Reverse Transcriptase-polymerase Chain Reaction Test Research Articles

Diagnostic accuracy of rapid antigen tests for detection of Delta and Omicron variants of severe acute respiratory syndrome coronavirus 2: Direct evidence from prospective clinical settings.

Despite widespread application during the coronavirus disease-19 pandemic, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection using patient-performed rapid antigen tests (RATs) is limited, especially regarding the Delta and Omicron variants. Therefore, in this study, we evaluated the performance of RATs in identifying Delta and Omicron infections in self-test settings. In this multicenter clinical performance study conducted in Korea between November 2021 and February 2022, we included participants without prior diagnostic device experience. Using 2 RAT types, we compared the results with real-time reverse transcriptase-polymerase chain reaction testing, focusing on clinical sensitivity and specificity. Reverse transcriptase-polymerase chain reaction helped confirm 77 SARS-CoV-2 infections among 280 participants. RATs exhibited high positive agreement for Omicron detection but lower rates for Delta, especially among partially vaccinated individuals. This study provides direct evidence that RATs, originally developed for ancestral strains of SARS-CoV-2, effectively detect major variants such as Delta and Omicron in real patient/clinical settings. By confirming variant presence through sequencing, our research offers significant and novel insights into the performance of RATs, particularly in the context of breakthrough infections postvaccination, with precise data on vaccination status and timing obtained from government records.

Acceptance of SARS-CoV-2 Surveillance Testing Among Patients Receiving Dialysis

Integrating routine SARS-CoV-2 testing in dialysis facilities may benefit patients receiving dialysis by mitigating risks of serious illness and reducing transmission. Patient acceptance of nonmandatory testing is unknown. To evaluate the acceptance of 2 SARS-CoV-2 testing strategies among patients in hemodialysis facilities nationwide. This nationwide cluster (dialysis facility-level) randomized trial investigated the acceptance of SARS-CoV-2 testing among patients receiving maintenance hemodialysis at facilities located in 22 states. Anterior nares real-time reverse transcriptase-polymerase chain reaction tests offered once every 2 weeks (static testing facilities) vs offered once a week, once every 2 weeks, or once a month depending on county COVID-19 infection prevalence (dynamic testing facilities). Facilities were randomized by county, and tests were offered for 3 months between February 4 and July 24, 2023. The primary outcome was test acceptance. Secondary outcomes included the proportion of patients who accepted at least 1 test. In total, 62 hemodialysis facilities were randomized and 57 participated. Among 2389 participating patients, the median age was 64 (IQR, 54-74) years, 1341 (56%) were male, 138 (6%) were categorized as American Indian, 60 (3%) Asian, 885 (37%) Black, 75 (3%) Native Hawaiian or Pacific Islander, 338 (14%) Hispanic, and 876 (37%) White; and 1603 (67%) had diabetes. A median of 6 (IQR, 6-6) tests were offered per patient in the static arm and 4 (3-6) tests in the dynamic arm. Test acceptance was low: 8% of offered tests were accepted in each of the test arms. Among 503 patients who accepted at least 1 test, the median percentage of offered tests that were accepted was 16% (IQR, 17%-42%) using the static testing strategy and 50% (IQR, 33%-75%) using the dynamic testing strategy (P < .001). Older patients (odds ratio [OR], 1.08 [95% CI, 1.01-1.16] per 5-year age increment), patients with (vs without) diabetes (OR, 1.59 [95% CI, 1.18-2.16]), and women compared with men (OR, 1.30 [95% CI, 0.98-1.73]) were more likely to accept multiple tests. Patients designated in the electronic health record as Hispanic were more likely than patients designated as White (OR, 1.78 [95% CI, 1.15-2.76]) to accept at least 1 test, whereas patients living in zip codes electing Republican representatives to Congress were less likely than patients living in zip codes electing Democratic representatives (OR, 0.34 [95% CI, 0.17-0.69]) to accept multiple tests. In this cluster randomized trial evaluating 2 SARS-CoV-2 testing strategies in dialysis facilities, test acceptance was low, and a dynamic testing strategy anchored to COVID-19 infection prevalence did not outperform a static testing strategy of every 2 weeks. ClinicalTrials.gov Identifier: NCT05225298.

COVID-19 infection and 2-year mortality in nursing home residents who survived the first wave of the pandemic

BackgroundDuring the first COVID-19 pandemic wave (1st CoPW), nursing homes (NHs) experienced a high rate of COVID-19 infection and death. Residents who survived the COVID-19 infection may have become frailer. This study aimed to determine the predictive value of having a COVID-19 infection during the 1st CoPW for 2-year mortality in NH residents.MethodsThis was a retrospective study conducted in three NHs. Residents who had survived the 1st CoPW (March to May 2020) were included. The diagnosis of COVID-19 was based on the results of a positive reverse transcriptase-polymerase chain reaction test. The collected data also included age, sex, length of residence in the NH, disability status, legal guardianship status, nutritional status, need for texture-modified food, hospitalization or Emergency Department visits during lockdown and SARS-COV2 vaccination status during the follow-up. Non-adjusted and adjusted Cox models were used to analyse factors associated with 2-year post-1st CoPW mortality.ResultsAmong the 315 CoPW1 survivors (72% female, mean age 88 years, 48% with severe disability), 35% presented with COVID-19. Having a history of COVID-19 was not associated with 2-year mortality: hazard ratio (HR) [95% confidence interval] = 0.96 [0.81–1.13], p = 0.62. The factors independently associated with 2-year mortality were older age (for each additional year, HR = 1.05 [1.03–1.08], p < 0.01), severe disability vs. moderate or no disability (HR = 1.35 [1.12–1.63], p < 0.01) and severe malnutrition vs. no malnutrition (HR = 1.29 [1.04–1.60], p = 0.02). Considering that vaccination campaign started during the follow-up, mortality was associated with severe malnutrition before and severe disability after the start of the campaign. Vaccination was independently associated with better survival (HR 0.71 [0.55–0.93], p = 0.02).ConclusionsHaving survived a COVID-19 infection during the 1st CoPW did not affect subsequent 2-year survival in older adults living in NHs. Severe malnutrition and disability remained strong predictor of mortality in this population, whereas vaccination was associated to better survival.

Oral Nirmatrelvir–Ritonavir as Postexposure Prophylaxis for Covid-19

BackgroundClinical trials of treatments for coronavirus disease 2019 (Covid-19) have not shown a significant benefit of postexposure prophylaxis.MethodsWe conducted a phase 2–3 double-blind trial to assess the efficacy and safety of nirmatrelvir–ritonavir in asymptomatic, rapid antigen test–negative adults who had been exposed to a household contact with Covid-19 within 96 hours before randomization. The participants were randomly assigned in a 1:1:1 ratio to receive nirmatrelvir–ritonavir (300 mg of nirmatrelvir and 100 mg of ritonavir) every 12 hours for 5 days or for 10 days or matching placebo for 5 or 10 days. The primary end point was the development of symptomatic SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection, confirmed on reverse-transcriptase–polymerase-chain-reaction (RT-PCR) or rapid antigen testing, through 14 days in participants who had a negative RT-PCR test at baseline.ResultsA total of 2736 participants were randomly assigned to a trial group — 921 to the 5-day nirmatrelvir–ritonavir group, 917 to the 10-day nirmatrelvir–ritonavir group, and 898 to the placebo group. Symptomatic, confirmed SARS-CoV-2 infection developed by day 14 in 2.6% of the participants in the 5-day nirmatrelvir–ritonavir group, 2.4% of those in the 10-day nirmatrelvir–ritonavir group, and 3.9% of those in the placebo group. In each nirmatrelvir–ritonavir group, the percentage of participants in whom symptomatic, confirmed SARS-CoV-2 infection developed did not differ significantly from that in the placebo group, with risk reductions relative to placebo of 29.8% (95% confidence interval [CI], –16.7 to 57.8; P=0.17) in the 5-day nirmatrelvir–ritonavir group and 35.5% (95% CI, –11.5 to 62.7; P=0.12) in the 10-day nirmatrelvir–ritonavir group. The incidence of adverse events was similar across the trial groups, with dysgeusia being the most frequently reported adverse event (in 5.9% and 6.8% of the participants in the 5-day and 10-day nirmatrelvir–ritonavir groups, respectively, and in 0.7% of those in the placebo group).ConclusionsIn this placebo-controlled trial, postexposure prophylaxis with nirmatrelvir–ritonavir for 5 or 10 days did not significantly reduce the risk of symptomatic SARS-CoV-2 infection. (Funded by Pfizer; ClinicalTrials.gov number, NCT05047601.)

The 90-Day Risk of Hospitalization in Heart Transplant Recipients After COVID-19 Infection

BackgroundHeart transplant recipients are at a high-risk of complications from the coronavirus-2019 (COVID-19) infection. Heart transplant recipients are a special group of persistently immunosuppressed people, and COVID-19 may cause them to experience an unpredictable course of infection, with a risk of hospitalization occurring well beyond their initial infection period. The seriousness of COVID-19 disease in heart transplant recipients emphasizes how vital it is to refer patients promptly and early to specialized heart transplant centers. MethodsWe retrospectively reviewed all heart transplant recipients at a single center between March 2019 and October 2021. All recipients with positive nasopharyngeal reverse transcriptase-polymerase chain reaction tests for COVID-19 were included in this study. After IRB approval, we obtained medical records and patient data from electronic medical records. ResultsThis study followed 126 heart transplant patients from March 2019 to October 2021 of which only 49 had COVID-19 infections. The median age at infection was 58 years (49-65), with 41% female. Race distribution was as follows: 59% Caucasian and 39% African American. The median time from transplant to infection was 384 days (237-677). All infected patients had a 50% dose reduction in mycophenolate mofetil per institutional protocol. The majority of symptoms were cough, fatigue, shortness of breath, and fever. Among all patients with COVID-19, 45 (92%) were vaccinated. Of those vaccinated, 27 (60%) patients received Pfizer initial and booster doses, whereas 18 (40%) received Moderna initial and booster doses. Twelve patients (24%) were hospitalized within 90 days of infection, with only two requiring ICU level of care. The median duration of hospitalization was 5 days (4-9). Of the hospitalized patients, 11 (92%) were discharged, and 1 (8%) died in the hospital. Three of the four unvaccinated patients were hospitalized, and one died while hospitalized. The remaining 37 patients were managed as outpatients. ConclusionHeart transplant recipients have an increased risk of contracting COVID-19 and developing severe symptoms due to multiple healthcare contacts, preexisting health conditions, and weakened immune systems. Our data highlight that most vaccinated patients do not require hospitalization within 90 days of infection, and those hospitalized have a high likelihood of survival without needing ICU care.

Analysis of clinical management and radiological affection of coronavirus disease 2019 patients under isolation: an experience from a University Hospital

Background During the coronavirus disease 2019 (COVID-19) pandemic, Egypt was among the minor epidemic areas. COVID-19 has wide variations in the clinical presentation manifesting as a heterogeneous disease severity varying from mild, moderate, and severe to critical illness. Objective This study aimed to identify the potential clinical, radiological, and laboratory characteristics and prognosis of the COVID-19 patients obtained during the first peak of this pandemic at a University Hospital in Egypt, and to provide a reference for the pandemic management in the subsequent peaks. Patients and methods A single-center prospective study was done on patients with COVID-19 admitted to Fayoum University Hospital during the period from May to July 2020. All patients had full medical history taking, clinical examination, laboratory assessment, oxygen-saturation monitoring, chest computed tomography (CT), and reverse transcriptase-PCR testing. All the patients were treated with the treatment protocol accredited by the Egyptian Ministry of Health and accordingly disease outcome was determined. Results The study included 162 COVID-19 patients, 80 (49.4%) had mild cases, 40 (24.7%) had moderate cases, and 26 (16.0%) and 16 (9.9%) had severe and critical cases, respectively. The median CT-severity score was 10 (3.75–11.25). Significantly high serum levels of C-reactive protein, D-dimer, lactate dehydrogenase, and ferritin levels were observed in severe cases (P&lt;0.01 for all) in comparison with mild/moderate cases. By comparing died cases with other severe cases, the proportion of cases with CURB 65 score (comorbidity, confusion, urea, respiratory rate, blood pressure, and 65 years of age or older score) more than or equal to 4, PaO2/FiO2 less than 300, hypoxemia less than 85%, higher levels of ferritin, D-dimer, alanine aminotransferase, aspartate aminotransferase, CT severity, and consolidation score were significantly higher in died cases than other severe cases. By regression analysis, among severe cases, predictors of death were the presence of comorbidity and increased consolidation size. Conclusion All healthcare workers should understand the presentation of the disease, workup, and supportive care experienced from the first outbreak and offer an evidence-based management for succeeding outbreaks in our community.

Pregnancy and COVID—Complications and its Challenges: A Case Series from a Tertiary Care Center in the Northeastern Part of India

The objective was to describe the course of management of all the coronavirus disease 2019 (COVID-19)-positive pregnant women, admitted to a 150-bedded tertiary care center in Guwahati, Assam, from March 01, 2021, till June 15, 2021. We collected a case series of 13 COVID-19-positive pregnant women, mostly in their second and third trimesters, admitted to our center between March 01, 2021, and June 15, 2021. All of the cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were confirmed by a positive result on real-time reverse transcriptase-polymerase chain reaction (RT-PCR) tests. We aimed to show the course of management and maternal outcomes in these cases. The Results show that among the 13 infected pregnant women, three presented with severe SARS-CoV-2 pneumonia and were treated in the intensive care unit (ICU) and the rest were treated in wards as the mild category and discharged successfully. Two among them required invasive mechanical ventilation (IMV), and one was managed on non-invasive ventilation (NIV). Of the two mechanically ventilated patients, one succumbed to the illness and the other patient was successfully weaned in 5 days and shifted out after 15 days of the ICU stay. The third patient was on NIV support for 7 days, weaned off to low-flow oxygen therapy via face mask/ nasal prongs, and shifted out after 17 days of the ICU stay. Data on pregnant women with coronavirus infection are scarce and contradictory as the effect of SARS-CoV-2 on pregnancy is not clear. It is highly important to systemically investigate the clinical characteristics and outcomes of pregnant women with COVID-19 to provide strong guidelines for prevention, treatment, and management.

Analysis of real-time RT-PCR and rapid antigen test and its correlation with clinical characteristics, investigation profile, and imaging of SARI-suspected COVID-19 infections

Abstract Background: Coronavirus disease 2019 (COVID-19) continues to be a significant global public health issue. Aims and Objectives: This study aims to describe the demographic characteristics, comorbidities, clinical presentations, inflammatory biomarkers, and chest computed tomography (CT) findings of patients with severe acute respiratory infection (SARI) at a tertiary care hospital in Odisha, India. Additionally, the study aims to evaluate different COVID-19 diagnostic methods. Materials and Methods: A prospective observational study was conducted at a tertiary care hospital in Odisha, India. All admitted SARI patients underwent COVID-19 testing. Data on demographics, clinical presentations, laboratory investigations, and outcomes at 72 h were collected. COVID-19 diagnostic methods were also analyzed. Statistical Analysis: The statistical analysis was performed using GraphPad Prism 9.5. Results: Among the 830 patients studied, 305 tested positive for COVID-19. The rapid antigen test (RAT) demonstrated a sensitivity of 93.85% and a specificity of 97.43% compared to the real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test. Discrepancies with RAT results were noted in cases with higher cycle threshold (Ct) values (&gt;25). A male predominance was observed, with a mean age of 43.30 ± 15.19 years in the COVID-19-positive group and 40.95 ± 17.15 years in the COVID-19-negative group. Patients with multiple comorbidities (15.68%) had a higher susceptibility to COVID-19 infection. The COVID-19-positive group showed a significantly elevated neutrophil-to-lymphocyte ratio (NLR) (P = 0.0001) and thrombocytopenia (P = 0.001). Inflammatory biomarkers, including CRP, LDH, ferritin, D-dimer, and IL-6, were markedly elevated in swab-positive cases. Bilateral chest involvement and ground glass opacities were common radiological findings in both groups. Conclusion: In resource-limited settings, the RAT is considered an alternative screening tool for COVID-19. Initial laboratory and radiological investigations may aid clinicians in effective management of such patients.

Performance of and Severe Acute Respiratory Syndrome Coronavirus 2 Diagnostics Based on Symptom Onset and Close Contact Exposure: An Analysis From the Test Us at Home Prospective Cohort Study.

Understanding changes in diagnostic performance after symptom onset and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposure within different populations is crucial to guide the use of diagnostics for SARS-CoV-2. The Test Us at Home study was a longitudinal cohort study that enrolled individuals across the United States between October 2021 and February 2022. Participants performed paired antigen-detection rapid diagnostic tests (Ag-RDTs) and reverse-transcriptase polymerase chain reaction (RT-PCR) tests at home every 48 hours for 15 days and self-reported symptoms and known coronavirus disease 2019 exposures immediately before testing. The percent positivity for Ag-RDTs and RT-PCR tests was calculated each day after symptom onset and exposure and stratified by vaccination status, variant, age category, and sex. The highest percent positivity occurred 2 days after symptom onset (RT-PCR, 91.2%; Ag-RDT, 71.1%) and 6 days after exposure (RT-PCR, 91.8%; Ag-RDT, 86.2%). RT-PCR and Ag-RDT performance did not differ by vaccination status, variant, age category, or sex. The percent positivity for Ag-RDTs was lower among exposed, asymptomatic than among symptomatic individuals (37.5% (95% confidence interval [CI], 13.7%-69.4%) vs 90.3% (75.1%-96.7%). Cumulatively, Ag-RDTs detected 84.9% (95% CI, 78.2%-89.8%) of infections within 4 days of symptom onset. For exposed participants, Ag-RDTs detected 94.0% (95% CI, 86.7%-97.4%) of RT-PCR-confirmed infections within 6 days of exposure. The percent positivity for Ag-RDTs and RT-PCR tests was highest 2 days after symptom onset and 6 days after exposure, and performance increased with serial testing. The percent positivity of Ag-RDTs was lowest among asymptomatic individuals but did not differ by sex, variant, vaccination status, or age category.

Clinical and epidemiological risk factors associated with hospitalization and mortality rate of COVID-19 patients in Banja Luka County: A retrospective observational cohort study on 40,000 patients.

Since beginning of the coronavirus disease (COVID-19) it became clear that severe forms of this infection have primarily affected patients with chronic conditions. The aim of the study was to explore clinical and epidemiological characteristics associated with COVID 19 outcomes. The retrospective observational study included 40,692 citizens of Banja Luka County, Bosnia and Herzegovina, who were confirmed as reverse transcriptase polymerase chain reaction (RT-PCR) positive on COVID-19 at a primary healthcare centre from March 2020 to September 2022. Epidemiological data were obtained from Web-Medic medical records of patients. The COVID-19 data were obtained from COVID-19 data sheets comprised of patients' RT-PCR testing forms, surveillance forms for severe acute respiratory syndrome coronavirus-2 status, and a map of their positive and isolated contacts. Differences regarding the distributions of patients between groups were analysed using the Pearson chi-square test and Mantel-Haenszel chi-square test for trends, while differences in mean values were compared using an independent sample t-test. The average age of hospitalised patients was significantly higher compared to the age of non-hospitalised patients (P < 0.001). The average age of patients with lethal outcomes was nearly twice as high in comparison to patients with non-lethal outcomes (P < 0.001). Male patients had a higher hospitalization and mortality rate (P < 0.001). The highest hospitalization rate was in patients with chronic renal failure (CRF), diabetes and cardiovascular diseases (CVDs), while the death rate was the highest among patients with CRF and hearth comorbidities. Patients with fatigue and appetite loss had a higher percentage of lethal outcomes. Vaccinated patients had a significantly lower rate of lethal outcome. Clinical symptoms, signs and outcomes, are posing as predictive parameters for further management of COVID-19. Vaccination has an important role in the clinical outcomes of COVID-19.

Association between SARS-CoV-2 Infection and Adverse Perinatal Outcomes by Race/Ethnicity in a Large Integrated Health Care System.

Recent studies have reported associations between severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during pregnancy and adverse perinatal outcomes but the extent to which these associations vary by race/ethnicity remains uncertain. Therefore, we examined how the association between prenatal SARS-CoV-2 infection and adverse perinatal outcomes may be modified by race/ethnicity. A retrospective cohort study was performed using data on 67,986 pregnant women extracted from the Kaiser Permanente Southern California electronic health records between April 6, 2020, and December 31, 2021. Upon admission to labor and delivery, all women were routinely tested for coronavirus disease 2019 (COVID-19) using real-time reverse-transcriptase polymerase chain reaction test. Adjusted odds ratios (aORs) were used to estimate associations. During the study period, COVID-19 was diagnosed in 4,960 (7%) of singleton pregnancies, with the highest rates observed among Hispanics (9.4%) and non-Hispanic Blacks (6.2%). Compared with non-Hispanic Whites, Hispanics (aOR: 1.12, 95% CI: 1.03, 1.21) with SARS-CoV-2 infection had the highest odds of a pregnancy associated with nonreassuring fetal heart rate tracing. Neonates of all races/ethnicities, except for non-Hispanic Blacks, showed significantly increased odds of SARS-CoV-2 infection, with the highest risk observed among Asians/Pacific Islanders (aOR: 10.88, 95% CI: 1.33, 89.04). Non-Hispanic White mothers who tested positive were admitted to intensive care unit (ICU) at a higher rate at delivery and within 7 days of delivery (aOR: 34.77, 95% CI: 11.3, 107.04; aOR: 26.48, 95% CI: 9.55, 73.46, respectively). Hispanics were also at a significantly higher odds of admission to ICU (aOR: 4.62, 95% CI: 2.69, 7.94; aOR: 4.42, 95% CI: 2.58, 7.56, respectively). Non-Hispanic Black, Hispanic, and Asian/Pacific Islander mothers who tested positive for SARS-CoV-2 prenatally, were at increased risk for preeclampsia/eclampsia, and preterm birth as compared to non-Hispanic White mothers. The findings highlight racial/ethnic disparities in the association between SARS-CoV-2 infection and adverse perinatal outcomes. The risk of neonatal SARS-CoV-2 infection was highest for Asian/Pacific Islanders. We also observed a remarkably high risk of ICU admission for non-Hispanic White mothers infected with SARS-CoV-2. · Race/ethnicity influences perinatal outcomes in pregnancies impacted by SARS-CoV-2.. · The risk of neonatal SARS-CoV-2 infection was highest for Asian/Pacific Islanders.. · White mothers had a notably high risk of ICU admission at delivery following SARS-CoV-2 infection..

The Relation of Polymerase Chain Reaction and Computed Tomography Infiltrations of Suspected Covid-19 Patients in Emergency Department

Aims: In the context of the persistent global challenge posed by COVID-19, effective diagnostic methods are crucial. Considering the limitations of Polymerase Chain Reaction (PCR) in the Emergency Department (ED), alternative confirmation methods for assessing Covid-19 are needed. This study aimed to evaluate the performance of Thorax-Computed Tomography (T-CT), following Radiological Society of North America (RSNA) recommendations, for suspected Covid-19 patients with pulmonary infiltrations. Materials and Methods: From March to August 2020, 324 ED patients with suspected Covid-19 underwent T-CT scans. Blinded radiologists independently assessed T-CT scans based on RSNA guidelines. Reverse-transcriptase polymerase chain reaction (RT-PCR) served as the reference test. Results: Of 324 patients, 35% tested positive via RT-PCR. T-CT categories were typical (35.2%), indeterminate (47.5%), and atypical (11.1%). Using a typical T-CT category threshold resulted in 66% sensitivity, 81% specificity, 65% positive predictive value (PPV), 82% negative predictive value (NPV), and 76% accuracy. Subgroup analysis of repeat RT-PCR tests improved performance: 80% sensitivity, 79% specificity, 76% PPV, 83% NPV, and 79% accuracy. Combining RT-PCR and T-CT in the ED achieved 95.5% sensitivity, 79% PPV, and 86.4% accuracy. Conclusion: Following RSNA guidelines, T-CT exhibits moderate sensitivity and high specificity for detecting Covid-19. In ED settings with suspected cases, T-CT aids in recommending retesting after an initial negative RT-PCR result, facilitating early management and enabling timely isolation measures. The combined use of RT-PCR and T-CT enhances diagnostic performance, emphasizing the potential benefits of integrating these methods.

Dual testing for SARS Covid-19 in asymptomatic medico-legal cases: Experience and suggestions

ABSTRACT Context: A person caught by police known as a Medical Legal Case (MLC) should be negative for Covid-19 before they are presented in court. Police officers always insist on collecting a sample from MLC patients for both the rapid antigen test (RAT) and reverse transcriptase polymerase chain reaction (RTPCR). Using both tests for the same patient at the same time is a waste of resources. The aim of the study is to analyze and compare Covid-19 RAT and RTPCR testing results in MLC cases and to find out the need to prevent resource wasting due to dual tests. Methods: The study was conducted for 6 months on all the MLC patients who were brought by the police officer for Covid-19 testing at the center. Oropharyngeal or nasopharyngeal swabs were collected in viral transport media for Covid-19 RTPCR and RAT test. RAT is performed at the collection center, while viral transport media is transported to an authorized testing center for RTPCR. Result: All 156 patients’ RAT and RTPCR tests were performed as per requirements and rules. Only two specimens (1.28%) reported positive for Covid-19 in RTPCR and other samples (98.71%) reported negative for Covid-19 in RTPCR, while all 156 samples (100%) were reported negative for Covid-19 by RAT test. Conclusion: As per the current study, we can consider the RAT results for presenting the criminal person to court, but for sending them to prison, RTPCR is recommended to prevent the spread of disease.

Effect of Andrographis paniculata Herbal Extract on Cytotoxicity, Proliferation and Osteogenic/Odontogenic Differentiation of Human Dental Pulp Stem Cells: An In Vitro Study.

Research has been conducted to assess the regenerative potential of dental pulp stem cells (DPSCs) following pretreatment of stem cells with certain molecules, bioactive compounds, plant extract and physical stimulation. Andrographis paniculata (AP) herbal extract with important medicinal properties is proven to have a preosteogenic effect on osteoblasts. This study aimed to determine the effect of various concentrations of AP extract on the cytotoxicity and osteogenic and odontogenic potential of DPSCs. Dental pulp stem cells were subjected to treatment with various concentrations of AP herbal extract (7 ug/ml, 5.2 ug/ml, 3.5 ug/ml, 1.7 ug/ml and 0.8 ug/ml), following which the cells were subjected to tests-3-[4,5-dimethylthiazol-2-yl]-2,5 diphenyl tetrazolium bromide (MTT) analysis for cytotoxicity and real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test for expression of genes (bone morphogenetic protein (BMP), osteocalcin (OCN), dentin sialophosphoprotein (DSPP) and alkaline phosphatase (ALP)). AP extract at concentration of 0.8 ug/ml-5.2 ug/ml had no cytotoxicity supporting cell growth. 3.5 ug/ml showed significant upregulation of genes on the third day. AP, a commonly occurring medicinal plant through its effect on DPSCs, could serve as an effective pretreatment modality for cell-based regenerative therapy and vital pulp therapy.

Diagnostic Precision of Molecular Testing for Severe Acute Respiratory Syndrome Coronavirus 2 versus Chest Computer Tomography

Abstract Background: Molecular detection is considered benchmark criteria for SARS-CoV-2 diagnosis. Both computer tomography (CT) chest imaging and reverse transcriptase polymerase chain reaction (RTPCR) can give false-negative test results in the initial state of coronavirus infection. This study aimed to assess the precision of computer tomography (CT) chest imaging and RTPCR assay and to compare the role of CT chest imaging and molecular testing (RTPCR) in the early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods: Retrospective analysis of 588 clinically suspected coronavirus disease cases was performed over from April 2021 to June 2021. RTPCR test result was compared with chest computer tomography and diagnostic precision of computer tomography (CT) scan was determined using RTPCR as reference standard. Categorical variables were statistically analyzed as frequencies and percentages. Results: Out of 465 patients who tested positive by chest computer tomography (CT) scan findings, 132 (28.39%) tested RTPCR positive and 333 (71.61%) tested RTPCR negative. 306/465 (65.81%) cases showed moderate-to-severe infection and 159/465 (34.19%) had mild infection. Diagnostic precision of imaging chest computer tomography (CT) scan was observed to be 38.44%. Low sensitivity of RTPCR detection method in the early identification of coronavirus disease was observed. Conclusion: The use of computer tomography (CT) scan in the early detection of coronavirus disease is supplemental to RTPCR assay and is limited to the detection of laboratory-confirmed coronavirus disease cases as imaging characteristics of SARS-CoV-2 pneumonia superimposed with other types of pneumonia.

Contact patterns between index patients and their close contacts and assessing risk for COVID-19 transmission during different exposure time windows: a large retrospective observational study of 450 770 close contacts in Shanghai

IntroductionTo characterise age-mixing patterns among index cases and contacts of COVID-19, and explore when patients are most infectious during the disease process.MethodsThis study examined all initial 90 885 confirmed index...

Association between pancreatic lipase levels and coronavirus disease 2019

Aims: Elevated pancreatic enzyme can be observed in the course of coronavirus disease-2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Here, we aimed to determine the frequency of lipase elevation in the course of COVID-19 and examine its effect on disease outcomes. &#x0D; Methods: Of 42742 patients with the positivity of SARS-CoV-2 reverse transcriptase-polymerase chain reaction test (RT-PCR), 3167 undergoing lipase tests were included. The relationship between patients’ clinical features, development of acute pancreatitis (AP), and mortality rates was investigated. &#x0D; Results: Higher lipase levels than normal limits were found in 399 (12.6%) patients. Lipase levels were three times higher than the normal limit in 119 (3.8%) patients; compared to the rest of the patients, patients’ age (62.8±17.9 vs 52.1±17.9 years, p

Impact of COVID-19 vaccination on clinical outcomes in kidney transplant patients

IntroductionThe global health crisis caused by the COVID-19 pandemic has resulted in severe mortality and morbidity. Immunosuppressed patients, such as kidney transplant recipients, are particularly susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. ObjectiveThe aim of this cohort study was to evaluate the impact of COVID-19 vaccination on clinical outcomes in patients with kidney transplants. Materials and methodsIn this retrospective study, 254 patients with kidney transplants were vaccinated against SARS-CoV-2 and a fraction of these contracted COVID-19. The diagnosis of COVID-19 was carried out by reverse transcriptase-polymerase chain reaction testing, and the patients received treatment involving immunosuppressive and COVID-19-specific protocols. ResultsSARS-CoV-2 infection was diagnosed in 38 (14.96%) patients before the COVID-19 vaccine was administered. After vaccination, an additional 29 (11.42%) patients were diagnosed with COVID-19. Risk factors for hospitalization included age, body mass index (BMI), comorbidities, and time elapsed since renal transplantation (p = 0.025, 0.038, 0.012, and 0.046, respectively). COVID-19 vaccination resulted in a significant decrease in the rate of hospital-acquired SARS-CoV-2 infection from 63.16% to 34.48% (p = 0.020). The proportion of patients from this cohort placed in intensive care units decreased from 23.68% to zero. Allograft rejections exhibited a decreasing trend from 13.16% to 6.90% (p = 0.690). This patient cohort displayed 15.79% mortality prior to COVID-19 vaccination that was reduced to nil after immunization. ConclusionCOVID-19 vaccination significantly reduced COVID-19 severity and mortality in this cohort of patients with kidney transplants. The risk factors for hospitalization were determined to be age, BMI, comorbidities, and time since renal transplantation. COVID-19 vaccination resulted in a clinical outcome of reduced hospitalization and a decrease in clinical complications. The COVID-19 vaccination-derived adverse effects in this cohort were found to be comparable to those in the immunocompetent population.

Prognostic Factors for Mortality in Adults Hospitalized With COVID-19 Infection in the Americas.

Many reports on COVID-19have highlighted an association between patient characteristics upon admission for COVID-19 and how they affect variable progressions of the disease severity and, ultimately mortality. In this cohort, we analyzed data from patients in the Americas who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19, and were hospitalized. We retrieved data from identified studies selected from full-text screening to identify relevant patient demographics: age, gender, race, duration of hospital stay, and comorbidities. Data were assessed for consistency, missing values, presence of outliers, and implausible values were documented. Our analysis was performed by calculating the case fatality rates for data reported by the original authors within the studies. The primary outcome was mortality. Participants in the review were COVID-19 inpatients diagnosed through reverse-transcriptase polymerase chain reaction tests (RT-PCR) and above the age of 45 years in the North and South American continents. The study included 12,895 patients who were hospitalized with the COVID-19 infection, and an overall 14.4% in-hospital case-fatality rate was demonstrated. The prognostic factor with the most significant association for increased risk of in-hospital mortality in the elderly was having a high viral load of the COVID-19 virus with a case-fatality rate of 41.4%. In addition, being of Caucasian ethnicity and having the comorbidity of chronic obstructive pulmonary disease (COPD) were also associated with higher rates of mortality among elderly hospitalized patients with case-fatality rates of 40.8% and 35.7% respectively. Prognostic factors for COVID-19 mortality were determined by having a high viral load of the infection, being of Caucasian ethnicity, and having underlying pulmonary comorbidities such as COPD. In the future research should be undertaken to determine the underlying mechanisms behind these effects.

Diagnostic performance of the WHO definition of probable dengue within the first 5 days of symptoms on Reunion Island.

The relevance of the World Health Organization (WHO) criteria for defining probable dengue had not yet been evaluated in the context of dengue endemicity on Reunion Island. The objective of this retrospective diagnostic study was to evaluate the diagnostic performance of the 2009 WHO definition of probable dengue and to propose an improvement thereof. From the medical database, we retrieved the data of subjects admitted to the emergency department of the University Hospital of Reunion Island in 2019 with suspected dengue fever (DF) within a maximum of 5 days post symptom onset, and whose diagnosis was confirmed by a Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). The intrinsic characteristics of probable dengue definitions were reported in terms of sensitivity, specificity, positive and negative likelihood ratios (LR+ and LR-), using RT-PCR as the gold standard. Of the 1,181 subjects who exhibited a positive RT-PCR, 652 (55%) were classified as probable dengue. The WHO definition of probable dengue yielded a sensitivity of 64% (95%CI 60-67%), a specificity of 57% (95%CI 52-61%), a LR+ of 1.49 (95%CI 1.33-1.67), and a LR- of 0.63 (95%CI 0.56-0.72). The sensitivity and LR- for diagnosing and ruling out probable dengue could be improved by the addition of lymphopenia on admission (74% [95%CI: 71-78%] and 0.54 [95%CI: 0.46-0.63] respectively), at the cost of slight reductions of specificity and LR+ (48% [95%CI: 44-53%] and 1.42 [95%CI: 1.29-1.57], respectively). In the absence of, or when rapid diagnostic testing is unreliable, the use of the improved 2009 WHO definition of probable dengue could facilitate the identification of subjects who require further RT-PCR testing, which should encourage the development of patient management, while also optimizing the count and quarantine of cases, and guiding disease control.