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1.
Preprint in English | medRxiv | ID: ppmedrxiv-21250365

ABSTRACT

Limitations in timely testing for SARS-CoV-2 drive the need for new approaches in suspected COVID-19 disease. We queried whether viral load (VL) in the upper airways at presentation could improve the management and diagnosis of patients. This study was conducted in a 9 hospital system in Allegheny County, Pennsylvania between March 1-August 31 2020. Viral load was determined by PCR assays for patients presenting to the Emergency Departments (ED), community pediatrics practices and college health service. We found that for the ED patients, VL did not vary substantially between those admitted and not. VL was relatively equivalent across ages, except for the under 25 age groups that tended to present with higher loads. To determine if rapid antigen testing (RAT) could aid diagnosis in certain populations, we compared BD Veritor and Quidel Sofia to SOC PCR-based tests. The antigen assay provided a disease-detection sensitivity of >90% in a selection of 32 positive students and was modeled to have an 80% sensitivity in all positive students. In the outpatient pediatric population, the antigen assay detected 70% of PCR-positives. Extrapolating these findings to viral loads in older hospitalized patients, a minority would be detected by RAT (40%). Higher loads did correlate with death, though the prognostic value was marginal (ROC AUC of only 0.66). VL did not distinguish between those needing mechanical ventilation and routine inpatients. We conclude that VL in upper airways, while not prognostic for disease management, may aid in selecting proper testing methodologies for certain patient populations.

2.
B. Joseph Elmunzer; Rebecca L. Spitzer; Lydia D. Foster; Ambreen A. Merchant; Eric F. Howard; Vaishali A. Patel; Mary K. West; Emad Qayad; Rosemary Nustas; Ali Zakaria; Marc S. Piper; Jason R. Taylor; Lujain Jaza; Nauzer Forbes; Millie Chau; Luis F. Lara; Georgios I. Papachristou; Michael L. Volk; Liam G. Hilson; Selena Zhou; Vladimir M. Kushnir; Alexandria M. Lenyo; Caroline G. McLeod; Sunil Amin; Gabriela N. Kuftinec; Dhiraj Yadav; Charlie Fox; Jennifer M. Kolb; Swati Pawa; Rishi Pawa; Andrew Canakis; Christopher Huang; Laith H. Jamil; Andrew M. Aneese; Benita K. Glamour; Zachary L. Smith; Katherine A. Hanley; Jordan Wood; Harsh K. Patel; Janak N. Shah; Emil Agarunov; Amrita Sethi; Evan L. Fogel; Gail McNulty; Abdul Haseeb; Judy A. Trieu; Rebekah E. Dixon; Jeong Yun Yang; Robin B. Mendelsohn; Delia Calo; Olga C. Aroniadis; Joseph F. LaComb; James M. Scheiman; Bryan G. Sauer; Duyen T. Dang; Cyrus R. Piraka; Eric D. Shah; Heiko Pohl; William M. Tierney; Stephanie Mitchell; Ashwinee Condon; Adrienne Lenhart; Kulwinder S. Dua; Vikram S. Kanagala; Ayesha Kamal; Vikesh K. Singh; Maria Ines Pinto-Sanchez; Joy M. Hutchinson; Richard S. Kwon; Sheryl J. Korsnes; Harminder Singh; Zahra Solati; Amar R. Deshpande; Don C. Rockey; Teldon B. Alford; Valerie Durkalski; Field F. Willingham; Patrick S. Yachimski; Darwin L. Conwell; Evan Mosier; Mohamed Azab; Anish Patel; James Buxbaum; Sachin Wani; Amitabh Chak; Amy E. Hosmer; Rajesh N. Keswani; Christopher J. DiMaio; Michael S. Bronze; Raman Muthusamy; Marcia I. Canto; V. Mihajlo Gjeorgjievski; Zaid Imam; Fadi Odish; Ahmed I. Edhi; Molly Orosey; Abhinav Tiwari; Soumil Patwardhan; Nicholas G. Brown; Anish A. Patel; Collins O. Ordiah; Ian P. Sloan; Lilian Cruz; Casey L. Koza; Uchechi Okafor; Thomas Hollander; Nancy Furey; Olga Reykhart; Natalia H. Zbib; John A. Damianos; James Esteban; Nick Hajidiacos; Melissa Saul; Melanie Mays; Gulsum Anderson; Kelley Wood; Laura Mathews; Galina Diakova; Molly Caisse; Lauren Wakefield; Haley Nitchie.
Preprint in English | medRxiv | ID: ppmedrxiv-20143024

ABSTRACT

BackgroundThe prevalence and significance of digestive manifestations in COVID-19 remain uncertain. MethodsConsecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were manually abstracted from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19. ResultsA total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least one gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were elevated to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio 0.93, 95% confidence interval 0.76-1.15) or liver test abnormalities on admission (odds ratio 1.31, 95% confidence interval 0.80-2.12) were not independently associated with mechanical ventilation or death. ConclusionsAmong patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common but the majority were mild and their presence was not associated with a more severe clinical course

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