Disease In Symptomatic Patients Research Articles

News Brief: Blood biomarkers can diagnose early Alzheimer disease in symptomatic patients.

News Brief: Blood biomarkers can diagnose early Alzheimer disease in symptomatic patients.

Predictive role of monocyte count for significant coronary artery disease identification in patients with stable coronary artery disease.

The coronary artery disease (CAD) remains the leading cause of morbidity that is characterized by broad spectrum of symptoms. Up to 30% of performed angiographies reveal normal coronary arteries. The aim of the study was to find simple predictor for significant epicardial artery stenosis among patients with chronic coronary syndrome. There were 187 patients (131 (709%) men and 56 (30%) women) in the median (Q1-Q3) age of 67 [58-72] presenting with stable CAD symptoms enrolled into the present retrospective analysis. The demographical, clinical and laboratory characteristics between patients with normal and significant coronary artery stenosis were compared. The multivariable analysis revealed coexistence of hypercholesterolemia as significant differentiation factor (odds ratio [OR]: 4.38, 95% confidence interval [CI]: 1.78-10.80, p = 0.001) for significant CAD and inverse relation to serum high density lipoprotein (OR: 0.19, 95% CI: 0.05-0.72, p = 0.015) and relation to creatinine concentration (OR: 1.03, 95% CI: 1.00-1.05, p = 0.012). Among whole peripheral blood count analysis, the significant relation was noticed to be hemoglobin concentration (OR: 1.09, 95% CI: 1.10-1.18, p = 0.022) and monocyte count (OR: 32.3, 95% CI: 1.09-653.6, p = 0.017). Receiver operator curve revealed (AUC: 0.641, p = 0.001) with the optimal cut-off value above 0.45 K/uL for monocyte, yelding sensitivity of 81.82% and specificity of 58.06%. The peripheral monocyte count above 0.45 k/uL may be considered as a predictor of significant coronary artery disease in symptomatic patients with chronic coronary syndrome.

Polygenic Risk Scores in Predicting Coronary Artery Disease in Symptomatic Patients. A Validation Study.

Clinical risk scores for coronary artery disease (CAD) are used in clinical practice to select patients for diagnostic testing and therapy. Several studies have proposed that polygenic risk scores (PRSs) can improve the prediction of CAD, but the scores need to be validated in clinical populations with accurately characterized phenotypes. We assessed the predictive power of the three most promising PRSs for the prediction of coronary atherosclerosis and obstructive CAD. This study was conducted on 943 symptomatic patients with suspected CAD for whom the phenotype was accurately characterized using anatomic and functional imaging. Previously published genome-wide polygenic scores were generated to compare a genetic model based on PRSs with a model based on clinical data. The test and PRS cohorts were predominantly Caucasian of northern European ancestry. All three PRSs predicted coronary atherosclerosis and obstructive CAD statistically significantly. The predictive accuracy of the models combining clinical data and different PRSs varied between 0.778 and 0.805 in terms of the area under the receiver operating characteristic (AUROC), being close to the model including only clinical variables (AUROC 0.769). The difference between the clinical model and combined clinical + PRS model was not significant for PRS1 (p=0.627) and PRS3 (p=0.061). Only PRS2 slightly improved the predictive power of the model (p=0.04). The likelihood ratios showed the very weak diagnostic power of all PRSs. The addition of PRSs to conventional risk factors did not clinically significantly improve the predictive accuracy for either coronary atherosclerosis or obstructive CAD, showing that current PRSs are not justified for routine clinical use in CAD.

A Novel Sirolimus-Coated Balloon for the Treatment of Femoropopliteal Lesions: The SELUTION SFA Japan Trial

BackgroundSirolimus-coated balloons (SCB) for the treatment of femoropopliteal (FP) lesions have not been systematically studied, but initial outcomes from early studies are promising. ObjectivesThe authors sought to evaluate the safety and efficacy of the SELUTION SLR SCB, composed of proprietary microreservoir technology combining sirolimus and biodegradable polymer, when used to treat mild-to-moderate FP disease in a Japanese population. MethodsThis multicenter, prospective, single-arm study (SELUTION SFA JAPAN) enrolled 134 patients with FP disease. It was independently adjudicated by an imaging core laboratory and clinical events committee. The primary endpoint was 12-month primary patency, defined as peak systolic velocity ratio ≥2.5 by duplex ultrasound and compared against a prespecified performance goal of 60% based on established angioplasty data. ResultsThe mean age was 73.8 ± 6.9 years, and 60.3% of patients had diabetes mellitus. The mean lesion length was 127.4 ± 59.7 mm, 17.2% were chronic total occlusions, and 47.8% involved the popliteal artery. Data on 12-month restenosis were available in 127 patients (94.8%). The 12-month primary patency rate was 87.9%, and the freedom from clinically driven target lesion revascularization (CD-TLR) was 97.0% per Kaplan-Meier estimate. The major adverse event rate was 6.7%, driven by 4 CD-TLRs and 5 deaths, none of which were related to the device or procedure. Ankle-brachial index data improved significantly from 0.73 ± 0.16 at baseline to 0.96 ± 0.14 at 30 days postprocedure and was sustained through 12 months (0.94 ± 0.13). ConclusionsThe SELUTION SFA JAPAN trial demonstrated that a novel SELUTION SCB is a safe and effective treatment option for FP disease in symptomatic patients.

Hypomagnesemia may be associated with symptomatic disease in patients with primary hyperparathyroidism.

Magnesium (Mg) homeostasis is closely related to calcium (Ca) metabolism. Hypercalcemia inhibits the reabsorption of Mg from the kidneys, leading to hypomagnesemia. Therefore, patients with primary hyperparathyroidism (PHPT) are predisposed to hypomagnesemia. However, there are few studies on the clinical significance of hypomagnesemia in PHPT. The aim of this study was to retrospectively evaluate the association of hypomagnesemia with the clinical outcomes of PHPT. A retrospective evaluation was made of the data of 538 consecutive patients (478 females, 60 males) diagnosed with PHPT in our center. The mean age of the study population was 56.5 ± 11.66 years. The mean serum Mg level was 2 ± 0.26 mg/dl. Asymptomatic disease was present in 241 (44%) patients. Symptomatic patients with osteoporosis, Ca level ≥11.2 mg/dl, and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 had lower levels of Mg (p < 0.05). Hypomagnesemia was detected in 129 of 538 patients (23.9%). The patients with hypomagnesemia had a higher rate of symptomatic disease (80% vs. 48%, p < 0.0001). The serum parathormone (PTH) level was found to be higher in patients with hypomagnesemia and the lumbar and femur T-scores and serum vitamin D levels were lower (p < 0.05). Patients with hypomagnesemia had higher rates of kidney stones (34% vs. 21%, p = 0.003) and osteoporosis (74% vs. 32%, p < 0.001). Multivariate logistic regression analysis revealed that hypomagnesemia had a significant effect on the development of symptomatic disease (OR:6.88, CI 95%: 5.20-11.27, p < 0.001). The current study results demonstrate that hypomagnesemia may be associated with a higher risk of osteoporosis and kidney stones in PHPT patients. Routine evaluation of serum Mg may predict the clinical outcomes of PHPT.

Influence of Age on the Diagnostic Value of Coronary Artery Calcium Score for Ruling Out Obstructive Coronary Disease in Symptomatic Patients

Concerns have been raised about the added diagnostic value of coronary artery calcium score (CACS) of 0 for reducing the likelihood of obstructive coronary artery disease (CAD) in younger patients. Our study aimed to assess the influence of age on the value of CAC=0 in symptomatic patients who underwent coronary computed tomography angiography (CCTA). We conducted a 2-center retrospective study assessing symptomatic patients with suspected CAD who underwent CACS and CCTA. Pretest probability was calculated according to the Juarez-Orozco method and obstructive CAD was defined as ≥50% luminal stenosis. The diagnostic likelihood ratios and negative predictive values were used to assess the diagnostic value of a CACS of 0 to rule out obstructive CAD. A total of 2,043 patients (mean age 60 ± 11years, 60% women, 48.5% CACS of 0) were analyzed. The pretest probability of obstructive CAD increased with age, whereas the proportion of patients with a CACS of 0 decreased with age. The added diagnostic value of a CACS of 0 was lower in younger patients (negative likelihood ratios ranging from 0.36 for <50years to 0.10 for ≥70years). However, the prevalence of obstructive CAD in patients with a CACS of 0 was low in all age groups. In a cohort of symptomatic patients who underwent CCTA for suspected CAD, the added diagnostic value of a CACS of 0 decreases significantly at younger ages. However, it is offset by their lower pretest probabilities, yielding high negative predictive values independently of age.

Polygenic risk scores in predicting the presence of coronary artery disease in symptomatic patients - A validation study utilizing an accurate phenotype based on state-of-the-art imaging

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Academy of Finland Turku University Hospital. Background Clinical risk scores for coronary artery disease (CAD) are used routinely in clinical practice to identify high risk patients in which diagnostic testing and therapy are warranted. Several recent studies suggested that polygenic risk scores (PRS) derived from millions genetic variants and hundreds of thousands subjects are able to identify those with higher risk of developing CAD. PRSs have been proposed to be included in clinical care, but their performance in clinical setting has not been validated. Purpose Our aim was to assess the predictive power of 4 established PRSs in prediction of CAD. Methods The study was carried out in 943 symptomatic patients with suspected CAD for whom the phenotype has been accurately characterized using state-of-the-art anatomic (CTA) and functional imaging (PET perfusion). Results The ROC curves for models combining clinical data and PRS in predicting obstructive CAD are shown in Figure. The predictive accuracy of the models combining clinical data and different PRS varied between 0.778–0.805 (in terms of AUROC), being close to the model including only clinical variables (AUROC 0.769) and yielding an improvement of only 0.9–3.6 percentage points over clinical data alone. The difference between clinical model and combined clinical + PRS model was not significant for PRS1 (p = 0.479), PRS2 (p = 0.627) and PRS4 (p = 0.061), respectively. Only PRS3 slightly (AUC change 0.036) but nominally significantly improved the predictive power of the model (p = 0.04). Conclusions We found that the addition of PRSs to conventional risk factors did not clinically significantly improve the predictive accuracy for either coronary atherosclerosis or obstructive CAD, suggesting that current PRSs are not justified for clinical routine for CAD.

IgA deficiency destabilizes homeostasis toward intestinal microbes and increases systemic immune dysregulation.

The ability of most patients with selective immunoglobulin A (IgA) deficiency (SIgAD) to remain apparently healthy has been a persistent clinical conundrum. Compensatory mechanisms, including IgM, have been proposed, yet it remains unclear how secretory IgA and IgM work together in the mucosal system and, on a larger scale, whether the systemic and mucosal anti-commensal responses are redundant or have unique features. To address this gap in knowledge, we developed an integrated host-commensal approach combining microbial flow cytometry and metagenomic sequencing (mFLOW-Seq) to comprehensively define which microbes induce mucosal and systemic antibodies. We coupled this approach with high-dimensional immune profiling to study a cohort of pediatric patients with SIgAD and household control siblings. We found that mucosal and systemic antibody networks cooperate to maintain homeostasis by targeting a common subset of commensal microbes. In IgA-deficiency, we find increased translocation of specific bacterial taxa associated with elevated levels of systemic IgG targeting fecal microbiota. Associated features of immune system dysregulation in IgA-deficient mice and humans included elevated levels of inflammatory cytokines, enhanced follicular CD4 T helper cell frequency and activation, and an altered CD8 T cell activation state. Although SIgAD is clinically defined by the absence of serum IgA, the symptomatology and immune dysregulation were concentrated in the SIgAD participants who were also fecal IgA deficient. These findings reveal that mucosal IgA deficiency leads to aberrant systemic exposures and immune responses to commensal microbes, which increase the likelihood of humoral and cellular immune dysregulation and symptomatic disease in patients with IgA deficiency.

Can prediabetes diagnosed using HemoglobinA1c or oral glucose tolerance test predict presence and severity of coronary artery disease in symptomatic patients?

We investigated whether prediabetes diagnosed by hemoglobinA1c (HbA1c) or oral glucose tolerance test (OGTT) could predict presence and severity of coronary artery disease (CAD) in symptomatic patients. The presence of plaque, stenosis, plaque characteristics, and coronary artery calcium (CAC) were evaluated by coronary CT angiography in 702 patients with suspicion of CAD. Patients were classified by glycemic status using the American Diabetes Association criteria for HbA1c and OGTT, and compared to their respective normal ranges. Prediabetes was observed in 24% by HbA1c and 72% by OGTT. Both prediabetes classifications were associated with increased presence of plaque, stenosis, calcified plaques, CAC >400, and a lower frequency of zero CAC compared to their respective normal range (all, p < 0.05). After adjusting for potential confounders, patients with HbA1c-prediabetes had an odds ratio of 2.1 (95% CI: 1.3-3.5) for CAC >400 and 1.5 (95% CI: 1.0-2.4) for plaque presence, while none of the associations for OGTT-prediabetes were significant. The receiver operating characteristic-curve for HbA1c-prediabetes showed an area under the curve of 0.81 for CAC >400 and 0.77 for plaque presence. Prediabetes defined by HbA1c predicts presence and severity of CAD. Although OGTT identified more patients with prediabetes, their risk of CAD were not explained by prediabetes using these diagnostic-criteria.

INSUFICIÊNCIA CORONARIANA CRÔNICA: INOVAÇÕESEM TOMOGRAFIA CARDÍACA

Cardiac tomography in chronic coronary atherosclerotic disease is based on the interpre-tation of two main parameters: coronary calcium score, for the definition of cardiovascular risk in asymptomatic patients, and anatomical evaluation of coronary stenosis by angiotomography, for the diagnosis of coronary atherosclerotic disease in symptomatic patients. Calcium score, combined with clinical evaluation of the patient, is the most accurate complementary method for stratification and restratification of cardiovascular risk, while angiotomography has become the preferred investigation method in patients with suspected stable angina, especially in those with pre-test intermediate probability. Angiotomography presents recent technological advances that have brought the capacity for functional and histological assessments of co-ronary atherosclerosis, such as fractional flow reserve by tomography (FFR-CT) and dynamic myocardial perfusion by tomography (PMD-CT), which optimize diagnostic accuracy by improving the specificity and positive predictive value of the test, as well as high-risk plaque (HRP) and analysis of the fat attenuation index, which provide more accurate prognostic information, especially for cases in which no significant stenoses are identified.

Vaccination Is Reasonably Effective in Limiting the Spread of COVID-19 Infections, Hospitalizations and Deaths with COVID-19.

This paper uses large cross-country data for 110 countries to examine the effectiveness of COVID vaccination coverage during the delta variant outbreak. Our results confirm that vaccines are reasonably effective in both limiting the spread of infections and containing more severe disease progression in symptomatic patients. First, the results show that full vaccination rate is consistently negatively correlated with the number of new COVID cases, whereby a 10 percent increase in vaccination rate is associated with a 1.3 to 1.7 percent decrease in new COVID cases. Second, the magnitude of vaccination is shown to contribute significantly to moderating severe disease progression. On average, a 10 percent increase in the rate of vaccination leads to a reduction of about 5 percent in the number of new hospitalizations, 12 percent decrease in the number of new intensive care patients and 2 percent reduction in the number of new deaths. Finally, by comparing the data for the same period between 2020 and 2021, we also check how well vaccination performs as a substitute for lockdowns or other stringent government protection measures. Results suggest that vaccination appears to be an effective substitute for more stringent government safety measures to contain the spread of COVID infections only at a sufficiently high vaccination coverage threshold (more than 70 percent). On the other hand, vaccination is shown to be quite effective in limiting the more severe course of the disease in symptomatic patients already at moderate vaccination coverage (between 40 and 70 percent). This suggests that vaccination can also help to reduce pressure on the health system and thus benefit the overall public health of society. On the other hand, the efficient rollout of vaccines could explain the favourable economic performance in the second half of 2021 despite the severe outbreak of the delta variant.

CELIAC DISEASE AMONG GASTROINTESTINAL PATIENTS IN YEMEN: ITS PREVALENCE, SYMPTOMS AND ACCOMPANYING SIGNS, AND ITS ASSOCIATION WITH AGE AND GENDER

Background and objectives: Celiac disease is a long-standing autoimmune illness that principally affects the small intestine. Typical symptoms comprise digestive problems such as chronic diarrhea, flatulence, malabsorption, loss of appetite, and failure of children to grow normally. The prevalence of celiac disease has not been established in Yemen, either in the general population or in symptomatic patients. Therefore, the current study aimed to assess the prevalence of disease in symptomatic patients and to investigate associated symptoms and signs; and whether prevalence of CD varies greatly between different ages and genders in a hospital in Sana'a. Methods: A cross sectional study based on the results of serological markers; IgA anti-tissue glutaminase and small bowel biopsies of 600 patients with gastrointestinal symptoms who were all patients who attended in the research period. Data were collected from hospital records during the period from March 2014 to December 2018. 600 suspected patients (245 males and 355 females) were subjects and the mean age of ±SD patients was 30.6±14.5 years (range 2-92 years). Results: The prevalence of CD among patients with gastrointestinal symptoms was 9.2%. There was a significant association between CD with females (rate being 11.3% , OR=1.9, p=0.03), and 2-19 years age group (21.4% , OR=4.3, p&lt;0.001), Considering the clinical signs and symptoms there was a significant association between celiac disease and chronic diarrhea (OR=18.4), steatorrhea ( OR=9.6), foul odor (OR=8.3), weight loss (OR=5.7), anemia (OR=10.2), abdominal distension (OR=3.1), mouth ulcers (OR=7.2), abdominal bleeding (OR=13.5), diabetes mellitus I (OR=18), and hypothyroidism (OR=79.3). Conclusion: A high rate of CD was identified among gastrointestinal symptoms patients arriving at the general hospital in Sana’a, Yemen, and this demonstrates the importance of general practitioners in identifying patients with CD, especially in the absence of a medical facility for CD, and this was facilitated through the serological markers test. Peer Review History: Received: 11 September 2021; Revised: 12 October; Accepted: 29 October, Available online: 15 November 2021 Academic Editor: Ahmad Najib, Universitas Muslim Indonesia, Indones UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.5/10 Reviewers: Dr. Gulam Mohammed Husain, National Research Institute of Unani Medicine for Skin Disorders, Hyderabad, India, gmhusain@gmail.com Dr. Vanina Doris Edo’o, University of Yaounde I, Yaounde, Cameroun, vanina_edoo@yahoo.com Similar Articles: THE ASSOCIATION OF ADULT MALE AND FEMALE INFERTILITY WITH CELIAC DISEASE PATIENTS IN YEMEN

Clinical profile of COVID-19 patients at a tertiary care hospital in North India: A retrospective analysis

Background: Corona virus is known to human kind since 1930. It was first discovered in domesticated chicken with symptoms of pulmonary infection. Human corona virus was first discovered in 1960 and isolated from a boy suffering from common cold.Aims and Objectives: To assess the clinical profile of corona virus patients.Material and Methods: The present retrospective study was carried out in the Department of Medicine, World College of Medical Sciences Research and Hospital, Gurawar, Distt. Jhajjar (Haryana). A total of 498 patients were observed during the study period of May 2020 to April 2021.Results: A total of 498 confirmed corona positive patients, having moderate to severe illness/critically ill admitted to World College of Medical Sciences Research and Hospital, Gurawar, Distt. Jhajjar were examined. Out of 498 patients admitted during the study period, there were 140 patients in severe category as per MOHFW guidelines. We found older age, delay in seeking medical help, oxygen saturation less than 90% at the time of admission, ARDS/Sepsis/Acute renal failure at admission; CRP >100 mg/L and D dimer >1000 ng/ml associated with adverse outcome.Conclusion: Only few patients with confirmed COVID-19 & having elderly age group with other comorbid illnesses, presented with critical condition at the time of presentation. We recommend early detection of disease in symptomatic patients and timely seeking of medical help might have facilitated in reducing the mortality among COVID-19 patients.

Pulmonary Hypertension from Cardiorenal Sequelae in an 18-Year-Old 46, XY Phenotypically Female Patient with Denys-Drash Syndrome: Case Report and Review of Literature

Denys-Drash Syndrome (DDS) is a rare cause of end-stage renal disease (ESRD) stemming from genetic mutations in the Wilms’ tumor 1 (WT1) gene. Albeit uncommon, it and other congenital nephropathies (e.g., Frasier syndrome) may warrant a clinical workup of cardiovascular disease in symptomatic patients with cardiopulmonary deficits, as the latter is associated with renal dysfunction given the multifarious physiologic roles and nodes of action concerning the kidneys. These include not only serving as a site of neural and hormonal stimuli that affect systemic equilibrium, but the regulation of blood pressure and osmolality as well. The cardiorenal demise classically seen in later stages of chronic kidney disease (CKD) in relatively older adults may arise earlier in these patients. We report the case of an 18-year-old 46, XY phenotypic female with DDS who complained of increasingly nettlesome dyspnea. Initially, she presented with a low index of suspicion for diminished cardiopulmonary fitness. However, further clinical workup which included catheterization and cardiac imaging was significant for findings of pulmonary hypertension.

Coronary artery calcium score: pivotal role as a predictor for detecting coronary artery disease in symptomatic patients.

Chest pain and dyspnea are common presentations for symptomatic individuals with suspected coronary artery disease (CAD) in the primary care office and cardiology clinics. However, it is imperative to properly diagnose who should undergo further evaluation for cardiac etiologies of chest pain, with either noninvasive or invasive imaging tests. The purpose of this review is to highlight the role of coronary artery calcium (CAC) score as a screening tool for symptomatic patients to detect CAD. The purpose of CAC scoring is to establish the presence and severity of coronary atherosclerosis that can play a vital role in symptomatic patients. The use of CAC testing in symptomatic patients has traditionally been limited due to fundamental concerns, including the occurrence of coronary calcification relatively late in the atherosclerotic process and high prevalence of CAC in the population. Further issue relates to its low specificity for obstructive CAD, as well as demonstration of significant ethnic variability in plaque composition and calcification patterns. CAC testing gained attention as an inexpensive, rapid, reproducible and a well-tolerated alternative to exclude CAD in symptomatic patients and defer further invasive imaging tests. This article will review the available literature in regard to the use of CAC in symptomatic populations.

Association of hepatic steatosis with epicardial fat volume and coronary artery disease in symptomatic patients.

This study aims to investigate whether HS-when associated with an excessive amount of epicardial adipose tissue-correlates with CAD in subjects with symptoms suggestive of CVD. CCTA images, demographic and clinical variables of 1.182 individuals were retrieved: semi-automated measurements for EFV, CAC, and MLD were obtained. Individuals were grouped into three categories according to the presence of CAD, resulting in absent (CAD0), non-obstructive (CAD1) or obstructive (CAD2) disease-groups, and into two categories based on the presence of HS (with no HS, named HS-, and with HS, named HS+). EFV was significantly higher in HS+ than in HS- group (p < 0.001), whereas MLD was lower in CAD+ than in CAD- subjects (p < 0.001). Two predictive models for CAD were tested: the former included clinical risk factors for CAD along with age, gender, EFV and MLD, whereas the latter did not include clinical variables. The logistic regression analysis of the second proposed model reliably discriminated CAD0 from CAD1 and CAD2 (AUC of 0.712, range 0.682-0.742). Lower MLD was associated with increased EFV, and MLD-as a marker of HS-discriminate symptomatic patients with CAD from whom without.

Prospects for Using the ELISPOT Technological Platform as Part of Anti-Epidemic Measures Against the New Coronavirus Infection COVID-19

Determination of T-cell immune response to SARS-CoV-2 is important both for diagnosis of the disease in symptomatic patients, and for determination of the total number of people who have had the disease, including its asymptomatic form. In addition, these assays are efficient for assessing the immune response after vaccination, as well as immunity levels in risk groups and in convalescent patients. The most promising method of T-cell immune response assessment is an ELISPOT-based assay measuring the release of interferon-gamma (IGRA) after stimulation with coronavirus-specific antigens. The present review analyses the prospects for using the ELISPOT technological platform in the clinical laboratory setting when dealing with the new coronavirus infection COVID-19, given specific aspects of the immune response. The review summarises data from articles published in peer-reviewed journals, preprints of articles available at arXiv resources, and information that some leading immunologists shared with the authors during private discussions. It has been shown that the introduction of B- and T-cell ELISPOT assays will make it possible to monitor the immunological status of patients, select a treatment strategy, identify the most vulnerable populations, carry out comprehensive assessment of vaccines during the development, clinical trials and implementation stages. The paper discusses the issues of maintaining T-cell immunity in the blood of people who have had HCoV, SARS, MERS, and COVID-19 coronavirus infections. It also discusses the advantages of the T-cell ELISPOT assay over serological tests as regards epidemiological assessment of the prevalence of the new coronavirus infection, and clinical trials of COVID-19 vaccines. Biotechnology companies have a ready-made technological platform for the development and industrial-scale production of ELISPOT kits, and this platform is easily adaptable to specific types of assays and pathogens. The paper supports the need to develop vaccines that would stimulate both cellular and humoral immune responses, and raises the question of the protective potential of cross-immunity acquired before the COVID-19 pandemic.

Proposed Scoring System for Evaluating Clinico-radiological Severity of COVID- 19 using Plain Chest X- ray (CXR) changes (CO X-RADS): Preliminary results.

Background:Plain chest radiograph (CXR), although less sensitive than chest CT, is usually the first-line imaging modality used for patients with symptomatic SARS-CoV-2 infection. The relation between radiological changes in CXR and clinical severity of the disease in symptomatic patients with COVID 19 has not been fully studied and there is no scoring system for the severity of the lung involvement, using the plain CXR.Aim of the study:Current COVID-19 radiological literature is dominated by CT and a detailed description CXR appearances in relation to the disease time course is lacking. We propose an easy scoring system (CO X-RADS) to describe the severity of chest involvement in symptomatic COVID 19 patients using CXR and to correlate the radiological changes with the clinical severity of the disease.Patients and methods:The clinical manifestations and CXR findings were recorded in 500 symptomatic COVID-19 positive patients who were admitted to Hamad Medical Corporation (HMC) COVID-19 designated facility Center from January to June 2020. The severity and outcome of the disease included: intensive care unit admission, need for oxygen therapy, mechanical ventilation. and mortality rate.Results:Most of our symptomatic patients (86.8%) had mild and moderate clinical manifestations. The remaining 13.2% had severe manifestations, including: fever, persistent dry cough, shortness of breath, dyspnea, abdominal and generalized body pains. Based on our radiological scoring system (0 to 10) patients were distributed according to their CXR findings into different categories and according to our suggested (CO X-RADS) severity system into five categories (0 to IV). Patients with mild clinical manifestations showed low scoring in CXR (score 0 up to 4) and they represented 72% of our patients. Patients with moderately severe clinical manifestations showed mainly GGO (scoring 5 and 6) and represented about 14.8% of patients. Patients presented with severe clinical manifestations had obvious lung consolidations at the time of presentation with CXR scoring system ≥ 7 and represented about 13.2% of patients.Conclusion:We proposed a simple CXR reporting scoring system (CO X-RADS) to categorize COVID19 patients according to their radiological severity. This radiological score was correlated well with the clinical severity score of patients. We encourage other centers to test this scoring system in correlation with the clinical status of patients. (www.actabiomedica.it)

A Novel, Highly Sensitive Quantitative Polymerase Chain Reaction Assay for the Diagnosis of Subarachnoid and Ventricular Neurocysticercosis and for Assessing Responses to Treatment.

Treatment of subarachnoid neurocysticercosis (NCC) is complicated, and assays that can guide treatment are not widely available. The reproducibility and scalability of molecular-based biomarkers would be of great use. The Taenia solium genome was mined and primers and probes were designed to target repeats with the highest coverage; the most sensitive, specific, and efficient repeat (TsolR13) was selected for clinical testing. We tested 46 plasma samples and 36 cerebral spinal fluid (CSF) samples taken from patients with subarachnoid or ventricular disease using quantitative polymerase chain reaction (qPCR). The analytic sensitivity of TsolR13 was 97.3% at 240 attograms (ag) of T. solium genomic DNA and 100% analytic specificity. The clinical sensitivity in detecting active subarachnoid or ventricular disease in symptomatic patients was 100% in CSF and 81.3% in plasma. The predictive ability to distinguish active from cured disease was better for CSF (94.4% of those cured had negative qPCR results) than for plasma (86.7% of those cured tested negative). Some subjects also had plasma DNA detectable intermittently for years after being cured. Overall, the test performance was equivalent to T. solium antigen detection. A qPCR test for the detection of the highly repetitive Tsol13 sequence has been developed and shown to be highly sensitive and specific for NCC, but also useful as a test of cure in CSF and for the definitive diagnosis of NCC in plasma.

Impact of sex-specific differences in calculating the pretest probability of obstructive coronary artery disease in symptomatic patients: a coronary computed tomographic angiography study.

ObjectivesLittle is known about the impact of sex-specific differences in calculating the pretest probability (PTP) of obstructive coronary artery disease. We sought to determine whether the calculation of PTP differ by sex in symptomatic patients referred to coronary computed tomographic angiography (CCTA).Patients and methodsThe characteristics of 5777 men and women who underwent CCTA were compared. For each patient, PTP was calculated according to the updated Diamond–Forrester method (UDFM) and the Duke clinical score (DCS), respectively. Follow-up clinical data were also recorded. Area under the receiver operating characteristic curve, integrated discrimination improvement, net reclassification improvement, and the Hosmer–Lemeshow goodness-of-fit statistic were used to assess the models’ performance.ResultsThe area under the receiver operating characteristic curve of UDFM and DCS showed little difference in men (0.782 vs. 0.785, P=0.4708) and women (0.668 vs. 0.654, P=0.1255), and calibration of neither model was satisfactory. Compared with UDFM, DCS showed positive integrated discrimination improvement (10% in men, P<0.0001, and 8% in women, P<0.0001, respectively), net reclassification improvement (12.17% in men, P<0.0001, and 27.19% in women, P<0.0001, respectively), and obviously reduced unnecessary noninvasive testing for women with negative CCTA.ConclusionAlthough the performance of neither model was favorable, DCS offered a more accurate calculation of PTP than UDFM and application of DCS instead of UDFM would result in a significant decrease in inappropriate testing, especially in women.