Negative PCR Research Articles

Lasting liver injury following COVID-19 infection characterized by ultrasound shear wave elastography

ObjectiveTo assess for lasting hepatic injury using ultrasound shear wave elastography (SWE) in patients following COVID-19 infection. MethodsIn this retrospective cohort study, patients with SWE exams between January 2019 and 2022 were categorized into three groups: 1) post-COVID-19 subjects with positive COVID-19 PCR assay, 2) random sample of contemporaneous unexposed patients with only negative prior COVID-19 PCR tests, and 3) random sample of pre-pandemic patients to address possible undiagnosed COVID-19 infection in the contemporaneous group. The average difference in median Young’s modulus between post-COVID-19 patients and controls was calculated using a linear regression model after controlling for confounders. Results130 patients (mean age ± SD, 56 years ± 13; 66 women) were evaluated, including 30 patients after COVID-19 infection (mean age ± SD, 53 years ± 11; 15 women), 50 contemporaneous unexposed patients (mean age ± SD, 55 years ± 13; 27 men), and 50 pre-pandemic patients (mean age ± SD, 58 years ± 13; 28 women). SWE scans were performed on General Electric LOGIQ E9 or E10 an average of 44 (range, 12-81) weeks after COVID-19 infection. COVID-19 infection was associated with an average increase in median Young’s modulus of 1.5 kPa (95% CI [0.44, 2.355], p=0.006) after controlling for age, sex, obesity, history of chronic liver disease, and time period. Post-COVID-19 patients had higher liver stiffness compared to contemporaneous controls (median = 7.58 vs 5.99 kPa, p=0.001) but not pre-pandemic controls (median = 7.00 kPa, p=0.51). ConclusionsCOVID-19 infection is associated with increased liver stiffness, which may reflect lasting hepatic injury such as ongoing inflammation or the development of fibrosis. US SWE may serve as a noninvasive tool for long-term liver health monitoring after COVID-19 infection.

NCMP-09. SPONTANEOUS RESOLUTION OF PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY (PML) DEVELOPED AFTER RITUXIMAB TREATMENT FOR LOW-GRADE B-CELL LYMPHOMA

Abstract Progressive multifocal leukoencephalopathy (PML) is a rare viral infection caused by the reactivation of the JC virus, which causes significant morbidity and mortality. Rituximab, a CD20 inhibitor used for B-cell neoplasms as well as autoimmune diseases, is associated with the development of PML. Here, we report a case of a 74-year-old woman with a history of low-grade B-cell lymphoma with biopsy-proven PML with spontaneous immune reconstitution with clinical and radiographic improvement. For her low-grade B-cell lymphoma, she received six cycles of rituximab and bendamustine, followed by one cycle of maintenance rituximab, which was discontinued due to intolerance. Ten months later, she developed progressive left-sided paresthesias, paresis, and incoordination. Brain MRI revealed a large right subcortical frontal-parietal FLAIR hyperintense and peripherally enhancing lesion with leading-edge diffusion restriction. CSF studies revealed elevated protein (385 mg/dL) and negative JCV PCR. A brain biopsy was performed with tissue staining positive for SV40, consistent with PML. Her CD4 count was 88 cells/mm3. A repeat CSF sample one month later showed near normalization CSF protein (47 mg/dL) and negative CSF JCV PCR. MRI of the brain one month later demonstrated complete enhancement resolution and decreased FLAIR abnormality, which correlated with subjective and objective clinical improvement. Her serum CD4 also increased to 134 cells/mm3. This highlights a rare case of PML related to rituximab with spontaneous improvement, which may help guide clinicians in counseling patients who may also develop this complication. Furthermore, this supports the biological rationale for continued investigation of T-cell therapies to achieve immune reconstitution.

High rates of Dientamoeba fragilis and Blastocystis species in children’s stool but minor clinical significance

ObjectiveThe aim of this study was to describe the epidemiology and the clinical significance of dientamoeba fragilis (DF) and blastocystis (Bs) in pediatric stool samples. MethodsA historical cohort study of children under 18 years of age who underwent stool multiplex PCR for bacteria and parasites. DF and Bs results were not routinely reported. We assessed the frequency of various stool microorganisms and analyzed a composite of symptoms occurring within 14 days before testing and four post-test composite outcomes (symptoms, further medical evaluation, prescriptions of symptomatic treatment or antibiotics). Comparisons were made between children mono-infected with DF or Bs, those with negative PCR results, and those positive for microorganisms with established pathogenicity. ResultsOf 36,008 eligible children, 32.5% were positive for DF and 7.9% for Bs. Children positive for DF or Bs did not exhibit higher odds for pre- or post-test composite outcomes compared to those with all-negative PCR results, except for increased rates of abdominal pain and referrals for anti-TTG testing among DF-positive children. Antibiotic prescription was significantly more common among those positive for microorganisms of known pathogenicity. ConclusionsWhile DF and Bs are frequently detected in pediatric stool samples, their clinical significance appears to be limited.

Molecular and serological diagnosis of the circulating Trypanosoma evansi in Egyptian livestock with risk factors assessment

This study aimed to characterize and determine the prevalence and the associated risk factors of trypanosomiasis in different Egyptian livestock from various governorates using molecular and serological techniques, adding to an assessment of some biochemical alterations in serum samples. A total 1019 blood samples were collected from nine governorates in the period from January 2020 to September 2021 from cattle (n = 752), buffaloes (n = 42), sheep (n = 65), goats (n = 60), donkeys (n = 54), and horses (n = 46). Molecular investigation followed by sequencing confirmed the presence of only Trypanosoma evansi (T. evansi) infection with a prevalence rate of 3.73 % (38/1019). Serologically, T. evansi was detected by indirect ELISA in 11 samples out of 519 negative PCR ones, with an overall prevalence 2.1 %. Furthermore, statistical difference was found between investigated governorates in both molecular and seroprevalence. Surprisingly, the risk of T. evansi infection was significantly (P < 0.05) higher in winter (9.83 %) than in autumn (1.4 %), while no infection was recorded in the spring and summer seasons. No significant difference regarding animal hosts, age, and sex as risk factors was recorded. Serum biochemical analysis showed a non-significant decrease of total proteins, albumin, A/G ratio, and HDL-cholesterol in cattle, equine, and goats with a non-significant increase in total globulins level. In sheep, a significant increase was determined in all tested parameters except a significant decrease in the level of albumin and A/G ratio. To the best of our knowledge, this is the first large-scale epidemiological study determining the endemicity of the neglected T. evansi infection in different animal species in multiple governorates of Egypt. It is recommended to use both molecular and serological techniques for efficient diagnosis of trypanosomiasis as a preliminary approach to control the disease.

Clinical course of atrial fibrillation in patients who experienced coronavirus disease (COVID-19): results of a 6-month follow-up

Atrial fibrillation (AF) is the most common extrapulmonary complication of the past SARS-CoV-2 infection. According to experts, almost 20% of patients with past COVID-19 have a history of atrial fibrillation and the incidence of new paroxysms of this arrhythmia ranges from 10 to 18%. Referring to the studied patients who experienced COVID-19 more than 6 months ago, the subjective perception of cardiac arrhythmia is the most frequent complaint, reported by approximately two-thirds of patients. The aim of our study was to determine the course of atrial fibrillation in patients after past 2019 coronavirus disease (COVID-19) during a dynamic 6-month follow-up after the initial hospitalization for atrial fibrillation in the specialized department of cardiac arrhythmias of the SI “National Scientific Center” “M.D. Strazhesko Institute of cardiology, clinical and regenerative medicine of the National Academy of Medical Sciences of Ukraine” depending on the clinical and anamnestic, demo­graphic, anthropometric factors, the results of laboratory research methods and the received treatment. 36 patients were included in the study, 27 of them formed the first group, which included patients in whom the course of atrial fibrillation improved against the background of recommended antiarrhythmic treatment after initial hospitalization for AF and past COVID-19, who at the time of hospitalization had a negative PCR test, of which 17 were women and 10 were men, aged 62.38±1.83 years. The second group consisted of 9 patients including 4 women and 5 men, aged 69.88±2.60 years in whom the course of atrial fibrillation neither changed nor worsened. We determined that the number of patients in whom the course of atrial fibrillation improved during the 6-month follow-up was three times greater than those in whom the course of this arrhythmia neither changed nor worsened (75% and 25%, respectively). Patients with a more favorable course of atrial fibrillation were younger (on average by 7.5 years), three times less likely to suffer from diabetes and not often had arterial hypertension of the III stage, than those examined, in whom the course of this arrhythmia did not change or worsen. Systemic inflammation and severity of heart failure significantly worsen the course of AF within 6 months after the hospital stage of treatment. However signs of deterioration of lipid metabolism are characteristic of patients with an unfavorable course of atrial fibrillation during 6 months after hospitalization, which is probably caused by the activation of systemic inflammation in them. The improvement of the prognosis of the examined patients was probably influenced by the appointment of antiarrhythmic drugs, such as: amiodarone, flecainide, beta-blockers, statins – from the "up-stream" therapy drugs.

Mycobacterium terrae Complex Associated Lymphadenitis: Negative AFB PCR

Abstract Introduction/Objective Nontuberculous mycobacteria included with the Mycobacterium terrae complex (MTC) include a ubiquitous, slow-growing collection of mycobacteria known for causing severe resistant skin, joint, and bone infections. There are limited reports of M. Arupensis, included under MTC, causing human infections despite environmental ubiquity. Low sequencing sensitivity for species such as M. Arupensis may result in negative preliminary PCR speciation thus influencing the negative predictive value of this method of organism detection. No prior case reports have described MTC infection presenting as subacute lymphadenitis. Methods/Case Report A 48 year old El Salvadorian male with known diagnosis of HIV presented with oral thrush and significant left-sided lymphadenopathy. He was initially diagnosed with HIV in El Salvador and on ART until immigrating to the US six months prior. HIV antigen and antibody was positive with positive reflex viral PCR. QuantiFERON-TB Gold resulted positive, but CXR was without evidence of pulmonary TB. TB1, TB2, and mitogen minus NIL were negative. He was referred for fine needle aspiration and core needle biopsy of the left cervical lymph node. AFB and AFB FITE stains were performed, but no definitive mycobacteria were identified. GMS was performed and negative for fungal elements. A final histological diagnosis of necrotizing granuloma was given and the tissue was sent for bacterial, AFB, and fungal DNA PCR; no organisms were detected. A sputum sample was obtained and cultured four months after initial presentation and was positive for acid fast bacilli: Mycobacterium terrae complex, most closely resembling Mycobacterium arupensis. The Fite and AFB stains were again reviewed, revealing one single acid fast bacilli organism identified on Fite stain in the necrotizing granuloma. Results (if a Case Study enter NA) N/A Conclusion The negative AFB DNA PCR result may have been a false negative result due to poor sensitivity or selectivity for M. arupensis. There are no former reported cases of M. Arupensis associated necrotizing granulomas in lymph node. This unusual MTC infection presenting as chronic unilateral lymphadenitis underscores the importance of broadening clinical laboratory AFB DNA PCR sensitivity especially in cases of suspected AFB or modified AFB associated necrotizing granulomas.

Clinical Utility of Broad Range PCR for Infectious Organisms

Abstract Broad range PCR is used to identify infectious organisms when bacterial, fungal, and mycobacterial cultures are negative despite clinical evidence of infection. We performed a 6-month retrospective chart review to assess the actionability of broad range PCR and identify opportunities to improve the utility of this referral test at our institution. One hundred eleven broad range PCR tests were ordered from July to December 2023. Seventy-five (67.6%) results did not affect patient management, 18 (16.2%) results affected patient management, and the treatment impact of 18 (16.2%) results is unknown because they were from outside consult cases. There were no instances in which antibiotic therapy was completely discontinued due to a negative broad range PCR result. Concurrent in-house microbiology testing yielded a positive result in 15 (13.5%) cases, of which 8 (53%) had a negative broad range PCR result and 2 (13.3%) had a conflicting broad range PCR result. Thirty-eight (34.2%) specimens were formalin fixed paraffin embedded tissue, 29 (26.1%) were fresh tissue, 13 (11.7%) were ESWABS, and the remaining 31 specimens were various fluid types (27.9%). While fresh tissue is the preferred specimen, broad range PCR detected an organism in 20 (53%) formalin fixed paraffin embedded tissue specimens, 11 (37.9%) fresh tissue specimens, 3 (23.1%) ESWAB specimens, and 2 (6.5%) fluid specimens (abscess aspirate and cerebrospinal fluid). Improvements in physician communication and laboratory workflow are necessary to improve the specimen quality and thus the utility of this referral test at our institution.

Unusual Presentation of Tuberculosis in the Lungs and Lymph Nodes

Abstract Introduction/Objective Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis mainly affecting the lungs. Despite treatment advancements, TB remains a major cause of morbidity. This report presents a patient with active pulmonary and lymph node TB. Methods/Case Report The patient is a 41-year-old male from Bangladesh admitted for worsening cough and shortness of breath. Earlier, he had a cough and right cervical lymphadenopathy with lymph node biopsy demonstrating noncaseating granuloma and a positive Quantiferon-Gold. Outpatient workup included negative sputum TB PCR with negative cultures. The patient was febrile, tachycardic, and oxygenating normally. D-dimer was 1484. CT angiography was negative for emboli and showed mediastinal and right hilar lymphadenopathy. Imaging was otherwise non-indicative of active TB. We started rifampin, isoniazid, pyrazinamide, and ethambutol (RIPE) therapy with bronchoalveolar lavage for additional sputum sampling and excisional lymph node biopsy to rule out malignancy. Workup for autoimmune disease and sarcoidosis was negative. An acid-fast bacilli stain of the biopsy was positive, indicating active TB. The patient was discharged on RIPE with outpatient follow-up. Results (if a Case Study enter NA) NA Conclusion Histological findings of TB demonstrate caseating granulomatous lesions. Sarcoidosis can be considered in patients with hilar or mediastinal lymphadenopathy with noncaseating granulomatous lesions. However, both active and inactive TB should be considered in the differential diagnosis with biopsy results indicating noncaseating granuloma, as infected tissues can lack the central necrosis to produce caseation. Common chest radiographic findings in TB include pulmonary consolidation, hilar and mediastinal lymphadenopathy, disseminated miliary disease, and a normal chest radiograph. Our patient had just hilar and mediastinal lymphadenopathy. While a common finding in tuberculosis, this is also present in other inflammatory pathologies, emphasizing the importance of keeping a broad differential even in settings where initial biopsy and imaging results may indicate latent infection or other diagnoses. We utilized the expertise of pathologists to identify lymph nodes with active TB infection in a patient who previously had inconsistent pathological and radiological findings. Without the help of the pathologists in this case, diagnosing and treating this patient would not have been possible, showing the necessity of histopathological correlation with clinical and radiologic findings.

Dual detection of Neoehrlichia mikurensis and Anaplasma phagocytophilum: How biplex PCR led in France to the diagnosis of neoehrlichiosis in post-tick bite fever

ObjectivesNeoehrlichia mikurensis (NM) is an emerging intracellular bacterium member of the Anaplasmatacecae family. So far, only four cases have been described in France, all of them retrospectively. MethodsThis study describes two new cases of NM discovered following implementation of a biplex PCR targeting both Anaplasma and NM. ResultsTwo immunocompetent patients developed a flu-like illness within 14 days after an identified tick bite. Both had negative Anaplasma PCR, but by using this biplex PCR NM, infection was diagnosed in both cases. One patient recovered spontaneously while the second was successfully treated by a seven-day course of doxycycline. ConclusionPresent in Eastern France, NM is underdiagnosed. Biplex PCR screening of NM with A.phagocytophilum could effectively address this issue.

Prevalence of HCV among ESRD Patients on Regular Hemodialysis in Ain Shams University Hospitals after Implementation of National Eradication Initiative

Abstract Background Egypt is one of the highest countries in the world regarding the prevalence of hepatitis C virus (HCV) infection. End stage renal disease (ESRD) patients are at higher risk for HCV infection more than general population. Since 2014 Egypt has started a large elimination program for screening and treatment of HCV. Goal was early detection and treatment of HCV patients. Intending HCV prevalence reduction to &amp;lt; 2% in 10 years, in line with global targets. In addition, Egypt has aimed to treat 250000 people annually up to 2020 in the first phase of their treatment program aiming at reducing the number of viremic patients, thus limiting the ongoing HCV transmission. Aim of the Work to measure the prevalence of HCV infection among ESRD patients and to identify the reasons of missed treatment among those who were offered the treatment free of charge. Patients and Methods This multi-center cross sectional study included 410 patients receiving hemodialysis sessions on regular basis 4 hours/3 times per week for more than 6 months in Ain Shams University Hospitals, patient recruitment from March 2023 to August 2023. Results Our studied 410 patients had mean age of 47.13 ± 18.19 ranging between 18 – 85 years old with male predominance (62.4%). With different educational levels. Most of them had comorbidities (85.6%), as HTN (54.1%) being most predominant. Prevalence of HCV infection is (27.6%), Among patients with HCV infection, (84.1 %) received treatment and (15.9%) didn't receive treatment due to several causes. The patients with positive HCV infection had a lower educational level than negative HCV infection with a statistically significant difference (P = 0.027). The patients with positive HCV PCR had a prolonged onset of renal function impairment than negative HCV PCR with a statistically highly significant difference (P = 0.009), and also positive HCV PCR had prolonged dialysis duration and a prolonged duration of HCV infection than negative HCV PCR with a statistically significant difference. Conclusion The low prevalence of HCV among hemodialysis patients of HCV in hemodialysis patients confirms that HCV infection doesn’t become a major health problem among patients on maintenance hemodialysis. However, strict adherence to effective and proper procedures for controlling hepatitis infections will warrant preventing and reducing the prevalence of hepatitis infections. Clinically, hemodialysis patients require more attention and resources than the general population.

Comparison of Dual Monoclonal Antibody Therapies for COVID-19 Evolution: A Multicentric Retrospective Study.

Neutralizing antibodies targeting the SARS-CoV-2 Spike protein reduce COVID-19-related risk of hospitalization, particularly in high-risk individuals. The COCOPREV-R study aimed to evaluate and compare clinical outcomes in high-risk SARS-CoV-2 patients treated with dual monoclonal antibody therapies and to identify associated virological factors. The COCOPREV-R study retrospectively collected real-world data from high-risk patients receiving Bamlanivimab/Etesevimab or Casirivimab/Imdevimab dual monoclonal antibody therapies (22 February 2021 to 15 June 2021). The study included 1004 patients with COVID-19, of whom 691 received Bamlanivimab/Etesevimab and 313 received Casirivimab/Imdevimab. The alpha variant represented 90.1% of those for whom data were available. The risk of hospitalization within 30 days was lower with Bamlanivimab/Etesevimab (12.7%, CI 95% [9.9-16.3%]) compared to Casirivimab/Imdevimab (28.4%, CI 95% [22.7-35.1%) (p < 0.001). The 30-day mortality rates were comparable between both groups (p = 0.982). Analysis of SARS-CoV-2 PCR negativity showed no difference between the two treatment groups (95.2% [93.0-96.9%] and 93.5% [89.1-96.6%] until day 30, p = 0.851 for Bamlanivimab/Etesevimab and Casirivimab/Imdevimab, respectively). Among persistently positive samples with available sequencing results (n = 43), Spike protein changes occurred only in Bamlanivimab/Etesevimab (42.9%) vs. Casirivimab/Imdevimab (0.0%) groups. Q493R (25.0%) and E484K (12.5%) were the most common mutations selected by Bamlanivimab/Etesevimab in follow-up samples. Other factors (immunodepression, comorbidities, and age) did not appear to be associated with the occurrence of Spike protein mutations. A higher rate of hospitalization was seen with Casirivimab/Imdevimab (RONAPREVE®) in comparison with Bamlanivimab/Etesevimab treatment, but with the emergence of Spike mutations only in the Bamlanivimab/Etesevimab group.

Zonulin — effective biomarker for the diagnosis of intestinal lesions in patients with nonalcoholic fatty liver disease in COVID‑19

The SARS‑CoV‑2 virus mainly attacks the respiratory system, but can also affect several organs, in particular, causing gastrointestinal symptoms such as vomiting, diarrhea or abdominal pain in the early stages of the disease. Intestinal dysfunction leads to a change in intestinal microorganisms and an increase in the content of inflammatory cytokines. Liver dysfunction is also relatively common in patients with coronavirus disease 2019 (COVID19). Objective — to investigate the efficacy of zonulin in determining intestinal damage in patients with nonalcoholic fatty liver disease with COVID‑19. Materials and methods. The study included 76 patients with non‑alcoholic fatty liver disease (NAFLD) who had complaints indicating intestinal disorders during the outpatient stage of follow‑up after ­COVID‑19. From the anamnesis, it was found that all examined patients had a confirmed diagnosis of infection with SARS‑CoV‑2 virus. All patients had a mostly mild course of COVID‑19, which did not require hospitalization. Patients with NAFLD were divided into two groups depending on defecation violation: group I — 36 patients who, after an acute respiratory infection caused by the SARS‑CoV‑2 virus, developed periodic diarrhea (on average, in (38.7±5.2) days after a negative PCR result for SARS‑CoV‑2 virus); group II — 40 patients with constipation, which began to bother on average in (86.9±7.4) days after a negative PCR result. The control group included 20 practically healthy individuals. The level of zonulin was determined in blood serum and faeces by enzyme‑linked immunosorbent assay. Patients underwent faecal culture to assess the quantitative and qualitative composition of the colon microflora. Results. During the anthropometric examination, overweight and first‑degree obesity were detected more frequently in patients of both groups: overweight was diagnosed most frequently in patients of group I (38.9%) and first‑degree obesity in patients of group II (35.0%). The microbiological examination of faeces in both groups of patients revealed a decrease in the number of bifidus and lactobacilli, as well as Enterococcus and E. coli with normal enzymatic properties. In group I patients, Citrobacter and Staphylococcus were statistically significantly (p &lt;0.05) more often detected in increased concentrations in faeces, whereas in group II patients Enterobacter, Klebsiella and Clostridium were detected (p &lt;0.05). Significant changes were found in the analysis of zonulin levels in both serum and faeces in patients with NAFLD after COVID‑19. Serum zonulin levels in patients of group I increased 6.5‑fold, and in patients of group II—8.6‑fold (p &lt;0.001). An increase in the concentration of zonulin in the faeces was also detected — by 7.5 and 9.7 times, respectively (p &lt;0.001). A correlation was established between the level of zonulin in both blood serum and faeces and a decrease in the number of bifidus and lactobacilli in faeces in patients of both groups. Also, a strong correlation was found between the number of Enterobacter, Klebsiella and Clostridium and a medium intensity correlation between the number of Staphylococcus in the faeces in patients of group ІІ. In patients of group І, a correlation was found between the number of Staphylococcus and Citrobacter. The level of zonulin (both in blood serum and faeces) directly depended on changes in body mass index in the patients we examined, namely, overweight in patients of group І and obesity of the first degree in patients of group ІІ. Conclusions. In patients with NAFLD after COVID19, changes in the quantitative and qualitative composition of the colon microflora were found in the intestinal lesions, including a decrease in the number of bifidobacteria and lactobacilli, as well as an increase in the content of Staphylococcus and Citrobacter in the faeces in patients with predominant diarrhoea and Enterobacter, Klebsiella and Clostridium in patients with predominant constipation. An increase in the level of zonulin in the blood serum and faeces in patients with NAFLD after ­COVID‑19 was detected. A more pronounced deviation from the norm was found in patients of group ІІ (with complaints of constipation). A direct correlation was established between the level of zonulin in the blood serum and faeces and changes in the quantitative and qualitative composition of the colon microflora, as well as an increase in body mass index in patients with NAFLD after ­COVID‑19.

Washing Illness Away: A Systematic Review of the Impact of Nasal Irrigation and Spray on COVID-19.

Nasal irrigation is a common treatment for sinonasal disorders; however, it is unknown if it can reduce SARS-CoV-2 nasopharyngeal viral load (NVL). This systematic review investigated the efficacy of nasal irrigation with saline, povidone iodine (PVP-I), and intranasal corticosteroids (INCS) at reducing SARS-CoV-2 NVL and transmissibility. Databases including Embase, MEDLINE, Web of Science, and ClinicalTrials.gov. A systematic review was completed with pre-defined search criteria using keywords related to nasal irrigation and COVID-19 from 1946 through January 2024. This review followed PRISMA reporting guidelines and was registered on PROSPERO. Only in-vivo studies testing nasal irrigation with either saline, PVP-I, or INCS for reducing NVL were included. Nine out of ten studies on saline-based solutions reported positive effects in reducing NVL, with benefits noted in earlier time to negative nasopharyngeal PCR and a greater decline in NVL during early study time points, compared with controls. Isotonic and hypertonic saline mediums were found to be effective with three studies demonstrating enhanced efficacy with additives. Four out of seven studies on PVP-I showed a positive effect on reducing NVL, but results were heterogenous. Four studies demonstrated reduction of transmission with saline or PVP-I. No studies were found on INCS. Saline nasal irrigation showed the best efficacy in reducing SARS-CoV-2 NVL. Additives to saline may have a clinical benefit, but further studies are needed to elucidate their isolated impacts on NVL. Data on PVP-I is inconclusive and further studies are warranted to determine the ideal concentration for irrigation. Laryngoscope, 2024.

Neonatal and short-term outcome after late vertical transmission in congenital CMV-infected fetuses following primary first-trimester maternal seroconversion

ObjectiveTo document the course of neonatal and short-term outcomes in pregnancies after first trimester CMV (cytomegalovirus) seroconversion and negative amniotic fluid (AF) CMV PCR.MethodsWe included 375 patients with a first-trimester...

Executive deficits after SARS-CoV-2 infection: A cross-sectional population study

ImportanceDespite the major implications of executive deficits in day-to-day functioning, few studies have investigated this in post-acute sequelae of SARS-CoV-2 infection using standardized measures that differentiate between aspects of executive function. ObjectiveExamine whether SARS-CoV-2 infection is associated with deficits in executive functions and if so, investigate the duration of this association. Design, Setting, and ParticipantsThe present research has a cross-sectional design and uses data from the Norwegian Covid-19 Cohort study. The current cohort (n = 8102) completed the Behavior Rating Inventory of Executive Function- Adult Version (BRIEF-A) electronically between April 2021 and September 2021. During the assessment, 4183 of the included participants had a prior positive polymerase chain reaction test (PCR) for SARS-CoV-2 and 3919 were untested or had a confirmed negative PCR test. ExposureLaboratory-confirmed SARS-CoV-2 infection. Main outcomes and measuresExecutive functions were measured using the BRIEF-A, a self-report questionnaire comprising 75 items within nine theoretically and empirically distinct clinical scales. All participants self-reported on demographical variables and comorbidity. Information on sex and age was derived from the personal identification number, and vaccination status was obtained from the Norwegian Immunization Registry (SYSVAK). ResultsParticipants with a positive SARS-CoV-2 status reported executive deficits in everyday life above the clinical threshold (T-score ≥65) more often than non-infected controls (383 vs. 225). Specifically, the SARS-CoV-2 positive status group indicated significantly more deficits related to metacognition, with the greatest difference demonstrated for working memory. This difference remained when adjusting for various demographic factors and comorbidities, with significantly greater odds of reporting above the clinical threshold following SARS-CoV-2 infection, as observed on the global executive composite score 6–12 months after infection (OR 1.97; 95% CI 1.51 to 2.55). ConclusionsOur study confirms more perceived executive deficits following SARS-CoV-2 infection compared to non-infected controls, with metacognitive aspects being the most affected. These findings shed light on the potential functional difficulties that individuals may encounter during the post-acute phase of SARS-CoV-2 infection and may guide further development of targeted interventions addressing metacognitive domains of executive functioning.

Results from a retrospective case finding and re-engagement exercise for people previously diagnosed with hepatitis C virus to increase uptake of directly acting antiviral treatment

BackgroundDirect acting antivirals (DAAs) for the Hepatitis C virus (HCV) have shifted the World Health Organisation global strategic focus to the elimination of HCV by 2030. In England, the UK Health Security Agency (UKHSA) led a national ‘patient re-engagement exercise’, using routine surveillance data, which was delivered through the HCV Operational Delivery Networks (ODNs) with support from National Health Service England (NHSE), to help find and support people with a positive HCV PCR test result to access treatment. We report a quantitative evaluation of outcomes of this exercise.MethodsIndividuals with a recorded positive HCV antibody or PCR result between 1996 and 2017 were identified using UKHSA’s records of HCV laboratory diagnosis. Linkage with established health-care datasets helped to enhance patient identification and minimise attempts to contact deceased or previously treated individuals. From September to November 2018 each ODN was provided with a local list of diagnosed individuals. ODNs were asked to perform further data quality checks through local systems and then write to each individual’s GP to inform them that the individual would be contacted by the ODN to offer confirmatory HCV PCR testing, assessment and treatment unless the GP advised otherwise. Outcomes of interest were receipt of treatment, a negative PCR result, and death. Data were collected in 2022.ResultsOf 176,555 individuals with a positive HCV laboratory report, 55,329 individuals were included in the exercise following linkage to healthcare datasets and data reconciliation. Participants in the study had a median age of 51 years (IQR: 43, 59), 36,779 (66.5%) were males, 47,668 (86.2%) were diagnosed before 2016 and 11,148 (20.2%) lived in London. Of the study population, 7,442 (13.4%) had evidence of treatment after the re-engagement exercise commenced, 6,435 (11.6%) were reported as PCR negative (96% had no previous treatment records), 4,195 (7.6%) had prescription data indicating treatment before the exercise commenced or were reported to have been treated previously by their ODN, and 2,990 (5.4%) had died. The status of 32,802 (59.3%) people remains unknown.ConclusionsA substantial number of those included had treatment recorded after the exercise commenced, however, many more remain unengaged. Evaluation of the exercise highlighted areas that could be streamlined to improve future exercises.

Pediatric Clinical Outcomes of Nasal Methicillin-resistant Staphylococcus aureus Polymerase Chain Reaction Utilization.

Methicillin-resistant Staphylococcus aureus (MRSA) is a clinical challenge in selecting empiric antimicrobials for pediatric infections. We implemented nasal MRSA polymerase chain reaction (nMRSA PCR) screening as a diagnostic tool and evaluated its impact on empiric antibiotic use and clinical outcomes. A retrospective single-center study of patients hospitalized with infections who were empirically prescribed anti-MRSA antibiotics was conducted prior to and following the initiation of nMRSA PCR screening. Electronic medical records, pharmacy data and bacterial cultures results were reviewed. Predictive values of nMRSA PCR testing were calculated and the duration of anti-MRSA empiric therapy and clinical outcomes preimplementation and postimplementation were compared. During the preimplementation period, there were 382 distinct episodes (294 unique patients) that met the inclusion criteria and during post-nMRSA PCR implementation, 394 episodes (360 unique patients) were identified. The median time to discontinuation of anti-MRSA antibiotics and proportion of patients prescribed anti-MRSA antibiotics at discharge were significantly lower in postimplementation compared with preimplementation period; 48 versus 56 hours, P < 0.001 and 20.1% versus 40.3%, P < 0.001, respectively. The negative and positive predictive values of nMRSA PCR compared to clinical culture results were 95.6% and 51.2%, respectively. Predefined adverse outcomes were documented in 11 patients who had early anti-MRSA discontinuation with negative nMRSA PCR results but only 3 were restarted on anti-MRSA treatment and none grew MRSA in clinical cultures. Shortened anti-MRSA antibiotic duration, high negative predictive value and low adverse events provide promising evidence that nMRSA PCR is an effective, rapid antimicrobial stewardship tool for hospitalized children.

Randomized trial of influence of vitamin D on the prevention and improvement of symptomatic COVID-19

We aimed to investigate the preventive effect of vitamin D2 on COVID-19 and the improvement of symptoms after COVID-19 infection. The study recruited 228 health care workers who tested negative PCR or antigen for COVID-19. Subjects were randomly allocated to vitamin D2 or non-intervention at a ratio 1:1. Subjects recorded PCR or antigen tests and the symptoms of COVID-19 twice a week during the follow-up visit. The concentration of serum 25-hydroxyvitamin D (25(OH)D), C-reaction protein (CRP), complement component C1q and inflammatory cytokines were measured. The rates of COVID-19 infection were 50.5% in the vitamin D2 group and 52.4% in the non-intervention group (P = 0.785). There was no difference in the COVID-19 symptoms between the two groups. The mean 25(OH)D level significantly increased from 14.1 to 31.1 ng/mL after administration (P < 0.001). The difference between the two groups was not significant for the concentrations of CRP, C1q and inflammatory cytokines on the thirtieth day of the trial. According to the second level of vitamin D, there was a 14.3% difference in positive infection rates between the vitamin D adequate (> 30 ng/mL) and deficient groups (< 20 ng/mL). Adequate vitamin D had a tendency to prevent COVID-19.Trial registration: ClinicalTrials.gov NCT05673980, dated: 12/2022.

Intermittent High-Degree AV Block, Rash, and Facial Droop with Negative Lyme PCR

Intermittent High-Degree AV Block, Rash, and Facial Droop with Negative Lyme PCR

Screening for BK Virus Infection in Kidney Transplant Recipients at Mohamed V Military Teaching Hospital

After kidney transplantation, BK polyomavirus reactivation can manifest as nephropathy in 1% to 10% of patients. PCR testing of urine and blood is commonly used to screen for BK polyomavirus nephropathy. The study aims to detect BK virus infection in kidney transplant patients to prevent tubulointerstitial nephropathy and graft loss. This retrospective study includes 26 patients who underwent kidney transplants between January 2019 and December 2023. We diagnosed BK virus infection by performing real-time PCR on blood and urine samples. BKV DNA was detected in 3 patients. Reducing immunosuppressive therapy led to negative PCR results and favorable clinical and biological outcomes in these 3 patients.