Validation of a commercially available SARS-CoV-2 serological immunoassay.

OBJECTIVES: To validate the diagnostic accuracy of a Euroimmun SARS-CoV-2 IgG and IgA immunoassay for COVID-19. METHODS: In this unmatched (1:2) case-control validation study, we used sera of 181 laboratory-confirmed SARS-CoV-2 cases and 326 controls collected before SARS-CoV-2 emergence. Diagnostic accuracy of the immunoassay was assessed against a whole spike protein-based recombinant immunofluorescence assay (rIFA) by receiver operating characteristic (ROC) analyses. Discrepant cases between ELISA and rIFA were further tested by pseudo-neutralization assay. RESULTS: COVID-19 patients were more likely to be male and older than controls, and 50.3% were hospitalized. ROC curve analyses indicated that IgG and IgA had high diagnostic accuracies with AUCs of 0.990 (95% Confidence Interval [95%CI]: 0.983-0.996) and 0.978 (95%CI: 0.967-0.989), respectively. IgG assays outperformed IgA assays (p=0.01). Taking an assessed 15% inter-assay imprecision into account, an optimized IgG ratio cut-off > 2.5 displayed a 100% specificity (95%CI: 99-100) and a 100% positive predictive value (95%CI: 96-100). A 0.8 cut-off displayed a 94% sensitivity (95%CI: 88-97) and a 97% negative predictive value (95%CI: 95-99). Substituting the upper threshold for the manufacturer's, improved assay performance, leaving 8.9% of IgG ratios indeterminate between 0.8-2.5. CONCLUSIONS: The Euroimmun assay displays a nearly optimal diagnostic accuracy using IgG against SARS-CoV-2 in patient samples, with no obvious gains from IgA serology. The optimized cut-offs are fit for rule-in and rule-out purposes, allowing determination of whether individuals in our study population have been exposed to SARS-CoV-2 or not. IgG serology should however not be considered as a surrogate of protection at this stage.

Higher rates of osteoporosis treatment initiation and persistence in patients with newly diagnosed vertebral fracture when introduced in inpatients than later in outpatients.

Whether in-hospital management of patients with newly identified vertebral fractures leads to a higher rate of osteoporosis medication than delayed outpatient management remains unknown. Our study showed that early osteoporosis therapy initiation in a fracture liaison service during hospital stay was a more efficacious strategy for secondary fracture prevention. INTRODUCTION: Fracture liaison services are standard care for secondary fracture prevention. A higher rate of osteoporosis treatment initiation may be considered when introduced in the hospital rather than an outpatient recommendation to a primary care physician (PCP). Whether this applies to patients with newly detected vertebral fractures in a general internal medicine ward remains unknown. We prospectively investigated whether in-hospital management of newly identified vertebral fractures led to a higher rate of osteoporosis medication initiation and persistence at 3 and 6 months than delayed outpatient management by a PCP. METHODS: We conducted a prospective study including hospitalized patients > 60 years systematically searched for asymptomatic vertebral fractures on lateral chest and/or abdominal radiographs. Patients were included either in phase 1 (outpatient care recommendations on osteoporosis management to a PCP) or in phase 2 (inpatient care management initiated during hospitalization). The percentage of patients under osteoporosis treatment was evaluated by telephone interview at 3 and 6 months. RESULTS: Outpatients' (84 with fracture/407 assessed (21%); 75.7 ± 7.7 years) and inpatients' (100/524 (19%); 77.8 ± 9.4 years) characteristics were similar. Osteoporosis medication was more often prescribed in inpatients at 3 (67% vs. 19%, respectively; p < 0.001) and 6 months (69 vs. 27%, respectively; p < 0.001). The percentage under treatment was also higher in inpatients than in outpatients at 3 (52 vs. 19%, p < 0.001) and 6 months (54 vs. 22%, p < 0.001). Length of stay and destination post-discharge were not different between groups. CONCLUSIONS: Early patient management after a newly detected vertebral fracture during hospitalization was a more efficacious strategy of secondary fracture prevention than delayed outpatient management following discharge.

[Causes of death in woman, between heart and cancer]. / Les causes de mortatité chez ta femme, entre cœur et cancer.

Cardiovascular diseases are the first cause of death in women, while cancers come second. Increased tobacco use in women causes a higher incidence of both lung cancer and cardiovascular diseases. The end of the hormonal substitution, since it was identified as increasing breast cancer risk, has produced a decreased incidence of the later, while cardiovascular diseases keep increasing after menopausal. These examples highlight the necessity of medical studies taking into consideration women specificities, as well as of an individual weighting of risk factors by physicians.

[Hospital based internal medicine in 2012]. / Médecine interne hospitalière: l'année 2012 en revue.

In an era in which primary and secondary prevention have important implications for public health and health care costs, a series of publications and guidelines give added weight or precision to current medical practice in the fields of hospital based internal medicine. This article presents a selective review of new guidelines and therapeutic options for areas of cardiovascular disease, pulmonary disease, gastroenterology and oncology.

[What was new in ambulatory general internal medicine in 2011?]. / Nouveautés 2011 en médecine interne générale ambulatoire.

This review of articles published in 2011 covers a large spectrum of topics that are of interest for the practice of general internal medicine and of primary care. Authors discuss public health issues, such as sleep disorders and their relationship with subsequent weight disorders, and the benefits of commercial weight reduction programs. Clinical topics, such as the management of victims of sexual violence and screening strategies for lung cancer, streptococcal pharyngitis, functional bowel disorders and hypertension in ambulatory settings are also reviewed. Besides, authors cover therapeutic issues, such as the treatment of hand arthritis with chondroitin sulfate and the management of plantar warts with salicylic acids and cryotherapy.