Comparison of four automated SARS-CoV-2 serological immunoassays in Lebanon.

Automated immunoassays have been introduced to complement real time PCR (RT-PCR) in the battle against SARS-CoV-2. This study compares four serological automated immunoassays by different manufacturers (Abbott, Euroimmun, Roche and Snibe) that are available in Lebanon with regards to specificities, sensitivities, inter-agreement and positive/negative distinction abilities. One hundred and fifty-seven samples (73 with a positive RT-PCR and 84 controls) were analyzed. The 73 study samples were divided into 3 time categories: ≤ 7 days, 8-13 days and ≥ 14 days based on time since first positive RT-PCR or first symptoms. The category "total days" was studied as the average of all the three time categories. All assays had 100% specificity and their sensitivities in the "total days" category ranged from 75.3% to 20.6% (Snibe IgM). The sensitivity was low for all at ≤ 7 days and increased gradually in the other time categories. The IgG assays by different manufacturers showed high inter-agreement. The assays also showed good positive/negative discriminative abilities after 14 days. The four studied automated immunoassays (except for Snibe IgM) show an adequate diagnostic performance when used 14 days after first positive PCR or first symptom onset.

Challenges facing COVID-19 in rural areas: An experience from Lebanon.

The COVID-19 pandemic first affected Lebanon on February 21st, 2020, and one month later it reached Bcharri, a small remote town in northern Lebanon. When similar rural areas with under-equipped facilities and financial limitations are affected, outcomes could be catastrophic, raising the need for meticulous preparation and rapid response. In our study, we describe the different measures taken to prepare this town for the COVID-19 outbreak, as well as our rapid response after the first case was confirmed. We emphasize the distinctions and the needs of rural areas when facing such threats, and the importance of a proactive community and local initiatives. We also detail our contact tracing strategy and massive testing campaign, as well as our early management of patients infected with COVID-19. We hope that our experience can be reproducible in areas with similar rural settings, during the COVID-19 pandemic and future outbreaks.

SYNDROME DES ANTIPHOSPHOLIPIES. À PROPOS DE 30 CAS.

OBJECTIVES: To analyze clinical and immuno- logic manifestations of Lebanese patients with the antiphos- pholipid syndrome (APS). PATIENTS AND METHODS: Our study was retrospective and was done on hospitalized patients be- tween 2001 and 2013. All these patients fulfilled the interna- tional criteria for diagnosis (Sydney criteria). RESULTS: Of the 30 patients selected, we noticed a female predominance (sex ratio: 2.75). The age at diagnosis ranged between 9 and 72 years with a mean age of 43 - 17 years. "Primary" APS was present in 70% of patients; APS was associated with systemic lupus erythematosus (SLE) in 23% of patients, with a mixed connective tissue disease in 3% and systemic vasculitis in 3%. A catastrophic APS occurred in 3 cases (10%). The most com- mon presenting manifestations were deep venous thrombosis (53%), pulmonary embolism (33%) and stroke (13%). Eleven patients (37%) had venous thrombosis, 7 (23%) had arterial thrombosis alone and 7 (23%) both arterial and venous throm- bosis. Deep venous thrombosis occurred mostly in the lower limbs (70%) whereas arterial thrombosis occurred in cerebral arteries in 50% of cases. The most common fetal complica- tions were early fetal loss (62.5%). Anticardiolipin antibodies were the most frequently identified antibodies (83%), followed by anti-p2GPI (70%) and anticoagulant lupus (11%). An effec- tive anticoagulation by anti-vitamin K was performed in 29 pa- tients. Corticosteroids were prescribed in 13 cases and were associated to immunosuppressant drugs in 6 cases of second- ary APS and the 3 catastrophic APS. The patients with cat- astrophic APS received also intravenous immunoglobulin. Response to treatment was favorable in 86% of patients with a mean follow up of 6 4 years. We deplored 4 deaths, 2 with- in the catastrophic APS. CONCLUSION: The APS does not seem to have particular features in Lebanon. The primary form seems to be the most common. It is important to diagnose this syn- drome earlier before the onset of serious complications.