Negative Test Group Research Articles

Long-term multi-systemic complications after SARS-CoV-2 Omicron and Delta infection in children: a retrospective cohort study.

Most studies on long-term sequelae of SARS-CoV-2 infection in children were conducted pre-Omicron and pre-dated vaccination rollout. We examined long-term risk of new-incident multi-systemic sequelae following SARS-CoV-2 Delta/Omicron infection in a multi-ethnic Asian paediatric population. Retrospective cohort study of Singaporean children aged 1-17years infected during Delta/Omicron BA.1/2 transmission, and contemporaneous test-negative groups. Cox regression was utilized to estimate risks of new-incident sequelae at 31-300days post-infection. A total of 267,952 SARS-CoV-2-infected children were included, together with 273,517 test negatives. ≥95% were infected during Omicron. During Delta, 23.6% of infected cases were fully vaccinated; during Omicron, 60.4% were fully vaccinated. ≥98% had mild infection not requiring hospitalization. Overall, there was a modestly increased risk of long-term respiratory sequelae (adjusted hazard ratio [aHR]=1.09, 95% CI: 1.01-1.18) and specifically bronchitis (aHR=1.17, 95% CI: 1.06-1.29) in the SARS-CoV-2-infected group vs. test negatives. During Delta, an increased risk of endocrine conditions (e.g. diabetes) was observed (aHR=3.63, 95% CI: 1.25-10.50); whereas during Omicron, an increased risk of bronchitis (aHR=1.09, 95% CI: 1.02-1.20) was observed in COVID-19 cases vs. test negatives. Elevated risk of bronchitis was observed among unvaccinated COVID-19 cases (aHR=1.17, 95% CI: 1.06-1.29) vs. test negatives, but not in individuals who had received ≥1 vaccine dose. Risks of chronic sequelae after COVID-19 hospitalization were comparable with those after historical influenza hospitalization; albeit reduced when compared with respiratory sequelae after historical hospitalizations for respiratory syncytial virus. Evidence of chronic sequelae in organ systems other than the respiratory system was limited in a paediatric cohort predominantly infected with mild SARS-CoV-2 Omicron infection. Risks of chronic sequelae in hospitalized COVID-19 cases did not substantially differ from historical influenza hospitalizations. Elevated risk of bronchitis was observed after SARS-CoV-2 infection in children vs. test negatives; an increased risk of respiratory sequelae was documented post respiratory syncytial virus hospitalization versus COVID-19, including children aged under 5 years.

Clinical and metagenomic predicted antimicrobial resistance in pediatric critically ill patients with infectious diseases in a single center of Zhejiang

BackgroundAntimicrobial resistance (AMR) poses a significant threat to pediatric health; therefore, precise identification of pathogens as well as AMR is imperative. This study aimed at comprehending antibiotic resistance patterns among critically ill children with infectious diseases admitted to pediatric intensive care unit (PICU) and to clarify the impact of drug-resistant bacteria on the prognosis of children.MethodsThis study retrospectively collected clinical data, identified pathogens and AMR from 113 children’s who performed metagenomic next-generation sequencing for pathogen and antibiotic resistance genes identification, and compared the clinical characteristic difference and prognostic effects between children with and without AMR detected.ResultsBased on the presence or absence of AMR test results, the 113 patients were divided into Antimicrobial resistance test positive group (AMRT+, n = 44) and Antimicrobial resistance test negative group (AMRT-, n = 69). Immunocompromised patients (50% vs. 28.99%, P = 0.0242) and patients with underlying diseases (70.45% vs. 40.58%, P = 0.0019) were more likely to develop resistance to antibiotics. Children in the AMRT + group showed significantly increased C-reaction protein, score of pediatric sequential organ failure assessment and pediatric risk of mortality of children and longer hospital stay and ICU stay in the AMRT + group compared to the AMRT+- group (P < 0.05). Detection rate of Gram-negative bacteria was significantly higher in the AMRT + group rather than Gram-positive bacteria (n = 45 vs. 31), in contrast to the AMRT- group (n = 10 vs. 36). Cephalosporins, β-lactams/β-Lactamase inhibitors, carbapenems and sulfonamides emerged as the most common types of drug resistance in children. Resistance rates to these antibiotics exhibited considerable variation across common pathogens, including Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii.ConclusionsThe development of drug resistance in bacteria will significantly affect the prognosis of patients. The significant differences in drug resistance of common pathogenic bacteria indicate that identification of drug resistance is important for the rational use of antibiotics and patient prognosis.

Long-term cardiovascular, cerebrovascular, and thrombotic complications after SARS-CoV-2-Omicron infection: a retrospective cohort study

Evidence suggests that some COVID-19 survivors experience a wide range of post-COVID-19 sequelae; however, the majority of studies were conducted before the emergence of the milder Omicron variant. We examined the post-acute risk of new-incident cardiovascular complications after SARS-CoV-2 infection in a multi-ethnic Asian population, during Omicron predominance. This cohort study used national testing and healthcare claims databases in Singapore to build a cohort of individuals with confirmed SARS-CoV-2 infection during Omicron BA.1/2 transmission and a contemporaneous test-negative group. Participants in both groups were followed up for a median of 300days. We estimated risks of new-incident cardiovascular complications using doubly robust competing-risks survival analysis. Risks were reported using two measures: hazard ratio and excess burden. We included 375903 test-positive, infected individuals (mean age 48years) and 619379 test-negative controls (mean age 47years). The majority (97.5%, 366593/375903) of infected individuals had mild infection not requiring hospitalization. There was no overall increased risk of new-incident cardiovascular complications, (adjusted hazards ratio, aHR=1.01 [0.97-1.07]) amongst COVID-19 survivors when compared against test-negatives. A modestly increased risk and excess burden of dysrhythmias amongst COVID-19 survivors (aHR=1.09 [1.01-1.19]) was observed. Risk and burdens of new-incident cardiovascular complications predominantly accrued in hospitalized (aHR = 2.81 [2.26-3.50]) and severe COVID-19 cases (aHR = 5.52 [3.76-8.10]). No significantly increased overall risk of any cardiovascular complication was observed in the 300days following COVID-19 infection during the Omicron-dominant period when compared against test-negatives, with the exception of a small increased occurrence of dysrhythmias.

Utility of Supine Stress Test to Anticipate Spinal Anaesthesia Induced Hypotension in Patients Undergoing Elective Cesarean Section

INTRODUCTION Reduction in venous return caused by compression of the inferior vena cava by the gravid uterus, known as the supine hypotensive syndrome of pregnancy, is one of the reasons for particular susceptibility to hypotension at cesarean delivery. The hypotensive effect of spinal anaesthesia further exacerbates maternal hypotension in the supine position in term parturients. This study was conducted with the objective to evaluate the ability of supine stress test to predict spinal anaesthesia induced hypotension in patients undergoing elective cesarean section. MATERIAL AND METHODS A prospective observational study was done among 232 singleton parturients scheduled for elective cesarean delivery under spinal anaesthesia in Universal College of Medical Sciences Teaching Hospital. Patients were subjected preoperatively to supine stress test and divided into two group of 116 patients each. SBP, DBP, MAP, HR were compared between two groups. Descriptive as well as inferential statistics were used to analyze the data. RESULTS Supine stress test was positive by heart rate criteria in 50% of positive patient. The incidence of hypotension in positive test group was 73.3%, while it was 11.2% in negative test group, which was statistically significant (p&lt;0.001). CONCLUSION This study demonstrates supine stress test preferably can easily identify parturients in risk of developing hypotension during cesarean section under spinal anaesthesia.

Bacterial Leakage Evaluation Through DNA-DNA Checkerboard Hybridization Technique in Morse Taper Implant-Abutment Connections: An In Vitro Study

Purpose: The objective of this in vitro study was to evaluate the activity of local gel containing metronidazole (MN) in the leakage area, which was analyzed by the DNA-DNA checkerboard hybridization method. Materials and Methods: Thirty-six sets of Morse taper/mini-pillar implants were used in this study. These implants were equally divided into the following three groups: MN gel (test group), no MN gel (negative test group), and no gel (control). The gel was prepared with metronidazole (15%). Unstimulated saliva samples were collected, transferred to a Falcon tube, and stored at 37°C. The sets were partially immersed in microtubes containing 300 μL of saliva and were incubated at 37°C ± 1°C for 7 days. Microbial infiltration was evaluated (37 bacterial species and 5 species of Candida). The results were analyzed with Wald-Type, ANOVA, and multiple comparisons analysis between groups. Results: After comparing the quantity of microorganisms, both gel-treated groups (no MN gel and MN gel) had more significant microorganism presence than the control group (P < .001), and no significant result was found between the no MN gel and MN gel groups (P > .05). Regarding the bacteria found, the most common were Aggregatibacter actinomycetemcomitans, Prevotella melaninogenica, Bacteroides fragilis, and Candida tropicalis. Conclusion: Within the limitations of this study, it was concluded that the gel containing metronidazole used in this study was not effective in preventing the infiltration of microorganisms through the Morse taper implant-abutment interface.

The importance of mean platelet volume lymphocyte ratio and mean platelet volume platelet ratio in COVID-19 patients

Objective: The mean platelet volume lymphocyte ratio (MPVLR) and mean platelet volume platelet ratio (MPVPR) reflect inflammation more effectively and strongly than MPV, lymphocyte, platelet, and neutrophil counts separately, we aimed to evaluate the importance of MPVLR and MPVPR in COVID-19 patients. Material and Methods: Patients with COVID-19 were divided into two groups based on whether their RT-PCR test resulted in a positive or negative result. MPVLR, MPVPR, neutrophil, lymphocyte, platelet, MPV and RDW levels were compared between these two groups. In addition, the changes in MPVLR, MPVPR, neutrophil, lymphocyte, platelet, MPV, and RDW levels before and after treatment were compared in the whole patient population. Results: There were 113 patients diagnosed with COVID-19 with a positive PCR test and 79 patients with a negative PCR test. Before treatment, the MPVLR level was 7.2±0.85 in the PCR test positive group and 5.4±0.29 in the PCR test negative group (p=0.04). Post-treatment MPVLR levels were 5.7±0.4 and 4.9±0.26 in the PCR positive and negative groups, respectively (p=0.09). The MPVPR level before treatment was 0.046±0.002 in the PCR test positive group and 0.035±0.001 in the PCR test negative group (p=0.003). After treatment, the MPVPR level was 0.040±0.002 in the PCR-positive group and 0.032±0.001 in the PCR-negative group (p=0.023) Conclusion: This study is the first to demonstrate high MPVLR and MPVPR in PCR-positive COVID-19 patients. Patients with negative PCR test and high MPVLR and MPVPR should be evaluated with radiological and clinical symptoms.

P437 Diagnostic utility of serum beta D glucan test to prescribe antifungal treatment and its effect on patient's outcome: a study from a tertiary care center in Western India

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMSerum Beta D glucan has 75%-80% sensitivity and 80% specificity to make a diagnosis of invasive candidiasis.ObjectivesThis study was designed to understand real-world diagnostic utility of S. Beta D Glucan (BDG) on antifungal prescription patterns associated patient outcomes.MethodsStudy design: Retrospective cohort studyStudy Population: All consecutive patients who underwent BDG (fungitell assay) testing with conclusive (positive or negative) results in the intensive care unit (ICU) setting between January 1, 2021 to December 31, 2021 at a tertiary care center in western India.Statistical Methods: We assessed the difference in continuous variables across compared groups using the independent samples t-test and binary logistic regression for categorical variables. We summarize the summary results as odds ratio and 95% confidence intervals. All P-values are 2-sided and set at 5% for all comparisons. All data analyses were performed using IBM SPSS ver 28.ResultsA total of 4481 patients were admitted in the ICU, of which 198 patients underwent BDG testing. Of the 198, 113 tested positive and 61 negative and formed the denominator for the study. Patients with intermediate BDG [24 (12.1%)] were excluded from the analysis. The mean (SD) age for the study cohort was 57.5 (14.7) years with 30.8% female. All the patients were receiving broad-spectrum antibiotics at the time of BDG collection. A total of 24 study patients had a positive blood culture (23 bacterial isolates and 1 Candida parapsilosis). The groups, positive and negative test results for BDG, were comparable for ventilator usage (P = .737), vasopressor prescription (P = .270), history of surgery (P = .791) central line placement (P = .403), liver disease (P = .144), CKD (P = .424), COVID-19 positivity (P = .238), WBC count (P = .137), CRP (P = .769), and serum procalcitonin (P = .784). Patients with ischemic heart diseases (IHD) (P = .013) and acute kidney injury requiring hemodialysis (AKI/HD) (P = .017) were significantly higher in the test positive group. Test negative group patients received early BDG testing, mean (SD) stay of 3.33 (3.77) days as compared to 5.61 for test positive (6.59) days P = .004). More test-positive patients received antifungal therapy (P <.0001), while 20.4% didn't receive antifungals. Caspofungin (25.9%), fluconazole (18.4%), anidulafungin (7.5%), voriconazole (6.9%), and combination antifungal were used in 10.9% of study patients. Logistic regression model showed no difference in mortality between the two groups (P = .413) with higher Odds of mortality in test-positive patients (1.357, 95% CI 0.705- 2.609). Treatment with caspofungin was associated with higher Odds of mortality (3.497; 95% CI 1.324–9.239, P = .012) as compared with fluconazole. Similar trend was observed with anidulafungin (OR: 4.089 95% CI 1.052-15.888, P = .042) as compared to fluconazole. This significance remained for caspofungin [OR 3.607 (1.262 -10.311) P = .017] while anidulafungin [OR: 3.934 (0.965-16.032) P = .56] didn't show significance with the multivariate model.ConclusionProbable invasive candidiasis as diagnosed with positive BDG test doesn't increase the risk of mortality. Patients treated with fluconazole were associated with better survival as compared with caspofungin.

Application of a Head-Up Tilt Table Test in Differentiation Between Epilepsy and Syncope in Children

Background: Distinguishing between seizure and neurally mediated syncope is challenging because of similar consequences and medical history. A head-up tilt test (HUTT) is a non-invasive, simple, and easy test to distinguish between epilepsy and syncope besides detailed history taking. Objectives: This study aimed to differentiate between epileptic events and reflex syncope (any different type of syncope) using the head-upright tilt test. Methods: We studied 59 patients (37 boys and 22 girls) between 4 to 18 years old (mean age, 10.5 ± 3.7 years) with a previous diagnosis of seizure who did not respond well to treatment. All patients underwent HUTT, and the test was positive in 26 patients. There were no significant differences in sex, age, provocative factors, associated syndrome, and family history between negative and positive groups. Results: There was a history of actual syncope in 26.9% of the positive tilt test group compared to 15.15% of the negative test group. Also, there was a positive family history of syncope in the positive tilt test group. Among 26 patients with a positive tilt test, 17 were diagnosed with vasovagal syncope (VVS) vasodepressor type and 9 with mixed type. Antiepileptic drugs were tapered for patients diagnosed with VVS, and they did not show any seizures after 18 ± 6 months of follow-up. Overemphasizing positive family history and inattention to history taking are 2 crucial factors leading to the misdiagnosis of epilepsy. Conclusions: Our study showed that HUTT is a non-invasive test that can be useful, especially for early and proper diagnosis in children with refractory epilepsy.

Clinical Features and Burden of Postacute Sequelae of SARS-CoV-2 Infection in Children and Adolescents

The postacute sequelae of SARS-CoV-2 infection (PASC) has emerged as a long-term complication in adults, but current understanding of the clinical presentation of PASC in children is limited. To identify diagnosed symptoms, diagnosed health conditions, and medications associated with PASC in children. This retrospective cohort study used electronic health records from 9 US children's hospitals for individuals younger than 21 years who underwent antigen or reverse transcriptase-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 between March 1, 2020, and October 31, 2021, and had at least 1 encounter in the 3 years before testing. SARS-CoV-2 positivity by viral test (antigen or RT-PCR). Syndromic (symptoms), systemic (conditions), and medication PASC features were identified in the 28 to 179 days following the initial test date. Adjusted hazard ratios (aHRs) were obtained for 151 clinically predicted PASC features by contrasting viral test-positive groups with viral test-negative groups using proportional hazards models, adjusting for site, age, sex, testing location, race and ethnicity, and time period of cohort entrance. The incidence proportion for any syndromic, systemic, or medication PASC feature was estimated in the 2 groups to obtain a burden of PASC estimate. Among 659 286 children in the study sample, 348 091 (52.8%) were male, and the mean (SD) age was 8.1 (5.7) years. A total of 59 893 (9.1%) tested positive by viral test for SARS-CoV-2, and 599 393 (90.9%) tested negative. Most were tested in outpatient testing facility settings (322 813 [50.3%]) or office settings (162 138 [24.6%]). The most common syndromic, systemic, and medication features were loss of taste or smell (aHR, 1.96; 95% CI, 1.16-3.32), myocarditis (aHR, 3.10; 95% CI, 1.94-4.96), and cough and cold preparations (aHR, 1.52; 95% CI, 1.18-1.96), respectively. The incidence of at least 1 systemic, syndromic, or medication feature of PASC was 41.9% (95% CI, 41.4-42.4) among viral test-positive children vs 38.2% (95% CI, 38.1-38.4) among viral test-negative children, with an incidence proportion difference of 3.7% (95% CI, 3.2-4.2). A higher strength of association for PASC was identified in those cared for in the intensive care unit during the acute illness phase, children younger than 5 years, and individuals with complex chronic conditions. In this large-scale, exploratory study, the burden of pediatric PASC that presented to health systems was low. Myocarditis was the most commonly diagnosed PASC-associated condition. Acute illness severity, young age, and comorbid complex chronic disease increased the risk of PASC.

Evaluation of methacholine challenge test results in patients with chronic unexplained cough

Introduction: Asthma is one of the most common chronic diseases in adults characterized by variable airway obstruction. Asthma is diagnosed with wheezing and shortness of breath, however it sometimes manifests as a chronic cough that is difficult to diagnose and requires spirometry stimulation tests. Objectives: This study aimed to investigate the relationship between methacholine test results and respiratory symptoms in patients with chronic unexplained cough. Patients and Methods: In this cross-sectional study, 102 patients with chronic cough and normal basal spirometry were included. All patients underwent a methacholine challenge test, and their airway irritabilities were assessed. Then, the relationship between methacholine test results and clinical symptoms and also demographic characteristics were investigated. Results: Of 102 patients, 69 (67.6 %) and 33 (32.4%) were female and male, respectively. Most of patients were non-smoker (90.2%). Around 25 (24.5%) patients had a positive methacholine test. Rhinitis had a statistically significant difference between patients with positive and negative tests (positive test group: 48%, negative test group: 23.4%; P = 0.01). Postnasal discharge was reported in 60% of positive methacholine test patients, which was significant compared to the negative group (36.4%; P = 0.03). Most patients who had positive tests were housewives (76%). Logistic regression showed that female gender (OR: 7.75, 95% CI: 1.7-35.2), postnasal discharge (OR: 3.19, 95% CI: 1.25-8.2), rhinitis (OR: 3.02, 95% CI: 1.17-7.79), and allergy symptoms OR: 3.51, 95% CI: 1.35-9.18) were directly associated with a positive methacholine test. Conclusion: The presence of airway hypersensitivity, postnasal discharge, allergic rhinitis, female gender and the housewife’s job were strongly associated with a positive methacholine test.

A clinic-corelative observational study on nasal smear eosinophilia in allergic rhinitis verses non-allergic rhinitis

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Diagnostic nasal cytology has been used in distinguishing allergic from nonallergic rhinitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; We sought to determine prospectively the frequency of nasal eosinophilia in 100 patients in whom having allergic rhinitis, nonallergic rhinitis, and other atopic conditions not involving the respiratory tract have been diagnosed. A nasal smear was obtained from consenting adults using the rhino-probe curette. Patients taking local or systemic corticosteroids, those with chronic rhinitis associated with aspirin sensitivity, and those with sinusitis were excluded. All cytograms were coded and read by a single ‘blinded’ investigator. NE was considered significant if greater than 20% of sampled cells were eosinophils.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;28 of 50 (56%) patients were with AR had NE. No NE was detected in the control population or in the skin test negative group of patients in whom having nonallergic rhinitis was diagnosed. One of 36 patients with allergic disease not involving the respiratory tract exhibited NE; this patient had atopic dermatitis with peripheral eosinophilia. No cases of eosinophilic nonallergic rhinitis were detected. There was no significant correlation of symptoms or the number of positive skin tests with NE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; These data suggest that the nasal smear for eosinophils is an insensitive but specific test for the diagnosis of allergic rhinitis, when patients with nasal polyposis and aspirin sensitivity and/or negative skin tests are excluded.&lt;/p&gt;

Physical and mental health 3 months after SARS-CoV-2 infection (long COVID) among adolescents in England (CLoCk): a national matched cohort study

SummaryBackgroundWe describe post-COVID symptomatology in a non-hospitalised, national sample of adolescents aged 11–17 years with PCR-confirmed SARS-CoV-2 infection compared with matched adolescents with negative PCR status.MethodsIn this national cohort study, adolescents aged 11–17 years from the Public Health England database who tested positive for SARS-CoV-2 between January and March, 2021, were matched by month of test, age, sex, and geographical region to adolescents who tested negative. 3 months after testing, a subsample of adolescents were contacted to complete a detailed questionnaire, which collected data on demographics and their physical and mental health at the time of PCR testing (retrospectively) and at the time of completing the questionnaire (prospectively). We compared symptoms between the test-postive and test-negative groups, and used latent class analysis to assess whether and how physical symptoms at baseline and at 3 months clustered among participants. This study is registered with the ISRCTN registry (ISRCTN 34804192).Findings23 048 adolescents who tested positive and 27 798 adolescents who tested negative between Jan 1, 2021, and March 31, 2021, were contacted, and 6804 adolescents (3065 who tested positive and 3739 who tested negative) completed the questionnaire (response rate 13·4%). At PCR testing, 1084 (35·4%) who tested positive and 309 (8·3%) who tested negative were symptomatic and 936 (30·5%) from the test-positive group and 231 (6·2%) from the test-negative group had three or more symptoms. 3 months after testing, 2038 (66·5%) who tested positive and 1993 (53·3%) who tested negative had any symptoms, and 928 (30·3%) from the test-positive group and 603 (16·2%) from the test-negative group had three or more symptoms. At 3 months after testing, the most common symptoms among the test-positive group were tiredness (1196 [39·0%]), headache (710 [23·2%]), and shortness of breath (717 [23·4%]), and among the test-negative group were tiredness (911 [24·4%]), headache (530 [14·2%]), and other (unspecified; 590 [15·8%]). Latent class analysis identified two classes, characterised by few or multiple symptoms. The estimated probability of being in the multiple symptom class was 29·6% (95% CI 27·4–31·7) for the test-positive group and 19·3% (17·7–21·0) for the test-negative group (risk ratio 1·53; 95% CI 1·35–1·70). The multiple symptoms class was more frequent among those with positive PCR results than negative results, in girls than boys, in adolescents aged 15–17 years than those aged 11–14 years, and in those with lower pretest physical and mental health.InterpretationAdolescents who tested positive for SARS-CoV-2 had similar symptoms to those who tested negative, but had a higher prevalence of single and, particularly, multiple symptoms at the time of PCR testing and 3 months later. Clinicians should consider multiple symptoms that affect functioning and recognise different clusters of symptoms. The multiple and varied symptoms show that a multicomponent intervention will be required, and that mental and physical health symptoms occur concurrently, reflecting their close relationship.FundingUK Department of Health and Social Care, in their capacity as the National Institute for Health Research, and UK Research and Innovation.

Studies of diagnostic test accuracy: Partial verification bias and test result-based sampling

Partial verification bias occurs in studies assessing the accuracy of existing diagnostic tests when a positive index test makes application of the reference standard more likely. This article first describes alternative sampling frames for a diagnostic test accuracy study then discusses partial verification bias. One approach to avoiding partial verification bias is to apply the reference standard to all individuals who are positive on the index test and a random sample of those who are negative. Estimating sensitivity and specificity then requires adjusting for the sampling fraction in the test-negative group. If a finding was already used to determine who should get the definitive test, one can't look at those who got the definitive test to determine the usefulness of the finding.

Is the Presence of a Typical Triad of COVID-19 Symptoms (Cough, Dyspnea, and Fever) Enough to Make a Decision About Diagnostic Testing? From the Perspective of an Emergency Department

Objective: The aim of this study is to show the consistence between the recommended guidelines regarding the triad of symptoms—cough, dyspnea, and fever—and the diagnosis of COVID-19. Methods: A prospective observational study conducted at a tertiary emergency department between April 2, 2020 and May 15, 2020 in Turkey. Detailed patient history, main presenting complaints and imaging findings were recorded. For COVID-19 confirmation, nasopharyngeal RT-PCR was used. The relationship between complaints and COVID-19 test results were analyzed. Results: Of the 1226, suspected COVID-19 patients, 127 were positive, 471 were negative, and 628 were discharged without any tests. The most common presenting complaints of the COVID-19 positive patients were throat pain (25.2%), dyspnea (15%), cough (22%), malaise and fatigue (11.8%), and fever (8.7%). There was no statistically significant difference between the positive and negative test groups as they had fever (χ2, p = 0.30), cough (χ2, p = 0.67) and dyspnea (χ2, p = 0.14). Conclusion: Considering that it is difficult to diagnose COVID-19 in emergency settings, testing decision and diagnosis should not depend only on classical symptoms;otherwise, patients with atypical and rare symptoms may be missed. Instead, patient history, clinical status, and radiological findings should be considered together.

False-negative real-time polymerase chain reaction tests in COVID-19 patients: an epidemiological analysis of 302 patients

ObjectivesPatients who arrive at the emergency department (ED) with COVID-19, who test negative at the first real-time polymerase chain reaction (RT-PCR), represent a clinical challenge. This study aimed to evaluate if the clinical manifestation at presentation, the laboratory and imaging results, and the prognosis of COVID-19 differ in patients who tested negative at the first RT-PCR compared with those who tested positive and also to evaluate if comorbid conditions patient-related or the period of arrival are associated with negative testing.Study designWe retrospectively collected clinical data of patients who accessed the ED from March 1 to May 15, 2020.MethodsWe compared clinical variables, comorbid conditions, and clinical outcomes in the two groups by univariate analysis and logistic regression.ResultsPatients who tested negative at the first RT-PCR showed a higher prevalence of cardiopathy, immunosuppression, and diabetes, as well as a higher leukocyte and lower lymphocyte counts compared with patients who tested positive. A bilateral interstitial syndrome and a typical pattern at computed tomography scan were prevalent in the test-negative group. Test-negative patients were more likely to be admitted to the hospital but less likely to need admission in a high level of care ward. The false-negative rate increased from March to May.ConclusionFalse-negative RT-PCR COVID-19 patients present a similar spectrum of symptoms compared with positive cohort, but more comorbidities. Imaging helps to identify them. True positives had a higher risk of serious complications.

Prokalsitonin, D-Dimer, Ferritin, Troponin ve Laktat Düzeylerinin COVID-19 Hastalığı ile İlişkisi

Aim: Coronavirus disease-2019 patients may experience an increase in inflammation or clotting disorders. It is believed that some biomarkers can be decisive in decision to hospitalize. Our aim in this study was to investigate the relationship between serum procalcitonin, troponin, D-dimer, ferritin and lactate levels, and Coronavirus disease-2019.Methods: Patients suspected of suffering from the Coronavirus disease-2019 and whose serum biochemistry and blood gas tests were performed, were included in the study. The relationships between the blood parameters of the patients with negative or positive Polymerase Chain Reaction test results, and those who were hospitalized or non-hospitalized, were examined.Results: Out of a total of 452 patients, 244 (54%) were male and 208 (46%) were female. There was a statistically significant difference between polymerase chain reaction test positive and test negative groups in terms of procalcitonin, D-dimer, lactate and troponin levels (p˂0.005). There was no statistically significant difference between hospitalized and non hospitalized patient in terms of ferritin (p=0.224). However, there was a significant difference in terms of procalcitonin, D-dimer and troponin levels (p˂0.005).Conclusion: Our results revealed that high serum procalcitonin, D-dimer, lactate and troponin levels are associated with the decision to hospitalize Coronavirus disease- 2019 patients, whereas ferritin levels played no such role.

Examination of the innominate movements in individuals with and without a positive march test.

[Purpose] The March Test (MT), evaluating hypomobility of the sacroiliac joint (SIJ), is often used in clinical practice to evaluate low back pain but has limited reported validity and reliability. Capturing the innominate movement at SIJ associated with the results of MT has not been examined. The purpose of this study was to determine if there was a significant difference in the motion of the innominate between a positive and a negative MT. [Participants and Methods] Sixteen healthy volunteers were assigned into two groups: positive or negative results of the MT. All participants were asked to perform three different tasks: standing on both limbs, static standing on one-limb and flexing the hip to 90 and 100 degrees, and active flexing the hip past 90 degrees. In a 3D motion analysis system, virtual vectors created by landmarks over the ilium defined innominate movement of the ilium related to the sacrum, which were compared between the groups. [Results] There was significantly limited innominate movement in the March Test positive group compared to the March Test negative group. [Conclusion] This study showed hypomobility at SIJ in the March test positive groups. Further investigation is needed for clinical applications.

Clinical features of neonates born to mothers with coronavirus disease-2019: A systematic review of 105 neonates.

BackgroundDespite the increasingly recognized impact of novel coronavirus disease (COVID-19), caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), on many aspects of health in adults and children, its effects on neonates born to infected mothers remain unclear. We conducted this study to investigate the outcomes of neonates born to mothers with COVID-19.MethodsWe searched the medical databases from inception to March 31, 2020 to perform a systematic review of outcomes in neonates born to mothers with COVID-19. Data were pooled using a random effects regression model. Primary and secondary outcomes were neonatal clinical outcomes and infectious status, respectively.ResultsFourteen studies involving 105 neonates fulfilling the study criteria were identified. The rates of preterm neonates and those small for gestational age (SGA) were 25 (23.8%) and 10 (11.2%), respectively. Among 91 neonates who were tested, 8 (8.8%) were positive for nucleic acids or antibodies for SARS-CoV-2. Additionally, 28 (26.7%) of the neonates were symptomatic and two test-negative neonates died, including one stillbirth. Between test-positive and test-negative groups, the rates of SGA, preterm delivery, duration between maternal symptom onset and delivery, and perinatal complication were not significantly different; but the rate of symptomatic after birth reached significant difference (62.5% vs 20.5%, p = 0.008).ConclusionsMost neonates born to infected mothers had favorable outcomes. Although direct evidences of intrauterine infection were scarce, the risk of intrauterine infection should be considered based on a positive test in 8.8% of the neonates. Symptomatic neonates born to infected mothers should receive tests for SARS-CoV-2 to initiate appropriate treatment and quarantine. Further studies are warranted to assess the outcomes of COVID-19 in neonates.

Shear force comparative evaluation for surface treated and non- treated 3D interim printed materials with different types of glass-ionomer cements.

BackgroundThe purpose of this investigation was to compare shear force of different glass-ionomer cements on 3D printed interim material in combination with and without surface pretreatment. Material and Methods120 rectangular specimens made of printable provisional material (Bego, Bremen, Germany) were used. After post-processing the specimens were blasted with aluminum oxide 110µm (Bego, Bremen, Germany). Extra 120 non-surface treated specimens were used as an experimental negative test group. All 240 specimens were divided randomly into 6 groups. All were cemented with a compressive load of 20 N using universal testing machine Z010 (Zwick/Roell, Ulm, Germany) to ensure a comparable cementing process. Each of the six groups were cemented with different cements (CX Plus (Shofu, Ratingen, Germany), Vivaglass CEM PL (Ivoclar Vivadent AG, Schaan, Liechtenstein), Aqua Cem (Dentsply Sirona, Bensheim, Germany), Ketac Cem (3M, Neuss, Germany), Meron Plus AC (Voco, Cuxhaven, Germany), and Fuji 1 (GC, Tokyo, Japan). Shear force test was performed, and forces were statistically analyzed via Anova test (significance level p<0.001). ResultsAll the pre-treated specimens showed a significantly higher bonding strength compared to not pretreated. Meron Plus AC showed the highest shear overall force. The Anova test showed a significant difference between all pretreated study groups (p<0.001). ConclusionsAn increase of the necessary forces for all groups was shown in pretreated group. Within the limitations of this study, a surface pretreatment is recommended when bonding a 3D interim material with glass ionomer cements. Key words:Shear force, 3D printing, glass ionomer cement, mechanical evaluation, CAD/CAM.

Impact factor analysis of cerebrospinal fluid tap test response in patients of idiopathic normal pressure hydrocephalus

Objective To facilitate diagnosis and predict the outcome of shunting surgery in idiopathic normal pressure hydrocephalus (iNPH) and to explore the influence of clinical and neuroimaging factors on cerebrospinal fluid (CSF) tap test response in Han Chinese patients with iNPH. Methods Forty-three patients with possible clinical diagnosis of iNPH at neurology clinic and neurology inpatient at Department of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from March 2013 to January 2017 were recruited and underwent CSF tap test. Patients were categorized into CSF tap test responders (24 patients) and non-responders (19 patients) justified by two iNPH professional neurologists. The clinical parameters in those 2 groups including gender, age onset, duration, walking ability, neuropsychological testing result, clinical scores were analyzed. The neuroimaging parameters including Evan's index, callosum corpus angle, sign of disproportion of enlarged subarachnoid space and white matter lesion (WML) Fazekas rating score were also analyzed. Results The univariate analysis showed that compared with CSF tap test negative group, the proportion of males in the positive group was significantly higher (male ∶female 20 ∶4 vs. 9 ∶10, P=0.03), the duration of walking disturbance was longer [M (QR): 30(17) months vs. 12(20) months, P=0.04], Z score of executive function was lower [M(QR): -10.3(25.0) vs. -4.8(11.3), P=0.04], Fasekas score of paraventricular white matter lesions was higher[M (QR): 2.5 (1.0) vs. 1.0 (1.0), P=0.03]. However, those factors had no statistical correlation with the CSF tap test response by multivariate logistic regression analysis(all P>0.05). Conclusions Longer disease duration, worse walking ability, worse executive function test performance and prominent white matter lesions might be the impact factors of CSF tap test. Further research of large sample size is needed in the future. Key words: Hydrocephalus, normal pressure; Factor analysis, statistical; Idiopathic; Cere-brospinal fluid tap test