Comparison of rapid antibody test and thorax computed tomography results in patients who underwent RT-PCR with the pre-diagnosis of COVID-19.

INTRODUCTION: In this study, it is planned to compare the real-time reverse transcription-polymerase chain reaction (RT-PCR) test, which is the gold standard in the diagnosis of COVID-19, with thorax computed tomography (CT) and rapid antibody test results. METHODS: Patients who were admitted to the emergency service of Izmir Çigli Training and Research Hospital between 01.04.2020 and 31.05.2020 and who were suspected of having COVID-19 infection were included in the study. The medical records of the patients were retrospectively analysed through the hospital data processing database. Age, gender, hospitalisation, status of home quarantine, real-time RT-PCR, thorax CT and rapid antibody test results of the patients were examined. The relationship between RT-PCR, thorax CT and rapid antibody test results was compared statistically. RESULTS: A total of 181 patients, 115 (63.5%) male and 66 (36.5%) female, with an average age of 56.4 ± 18.06 years were included in the study. The nasopharyngeal swab PCR result obtained at the first admission of the patients to the emergency department was positive in 71 (39.2%) patients. Rapid antibody tests performed at hospital admission were positive in 57 (31.5%) patients. Thorax CT was performed in 173 (95.6%) patients who applied to the emergency department, and 112 (64.7%) of them had findings that could be compatible with COVID-19. According to the thorax CT findings in patients, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for detecting COVID-19 infection were, respectively, 76.1%, 43.1%, 48.2% and 72.1% (ĸ: 0.176, P < .001). According to the rapid antibody test results, sensitivity, specificity, PPV and NPV for detecting COVID-19 infection were 57.5%, 85.5%, 71.9% and 75.8%, respectively (ĸ: 0.448, P < .001). In our study, the mortality rate for COVID-19 was found to be 2.8%. CONCLUSION: Rapid antibody test and thorax CT examinations were found to have low diagnostic value in patients who admitted to the emergency department of our hospital and whose first RT-PCR SARS-CoV-2 test was positive. Studies involving larger patient groups are needed for their use alone in diagnosis and screening.

Estimation of Cardiac Systolic Function Based on Mitral Valve Movements: An Accurate Bedside Tool for Emergency Physicians in Dyspneic Patients.

OBJECTIVES: The purpose of this study was to determine the success of mitral valve movements in the estimation of left ventricular ejection fraction (LVEF). METHODS: Adult patients whose principal symptom was dyspnea were included in this prospective observational study. The distance from the anterior mitral valve (AMV) to the interventricular septum (IVS) during early diastole was measured first in B-mode in the parasternal long axis (PLAX) named parasternal long axis-anterior leaflet septal separation. Second, the AMV-IVS distance was measured in M-mode in the PLAX named E-point septal separation. Third, AMV-IVS distance was measured in B-mode in the apical 4-chamber view named apical 4-chamber view-anterior leaflet septal separation. Finally, maximum distance between the 2 mitral leaflets in the apical 4-chamber view was measured and named mitral valve leaflet separation. Comprehensive echocardiography was performed by an experienced cardiologist. Correlation was calculated between mitral valve measurements and LVEF. Cutoff values were determined using receiver operating characteristic curves and the chi-square test. RESULTS: A total of 118 patients were included in the study. Parasternal long axis-anterior leaflet septal separation, E-point septal separation, and apical 4-chamber view-anterior leaflet septal separation were highly correlated with LVEF (correlation coefficient, -0.848, -0.833, and-0.822 [P < .001]). Parasternal long axis-anterior leaflet septal separation values less than 2.30 mm, E-point septal separation values less than 2 mm, and mitral valve leaflet separation values greater than 25.15 mm exhibited a 100% negative predictive value in excluding reduced LVEF. Parasternal long axis-anterior leaflet septal separation values less than 4.95 mm, EPSS values less than 5.85 mm, apical 4-chamber view-anterior leaflet septal separation values less than 6.95 mm, and mitral valve leaflet separation values greater than 24.05 mm exhibited a 100% negative predictive value in excluding severe reduced LVEF. CONCLUSIONS: Mitral valve measurement methods may be useful in predicting LVEF or values thereof as a complementary method of diagnosing challenging patients on echocardiographic images.

The role of inferior vena cava diameter in the differential diagnosis of dyspneic patients; best sonographic measurement method?

STUDY OBJECTIVE: We aimed to determine the role of inferior vena cava (IVC) diameter in making a differentiation between dyspnea of cardiac (acute heart failure [AHF]) and pulmonary origin. We also attempted to determine the best sonographic method for the measurement of IVC diameter. METHODS: This prospective observational study was conducted at the intensive care unit of the emergency department of a training and research hospital. This study enrolled patients with the main symptom of dyspnea who were categorized into 2 groups, cardiac dyspnea and pulmonary dyspnea groups, based on the final diagnosis. All patients underwent sonographic measurement of minimum and maximum diameters of IVC, and the caval index (CI) was calculated in both M-mode and B-mode. The sensitivity, specificity, and likelihood ratios (LR) of the IVC values for the differentiation of the 2 groups were calculated. RESULTS: This study included a total of 74 patients with a mean age of 72.8 years. Thirty-two patients had dyspnea of cardiac origin, and 42 patients had dyspnea of pulmonary origin. The IVC diameter measured with B-mode during inspiration (B-mode i) was the most successful method for differentiation of the 2 groups. B-mode i values greater than 9 mm predicted dyspnea of cardiac origin with a sensitivity of 84.4% and a specificity of 92.9% (+LR: 11.8, LR: 0.16). CONCLUSION: Sonographic assessment of the IVC diameter may be used as a rapid, readily, nonexpensive, complication-free, and reproducible technique for the differentiation of cardiac and pulmonary causes of dyspnea. B-mode i measurement may be more successful in the differentiation of dyspnea compared with other IVC diameters and calculations.