Sensitivity of Rapid Antigen Testing and RT-PCR Performed on Nasopharyngeal Swabs versus Saliva Samples in COVID-19 Hospitalized Patients: Results of a Prospective Comparative Trial (RESTART).

Saliva sampling could serve as an alternative non-invasive sample for SARS-CoV-2 diagnosis while rapid antigen tests (RATs) might help to mitigate the shortage of reagents sporadically encountered with RT-PCR. Thus, in the RESTART study we compared antigen and RT-PCR testing methods on nasopharyngeal (NP) swabs and salivary samples. We conducted a prospective observational study among COVID-19 hospitalized patients between 10 December 2020 and 1 February 2021. Paired saliva and NP samples were investigated by RT-PCR (Cobas 6800, Roche-Switzerland, Basel, Switzerland) and by two rapid antigen tests: One Step Immunoassay Exdia® COVID-19 Ag (Precision Biosensor, Daejeon, Korea) and Standard Q® COVID-19 Rapid Antigen Test (Roche-Switzerland). A total of 58 paired NP-saliva specimens were collected. A total of 32 of 58 (55%) patients were hospitalized in the intensive care unit, and the median duration of symptoms was 11 days (IQR 5-19). NP and salivary RT-PCR exhibited sensitivity of 98% and 69% respectively, whereas the specificity of these RT-PCRs assays was 100%. The NP RATs exhibited much lower diagnostic performance, with sensitivities of 35% and 41% for the Standard Q® and Exdia® assays, respectively, when a wet-swab approach was used (i.e., when the swab was diluted in the viral transport medium (VTM) before testing). The sensitivity of the dry-swab approach was slightly better (47%). These antigen tests exhibited very low sensitivity (4% and 8%) when applied to salivary swabs. Nasopharyngeal RT-PCR is the most accurate test for COVID-19 diagnosis in hospitalized patients. RT-PCR on salivary samples may be used when nasopharyngeal swabs are contraindicated. RATs are not appropriate for hospitalized patients.

[Syncope or palpitations during pregnancy]. / Syncope et palpitations chez la femme enceinte.

Syncope and palpitations are common symptoms during pregnancy ; they are elicited by physiological changes. Although they are often benign, careful management is essential to eliminate a serious aetiology requiring specialized care. Syncope is often of vasovagal origin, but trauma with possible secondary lesions that compromise the life-threatening of the mother and foetus must be researched. Some palpitations are the manifestation of serious rhythm disorders whose therapeutic management depends on their severity and must consider the potential side effects on the foetus.

Les syncopes ainsi que les palpitations sont des symptômes fréquents durant la grossesse ; elles sont favorisées par les modifications physiologiques. Si elles sont souvent bénignes, une prise en charge minutieuse est indispensable pour éliminer une étiologie grave nécessitant une prise en charge spécialisée. La syncope est dans la majorité des cas d'origine vasovagale, mais un traumatisme avec d'éventuelles lésions secondaires pouvant mettre en jeu le pronostic vital de la mère et du fœtus doit obligatoirement être recherché. Certaines palpitations sont la traduction de troubles du rythme graves dont la prise en charge thérapeutique dépend de la sévérité et doit tenir compte des potentiels effets secondaires sur le fœtus.