients without the four (fever, respiratory, gastrointestinal, and dermal) symptoms also had positive results. Among them, 18 patients with adenovirus and three with respiratory syncytial virus were isolated to private rooms. However, 12 (57.1%) patients were discharged without symptoms suggestive of viral infection. CONCLUSION: Multiplex PCR routine use for all inpatients may lead to excessive management of positive cases because FilmArray cannot quantify microorganisms. Thus, targets for testing should be considered carefully based on patients' symptoms and histories of sick contacts.

Comparison of the Effects of Nasopharyngeal Swab Methods on Anxiety Score During COVID-19 PCR Test

Objective: Coronavirus disease-19 pandemic affected the whole world in 2020 and so far caused nearly 2 million deaths. The most commonly used method in the diagnosis of coronavirus disease-19 is to take swabs from specific areas in the upper respiratory tract, especially the nasopharynx. In this article, it was aimed to compare the effects of transoral/transnasal nasopharyngeal swab methods on anxiety score before and after the procedure. Method(s): This study was designed as a prospective randomized clinical trial. Hundred and four volunteers between the ages of 18-65 were included in the study, and volunteers were divided into 2 groups. Transoral method was applied to group-1 and transnasal method was applied to group-2. Visual Analog Scale scoring was performed to measure the anxiety/pain/general discomfort levels of the participants before and after the procedure. Result(s): In this study, 50 volunteers from the transoral group and the rest 54 volunteers from the transnasal group, a total of 104 individuals were included. Before the procedure, no statistically significant difference in anxiety levels was observed between the groups. However, anxiety, pain, and general discomfort levels during the procedure were found to be lower in group 1. Conclusion(s): In the light of the results of our trial, we suggest that the transoral nasopharyngeal swab method can be a better alternative in selected patient groups. The prime advantage of this procedure is that it causes less pain and general discomfort. We think that many complications encountered in the transnasal method can be overcome by the transoral method. Copyright © 2022 B-ENT. All rights reserved.

A Novel Artificial Intelligence-Based Model for COVID-19 Diagnosis Using CT Scans

By the end of the year 2019, a global pandemic novel coronavirus, known as COVID-19, hits the world. The most widely used test for COVID-19 is the Real-Time Polymerase Chain Reaction. However, Real-Time Polymerase Chain Reaction test is time-consuming. Moreover, it suffers from a high false-negative diagnosis rate (low sensitivity). Computed Tomography scans, compared to the Real-Time Polymerase Chain Reaction test, can produce a result in a short amount of time. In this paper, we propose a novel model that hybridizes deep learning and machine learning together. Deep learning is utilized to extract the important features from Computed Tomography images, then the selected features are passed to an ensemble model for the classification. We used RseNet50 for features selection, and the classification is performed by an ensemble model that combines Support-vector Machine, Logistic Regression, and Multilayer Perceptron. The proposed model is compared with eleven state-of-the-art techniques and surpassed them using accuracy, precision, recall, and F1-score. The contribution of this paper is introducing a novel model with high performance for the diagnosis of COVID-19. With the aid of this model, we could identify positive cases rapidly for early isolation. At the same time, we can use it in combination with Real-Time Polymerase Chain Reaction test to increase its sensitivity.

Severity of COVID-19 Disease in Vaccinated and Non Vaccinated COVID-19 Positive Cases: A Cross-sectional Study

Introduction: Coronavirus disease 2019 (COVID-19) Vaccine was reported to be used in China, after the outbreak of Coronavirus. COVID-19 Vaccine requires validation of efficacy and adverse reactions as target vaccine population include high risk over the age of 60, medical frontline workers and people working in essential industries. After Spanish flu, COVID-19 pandemic is most devasting situation in the world. Aim: To evaluate the effectiveness of COVID-19 vaccine in COVID-19 positive vaccinated cases compared to non vaccinated cases. Materials and Methods: This cross-sectional study was conducted in Government Super specialty hospital from July 2021 to September 2021. COVID-19 positive was confirmed by Reverse Transcription Polymerase Chain Reaction (RT-PCR) test in vaccinated and non vaccinated patients, admitted in a government super specialty hospital. Severity of the disease was studied in 1423 non vaccinated and 601 vaccinated cases of all age group above 18 years. Patients were categorised based on symptoms and oxygen saturation (SpO(2)) in to Mild-SpO(2)> 94%, Moderate-SpO(2) <94%, Severe-SpO(2) <90%. Patients were subdivided into three groups based on age -1844 years, 45-64 years and >= 65 years age. Data was collected and tabulated using Microsoft excel and Statistical Package for the Social Sciences (SPSS) version 15.0. The statistics of percentage was used. Results: A total of 2024 COVID-19 positive cases were studied, out of which, 1423 were non vaccinated and 601 were vaccinated. Among non vaccinated group of 1423 cases, 712 cases had mild symptoms, 510 patients were of moderate symptoms, 201 patients were of severe symptoms. In 601 vaccinated cases, mild cases were 352, moderate cases were 185 with SpO(2) <94%-90%, 64 cases are severe with SpO(2) <90%. In this study the vaccinated patients had less severe disease with mild symptoms, in the cases of present study from COVID-19 compared to non vaccinated cases. Conclusion: Vaccine Effectiveness was noted after two doses. Vaccinated people had less severe symptoms and disease compared to non vaccinated people. Finding would support the effort to maximize vaccine with two doses among vulnerable population.

Prompt successful response to a COVID-19 outbreak: Performance of community-based rapid screening station.

An outbreak occurred in Wanhua District of Taipei City. It was traced to a cluster infection originating from a teahouse. To prevent further large-scaled community spread, the Taipei City Government established the first community rapid test screening station. This report describes the station's strategy and performance and key factors that contributed to its operation. The project involves collaboration among various departments of Taipei City Government, including the health, environmental, police, transportation, and fire departments. The station provides rapid screening, polymerase chain reaction (PCR) testing, and immediate isolation and follow-up medical services upon the detection of a positive case. These services are accessible to local residents and are intended to ease hospitals' burdens. In 36 days, a total of 8532 people were tested, and 419 confirmed cases were identified. Over the same period, the weekly number of positive cases in Wanhua District decreased from 356 to 40, and the PCR positive rate decreased from 21.7% to 1.2%. The policy of establishing rapid screening station, contact tracing and mask wearing policy are key strategies for interrupting chains of transmission of COVID-19. This intervention has become a model for preventing the spread of the epidemic and establishing community rapid screening stations in Taiwan.

[Trends of Implementation of Nonsmoking at Eating and Drinking Establishments One Year before and after April 2020: Consideration of the Status of Implementation of the Amendment Bill for the Health Promotion Act of Japan].

OBJECTIVE: In this study, we aimed to clarify the transition to the implementation of smoking prohibition at eating and drinking establishments one year before and after April 2020, the time when they became "nonsmoking" in principle following the implementation of the amendment bill for the Health Promotion Act of Japan. METHODS: The total number of nonsmoking/smoking eating and drinking establishments by industry were obtained using the data from "Tabelog®." The number of people who tested positive for COVID-19 by the polymerase chain reaction test on the day of the survey nationwide and the bankruptcy status of the companies (eating and drinking establishments, etc.) for each month were ascertained. RESULTS: In 2020, a state of emergency was declared owing to the increase in the number of people positive for COVID-19, and many eating and drinking establishments went bankrupt. Despite these circumstances, the number of nonsmoking eating and drinking establishments exceeded that of smoking establishments in March 2020 and continued to increase thereafter. Additionally, the number of nonsmoking "restaurants" increased and exceeded that of smoking restaurants in June 2020. The number of nonsmoking "cafes" already exceeded that of smoking "cafes" at the beginning of this survey and continued to increase. The number of nonsmoking "bars" increased, but that of smoking "bars" remained high. CONCLUSION: It is necessary to promote measures against passive smoking while paying attention to the trends for different types of eating and drinking establishments, rather than considering all establishments together.

Public Health Scotland - the first year: successes and lessons.

Over its first year Public Health Scotland (PHS) played a key role in the national vaccination programme by providing professional leadership and expertise. We expedited the reporting of all aspects of the pandemic, and accelerated rapid evidence reviews. We contributed to rigorous research showing that: vaccination reduced hospitalisation by 90%, and the transmission of COVID-19 within households by 55%; hence vaccination works. Lessons for the future included strengthening whole genome sequencing to manage COVID-19 and to prepare for future pathogens. COVID-19 also stimulated the redesign of many health and social care services: by exploiting digital media; by implementing evidence on reducing barriers to service delivery; and by greater integration - of projects rather than organisations - enabling groups who had not worked together to address common issues. PHS and partners soon recognised the need to mitigate the adverse impact of the pandemic on existing inequalities. So we aim to 'build back fairer' as the pandemic recedes, by pursuing PHS's four priorities: poverty; children and young people; place and community; and mental health and well-being.

Diagnostic performance of the combined nasal and throat swab in patients admitted to hospital with suspected COVID-19.

BACKGROUND: Accurate diagnosis in patients with suspected coronavirus disease 2019 (COVID-19) is essential to guide treatment and limit spread of the virus. The combined nasal and throat swab is used widely, but its diagnostic performance is uncertain. METHODS: In a prospective, multi-centre, cohort study conducted in secondary and tertiary care hospitals in Scotland, we evaluated the combined nasal and throat swab with reverse transcriptase-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in consecutive patients admitted to hospital with suspected COVID-19. Diagnostic performance of the index and serial tests was evaluated for a primary outcome of confirmed or probable COVID-19, and a secondary outcome of confirmed COVID-19 on serial testing. The diagnosis was adjudicated by a panel, who recorded clinical, laboratory and radiological features blinded to the test results. RESULTS: We enrolled 1368 consecutive patients (median age 68 [interquartile range, IQR 53-80] years, 47% women) who underwent a total of 3822 tests (median 2 [IQR 1-3] tests per patient). The primary outcome occurred in 36% (496/1368), of whom 65% (323/496) and 35% (173/496) had confirmed and probable COVID-19, respectively. The index test was positive in 255/496 (51%) patients with the primary outcome, giving a sensitivity and specificity of 51.4% (95% confidence interval [CI] 48.8 to 54.1%) and 99.5% (95% CI 99.0 to 99.8%). Sensitivity increased in those undergoing 2, 3 or 4 tests to 60.1% (95% CI 56.7 to 63.4%), 68.3% (95% CI 64.0 to 72.3%) and 77.6% (95% CI 72.7 to 81.9%), respectively. The sensitivity of the index test was 78.9% (95% CI 74.4 to 83.2%) for the secondary outcome of confirmed COVID-19 on serial testing. CONCLUSIONS: In patients admitted to hospital, a single combined nasal and throat swab with RT-PCR for SARS-CoV-2 has excellent specificity, but limited diagnostic sensitivity for COVID-19. Diagnostic performance is significantly improved by repeated testing.

Proposal of COVID-19 Clinical Risk Score for the management of suspected COVID-19 cases: a case control study.

BACKGROUND: No clinical scoring system has yet been established to estimate the likelihood of coronavirus disease (COVID-19) and determine the suitability of diagnostic testing in suspected COVID-19 patients. METHODS: This was a single-center, retrospective, observational study of patients with suspected COVID-19 and confirmed COVID-19. Patient background, clinical course, laboratory and computed tomography (CT) findings, and the presence of alternative diagnoses were evaluated. Clinical risk scores were developed based on clinical differences between patients with and without COVID-19. RESULTS: Among 110 patients suspected of having COVID-19, 60.9% underwent polymerase chain reaction (PCR) testing based on the judgment of physicians. Two patients were found to have COVID-19. The clinical characteristics of 108 non-COVID-19 patients were compared with those of 23 confirmed COVID-19 patients. Patients with COVID-19 were more likely to have a history of high-risk exposures and an abnormal sense of taste and smell. The COVID-19 group had significantly higher rates of subnormal white blood cell counts, lower eosinophil counts, and lower procalcitonin levels than the non-COVID-19 group. When blood test results, CT findings, and the presence of alternative diagnoses were scored on an 11-point scale (i.e., "COVID-19 Clinical Risk Score"), the COVID-19 group scored significantly higher than the non-COVID-19 group, more than four points in the COVID-19 group. All non-COVID patients who did not undergo PCR had a score of 4 or less. CONCLUSIONS: The COVID-19 Clinical Risk Score may enable the risk classification of patients suspected of having COVID-19 and can help in decision-making in clinical practice, including appropriateness of diagnostic testing. Further studies and prospective validation with an increased sample size are required.

Strategic planning to augment the testing capacity for COVID-19 in India.

Background & objectives: Nearly 5,500 tests for coronavirus disease 2019 (COVID-19) had been conducted on March 31, 2020 across the Indian Council of Medical Research (ICMR)-approved public and private laboratories in India. Given the need to rapidly increase testing coverage, we undertook an exercise to explore and quantify interventions to increase the daily real-time reverse transcription-polymerase chain reaction (qRT-PCR)-based testing capacity over the next few months. The objective of this exercise was to prepare a potential plan to scale-up COVID-19 testing in India in the public sector. Methods: Potential increase in daily testing capacity of the existing public laboratories was calculated across the three base scenarios of shifts (9, 16 and 24 h). Additional testing capacity was added for each shift scenario based on interventions ranging from procurement of additional qRT-PCR machines, leveraging spare capacity on available qRT-PCR machines not drafted into COVID-19 testing, to in-laboratory process optimization efforts. Results: Moving to a 24 h working model in the existing approved laboratories can enhance the daily testing capacity to 40,464 tests/day. The capacity can be further bolstered by leveraging qRT-PCR and nucleic acid amplification test (NAAT)-based machines available with the Multidisciplinary Research Units (MRUs), National AIDS Control Organisation (NACO) and National Tuberculosis Elimination Programme (NTEP). Using combination/multiplex kits, and provision of automated RNA extraction platforms at all laboratories could also optimize run time and contribute to capacity increase by 1.5-2 times. Interpretation & conclusions: Adopting these interventions could help increase public sector's daily testing capacity to nearly 100,000-120,000 tests/day. It is important to note that utilization of the scaled-up testing capacity will require deployment of additional workforce, procurement of corresponding commodities for testing and scale-up of sample collection and transportation efforts.