Diagnostic Testing Methods Research Articles

Bayesian method for comparing F1 scores in the absence of a gold standard

ABSTRACT In the field of medicine, evaluating the diagnostic performance of new diagnostic methods can be challenging, especially in the absence of a gold standard. This study proposes a methodology for assessing the performance of diagnostic tests by estimating the posterior distribution of the F 1 score using latent class analysis, without relying on a gold standard. The proposed method utilizes Markov Chain Monte Carlo sampling to estimate the posterior distribution of the F 1 score, enabling a comprehensive evaluation of diagnostic test methods. By applying this method to internet addiction, we demonstrate how latent class analysis can be effectively used to assess diagnostic performance, offering a practical solution for situations where no gold standard is available. The effectiveness of the proposed approach was evaluated through simulation studies by examining the coverage probability of the 95% highest density interval of the estimated posterior distributions.

Strategies to Enhance Diagnostic Capabilities for the New Drug-Resistant Tuberculosis (DR-TB) Drugs.

The global burden of drug-resistant tuberculosis (DR-TB) continues to challenge healthcare systems worldwide. There is a critical need to tackle DR-TB by enhancing diagnostics and drug susceptibility testing (DST) capabilities, particularly for emerging DR-TB drugs. This endeavor is crucial to optimize the efficacy of new therapeutic regimens and prevent the resistance and overuse of these invaluable weapons. Despite this urgency, there remains a lack of comprehensive review of public health measures aimed at improving the diagnostics and DST capabilities. In this review, we outline strategies to enhance the capabilities, especially tailored to address the challenges posed by resistance to new DR-TB drugs. We discuss the current landscape of DR-TB drugs, existing diagnostic and susceptibility testing methods, and notable gaps and challenges in these methods and explore strategies for ensuring fair access to DST while narrowing these disparities. The strategies include public health interventions aimed at strengthening laboratory infrastructure, workforce training, and quality assurance programs, technology transfer initiatives, involving drug developers in the DST development, establishing national or regional referral hubs, fostering collaboration and resources pooling with other infection control efforts, extending testing access in underserved areas through public-private partnerships, advocating for lowering costs or loans at low interest, remote technical support, and implementing mandatory molecular surveillance monitoring. This review underscores the urgent need to enhance DST capacities for new DR-TB drugs and identifies opportunities for innovation and improvement. Assessing the extent of the global health impact of these measures is crucial to ensure their effectiveness in combating DR-TB.

Laboratory practices for the diagnosis and management of mucormycosis in France, 2024

This study investigates the diagnostic practices for mucormycosis among 30 French University Hospital mycology laboratories, in 2024. All laboratories perform both direct examination and culture, with fluorescent brighteners being the most commonly used method for direct examination. While 77 % of the participating laboratories routinely identify Mucorales to the species level, with 70 % having adopted Mucorales-specific quantitative PCR, primarily for the diagnosis of invasive fungal infections. Antifungal susceptibility testing practices varied between centers, with 36.7 % of laboratories consistently performing these tests, primarily using gradient concentration strips. Amphotericin B, posaconazole, and isavuconazole were the most frequently tested antifungals. These findings highlight variations in laboratory practices and emphasize the importance of establishing uniform diagnostic and susceptibility testing methods to optimize mucormycosis management.

Bayesian accuracy estimates for diagnostic tests to detect tuberculosis in captive sun bears (Helarctos malayanus) and Asiatic black bears (Ursus thibetanus) in Cambodia and Vietnam.

Effective control of tuberculosis (TB) depends on early diagnosis of disease, yet available tests are unable to perfectly detect infected individuals. In novel hosts diagnostic testing methods for TB are extrapolated from other species, with unknown accuracy. The primary challenge to evaluating the accuracy of TB tests is the lack of a perfect reference test. Here we use a Bayesian latent class analysis approach to evaluate five tests available for ante-mortem detection of pulmonary TB in captive sun bears and Asiatic black bears in Southeast Asia. Using retrospective results from screening of 344 bears at three rescue centres, we estimate accuracy parameters for thoracic radiography, a serological assay (DPP VetTB), and three microbiological tests (microscopy, PCR (Xpert MTB/RIF, Xpert MTB/RIF Ultra), mycobacterial culture) performed on bronchoalveolar lavage samples. While confirming the high specificities (≥ 0.99) of the three microbiological tests, our model demonstrated their sub-optimal sensitivities (<0.7). Thoracic radiography was the only diagnostic method with sensitivity (0.95, 95% BCI: 0.76, 0.998) and specificity (0.95, 95% BCI: 0.91, 0.98) estimated above 0.9. We recommend caution when interpreting DPP VetTB results, with the increased sensitivity resulting from treatment of weakly visible reactions as positive accompanied by a drop in specificity, and we illustrate how the diagnostic value of weak DPP VetTB reactions is particularly reduced if disease prevalence and/or clinical suspicion is low. Conversely, the reduced utility of negative microbiological tests on bronchoalveolar lavage fluid samples when prevalence and/or clinical suspicion is high is demonstrated. Taken together our results suggest multiple tests should be applied and accompanied by consideration of the testing context, to minimise the consequences of misclassification of disease status of bears at risk of TB in sanctuary settings.

A-284 Development of a Low Positive Molecular Control for Mycoplasma genitalium and Trichomonas vaginalis Screening

Abstract Background Mycoplasma genitalium (MG) is a sexually transmitted gram -negative bacteria that infects the urinary and genital tracts. Trichomonas vaginalis (TV) is a protozoan parasite and is the most common curable sexually transmitted infection (STI) worldwide. TV/ MG infections often go unrecognized because infected individuals are either asymptomatic or have symptoms similar to other infections of the urogenital tract (cervicitis in females and urethritis in males). Left untreated, TV/MG can lead to severe health complications including pelvic inflammatory disease, adverse pregnancy outcomes such as preterm delivery and miscarriage, increased risk of HIV acquisition, sexually acquired reactive arthritis, and infertility. The rates of STIs are increasing and differentiating among different STIs is critical to ensure patients receive effective treatment. Amplified nucleic acid based tests (NAATs) have emerged as the gold standard for diagnosis of TV/MG infections due to their high sensitivity and high throughput using a variety of clinical samples including male and female urine. This study describes work to develop a low positive quality control material in human urine for TV/MG amplified nucleic acids tests. Methods A method was developed to eliminate residual enzymatic activity from raw, pooled human urine from both genders to create a homogeneous diluent that supports analyte stability. The urine diluent was tested for viral pathogens (HIV-1, HCV, HBV) and ensure urine proteins and chemistry analytes were within acceptable limits. TaqMan® assays for TV (targeting RNA polymerase Rpb1 gene) and MG (targeting SMC Chromosome segregation gene) were developed and qualified for digital PCR quantitation of these organisms using the BioRad QX200 system. Cultured Trichomonas vaginalis strain C-1:NIH and Mycoplasma genitalium strain G37 were spiked into the urine diluent along with 0.09% sodium azide as a preservative. The concentration of TV and MG was guided by digital PCR quantitation throughout formulation and the final product was tested on Abbott Alinity m STI Panel, Hologic Aptima® Mycoplasma genitalium Assay, and Hologic Aptima® Trichomonas vaginalis Assay. Results Three independent lots were produced that were each detected for both TV and MG on the Abbott Alinity m STI panel. The concentration of the controls targeted a cycle number (CN) of ∼27 for TV and ∼32 for MG and were within acceptable limits. The lots were also positive for TV and MG when tested on the Hologic Aptima TV and MG assays. Accelerated stability studies showed that the product is stable throughout 2 years of shelf life when stored frozen at -20 °C, but is also stable for up to 30 days at 2-8 °C refrigerated storage. Conclusions LGC Clinical Diagnostics is developing a stable, whole organism molecular control material for use with in vitro diagnostic test methods that detect TV and MG. The product will fulfill an unmet need for molecular quality controls for STI testing that are formulated in a true patient-like matrix like urine. This study helps ensure the molecular control will be a low positive on leading diagnostic assays, be consistent batch to batch, and have the needed stability to meet the needs of clinical testing labs.

Incidence of Typhoid Fever Infection among Febrile Patients attending FUDMA Clinic

Typhoid fever remains a public health concern in Nigeria, with its incidence poising substantial challenges to health care systems. Widal agglutination test is largely the only used diagnostic test method for the laboratory diagnosis of Typhoid infection which has been proven to be neither sensitive nor specific. This paper delves into the incidence, contributory factors as well as sensitivity and specificity of commonly used diagnostic tests of typhoid fever infection among febrile patients attending the FUDMA Clinic. A total of 55 Blood and stool samples were analyzed using standard procedures for slide agglutination test (Widal) and stool culture, before culturing, the samples were first inoculated in an enrichment medium (Selenite-F broth). After 4 hours of pre-enrichment, the samples were inoculated into Salmonella Shigella Agar and Mackonkey agar, while catalase, TSI, citrate utilization test, Indole test, and urease tests served to identify the organism biochemically. Socio-demographic data revealed that 55 Participants, 52.8% were males, 72.7% were students and 80% were singles. Slide agglutination test recorded a 90.9% incidence rate, stool culture had an incidence rate of 18.18%. Among the age groups that enrolled in this study, a 44.1% incidence rate was recorded among the age Group 20-26 years. Stool culture was to found have performed better diagnostically with a sensitivity of 60% as well as a specificity of 40%. Conclusively, A high Incidence of typhoid fever was observed in this study. This Therefore suggests that there is an urgent need for improved personal hygiene and more accessibility to potable drinking water.

The Accuracy of FNAB as Diagnostic Tool For Thyroid Cancer Compared to Anatomical Pathology Results as Gold Standard at Sanjiwani Hospital, Gianyar

Aim: The aim of this study was to assess the accuracy of fine needle aspiration biopsy (FNAB) as a diagnostic tool for thyroid cancer in Sanjiwani Hospital, Gianyar. Methods: This study used a diagnostic test method with a retrospective cross-sectional design. A total of 138 cases of thyroid nodules that received FNAB and anatomical pathology examinations were selected consecutively. The level of accuracy was determined from the number of sensitivity, specificity, positive predictive value and negative predictive value. Results: The results of this study showed a low sensitivity 11.53%, but high specificity 100%, positive predictive value 100%, and negative predictive value 82.96% of FNAB. The accuracy of FNAB as diagnostic tools of thyroid cancer was 83,3% compared with anatomical pathology results as gold standard. Conclusion: FNAB is less accurate to diagnose thyroid cancer, but FNAB examination is accurate in differentiate benign and cancer lesion in thyroid nodule.

Practical and analytical considerations when performing interim analyses in diagnostic test accuracy studies

Interim analysis is a common methodology in randomised clinical trials but has received less attention in studies of diagnostic test accuracy. In such studies, early termination for futility may be beneficial if early evidence indicates that a diagnostic test is unlikely to achieve a clinically useful level of diagnostic performance, as measured by the sensitivity and specificity. In this paper, we describe relevant practical and analytical considerations when planning and performing interim analysis in diagnostic accuracy studies, focusing on stopping rules for futility. We present an adaptation of the exact group sequential method for diagnostic testing, with R code provided for implementing this method in practice. The method is illustrated using two simulated data sets and data from a published diagnostic accuracy study for point-of-care testing for SARS-CoV-2. The considerations described in this paper can be used to guide decisions as to when an interim analysis in a diagnostic accuracy study is suitable and highlight areas for further methodological development.

Diagnosis of Chronic Granulomatous Disease: Strengths and Challenges in the Genomic Era.

Chronic granulomatous disease (CGD) is a group of rare primary inborn errors of immunity characterised by a defect in the phagocyte respiratory burst, which leads to severe and life-threatening infective and inflammatory complications. Despite recent advances in our understanding of the genetic and molecular pathophysiology of X-linked and autosomal recessive CGD, and growth in the availability of functional and genetic testing, there remain significant barriers to early and accurate diagnosis. In the current review, we provide an up-to-date summary of CGD pathophysiology, underpinning current methods of diagnostic testing for CGD and closely related disorders. We present an overview of the benefits of early diagnosis and when to suspect and test for CGD. We discuss current and historical methods for functional testing of NADPH oxidase activity, as well as assays for measuring protein expression of NADPH oxidase subunits. Lastly, we focus on genetic and genomic methods employed to diagnose CGD, including gene-targeted panels, comprehensive genomic testing and ancillary methods. Throughout, we highlight general limitations of testing, and caveats specific to interpretation of results in the context of CGD and related disorders, and provide an outlook for newborn screening and the future.

Retrospective study on the dengue fever outbreak in Puntland State, Somalia

BackgroundDengue infection is a mosquito-borne, endemic viral disease, particularly in developing countries. Here, we report the results of the clinicodemographic, serologic profile and the monthly occurrence of a recent dengue fever outbreak in Puntland State (Somalia).MethodologyWe analyzed the data of 956 dengue-suspected patients who were investigated using the rapid diagnostic testing (RDT) method for detecting NS1 (dengue virus non-structural protein) and IgM antibodies employing the SD Biosensor Dengue Dou NS Ag and IgM test kit (Germany) at the Puntland Public Health Referral Laboratory from November 21, 2022, to May 27, 2023.ResultsWe found that 118 cases were positive for dengue among the suspected patients enrolled in the present study. Of these cases, 76.2% were dengue NSI positive, 13.6% were dengue IgM positive, and 10.2% were both NSI and IgM positive. The number of females and males in the confirmed cases was equal, and most (48.3%) were aged 20 years or less. 43.1% of them lived in the Nugal region, particularly in Garowe. Clinically, fever was the most frequent symptom (88.9%). The cases peaked in December 2022 but dropped from January to March, with a slight rise in February, and then increased in April and May 2023.ConclusionThis study highlights the clinicodemographic characteristics, seroprevalence, and monthly occurrence of dengue in Puntland. We recommend improving vector control measures, enhancing case management, strengthening dengue surveillance, developing an early warning system, and conducting future studies to characterize the circulating strains.

Assessing the implications of using RDTS in donor blood screening for transfusion-transmissible infections (TTIs): analysis of trans-in donor blood at a Tertiary Hospital in Ghana

BackgroundBlood transfusion is a critical hemotherapeutic intervention. However, the widespread utilization of Rapid Diagnostic Test (RDT) methods in screening potential donors for TTIs poses a serious public health challenge. We investigated the prevalence of TTIs in donor blood units that were transported from external health facilities (Trans-in blood) to Ho Teaching Hospital for critical care. MethodWe adopted a cross-sectional design to investigate 727 units of Trans-in blood at the Ho Teaching Hospital's blood bank between January 1, 2021, to December 31, 2022. An apriori-developed data capture form was used to collect the data for this study. The chi-square test and Cramer's V or Phi were used to assess the association between variables of interest. Binary logistic regression analysis was used to determine the association between TTIs and donor's blood groups whereas spatial visualization was employed to present the distribution of missed TTIs. ResultsThe overall prevalence of missed TTIs was 6.19 % (95 % CI: 4.66–8.18), comprising missed HIV, HBV, and Syphilis infection rates of 1.79 % (95 % CI: 1.72–1.86), 1.24 % (95 % CI: 1.17–1.31), and 3.16 % (95 % CI: 3.09–3.23), respectively. There was a higher rate of missed HIV infections in 2022 (2.04 %, 95 % CI: 1.04–3.97) compared to 2021 (1.49 %, 95 % CI: 0.64–3.45), and a decline in the rates of missed HBV and Syphilis infection within the period. The prevalence of TTI was highest among donors with ABO blood group 'O' (68.89 %, 95 % CI: 54.34–80.47) and Rh 'D' Positive blood group (95.56 %, 95 % CI: 85.17–98.77). Compared to donors with blood group O, non-O donors had 4.53 times the odds (95 % CI: 1.12–18.27; p-value=0.034) of missed HBV infection. ConclusionThe observed prevalence of missed TTIs highlights potential gaps in current screening practices, posing a significant public health concern. Efforts made to clamp down on the spread of these infections within the population may be impeded if the current trend of missed TTIs continues. Further studies on a larger scale with more comprehensive data are advised to better appreciate the public health implications of missed TTIs in Ghana.

Risk and factors determining diabetes after mild, nonnecrotizing acute pancreatitis.

Diabetes mellitus (DM) is relatively common following acute pancreatitis (AP), even after mild acute pancreatitis (MAP), the most frequent AP presentation, in which there is no overt beta cell injury. Post-AP related diabetes is widely misdiagnosed, resulting in potentially inappropriate treatment and worse outcomes than type 2 diabetes (T2D). Thus, it is important to understand risk across the spectrum of AP severity. Biological mechanisms are unclear and may include local and systemic inflammation leading to beta cell dysfunction and insulin resistance, altered gut barrier and/or gut peptides and possibly islet autoimmunity, though no studies have specifically focused on MAP. While studies examining clinical risk factors on MAP exclusively are lacking, there are studies which include MAP. These studies vary in scientific rigor, approaches to rule out preexisting diabetes, variable AP severity, diagnostic testing methods, and duration of follow-up. Overall, disease related factors, including AP severity, as well as established T2D risk factors are reported to contribute to the risk for DM following AP. Though numerous studies have explored risk factors for DM after AP, few studies specifically focused on MAP, highlighting a key knowledge gap that is relevant to the majority of patients with AP.

Investigation on Malaria Parasitaemia, Knowledge and Attitudes towards Mosquito Control among Residents of Wukari Metropolis

This study was conducted to investigate malaria parasitaemia, knowledge and attitudes towards mosquito control. 162 subjects were selected at random from different locations in Wukari Metropolis and were examined for malaria parasitaemia. Blood samples from each of the subjects were collected by finger pricking for the determination of malaria parasite using the Rapid Diagnostic Test method. Out of 162 samples examined, the prevalence of malaria parasitaemia was 91(56.17%). Female subjects had the highest prevalence of malaria parasitaemia of (72.0%), while the male had (35.0%) and the difference was statistically significant (p&lt;0.05) between the rate of infection and gender. Age group ≥20 years recorded the highest infection rate of (62.12%), age group 14-16 years had the lowest infection rate of (48.94%), and there was no significant difference p&gt;0.05 between malaria prevalence and age groups. The hospital location had the highest prevalence of malaria parasitaemia at (64.44%) and (31.89%) within malaria, while the Fuwukari location had the least prevalence of malaria parasitaemia of (47.22%) and (18.68%) within malaria. The test on knowledge and awareness of malaria indicates that (31.48%) of the subjects have erroneous perception about the cause and means through which malaria is transmitted. It can be concluded that despite the high infectivity rate of malaria in the study area there is much knowledge and awareness of malaria in the study. There is a need for a comprehensive strategy for preventing malaria transmission such as effective use of insecticide-treated nets, public awareness campaigns, proper environmental sanitation and use of drugs.

Evaluation of Acute Myeloid Leukemia Genomes using Genomic Proximity Mapping.

Cytogenetic analysis encompasses a suite of standard-of-care diagnostic testing methods that is routinely applied in cases of acute myeloid leukemia (AML) to assess chromosomal changes that are clinically relevant for risk classification and treatment decisions. In this study, we assess the use of Genomic Proximity Mapping (GPM) for cytogenomic analysis of AML diagnostic specimens for detection of cytogenetic risk variants included in the European Leukemia Network (ELN) risk stratification guidelines. Archival patient samples (N=48) from the Fred Hutchinson Cancer Center leukemia bank with historical clinical cytogenetic data were processed for GPM and analyzed with the CytoTerra® cloud-based analysis platform. GPM showed 100% concordance for all specific variants that have associated impacts on risk stratification as defined by ELN 2022 criteria, and a 72% concordance rate when considering all variants reported by the FH cytogenetic lab. GPM identified 39 additional variants, including variants of known clinical impact, not observed by cytogenetics. GPM is an effective solution for the evaluation of known AML-associated risk variants and a source for biomarker discovery.

Diagnostic values of questionnaires of Convergence Insufficiency Symptom Survey and College of Optometrists Vision Development Quality of Life in the screening of convergence insufficiency.

To compare and analyse the diagnostic efficacy of the College of Optometrists Vision Development Quality of Life Questionnaire (COVD-QOL) and the Convergence Insufficiency Symptom Survey (CISS) in detecting convergence insufficiency and to compare their diagnostic value in clinical applications. Using the diagnostic test method, 62 adult patients with convergence insufficiency (age: 24.74±3.75y) and 62 normal participants (age: 23.61±3.13y) who visited the Optometry Clinic of West China Hospital of Sichuan University from April 2021 to January 2023 were included. All subjects completed the CISS and COVD-QOL. Statistical analysis of the sensitivity and specificity of the CISS and COVD-QOL and comparison and joint experimental analysis of their diagnostic efficacy were performed. The sensitivity of the CISS and COVD-QOL for convergence insufficiency was 64.5% and 71.0%, respectively, while the specificity was 96.8% and 67.7%, respectively. Compared to the CISS alone, the combination of the CISS and COVD-QOL demonstrated lower sensitivity and specificity. The areas under the receiver operating characteristic curve of CISS, COVD-QOL and CISS combined with COVD-QOL were 0.806, 0.694 and 0.782, respectively. Considering the low sensitivity of the CISS and the low specificity of the COVD-QOL, it is recommended to supplement these questionnaires with other screening tests for the detection of convergence insufficiency.

Screening Parameters of Transfusion-Transmitted Infection using Rapid Diagnostic Method

Blood transfusions are an important part of medicine for patient recovery. Therefore, the transfused blood must be free from viruses, bacteria, and even parasites that can be transmitted through blood transfusions. Human Immunodeficiency Virus (HIV/AIDS), Hepatitis C, Hepatitis B, and Syphilis are among the illnesses that can be transferred through blood transfusions. This research aims to determine screening parameters for transfusion-transmitted infection using the rapid diagnostic test method. This type of research is experimental with a cross-sectional design. The samples used were ten blood samples, taken intravenously and then centrifuged at a speed of 1300 rpm for 4 minutes. After that, screening is carried out with a rapid diagnostic test. The screening results of the ten blood samples examined were valid and negative or non-reactive for HIV/AIDS, Hepatitis C, Hepatitis B, and Syphilis. These results indicate that the blood samples tested can be categorized as blood samples that passed the screening test or the blood examination test for four parameters of transfusion-transmitted infection.

Distance learning technologies and their legal regulation in the Republic of Kazakhstan

This study addresses the pressing relevance of implementing distance learning technology in the Republic of Kazakhstan across various educational levels, guided by the framework of legal regulation. The study aims to investigate the benefits of using diverse distance learning technologies in modern education, improving access, motivation, and flexibility while fostering environmental awareness and societal prosperity. The chosen methodology is based on the diagnostic testing method to assess and analyze the educational needs and preferences of students. The study involved 100 participants, ranging in age from 19 to 26, from the Abai Kazakh National Pedagogical University. The study shows important signs and criteria for incorporating distance learning into legal rules in a way that works. These include factors related to the environment, motivation, cognition, analysis, and culture. This transformation of education aligns with real-life situations, adapting to changing circumstances and allowing students to select distance learning when necessary. The implementation of modern technology in distance education facilitates profound knowledge acquisition while accommodating evolving personal circumstances, ultimately fostering a conducive environment for continued high-quality education at cognitive and social levels.

Detection of Constitutional Structural Variants by Optical Genome Mapping: A Multisite Study of Postnatal Samples

Optical genome mapping is a high-resolution technology that can detect all types of structural variations in the genome. This second phase of a multisite study compares the performance of optical genome mapping and current standard-of-care methods for diagnostic testing of individuals with constitutional disorders, including neurodevelopmental impairments and congenital anomalies. Among the 627 analyses in phase 2, 405 were of retrospective samples supplied by five diagnostic centers in the United States and 94 were prospective samples collected over 18 months by two diagnostic centers (June 2021 to October 2022). Additional samples represented a family cohort to determine inheritance (n=119) and controls (n=9). Full concordance of results between optical genome mapping and one or more standard-of-care diagnostic tests was 98.6% (618/627), with partial concordance in an additional 1.1% (7/627).

Detection of Malaria Antigen by Rapid Diagnostic Method in Student STIKes Guna Bangsa Yogyakarta Origin East Nusa Tenggara

Malaria, caused by Plasmodium protozoa, affects 300-500 million annually, resulting in 1.5 to 2.7 million deaths worldwide. Particularly prevalent in East Nusa Tenggara, ranking third in malaria morbidity after Papua and West Papua One of the processes of transmitting malaria is through blood transfusions. Researchers see the need for malaria antigen testing to prevent the spread of malaria, especially to students from East Nusa Tenggara. This research aims to determine the proportion of malaria incidence among STIKes Guna Bangsa students from the East Nusa Tenggara area. The type of research used was descriptive observational with a cross-sectional design. The total sample was 36 students with malaria antigen screening using the Rapid Diagnostic Test (RDT) method (Standareagen diagnostic kit for Malaria Pf/Pv antigen), analyzing risk factors for malaria incidence and measuring hemoglobin levels. Generally, malaria is characterized by low hemoglobin levels. The results of this research were that 100% of the samples were non-reactive to malaria with normal hemoglobin levels, so it could be concluded that there was no incidence of malaria in the students' blood analysis samples from either the RDT or risk factors.

Myocarditis in Athletes: Risk Factors and Relationship with Strenuous Exercise.

Amidst the SARS-CoV-2 pandemic, myocarditis in athletes has demanded increased attention primarily because of the risk of sudden cardiac death. While most athletes who experience myocardial inflammation recover, extensive measures for screening and diagnosis are taken because of the possibility of cardiac necrosis, fibrosis, and remodeling. Several risk factors have been identified that may contribute to the development of this inflammatory response, predominantly a history of viral or bacterial upper-respiratory infections. Recent research suggests new risks specific to athletes remain in question, such as the intensity and longevity of sustained exercise, vaccination status, and genetic and epidemiologic factors. Electrocardiography, echocardiography, and cardiac magnetic resonance imaging are commonly utilized for the diagnosis of myocarditis; however, reference standards are lacking because of the variety of clinical presentations. In this article, we discuss the epidemiology, pathophysiology, and presentation of myocarditis in athletes. We then review the available literature to provide a deeper insight into the diagnostic testing methods available, with the aim of outlining the efficacy and prognostic value. Next, we discuss an algorithmic approach to patient care and treatment based upon hemodynamic stability, symptoms, and findings on testing. Finally, this article reviews the current return to play guidelines and the rationale for revisions to return-to-play protocols.