Conventional Diagnostic Tests Research Articles

The Use of Precision Epigenetic Methods for the Diagnosis and Care of Stable Coronary Heart Disease Reduces Healthcare Costs.

The cost of secondary prevention of coronary heart disease (CHD) is continuing to increase, with a substantial portion of this acceleration being driven by the expense of confirmatory diagnostic testing. Conceivably, newly developed precision epigenetic technologies could drive down these costs. However, at the current time, their impact on overall expense for CHD care is poorly understood. We hypothesized that the use of a newly developed, highly sensitive, and specific epigenetic test, PrecisionCHD, could decrease the costs of secondary prevention. To test this hypothesis, we constructed a budget impact analysis using a cost calculation model that examined the effects of substituting PrecisionCHD for conventional CHD diagnostic tests on the expenses of the initial evaluation and first year of care of stable CHD using a 1-year time horizon with no discounting. The model projected that for a commercial insurer with onemillion members, full adoption of PrecisionCHD as the primary method of initial CHD assessment would save approximately $113.6million dollars in the initial year. These analyses support the use of precision epigenetic methods as part of the initial diagnosis and care of stable CHD and can meaningfully reduce cost. Real-world pilots to test the reliability of these analyses are indicated.

Exploring viral aetiology in upper respiratory tract infections: insights from metagenomic next-generation sequencing in Swiss outpatients before and during the SARS-CoV-2 pandemic.

Upper respiratory tract infections are among the most common reasons for primary care consultations. They are diagnosed predominantly based on clinical assessment. Here, we investigated the benefit of viral metagenomic next-generation sequencing (mNGS) in an outpatient setting. This prospective cross-sectional study included immunocompetent patients with acute upper respiratory tract infections. General practitioners collected pharyngeal swabs and demographic and clinical data. Specimens were analysed using viral mNGS and conventional tests. Two hundred seventy-seven patients were recruited by 21 general practitioners between 10/2019 and 12/2020, of which 91% had a suspected viral aetiology. For 138 patients (49.8%), mNGS identified one or more respiratory viruses. The mNGS showed a high overall agreement with conventional routine diagnostic tests. Rhinoviruses were the most frequently detected respiratory viruses (20.2% of patients). Viral mNGS reflected the influenza wave in early 2020 and the SARS-CoV-2 pandemic outbreak in Switzerland in March 2020. Notably, rhinoviruses continued to circulate despite non-pharmaceutical hygiene measures. Viral mNGS allowed the initial diagnosis to be retrospectively re-evaluated. Assuming reduced turnaround times, mNGS has the potential to directly guide the treatment of upper respiratory tract infections. On an epidemiological level, our study highlights the utility of mNGS in respiratory infection surveillance, allowing early detection of epidemics and providing information crucial for prevention.

A New Approach in the Early Electrochemical Diagnosis of Hepatitis B Virus Infection using Carbon-based Nanomaterials.

The importance of early diagnosis of hepatitis B virus infection to treat and follow up this disease has led to many advances in diagnostic techniques and materials. Conventional diagnostic tests are not very useful, especially in the early stages of infection; it is therefore suggested that nanomaterials can enhance them by changing and strengthening their performance for a more accurate and rapid diagnosis. Electrochemical immunosensors with unique features such as miniaturization, low cost, specificity, and simplicity have become a convenient and vital tool in the rapid diagnosis of hepatitis B. Different strategies have been presented, such as graphene oxide and gold nanorods [GO-GNRs], graphene oxide [GO], copper metal-organic framework/ electrochemically reduced graphene oxide [Cu-MOF/ErGO] composite, label-free graphene oxide/Fe3O4/Prussian Blue [GO/Fe3O4/PB] immunosensor, and graphene oxide-ferrocene-CS/Au [ GO-Fc-CS/Au] nanoparticle layered electrochemical immunosensor. In this review, we discuss a group of the most widely used nanostructures, such as graphene and carbon nanotubes, which are used to develop electrochemical immunosensors for the early diagnosis of the hepatitis B virus.

Antimicrobial stewardship and molecular diagnostics: a symbiotic approach to combating resistance in the ED and ICU.

This review aims to evaluate the incorporation of rapid molecular diagnostics (RMD) in antimicrobial stewardship programs (ASPs) in the management of patients in the emergency department (ED) and intensive care unit (ICU), highlighting a shift from conventional microbiological diagnostic tests to RMD strategies to optimize antimicrobial use and improve patient outcomes. Recent advances in RMD have demonstrated the superior accuracy of RMD in identifying pathogens, combined with shorter turnaround times. RMD allows speeding up of antimicrobial decision making in the ED and facilitates faster escalation when empirical therapy was inappropriate, as well as more efficient de-escalation of empirical therapy later in the course of the treatment. Implementation of RMD however may be challenging. RMD hold great value in simplifying patient management and mitigating antimicrobial exposure, particularly in settings with high levels of antimicrobial resistance where the use of broad-spectrum antimicrobials is high. While the impact on the use of antimicrobials is significant, the impact on patient outcomes is not yet clear. Successful integration of RMD in clinical decision making in the ED and ICU requires a team approach and continued education, and its use should be adapted to the local epidemiology and infrastructure.

Use of Advanced Diagnostics for Timely Identification of Travel-associated Leptospira santarosai Infection in Four Adolescents Through Plasma Microbial Cell-free DNA Sequencing With the Karius Test.

Leptospirosis is an important zoonotic infection worldwide. Diagnosis of leptospirosis is challenging given its nonspecific clinical symptoms that overlap with other acute febrile illnesses and limitations with conventional diagnostic testing. Alternative advanced diagnostics, such as microbial cell-free DNA (mcfDNA), are increasingly being used to aid in the diagnosis of infections and can be applied to pathogens with public health importance such as Leptospira , a nationally notifiable disease. The Karius Test uses plasma mcfDNA sequencing to detect and quantify DNA-based pathogens. This test offered through the Karius lab detected 4 cases of Leptospira santarosai during a 5-month period across the United States in 2021 and were clinically reviewed. In our case series, 4 adolescents with recent travel to Central America (Costa Rica, n = 3 and Belize, n = 1) from April to August 2021 were diagnosed with leptospirosis. While a large workup was performed in all cases, mcfDNA testing was the first test to detect L. santarosai as the microbiological diagnosis in all cases. Results of the Karius Test enabled rapid, noninvasive diagnosis of leptospirosis allowing for targeted therapy. Use of mcfDNA can be utilized for diagnosis of pathogens where conventional testing is challenging or limited. This in turn can enable quick diagnosis for targeted treatment and potentially aid in supporting case definitions of reportable diseases of public health concern.

Diagnostic yield of viral multiplex PCR during acute exacerbation of COPD admitted to the intensive care unit: a pilot study

Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is one of the leading causes of admission to the intensive care unit, often triggered by a respiratory tract infection of bacterial or viral aetiology. Managing antibiotic therapy in this context remains a challenge. Respiratory panel molecular tests allow identifying viral aetiologies of AECOPD. We hypothesized that the systematic use of a respiratory multiplex PCR (mPCR) would help antibiotics saving in severe AECOPD. Our objectives were to describe the spectrum of infectious aetiologies of severe AECOPD, using a diagnostic approach combining conventional diagnostic tests and mPCR, and to measure antibiotics exposure. The study was bicentric, prospective, observational, and included 105 critically ill patients with a severe AECOPD of presumed infectious aetiology, in whom a respiratory mPCR with a viral panel was performed in addition to conventional microbiological tests. Altogether, the microbiological documentation rate was 50%, including bacteria alone (19%), respiratory viruses alone (16%), and mixed viruses and bacterial species (16%). The duration of antibiotic therapy was shorter in patients without documented bacterial infection (5.6 vs. 9 days; P = 0.0006). This pilot study suggests that molecular tests may help for the proper use of anti-infective treatments in critically ill patients with severe AECOPD.

Performance of ultra-sensitive malaria rapid diagnostic test to detect Plasmodium falciparum infection in pregnant women in Kinshasa, the Democratic Republic of the Congo

BackgroundLow peripheral parasitaemia caused by sequestration of Plasmodium falciparum in the placenta hampers the diagnosis of malaria in pregnant women, leading to microscopy or conventional rapid diagnostic tests (RDTs) false-negative results. Although mainly asymptomatic, maternal malaria remains harmful to pregnant women and their offspring in endemic settings and must be adequately diagnosed. Ultra-sensitive RDTs (uRDTs) are thought to be more sensitive than RDTs, and their diagnostic performance was assessed in the current study in pregnant women living in Kinshasa, a stable malaria transmission area in the Democratic Republic of the Congo.MethodsTo assess and compare the diagnostic performances of both RDTs and uRDTs, 497 peripheral blood samples were tested using microscopy and quantitative polymerase chain reaction (qPCR) as the index and the reference tests, respectively. The agreement between the different diagnostic tests assessed was estimated by Cohen's Kappa test.ResultsThe median parasite density by qPCR was 292 p/μL of blood [IQR (49.7–1137)]. Using qPCR as the reference diagnostic test, the sensitivities of microscopy, RDT and uRDT were respectively [55.7% (95% CI 47.6–63.6)], [81.7% (95%CI 74.7–87.3)] and [88% (95% CI 81.9–92.6)]. The specificities of the tests were calculated at 98.5% (95% CI 96.6–99.5), 95.2% (95% CI 92.5–97.2) and 94.4% (95% CI 91.4–96.6) for microscopy, RDT and uRDT, respectively. The agreement between qPCR and uRDT was almost perfect (Kappa = 0.82). For parasite density (qPCR) below 100 p/µL, the sensitivity of RDT was 62% (95% CI 47.1–75.3) compared to 68% (95% CI 53.3–80.4) for uRDT. Between 100 and 200 p/µL, the sensitivity of RDT was higher, but still lower compared to uRDT: 89.4% (95% CI 66.8–98.7) for RDT versus 100% (95% CI 82.3–100) for uRDT. In both cases, microscopy was lower, with 20% (95% CI 10–33.7) and 47.3% (95% CI 24.4–71.1) respectively.ConclusionsuRDT has the potential to improve malaria management in pregnant women as it has been found to be slightly more sensitive than RDT in the detection of malaria in pregnant women but the difference was not significant. Microscopy has a more limited value for the diagnosis of malaria during the pregnancy, because of its lower sensitivity.

Identification of potential diagnostic and prognostic biomarkers for breast cancer based on gene expression omnibus.

Breast cancer is regarded as a highly malignant neoplasm in the female population, posing a significant risk to women's overall well-being. The prevalence of breast cancer has been observed to rise in China, accompanied by an earlier age of onset when compared to Western countries. Breast cancer continues to be a prominent contributor to cancer-related mortality and morbidity among women, primarily due to its limited responsiveness to conventional treatment modalities. The diagnostic process is challenging due to the presence of non-specific clinical manifestations and the suboptimal precision of conventional diagnostic tests. There is a prevailing uncertainty regarding the most effective screening method and target populations, as well as the specificities and execution of screening programs. To identify diagnostic and prognostic biomarkers for breast cancer. Overlapping differentially expressed genes were screened based on Gene Expression Omnibus (GSE36765, GSE10810, and GSE20086) and The Cancer Genome Atlas datasets. A protein-protein interaction network was applied to excavate the hub genes among these differentially expressed genes. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway analyses, as well as gene set enrichment analyses, were conducted to examine the functions of these genes and their potential mechanisms in the development of breast cancer. For clarification of the diagnostic and prognostic roles of these genes, Kaplan-Meier and Cox proportional hazards analyses were conducted. This study demonstrated that calreticulin, heat shock protein family B member 1, insulin-like growth Factor 1, interleukin-1 receptor 1, Krüppel-like factor 4, suppressor of cytokine signaling 3, and triosephosphate isomerase 1 are potential diagnostic biomarkers of breast cancer as well as potential treatment targets with clinical implications. The screening of biomarkers is of guiding significance for the diagnosis and prognosis of the diseases.

Challenges in the Management of Invasive Fungal Infections in the Middle East: Expert Opinion to Optimize Management Using a Multidisciplinary Approach.

Invasive fungal infection (IFI) is a significant global healthcare concern among critically ill and immunocompromised patients. In Middle Eastern countries, IFI has been steadily increasing among hospitalized patients in the past two decades. Diagnosis of IFI at an early stage is crucial for efficient management. Invasive fungal infection management is complex and requires the involvement of physicians from different specialties. There are several challenges associated with IFI management in the countries in the Middle East. This review aims to understand the key challenges associated with IFI management in the Middle East, encompassing epidemiology, diagnosis, therapeutic options, and optimizing a multidisciplinary approach. In addition, this review aims to incorporate expert opinions from multidisciplinary fields for optimizing IFI management in different Middle Eastern countries by addressing key decision points throughout the patient's journey. Lack of epidemiological data on fungal infections, slow and poorly sensitive conventional culture-based diagnostic tests, limited availability of biomarker testing, lack of awareness of clinical symptoms of the disease, limited knowledge on fungal infections, lack of local practice guidelines, and complicated disease management are the major challenges associated with IFI diagnosis and management in the Middle Eastern countries. Implementation of a multidisciplinary approach, antifungal stewardship, improved knowledge of fungal infections, the use of rapid diagnostic tests, and enhanced epidemiological research are warranted to lower the IFI burden in the Middle East.

Diagnostic Accuracy of ki-67 Labeling Index in Endoscopic Ultrasonography-Fine-Needle Aspiration Cytology and Biopsy of Pancreatic Neuroendocrine Neoplasms.

This study aimed to compare the diagnostic accuracy of the Ki-67 labeling index (LI) between endoscopic ultrasonography-fine-needle aspiration cytology/biopsy (EUS-FNAC/FNB) and surgical specimens of pancreatic neuroendocrine neoplasms (PanNENs). Conventional meta-analysis and diagnostic test accuracy (DTA) reviews were performed on 17 eligible studies. The DTA review involved calculating the sensitivity, specificity, diagnostic odds ratio (OR), and area under the curve (AUC) of the summary receiver operating characteristic (SROC) curve. In addition, subgroup analysis was conducted based on EUS-FNAC and FNB, tumor grade, and tumor size. The overall concordance rate of WHO grade based on Ki-67 LI between the EUS-FNAC/FNB and the surgical specimen was 0.767 (95% confidence interval (CI), 0.713-0.814). Concordance rates of the EUS-FNAC and EUS-FNB subgroups were 0.741 (95% CI, 0.681-0.794) and 0.839 (95% CI, 0.738-0.906), respectively. In the DTA review for grade 3, the sensitivity and specificity were calculated to be 0.786 (95% CI, 0.590-0.917) and 0.998 (95% CI, 0.987-1.000), respectively. The diagnostic OR and AUC of the SROC curve were 150.220 (95% CI, 46.145-489.000) and 0.983, respectively. The sensitivity and specificity were observed to be highest in the grade 1 and 3 subgroups, respectively. Higher concordance of tumor grade based on Ki-67 LI was observed between EUS-FNAC/FNB and surgical specimens, indicating the potential usefulness of Ki-67 LI in predicting PanNEN tumor grade in EUS-FNAC/FNB.

Financial development and resources curse hypothesis: China's COVID-19 perspective of natural resources extraction

The current pandemic has increased natural resource volatility and unpredictability, impacting every economic and financial sector. Health problems and financial losses worsen the situation and push countries dangerously close to recession. This research examines the effects of natural resource rents on China's financial growth from 1988 to 2021, including the effects of oil, mineral, and forest rents. The study also covered other financial growth aspects, such as spending on R&D and renewable energy. So, in order to review our data, we also incorporated conventional and second-generation diagnostic tests. We used ADF with structural breaks and ADF-GLS to test the data's stationarity. The Johansen cointegration test is used to determine long-term cointegration. FMOLS, DOLS, CCR, and least squares with break years were used in the research to examine the factors' long-term impacts. At the same time, non-parametric quantile regression was included at the end to examine the findings non-parametrically as part of the robustness check. The results show long-term cointegration between variables and that the variables are static at the difference. Furthermore, long-term results show that oil and forest rentals have a detrimental influence on financial development. Mineral rents, on the other hand, have little and ambiguous long-term impacts. Investments in renewable energy and R&D. favorably and considerably impact financial development. The robustness findings show that, in contrast to R&D and renewable energy gains, oil rents also become small with time across all quantiles. The other factors continue to have a comparable impact and their results are consistent with the major findings.

P-749 Increased accuracy in infertility workup by the additional use of new modern diagnostic methods (“diagnostic TRIO”): results from a large retrospective analysis

Abstract Study question Is there any positive effect of adding new modalities to the traditional infertility work-up, like 3D sonography, office hysteroscopy and endometrial biopsy? Summary answer During infertility workup conventional diagnostic tests should be combined with new approaches (3D-TVS, OHSC and endometrial biopsy) to achieve more accurate and less invasive diagnostics. What is known already Female infertility can be explained by functional or organic abnormalities affecting the reproductive system. The most common organic causes include abnormalities within the uterine cavity (e.g. endometrial polyp, submucosal fibroid, intrauterine adhesion), morphological disorders (e.g. dysmorphic uterus, uterine septum) and abnormalities of the endometrium (e.g. chronic endometritis). Study design, size, duration In our retrospective study, we examined patients with primary and secondary infertility. All the patients were assessed by 3D-TVS and OHSC to detect morphological and intrauterine disorders, and in special cases (repeated implantation failure – RIF), endometrial biopsies were carried out to detect endometrial disorders. Participants/materials, setting, methods Data of 606 patients examined between 2018 and 2022 were analyzed retrospectively. Main results and the role of chance In 606 cases 3D-TVS and OHSC were performed in patients (65.51 % primary, 34.49 % secondary infertility), who had unknown reason to infertility. By the combination of 3D-TVS and OHSC we could verify uterine disorders in 39.93 % of cases. Together these two diagnostic methods found the probable infertility causing lesion almost 40 % of our patients. In the subgroup of 40 repeated implantation failure (RIF) patients, the “diagnostic TRIO” confirmed a disorder in 57.50 % of the cases. Limitations, reasons for caution Number of patients should be more to conclude more accurate data. Wider implications of the findings The proper condition of the uterine milieu, through correction of uterine cavity if necessary, endometrial receptivity are of paramount importance for the success of the treatment; as a result, intrauterine surgery as a new subspecialty has been developing. Trial registration number DE RKEB/IKEB: H.0250-2020

Stage-by-Stage Hydraulic Fracture and Reservoir Characterization through Integration of Post-Fracture Pressure Decay Analysis and the Flowback Diagnostic Fracture Injection Test Method

Summary The post-fracture pressure decay (PFPD) technique is a low-cost method allowing for stage-by-stage hydraulic fracture characterization. The analysis of the PFPD data is complex, with data affected by both hydraulic fracture and reservoir properties. Available analysis methods in the literature are oversimplified; reservoir or fracture properties are often assumed to be constant along the horizontal well, and therefore changes in the trend of pressure decay data are attributed to hydraulic fracture or reservoir properties only. Moreover, methods analogous to those applied to the analysis of conventional diagnostic fracture injection tests (DFITs) are often used and ignore critical mechanisms involved in main-stage hydraulic fracture stimulation. A conceptual numerical simulation study was first conducted herein to understand the key mechanisms involved in main-stage hydraulic fracturing. An analytical model was then developed to account for the dynamic behavior of the hydraulic fracture, leakoff, proppant distribution, multiple fractures, and propped- and unpropped-closure events. The analytical model is cast in the form of a new straightline analysis (SLA) method that provides stage-by-stage estimates of the ratio of unpropped fracture surface area to total fracture surface area. The SLA method was validated against numerical simulation results. Moreover, to account for the variation of reservoir properties along the horizontal well, the PFPD model is integrated with DFIT-flowback (DFIT-FBA) tests, performed at some points along the lateral, to obtain a reliable stage-by-stage hydraulic fracture and reservoir characterization approach. The practical application of the proposed integrated approach was demonstrated using PFPD and DFIT-FBA data from a horizontal well completed in 22 stages in the Montney Formation. The numerical simulation study demonstrated that the use of proppant and injection into multiple clusters (creating multiple fractures) results in multiple closure events. The closure process may start early after the pump-in period at a pressure significantly higher than the minimum in-situ stress. Using DFIT-based analytical models, which ignore the presence of proppant, causes significant errors in hydraulic fracture and reservoir property estimation. The PFPD field data examined herein exhibited a similar pressure trend to the numerical simulation cases. The ratio of unpropped fracture surface area to total fracture surface area was determined stage by stage using the PFPD SLA method, constrained by DFIT-FBA data. Engineers can use this information to optimize the hydraulic fracture stimulation design in real time, optimize the well spacing, and forecast the production. The cost and time advantages of this diagnostic method make this approach very attractive.

Transcriptome and Genome Analysis Uncovers a DMD Structural Variant: A Case Report.

Duchenne muscular dystrophy (DMD) is caused by pathogenic variants in the dystrophin gene (DMD). Hypermethylated CGG expansions within DIP2B 5' UTR are associated with an intellectual development disorder. Here, we demonstrate the diagnostic utility of genomic short-read sequencing (SRS) and transcriptome sequencing to identify a novel DMD structural variant (SV) and a DIP2B CGG expansion in a patient with DMD for whom conventional diagnostic testing failed to yield a genetic diagnosis. We performed genomic SRS, skeletal muscle transcriptome sequencing, and targeted programmable long-read sequencing (LRS). The proband had a typical DMD clinical presentation, autism spectrum disorder (ASD), and dystrophinopathy on muscle biopsy. Transcriptome analysis identified 6 aberrantly expressed genes; DMD and DIP2B were the strongest underexpression and overexpression outliers, respectively. Genomic SRS identified a 216 kb paracentric inversion (NC_000023.11: g.33162217-33378800) overlapping 2 DMD promoters. ExpansionHunter indicated an expansion of 109 CGG repeats within the 5' UTR of DIP2B. Targeted genomic LRS confirmed the SV and genotyped the DIP2B repeat expansion as 270 CGG repeats. Here, transcriptome data heavily guided genomic analysis to resolve a complex DMD inversion and a DIP2B repeat expansion. Longitudinal follow-up will be important for clarifying the clinical significance of the DIP2B genotype.

New Pump-In Flowback Model Verification with In-Situ Strain Measurements and Numerical Simulation

This study presents an analytical model for estimating minimum horizontal stress in hydraulic fracturing stimulations. The conventional Diagnostic Fracture Injection Test (DFIT) is not practical in ultra-tight formations, leading to the need for pump-in/flowback tests. However, ambiguities in the results of these tests have limited their application. The proposed model is based on the linear diffusivity equation and material balance, which is analytically solved and verified using a commercially available numerical simulator. The model generates a linear graph in which the pressure drop and its derivative are plotted versus the developed solution time function. The closure pressure is determined when the slope of the derivative deviates from linearity. The model was applied to several cycles of field flowback tests and found to eliminate the ambiguity associated with identifying the fracture closure. Furthermore, the minimum In-situ stresses estimated using this approach are verified via downhole strain measurement and synthetic data from a fully 3D commercial fracturing simulator. The proposed technique outperformed other conventional methods in analyzing challenging injection/shut-in tests, showing improved results and reducing uncertainty in estimated fracture parameters. This model is expected to scale down the need for multiple field trials and provide a reliable estimation of minimum stress.

A Preliminary Study to Compare Recombinase Polymerase Amplification-Lateral Flow and Quantitative PCR in the Detection of Cutaneous Leishmania in Communities from the Volta Region of Ghana.

Background: Leishmaniasis is a parasitic disease that mostly affects populations in tropical and subtropical countries. In Ghana, cutaneous leishmaniasis (CL) is the most common form of the disease affecting communities of the Volta Region. Conventional parasitological method (microscopy) is the commonly used test for CL diagnosis in many endemic countries, but has low sensitivity in chronic cases. Therefore, there is a clear need for a sensitive and easy-to-use point-of-care diagnostic method like an isothermal recombinase polymerase amplification-lateral flow (RPA-LF) test, suitable for use in austere and low-resource settings for the identification of CL cases. This study compared the efficacy of RPA-LF test with quantitative PCR (qPCR) in detecting Leishmania in suspected CL cases from the Volta Region. Methods: Twenty-five participants between 5 and 14 years were enrolled in the study from whom a total of 26 samples were obtained. Lesion samples were collected using FTA® filter papers applied to ulcerated lesions for molecular diagnosis. DNA isolated from filter papers was used for both the RPA-LF test and qPCR. Results: Twenty-two participants (88%) presented with one or two ulcerated active lesions per individual, while the rest of them had plaques or dried lesions. Among the 26 samples, 19/26 (73%) had concordant results when comparing the two diagnostic methods. Conclusion: Data from this study suggest that the RPA-LF test can be used in addition to a conventional parasitological diagnostic test (microscopy) to detect CL cases in communities of the Volta Region.

ASSESSMENT OF THE RISK OF UROTHELIAL CANCER IN THE BLADDER AND UPPER URINARY TRACT WITH THE IDENTIFY STUDY CALCULATOR: MONOCENTRIC PROSPECTIVE STUDY

Abstract Introduction The British Urology Researchers in Surgical Training (BURST) collaborative group developed a urothelial cancer risk calculator based on the IDENTIFY study, in patients with gross or microscopic hematuria. Our objective is the validation of this calculator in our environment. Methods Descriptive and ambispective study of 88 patients with hematuria, from June 2020 to November 2021. Demographic aspects, positivity of imaging tests, classification of the IDENTIFY risk calculator and the need for treatment were compared. Results 53 presented with macrohematuria (60.2%) and 35 with microhematuria (39.8%). 58 were men (65.9%) and 30 women (34.1%). The mean age was 64.66 years (SD: 15) and the median follow-up was 7 months. Of the 26 patients with high risk in the calculator, 17 had bladder tumors (65.4%), being 57.1% cTa and 35% cT2. Of the 38 patients with intermediate risk, 3 patients had tumors (7.9%). Of the 24 with low risk, none had tumors. Among the high-risk patients, 48.1% presented an ultrasound with lesions, of the intermediate-risk patients, 3% presented an ultrasound with lesions, and of the low-risk patients, none (p<0.05). With regard to high-risk patients, 58.8% presented cystoscopy with lesions, with 4% of intermediate-risk patients and only 2% of low-risk patients (p<0.05). Conclusions In our series, there are statistically significant differences according to the risk group of the IDENTIFY calculator and the finding of tumors in conventional diagnostic tests.

Comparative assessment of regulated methods and PCR in the diagnosis of trichophytosis in veterinary mycology.

There is an increase in the incidence of human and animal infectious skin diseases of fungal etiology in the world. The main source of infecting the population has become agricultural and stray animals. The objective of this study was to examine the morphophysiological and microbiological characteristics of pathogenic fungi belonging to the species Trichophyton verrucosum. This species is known to cause diseases in both humans and livestock in Kazakhstan. In addition, the study aimed to assess the feasibility of using the polymerase chain reaction (PCR) method for detecting T. verrucosum. This assessment was conducted in comparison to the outcomes of conventional laboratory diagnostic tests commonly employed for trichophytosis. The research focused on analyzing 141 samples of pathological material obtained from calves in Almaty, Turkestan, and Kyzylorda regions. These calves exhibited clinical symptoms of skin disease. The study aimed to identify the causative agent using various techniques, including microscopic examination, microbiological methods involving the isolation of pure cultures, and PCR. The detection of the causative agent of dermatophytosis using conventional methods was relatively low, 86% for the microscopic method, and 79% for the microbiological method with the isolation of the culture of the pathogen. Extraction and detection of the genetic material of the causative agent of the disease for PCR was carried out according to the method developed by the authors. The effectiveness of the PCR method was 97.9%, which is significantly higher (p < 0.05) compared with the diagnostic effectiveness of conventional methods. The PCR method using specific primers identified the causative agent in 98% of cases, which significantly (p < 0.05) exceeded the results obtained using conventional diagnostic methods. Accordingly, the PCR method had better sensitivity and specificity indicators. The conducted study recommends the method of PCR diagnosis of dermatophytosis for fast and reliable confirmation of the diagnosis of dermatophytosis in humans and animals in Kazakhstan.

Diagnostic Performance of Streptococcus pneumoniae Urinary Antigen Assay: A Cross-sectional Study on Comparative Analysis of Bacterial Culture and Molecular Detection in Pneumococcal Infections

Introduction: Pneumonia is the most prevalent infection worldwide, leading to hospitalisation and contributing to mortality rates. Among the bacterial agents associated with CommunityAcquired Pneumonia (CAP), Streptococcus pneumoniae remains the most common. Conventional microbiological diagnostic tests have various limitations, including issues with sample collection, prior antibiotic administration, and delayed specimen transport. Urinary Antigen Testing (UAT) shows promise in rapidly identifying the causative agent of CAP, allowing for targeted therapy. Aim: To evaluate the diagnostic accuracy of the pneumococcal UAT in identifying CAP. Materials and Methods: A cross-sectional analytical study was conducted over a period of one year from June 2022 to May 2023 at SRM Medical College Hospital and Research Centre, Kattankulathur, Chengalpattu, Tamil Nadu, India. A total of 38 patients (&gt;18 years of age) with clinically suspected CAP and who satisfied the clinical criteria for CAP were recruited for the study. Respiratory specimens were subjected to bacterial culture, real-time Polymerase Chain Reaction (PCR), and UAT using the Fluorescent Immunoassay (FIA) to detect Streptococcus pneumoniae. The sensitivity, specificity, positive and negative predictive values, and accuracy of the pneumococcal UAT for detecting CAP were assessed. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software, version 21.0. Results: The study revealed a female predominance 22 (57.89%). Bacterial culture and real-time PCR identified 7 (18.42%) of patients with S. pneumoniae, while the UAT only detected 1 (2.63%). The pneumococcal UAT showed low sensitivity (14.29%), high specificity (100%), and satisfactory accuracy (84.21%). Conclusion: The pneumococcal UAT, with its straightforward technology, ease of use, rapid results, non invasive approach, cost-effectiveness, and high specificity and accuracy, could be favoured over bacterial culture and molecular techniques for ruling out CAP.

319. Clinical accuracy and utility of plasma microbial cell free DNA NGS for the diagnosis of invasive aspergillosis in patients with hematologic malignancy and COVID-19

Abstract Background Invasive aspergillosis (IA) is a great threat to the severely immunocompromised and patients with coronavirus disease (COVID-19). However, diagnosis of IA is often difficult due to need for invasive biopsy and low sensitivity of other diagnostic tests. Next-generation sequencing (NGS) of plasma cell free DNA (cfDNA) can be a novel non-invasive diagnostic modality. We evaluated the clinical accuracy and utility of microbial cfDNA NGS for the diagnosis of IA in patients with hematologic malignancy (HM) and COVID-19. Methods A single-center prospective study of plasma microbial cfDNA NGS was conducted in a tertiary-care hospital in South Korea. We enrolled adult patients with HM and COVID-19, who suspected IA and performed conventional diagnostic tests for IA. The results of NGS were compared with the diagnosis of IA through conventional methods. IA cases were diagnosed according to EORTC/MSG definitions in patients with HM, and modified AspICU criteria in patients with COVID-19. (Figure 1). Figure 1.Flow chart for the participant selection method used in this study Results Between March 2021 and January 2022, a total of 33 participants (22 [64.7%] male, median age 66.0 [50.5, 72.0]) were enrolled;19 participants with HM and 15 with COVID-19 were analyzed (Figure1 and Table1). In participants with HM, aspergillus cfDNA was detected in 100% of both proven (1/1) and probable (12/12) IA cases, and 33.3% of both possible (1/3) and no IA (1/3) cases. In participants with COVID-19, 46.2% of probable IA (6/13) showed positive aspergillus cfDNA. Detection rate of aspergillus cfDNA was significantly higher in proven/probable IA cases in participants with HM compared to participants with COVID-19. (100% vs 46.2%, p=0.005) (Figure 2). As shown in Table 2, among proven/probable IA cases, participants with positive aspergillus cfDNA showed significantly higher rate of having uncontrolled hematologic disease, receiving stem cell transplantation and recent chemotherapy. In three participants with HM, non-aspergillus strains confirmed by cfDNA NGS were in accordance with pathogens identified through conventional culture methods. Table 1.Baseline characteristics of participants suspected of invaisve aspergillosis performing microbial cell free DNA NGSFigure 2.cfDNA detection rate in participants with suspected fungal infection according to the EORTC/MSG or modified AspICU diagnostic criteria Conclusion Detection of aspergillus cfDNA showed high concordance in the results of conventional diagnostic methods in proven/probable IA of patients with HM and could be a helpful non-invasive approach to IA diagnosis in those populations. Disclosures All Authors: No reported disclosures.