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Beghi E, Ivashynka A, Logroscino G, de Oliveira FF, Fleisher JE, Dumitrascu OM, Patel R, Savica R, Kim YJ. Pitfalls and biases in neuroepidemiological studies of COVID-19 and the nervous system: a critical appraisal of the current evidence and future directions. J Neurol 2023; 270:5162-5170. [PMID: 37682315 DOI: 10.1007/s00415-023-11981-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Neurological manifestations frequently occur in individuals with COVID-19, manifesting during the acute phase, persisting beyond the resolution of acute symptoms, and appearing days or weeks after the initial onset of COVID-19 symptoms. However, predicting the incidence, course, and outcome of these neurological manifestations at the individual patient level remains challenging. Biases in study design and limitations in data collection may contribute to the inconsistency and limited validity of the reported findings. Herein, we focused on critically appraising pitfalls and biases of prior reports and provide guidance for improving the quality and standardization of future research. Patients with COVID-19 exhibit diverse demographic features, sociocultural backgrounds, lifestyle habits, and comorbidities, all of which can influence the severity and progression of the infection and its impact on other organ systems. Overlooked or undocumented comorbidities and related treatments may contribute to neurological sequelae, which may not solely be attributable to COVID-19. It is crucial to consider the potential side effects of vaccines in relation to neurological manifestations. CONCLUSION To investigate neurological manifestations of COVID-19, it is essential to employ valid and reliable diagnostic criteria and standard definitions of the factors of interest. Although population-based studies are lacking, well-defined inception cohorts, including hospitalized individuals, outpatients, and community residents, can serve as valuable compromises. These cohorts should be evaluated for the presence of common comorbidities, alongside documenting the primary non-neurological manifestations of the infectious disease. Lastly, patients with COVID-19 should be followed beyond the acute phase to assess the persistence, duration, and severity of neurological symptoms, signs, or diseases.
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Affiliation(s)
- Ettore Beghi
- Department of Neuroscience, Istituto di Ricerch Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Andrei Ivashynka
- Department of Parkinson's Disease, Movement Disorders and Brain Injury Rehabilitation, "Moriggia-Pelascini" Hospital, Gravedona ed Uniti, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari "Aldo Moro" at "Pia Fondazione Card. G. Panico" Hospital Tricase, Lecce, Italy
| | | | - Jori E Fleisher
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Oana M Dumitrascu
- Departments of Neurology and Ophthalmology, Mayo Clinic, Scottsdale, AZ, USA
| | - Roshni Patel
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
- Neurology Service, Jesse Brown VA Medical Center, Chicago, IL, USA
| | - Rodolfo Savica
- Department of Neurology and Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Yun Jin Kim
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Jalan Sunsuria, Bandar Sunsuria, 43900, Sepang, Selangor, Malaysia.
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Choi JW, Seo WH, Kang T, Kang T, Chung BG. Droplet digital recombinase polymerase amplification for multiplexed detection of human coronavirus. LAB ON A CHIP 2023; 23:2389-2398. [PMID: 37083004 DOI: 10.1039/d3lc00025g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Since the outbreak of coronavirus 2019 (COVID-19), detection technologies have been attracting a great deal of attention in molecular diagnosis applications. In particular, the droplet digital PCR (ddPCR) has become a promising tool as it offers absolute quantification of target nucleic acids with high specificity and sensitivity. In recent years, the combination of the isothermal amplification strategies has made ddPCR a popular method for on-site testing by enabling amplification at a constant temperature. However, the current isothermal ddPCR assays are still challenging due to inherent non-specific amplification. In this paper, we present a multiplexed droplet digital recombinase polymerase amplification (MddRPA) with precise initiation of the reaction. First, the reaction temperature and dynamic range of reverse transcription (RT) and RPA were characterized by real-time monitoring of fluorescence intensities. Using a droplet-based microfluidic chip, the master mix and the initiator were fractionated and rapidly mixed within well-confined droplets. Due to the high heat transfer and mass transfer of the droplets, the precise initiation of the amplification was enabled and the entire assay could be conducted within 30 min. The concentrations of target RNA in the range from 5 copies per μL to 2500 copies per μL could be detected with high linearity (R2 > 0.999). Furthermore, the multiplexed detection of three types of human coronaviruses was successfully demonstrated with high specificity (>96%). Finally, we compared the performance of the assay with a commercial RT-qPCR system using COVID-19 clinical samples. The MddRPA assay showed a 100% concordance with the RT-qPCR results, indicating its reliability and accuracy in detecting SARS-CoV-2 nucleic acids in clinical samples. Therefore, our MddRPA assay with rapid detection, precise quantification, and multiplexing capability would be an interesting method for molecular diagnosis of viral infections.
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Affiliation(s)
- Ji Wook Choi
- Department of Mechanical Engineering, Sogang University, Seoul, Korea.
| | - Won Ho Seo
- Department of Biomedical Engineering, Sogang University, Seoul, Korea
| | - Taejoon Kang
- Bionanotechnology Research Center, Korea Research Institute of Bioscience and Biotechnology (KRIBB), Daejeon, Korea
- School of Pharmacy, Sungkyunkwan University (SKKU), Suwon, Korea
| | - Taewook Kang
- Department of Chemical and Biomolecular Engineering, Sogang University, Seoul, Korea
- Institute of Integrated Biotechnology, Sogang University, Seoul, Korea
| | - Bong Geun Chung
- Department of Mechanical Engineering, Sogang University, Seoul, Korea.
- Institute of Integrated Biotechnology, Sogang University, Seoul, Korea
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3
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Matthies A, Trauer M, Chopra K, Jarman RD. Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: a systematic review and meta-analysis. Emerg Med J 2023; 40:407-417. [PMID: 36868811 DOI: 10.1136/emermed-2021-212092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Point-of-care (POC) lung ultrasound (LUS) is widely used in the emergency setting and there is an established evidence base across a range of respiratory diseases, including previous viral epidemics. The necessity for rapid testing combined with the limitations of other diagnostic tests has led to the proposal of various potential roles for LUS during the COVID-19 pandemic. This systematic review and meta-analysis focused specifically on the diagnostic accuracy of LUS in adult patients presenting with suspected COVID-19 infection. METHODS Traditional and grey-literature searches were performed on 1 June 2021. Two authors independently carried out the searches, selected studies and completed the Quality Assessment Tool for Diagnostic Test Accuracy Studies (QUADAS-2). Meta-analysis was carried out using established open-source packages in R. We report overall sensitivity, specificity, positive and negative predictive values, and the hierarchical summary receiver operating characteristic curve for LUS. Heterogeneity was determined using the I2 statistic. RESULTS Twenty studies were included, published between October 2020 and April 2021, providing data from a total of 4314 patients. The prevalence and admission rates were generally high across all studies. Overall, LUS was found to be 87.2% sensitive (95% CI 83.6 to 90.2) and 69.5% specific (95% CI 62.2 to 72.5) and demonstrated overall positive and negative likelihood ratios of 3.0 (95% CI 2.3 to 4.1) and 0.16 (95% CI 0.12 to 0.22), respectively. Separate analyses for each reference standard revealed similar sensitivities and specificities for LUS. Heterogeneity was found to be high across the studies. Overall, the quality of studies was low with a high risk of selection bias due to convenience sampling. There were also applicability concerns because all studies were undertaken during a period of high prevalence. CONCLUSION During a period of high prevalence, LUS had a sensitivity of 87% for the diagnosis of COVID-19 infection. However, more research is required to confirm these results in more generalisable populations, including those less likely to be admitted to hospital. PROSPERO REGISTRATION NUMBER CRD42021250464.
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Affiliation(s)
- Ashley Matthies
- Emergency Department, Homerton University Hospital NHS Foundation Trust, London, UK .,School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Michael Trauer
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK.,Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Karl Chopra
- Emergency Department, Homerton University Hospital NHS Foundation Trust, London, UK.,School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Robert David Jarman
- Accident and Emergency Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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4
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Jeyananthan P. SARS-CoV-2 Diagnosis Using Transcriptome Data: A Machine Learning Approach. SN COMPUTER SCIENCE 2023; 4:218. [PMID: 36844504 PMCID: PMC9936926 DOI: 10.1007/s42979-023-01703-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 01/24/2023] [Indexed: 05/02/2023]
Abstract
SARS-CoV-2 pandemic is the big issue of the whole world right now. The health community is struggling to rescue the public and countries from this spread, which revives time to time with different waves. Even the vaccination seems to be not prevents this spread. Accurate identification of infected people on time is essential these days to control the spread. So far, Polymerase chain reaction (PCR) and rapid antigen tests are widely used in this identification, accepting their own drawbacks. False negative cases are the menaces in this scenario. To avoid these problems, this study uses machine learning techniques to build a classification model with higher accuracy to filter the COVID-19 cases from the non-COVID individuals. Transcriptome data of the SARS-CoV-2 patients along with the control are used in this stratification using three different feature selection algorithms and seven classification models. Differently expressed genes also studied between these two groups of people and used in this classification. Results shows that mutual information (or DEGs) along with naïve Bayes (or SVM) gives the best accuracy (0.98 ± 0.04) among these methods. Supplementary Information The online version contains supplementary material available at 10.1007/s42979-023-01703-6.
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Dobre D, Schwan R, Jansen C, Schwitzer T, Martin O, Ligier F, Rolland B, Ahad PA, Capdevielle D, Corruble E, Delamillieure P, Dollfus S, Drapier D, Bennabi D, Joubert F, Lecoeur W, Massoubre C, Pelissolo A, Roser M, Schmitt C, Teboul N, Vansteene C, Yekhlef W, Yrondi A, Haoui R, Gaillard R, Leboyer M, Thomas P, Gorwood P, Laprevote V. Clinical features and outcomes of COVID-19 patients hospitalized for psychiatric disorders: a French multi-centered prospective observational study. Psychol Med 2023; 53:342-350. [PMID: 33902760 PMCID: PMC8144831 DOI: 10.1017/s0033291721001537] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/31/2021] [Accepted: 04/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with psychiatric disorders are exposed to high risk of COVID-19 and increased mortality. In this study, we set out to assess the clinical features and outcomes of patients with current psychiatric disorders exposed to COVID-19. METHODS This multi-center prospective study was conducted in 22 psychiatric wards dedicated to COVID-19 inpatients between 28 February and 30 May 2020. The main outcomes were the number of patients transferred to somatic care units, the number of deaths, and the number of patients developing a confusional state. The risk factors of confusional state and transfer to somatic care units were assessed by a multivariate logistic model. The risk of death was analyzed by a univariate analysis. RESULTS In total, 350 patients were included in the study. Overall, 24 (7%) were transferred to medicine units, 7 (2%) died, and 51 (15%) patients presented a confusional state. Severe respiratory symptoms predicted the transfer to a medicine unit [odds ratio (OR) 17.1; confidence interval (CI) 4.9-59.3]. Older age, an organic mental disorder, a confusional state, and severe respiratory symptoms predicted mortality in univariate analysis. Age >55 (OR 4.9; CI 2.1-11.4), an affective disorder (OR 4.1; CI 1.6-10.9), and severe respiratory symptoms (OR 4.6; CI 2.2-9.7) predicted a higher risk, whereas smoking (OR 0.3; CI 0.1-0.9) predicted a lower risk of a confusional state. CONCLUSION COVID-19 patients with severe psychiatric disorders have multiple somatic comorbidities and have a risk of developing a confusional state. These data underline the need for extreme caution given the risks of COVID-19 in patients hospitalized for psychiatric disorders.
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Affiliation(s)
- Daniela Dobre
- Centre Psychothérapique de Nancy, LaxouF-54520, France
- INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, StrasbourgF-67 000, France
| | - Raymund Schwan
- Centre Psychothérapique de Nancy, LaxouF-54520, France
- INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, StrasbourgF-67 000, France
- Faculté de Médecine, Université de Lorraine, F-54500Vandoeuvre-lès-Nancy, France
| | - Claire Jansen
- Centre Psychothérapique de Nancy, LaxouF-54520, France
- Faculté de Médecine, Université de Lorraine, F-54500Vandoeuvre-lès-Nancy, France
| | - Thomas Schwitzer
- Centre Psychothérapique de Nancy, LaxouF-54520, France
- INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, StrasbourgF-67 000, France
- Faculté de Médecine, Université de Lorraine, F-54500Vandoeuvre-lès-Nancy, France
| | | | - Fabienne Ligier
- Centre Psychothérapique de Nancy, LaxouF-54520, France
- Faculté de Médecine, Université de Lorraine, F-54500Vandoeuvre-lès-Nancy, France
- EA 4360 APEMAC, Université de Lorraine, F-54500Vandoeuvre-lès-Nancy, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), CH Le Vinatier, Bron, France
- Services hospitalo-universitaires d'addictologie, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, UCBL, Centre de recherche en neurosciences de Lyon (CRNL), INSERM U1028, CNRS UMR5292, PSYR2, Bron, France
| | - Pierre Abdel Ahad
- Pôle hospitalo-universitaire de psychiatrie adultes Paris 15ème, GHU Paris psychiatrie et neurosciences, site Sainte-Anne, Paris, France
| | - Delphine Capdevielle
- IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
- University Department of Adult Psychiatry, CHU, Montpellier, France
| | - Emmanuelle Corruble
- Université department of Adult Psychiatry, Hôpital La Colombière, CHU de Montpellier, France
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin BicêtreF-94275, France
| | - Pascal Delamillieure
- CHU de Caen, Service de psychiatrie, Centre Esquirol, CaenF-14000, France
- Imagerie et Stratégies Thérapeutiques de la Schizophrénie (ISTS) EA 7466, Normandie Univ, GIP Cyceron, CaenF-14000, France
- UFR Santé, Normandie Univ, CaenF-14000, France
| | - Sonia Dollfus
- CHU de Caen, Service de psychiatrie, Centre Esquirol, CaenF-14000, France
- Imagerie et Stratégies Thérapeutiques de la Schizophrénie (ISTS) EA 7466, Normandie Univ, GIP Cyceron, CaenF-14000, France
- UFR Santé, Normandie Univ, CaenF-14000, France
| | - Dominique Drapier
- Pôle Hospitalo-Universitaire de Psychiatrie Adulte, Centre Hospitalier Guillaume Régnier, RennesF-35703, France
- EA 47 12 Comportement et Noyaux Gris Centraux, Université Rennes 1, RennesF-35703, France
| | - Djamila Bennabi
- Service de psychiatrie de l'adulte, CHRU de Besançon, F-25000Besançon, France
- Centre expert dépression résistante FondaMental, F-25000Besançon, France
| | - Fabien Joubert
- Département d'Information Médicale, CH Le Vinatier, Bron, France
| | | | - Catherine Massoubre
- Service Universitaire de Psychiatrie, EA TAPE 7423, CHU de Saint-Etienne, Saint Etienne, France
| | - Antoine Pelissolo
- UPEC, Université Paris-Est, Faculté de médecine, CréteilF-94000, France
- AP-HP, DMU IMPACT, Hôpitaux universitaires Henri-Mondor, Service de Psychiatrie, CréteilF-94000, France
- INSERM U955, Laboratoire Neuro-Psychiatrie translationnelle, CréteilF-94000, France
| | - Mathilde Roser
- UPEC, Université Paris-Est, Faculté de médecine, CréteilF-94000, France
- AP-HP, DMU IMPACT, Hôpitaux universitaires Henri-Mondor, Service de Psychiatrie, CréteilF-94000, France
- INSERM U955, Laboratoire Neuro-Psychiatrie translationnelle, CréteilF-94000, France
| | - Christophe Schmitt
- Département d'Information Médicale, Centre Hospitalier de Jury, MetzF-57073, France
| | - Noé Teboul
- Département d'Information Médicale, CH Le Vinatier, Bron, France
| | - Clément Vansteene
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Hôpital Sainte-Anne, 1 Rue Cabanis, 75014Paris, France
- INSERM U894, Centre de Psychiatrie et Neurosciences (CPN), Université Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
| | - Wanda Yekhlef
- Département Soins Somatiques-Préventions-Santé Publique, Pôle CRISTALES, EPS de Ville-Evrard, Neuilly sur Marne, France
| | - Antoine Yrondi
- Service de Psychiatrie et de Psychologie Médicale, Centre Expert Dépression Résistante FondaMental, CHU de Toulouse, Hôpital Purpan, Toulouse, France
- ToNIC Toulouse NeuroImaging Center, Université de Toulouse, INSERM, UPS, Toulouse, France
| | - Radoine Haoui
- Pôle de Psychiatrie Générale Rive Gauche, Centre Hospitalier Gérard Marchant, F-31057Toulouse, France
| | - Raphaël Gaillard
- Pôle hospitalo-universitaire de psychiatrie adultes Paris 15ème, GHU Paris psychiatrie et neurosciences, site Sainte-Anne, Paris, France
- Université de Paris, Paris, France
- Human Histopathology and Animal Models, Infection and Epidemiology Department, Institut Pasteur, Paris, France
| | - Marion Leboyer
- UPEC, Université Paris-Est, Faculté de médecine, CréteilF-94000, France
- AP-HP, DMU IMPACT, Hôpitaux universitaires Henri-Mondor, Service de Psychiatrie, CréteilF-94000, France
- INSERM U955, Laboratoire Neuro-Psychiatrie translationnelle, CréteilF-94000, France
| | - Pierre Thomas
- Univ. Lille, INSERM U1172, CHU Lille, Centre Lille Neuroscience & Cognition (PSY), F-59000Lille, France
- CHU Lille, Pôle de Psychiatrie, F-59000Lille, France
| | - Philip Gorwood
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Hôpital Sainte-Anne, 1 Rue Cabanis, 75014Paris, France
- Institute of Psychiatry and Neuroscience of Paris, University of Paris, INSERM U1266, Paris, France
- GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte-Anne, Paris, France
| | - Vincent Laprevote
- Centre Psychothérapique de Nancy, LaxouF-54520, France
- INSERM U1114, Fédération de Médecine Translationnelle de Strasbourg, Département de Psychiatrie, Centre Hospitalier Régional Universitaire de Strasbourg, StrasbourgF-67 000, France
- Faculté de Médecine, Université de Lorraine, F-54500Vandoeuvre-lès-Nancy, France
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Hohl CM, Hau JP, Vaillancourt S, Grant J, Brooks SC, Morrison LJ, Perry JJ, Rosychuk RJ. Sensitivity and Diagnostic Yield of the First SARS-CoV-2 Nucleic Acid Amplification Test Performed for Patients Presenting to the Hospital. JAMA Netw Open 2022; 5:e2236288. [PMID: 36223119 PMCID: PMC9557877 DOI: 10.1001/jamanetworkopen.2022.36288] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE Early and accurate diagnostic testing for SARS-CoV-2 is essential to initiate appropriate treatment and infection control and prevention measures among patients presenting to the hospital. OBJECTIVE To evaluate the diagnostic sensitivity of the SARS-CoV-2 nucleic acid amplification test (NAAT) performed within 24 hours of arrival to the emergency department among a nationally representative sample of patients. DESIGN, SETTING, AND PARTICIPANTS This diagnostic study was conducted at 47 hospitals across 7 provinces in Canada participating in the Canadian COVID-19 Rapid Response Emergency Department Network among consecutive eligible patients presenting to a participating emergency department who were tested for SARS-CoV-2 from March 1, 2020, to December 31, 2021. Patients not tested within 24 hours of arrival and those presenting with a positive result from a test performed in the community were excluded. MAIN OUTCOMES AND MEASURES The primary outcome was a positive result from the SARS-CoV-2 NAAT. Outcome measures were the diagnostic sensitivity and yield of the SARS-CoV-2 NAAT. RESULTS Of 132 760 eligible patients (66 433 women [50.0%]; median age, 57 years [IQR, 37-74 years]), 17 174 (12.9%) tested positive for SARS-CoV-2 within 14 days of their first NAAT. The diagnostic sensitivity of the SARS-CoV-2 NAAT was 96.2% (17 070 of 17 740 [95% CI, 95.9%-96.4%]) among all of the tests performed. Estimates ranged from a high of 97.7% (1710 of 1751 [95% CI, 96.8%-98.3%]) on day 2 of symptoms to a low of 90.4% (170 of 188 [95% CI, 85.3%-94.2%]) on day 11 of symptoms among patients presenting with COVID-19 symptoms. Among patients reporting COVID-19 symptoms, the sensitivity of the SARS-CoV-2 NAAT was 97.1% (11 870 of 12 225 [95% CI, 96.7%-97.3%]) compared with 87.6% (812 of 927 [95% CI, 85.2%-89.6%]) among patients without COVID-19 symptoms. The diagnostic yield of the SARS-CoV-2 NAAT was 12.0% (18 985 of 158 004 [95% CI, 11.8%-12.2%]) and varied from a high of 20.0% (445 of 2229 [95% CI, 18.3%-21.6%]) among patients tested on day 10 after symptom onset to a low of 8.1% (1686 of 20 719 [95% CI, 7.7%-8.5%]) among patients presenting within the first 24 hours of symptom onset. CONCLUSIONS AND RELEVANCE This study suggests that the diagnostic sensitivity was high for the first SARS-CoV-2 NAAT performed in the hospital and did not vary significantly by symptom duration. Repeated testing of patients with negative test results should be avoided unless their pretest probability of disease is high.
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Affiliation(s)
- Corinne M. Hohl
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey P. Hau
- Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Samuel Vaillancourt
- Department of Emergency Medicine, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Division of Emergency Medicine, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Grant
- Division of Medical Microbiology and Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven C. Brooks
- Department of Emergency Medicine, Faculty of Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Laurie J. Morrison
- Division of Emergency Medicine, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Emergency Medicine, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jeffrey J. Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Rhonda J. Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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7
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Antiochia R. Electrochemical biosensors for SARS-CoV-2 detection: Voltametric or impedimetric transduction? Bioelectrochemistry 2022; 147:108190. [PMID: 35738049 PMCID: PMC9188450 DOI: 10.1016/j.bioelechem.2022.108190] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 11/06/2022]
Abstract
During the COVID-19 pandemic, electrochemical biosensors have shown several advantages including accuracy, low cost, possibility of miniaturization and portability, which make them an interesting testing method for rapid point-of-care (POC) detection of SARS-CoV-2 infection, allowing the detection of both viral RNA and viral antigens. Herein, we reviewed advancements in electrochemical biosensing platforms towards the detection of SARS-CoV-2 based on voltametric and impedimetric transduction modes, highlighting the advantages and drawbacks of the two methods.
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Affiliation(s)
- Riccarda Antiochia
- Department of Chemistry and Technology of Drugs, Sapienza University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
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8
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Gierczyński R, Czerw A, Juszczyk G, Charkiewicz R, Nikliński J, Majewski P, Reszeć J, Piątyszek P, Baniecki H, Biecek P, Henry BM. Quantitative analysis of RT-PCR test results for SARS-CoV-2 diagnostics across Poland during COVID-19 pandemic: Comparison between early stage and major pandemic waves in 2020 and 2021 with reference to SARS-CoV-2 variants. Adv Med Sci 2022; 67:386-392. [PMID: 36191361 PMCID: PMC9468313 DOI: 10.1016/j.advms.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/15/2022] [Accepted: 09/07/2022] [Indexed: 11/01/2022]
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Cremades-Martínez P, Parker LA, Chilet-Rosell E, Lumbreras B. Evaluation of Diagnostic Strategies for Identifying SARS-CoV-2 Infection in Clinical Practice: a Systematic Review and Compliance with the Standards for Reporting Diagnostic Accuracy Studies Guideline (STARD). Microbiol Spectr 2022; 10:e0030022. [PMID: 35699441 PMCID: PMC9430610 DOI: 10.1128/spectrum.00300-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
We aimed to review strategies for identifying SARS-CoV-2 infection before the availability of molecular test results, and to assess the reporting quality of the studies identified through the application of the STARD guideline. We screened 3,821 articles published until 30 April 2021, of which 23 met the inclusion criteria: including at least two diagnostic variables, being designed for use in clinical practice or in a public health context and providing diagnostic accuracy rates. Data extraction and application of STARD criteria were performed independently by two researchers and discrepancies were discussed with a third author. Most of the studies (16, 69.6%) included symptomatic patients with suspected infection, six studies (26.1%) included patients already diagnosed and one study (4.3%) included individuals with close contact to a COVID-positive patient. The main variables considered in the studies, which included symptomatic patients, were imaging and demographic characteristics, symptoms, and lymphocyte count. The values for area under the receiver operating characteristic curve (AUC)ranged from 53-97.4. Seven studies (30.4%) validated the diagnostic model in an independent sample. The average number of STARD criteria fulfilled was 17.6 (maximum, 27 and minimum, 5). High diagnostic accuracy values are shown when more than one diagnostic variable is considered, mainly imaging and demographic characteristics, symptoms, and lymphocyte count. This could offer the potential to identify individuals with SARS-CoV-2 infection with high accuracy when molecular testing is not available. However, external validation for developed models and evaluations in populations as similar as possible to those in which they will be applied is urgently needed. IMPORTANCE According to this review, the inclusion of more than one diagnostic test in the diagnostic process for COVID-19 infection shows high diagnostic accuracy values. Imaging characteristics, patients' symptoms, demographic characteristics, and lymphocyte count were the variables most frequently included in the diagnostic models. However, developed models should be externally validated before reaching conclusions on their utility in practice. In addition, it is important to bear in mind that the test should be evaluated in populations as similar as possible to those in which it will be applied in practice.
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Affiliation(s)
| | - Lucy A. Parker
- Public Health, History of Medicine and Gynecology Department, Miguel Hernandez University, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Elisa Chilet-Rosell
- Public Health, History of Medicine and Gynecology Department, Miguel Hernandez University, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Blanca Lumbreras
- Public Health, History of Medicine and Gynecology Department, Miguel Hernandez University, Alicante, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Madrid, Spain
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10
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Lab practices that improve coronavirus disease 2019 detection accuracy using real-time PCR. INT J EVID-BASED HEA 2022; 20:172-179. [PMID: 35981309 PMCID: PMC9593322 DOI: 10.1097/xeb.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The number of coronavirus disease 2019 (COVID-19) cases significantly increased with the emergence of multiple variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This has led to an ongoing effort focused on developing the diagnostic detection tests. Among the currently available tests, real-time reverse transcriptase PCR (RT-PCR) has been considered as the ‘golden method’ for the detection of SARS-COV-2. However, a significant number of inaccurate (false-negative/false-positive) results have been reported in spite of this method's reliability and effectiveness. These unreliable results may arise because of various issues encountered throughout the entire testing process starting with the sampling phase, going through the PCR process, and ending with the result analysis. This article aims to shed light on the errors that occur during the COVID-19 testing process and suggest ways to overcome them effectively. Accurate testing could be optimized by following the correct swabbing technique, using adequate RT-PCR kits and controls, setting clear lab guidelines, and properly interpreting the results.
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11
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Tré-Hardy M, Piteüs S, Beukinga I, Blairon L. Clinical evaluation of the GSD NovaPrime® SARS-CoV-2 RTq-PCR assay. Diagn Microbiol Infect Dis 2022; 103:115718. [PMID: 35641362 PMCID: PMC9061580 DOI: 10.1016/j.diagmicrobio.2022.115718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 11/03/2022]
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12
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Martínez-Cortés M, León-Dominguez CM, Fernandez-Pinero J, Rodriguez M, Almonacid M, Ferrari MJ, Romero R, Antona A, Rivas MD, de La Fuente M, Pérez-Gómez B, Pollán M. SARS-CoV-2 surveillance strategy in essential workers of the Madrid City Council during the first epidemic wave in Spain, March-July 2020. Occup Environ Med 2022; 79:295-303. [PMID: 34599009 PMCID: PMC8492183 DOI: 10.1136/oemed-2021-107654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/07/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To study prevalence of infection in essential workers of Madrid City Council by occupation, related characteristics, use of protective devices, risk perception, and main concerns about COVID-19 during lockdown. METHODS A total of 30 231 workers were PCR tested for SARS-CoV-2 infection. Information was collected on COVID-19-related symptoms, risk factors, preventive equipment, and risk perception. The crude prevalence was calculated for infection, use of protective devices, perceived risk and main concerns. Additionally, adjusted prevalence and prevalence ratios (PR) were estimated for these variables using logistic regression models with age, gender, occupation, epidemiological week and laboratory as confounding factors. RESULTS Overall prevalence of infection was 3.2% (95% CI 3.0% to 3.4%), being higher among policemen (4.4%) and bus drivers (4.2%), but lower among emergency healthcare personnel, firefighters, food market workers and burial services (<2%). Lower excess risk was observed in workers reporting occupational contact with COVID-19 cases only (PR=1.42; 95% CI 1.18 to 1.71) compared with household exposure only (PR=2.75; 95% CI 2.32 to 3.25). Infection was more frequent in symptomatic workers (PR=1.28; 95% CI 1.11 to 1.48), although 42% of detected infections were asymptomatic. Use of facial masks (78.7%) and disinfectants (86.3%) was common and associated with lower infection prevalence (PRmasks=0.68; 95% CI 0.58 to 0.79; PRdisinfectants=0.75; 95% CI 0.61 to 0.91). Over 50% of workers felt being at high risk of infection and worried about infecting others, yet only 2% considered quitting their work. CONCLUSIONS This surveillance system allowed for detecting and isolating SARS-CoV-2 cases among essential workers, identifying characteristics related to infection and use of protective devices, and revealing specific needs for work-safety information and psychological support.
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Affiliation(s)
| | | | - Jovita Fernandez-Pinero
- Centro de Investigación en Sanidad Animal, Instituto Nacional de Investigación y Tecnología Agraria y Alimentaria (INIA-CISA, CSIC), Valdeolmos, Comunidad de Madrid, Spain
| | | | | | | | | | | | | | | | - Beatriz Pérez-Gómez
- National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBERESP, Madrid, Comunidad de Madrid, Spain
| | - Marina Pollán
- National Center for Epidemiology, Instituto de Salud Carlos III, Madrid, Spain
- CIBERESP, Madrid, Comunidad de Madrid, Spain
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Scott LE, Noble LD, Singh-Moodley A, Kahamba T, Hardie DR, Preiser W, Stevens WS. Challenges and complexities in evaluating severe acute respiratory syndrome coronavirus 2 molecular diagnostics during the COVID-19 pandemic. Afr J Lab Med 2022; 11:1429. [PMID: 35547331 PMCID: PMC9082082 DOI: 10.4102/ajlm.v11i1.1429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Lesley E Scott
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lara D Noble
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ashika Singh-Moodley
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Priority Programme, National Laboratory Services, Johannesburg, South Africa
| | - Trish Kahamba
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diana R Hardie
- Division of Medical Virology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Wolfgang Preiser
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- National Health Laboratory Service, Cape Town, South Africa
| | - Wendy S Stevens
- Department of Molecular Medicine and Haematology, School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- National Priority Programme, National Laboratory Services, Johannesburg, South Africa
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14
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Mancilla-Tapia JM, Lozano-Esparza V, Orduña A, Osuna-Chávez RF, Robles-Zepeda RE, Maldonado-Cabrera B, Bejar-Cornejo JR, Ruiz-León I, González-Becuar CG, Hielm-Björkman A, Novelo-González A, Vidal-Martínez VM. Dogs Detecting COVID-19 From Sweat and Saliva of Positive People: A Field Experience in Mexico. Front Med (Lausanne) 2022; 9:837053. [PMID: 35433718 PMCID: PMC9012113 DOI: 10.3389/fmed.2022.837053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
ContextMolecular tests are useful in detecting COVID-19, but they are expensive in developing countries. COVID-19-sniffing dogs are an alternative due to their reported sensitivity (>80%) and specificity (>90%). However, most of the published evidence is experimental, and there is a need to determine the performance of the dogs in field conditions. Hence, we aimed to test the sensitivity and specificity of COVID-19-sniffing dogs in the field.MethodsWe trained four dogs with sweat and three dogs with saliva of COVID-19-positive patients, respectively, for 4.5 months. The samples were obtained from a health center in Hermosillo, Sonora, with the restriction to spend 5 min per patient. We calculated sensitivity, specificity, and their 95% confidence intervals (CI).ResultsTwo sweat-sniffing dogs reached 76 and 80% sensitivity, with the 95% CI not overlapping the random value of 50%, and 75 and 88% specificity, with the 95% CI not overlapping the 50% value. The 95% CI of the sensitivity and specificity of the other two sweat dogs overlapped the 50% value. Two saliva-sniffing dogs had 70 and 78% sensitivity, and the 95% CI of their sensitivity and specificity did not overlap the 50% value. The 95% CI of the third dog's sensitivity and specificity overlapped the 50% value.ConclusionFour of the six dogs were able to detect positive samples of patients with COVID-19, with sensitivity and specificity values significantly different from random in the field. We considered the performance of the dogs promising because it is reasonable to expect that with gauze exposed for a longer time to sweat and saliva of people with COVID-19, their detection capacity would improve. The target is to reach the sensitivity range requested by the World Health Organization for the performance of an antigen test (≥80% sensitivity, ≥97% specificity). If so, dogs could become important allies for the control of the COVID-19 pandemic, especially in developing countries.
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Affiliation(s)
| | | | | | - Reyna Fabiola Osuna-Chávez
- División de Ciencias Biológicas y de la Salud, Departamento de Agricultura y Ganadería, Universidad de Sonora, Hermosillo, Mexico
| | - Ramón Enrique Robles-Zepeda
- División de Ciencias Biológicas y de la Salud, Departamento de Agricultura y Ganadería, Universidad de Sonora, Hermosillo, Mexico
| | - Blayra Maldonado-Cabrera
- División de Ciencias Biológicas y de la Salud, Departamento de Agricultura y Ganadería, Universidad de Sonora, Hermosillo, Mexico
| | - Jorge Rubén Bejar-Cornejo
- Hospital General del Estado de Sonora, Secretaria de Salud Pública del Estado de Sonora, Hermosillo, Mexico
| | - Iván Ruiz-León
- Hospital General del Estado de Sonora, Secretaria de Salud Pública del Estado de Sonora, Hermosillo, Mexico
| | | | - Anna Hielm-Björkman
- Department of Clinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Ana Novelo-González
- Laboratorio de Patología Acuática, Departamento de Recursos del Mar, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Unidad Mérida, Mérida, Mexico
| | - Victor Manuel Vidal-Martínez
- Laboratorio de Patología Acuática, Departamento de Recursos del Mar, Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional Unidad Mérida, Mérida, Mexico
- *Correspondence: Victor Manuel Vidal-Martínez
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15
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Uthman OA, Adetokunboh OO, Wiysonge CS, Al-Awlaqi S, Hanefeld J, El Bcheraoui C. Classification Schemes of COVID-19 High Risk Areas and Resulting Policies: A Rapid Review. Front Public Health 2022; 10:769174. [PMID: 35284361 PMCID: PMC8916531 DOI: 10.3389/fpubh.2022.769174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/20/2022] [Indexed: 11/13/2022] Open
Abstract
The COVID-19 pandemic has posed a significant global health threat since January 2020. Policies to reduce human mobility have been recognized to effectively control the spread of COVID-19; although the relationship between mobility, policy implementation, and virus spread remains contentious, with no clear pattern for how countries classify each other, and determine the destinations to- and from which to restrict travel. In this rapid review, we identified country classification schemes for high-risk COVID-19 areas and associated policies which mirrored the dynamic situation in 2020, with the aim of identifying any patterns that could indicate the effectiveness of such policies. We searched academic databases, including PubMed, Scopus, medRxiv, Google Scholar, and EMBASE. We also consulted web pages of the relevant government institutions in all countries. This rapid review's searches were conducted between October 2020 and December 2021. Web scraping of policy documents yielded additional 43 country reports on high-risk area classification schemes. In 43 countries from which relevant reports were identified, six issued domestic classification schemes. International classification schemes were issued by the remaining 38 countries, and these mainly used case incidence per 100,000 inhabitants as key indicator. The case incidence cut-off also varied across the countries, ranging from 20 cases per 100,000 inhabitants in the past 7 days to more than 100 cases per 100,000 inhabitants in the past 28 days. The criteria used for defining high-risk areas varied across countries, including case count, positivity rate, composite risk scores, community transmission and satisfactory laboratory testing. Countries either used case incidence in the past 7, 14 or 28 days. The resulting policies included restrictions on internal movement and international travel. The quarantine policies can be summarized into three categories: (1) 14 days self-isolation, (2) 10 days self-isolation and (3) 14 days compulsory isolation.
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Affiliation(s)
- Olalekan A. Uthman
- Warwick Centre for Global Health Research, The University of Warwick, Coventry, United Kingdom
| | - Olatunji O. Adetokunboh
- South African Centre for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, South Africa
| | - Charles Shey Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Sameh Al-Awlaqi
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Johanna Hanefeld
- Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
| | - Charbel El Bcheraoui
- Evidence-Based Public Health, Centre for International Health Protection, Robert Koch Institute, Berlin, Germany
- *Correspondence: Charbel El Bcheraoui
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16
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Grandjean D, Gallet C, Julien C, Sarkis R, Muzzin Q, Roger V, Roisse D, Dirn N, Levert C, Breton E, Galtat A, Forget A, Charreaudeau S, Gasmi F, Jean-Baptiste C, Petitjean S, Hamon K, Duquesne JM, Coudert C, Tourtier JP, Billy C, Wurtz JM, Chauvin A, Eyer X, Ziani S, Prevel L, Cherubini I, Khelili-Houas E, Hausfater P, Devillier P, Desquilbet L. Identifying SARS-COV-2 infected patients through canine olfactive detection on axillary sweat samples; study of observed sensitivities and specificities within a group of trained dogs. PLoS One 2022; 17:e0262631. [PMID: 35157716 PMCID: PMC8843128 DOI: 10.1371/journal.pone.0262631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 12/31/2021] [Indexed: 02/04/2023] Open
Abstract
There is an increasing need for rapid, reliable, non-invasive, and inexpensive mass testing methods as the global COVID-19 pandemic continues. Detection dogs could be a possible solution to identify individuals infected with SARS-CoV-2. Previous studies have shown that dogs can detect SARS-CoV-2 on sweat samples. This study aims to establish the dogs’ sensitivity (true positive rate) which measures the proportion of people with COVID-19 that are correctly identified, and specificity (true negative rate) which measures the proportion of people without COVID-19 that are correctly identified. Seven search and rescue dogs were tested using a total of 218 axillary sweat samples (62 positive and 156 negative) in olfaction cones following a randomised and double-blind protocol. Sensitivity ranged from 87% to 94%, and specificity ranged from 78% to 92%, with four dogs over 90%. These results were used to calculate the positive predictive value and negative predictive value for each dog for different infection probabilities (how likely it is for an individual to be SARS-CoV-2 positive), ranging from 10–50%. These results were compared with a reference diagnostic tool which has 95% specificity and sensitivity. Negative predictive values for six dogs ranged from ≥98% at 10% infection probability to ≥88% at 50% infection probability compared with the reference tool which ranged from 99% to 95%. Positive predictive values ranged from ≥40% at 10% infection probability to ≥80% at 50% infection probability compared with the reference tool which ranged from 68% to 95%. This study confirms previous results, suggesting that dogs could play an important role in mass-testing situations. Future challenges include optimal training methods and standardisation for large numbers of detection dogs and infrastructure supporting their deployment.
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Affiliation(s)
- Dominique Grandjean
- Ecole Nationale Vétérinaire d’Alfort (Alfort School of Veterinary Medicine), University Paris-Est, Maisons-Alfort, France
- * E-mail:
| | - Capucine Gallet
- Ecole Nationale Vétérinaire d’Alfort (Alfort School of Veterinary Medicine), University Paris-Est, Maisons-Alfort, France
| | - Clothilde Julien
- Ecole Nationale Vétérinaire d’Alfort (Alfort School of Veterinary Medicine), University Paris-Est, Maisons-Alfort, France
| | - Riad Sarkis
- Université Franco-Libanaise St Joseph (Saint Joseph University of Beirut), Beirut, Lebanon
| | - Quentin Muzzin
- Ecole Nationale Vétérinaire d’Alfort (Alfort School of Veterinary Medicine), University Paris-Est, Maisons-Alfort, France
| | - Vinciane Roger
- Ecole Nationale Vétérinaire d’Alfort (Alfort School of Veterinary Medicine), University Paris-Est, Maisons-Alfort, France
| | - Didier Roisse
- Service Départemental d’Incendie et de Secours de l’Oise (Fire and Rescue Service), Tillé, France
| | - Nicolas Dirn
- Service Départemental d’Incendie et de Secours de l’Oise (Fire and Rescue Service), Tillé, France
| | - Clement Levert
- Service Départemental d’Incendie et de Secours des Yvelines (Fire and Rescue Service), Versailles, France
| | - Erwan Breton
- Service Départemental d’Incendie et de Secours des Yvelines (Fire and Rescue Service), Versailles, France
| | - Arnaud Galtat
- Service Départemental d’Incendie et de Secours des Yvelines (Fire and Rescue Service), Versailles, France
| | - Alexandre Forget
- Service Départemental d’Incendie et de Secours des Yvelines (Fire and Rescue Service), Versailles, France
| | - Sebastien Charreaudeau
- Service Départemental d’Incendie et de Secours des Yvelines (Fire and Rescue Service), Versailles, France
| | - Fabien Gasmi
- Service Départemental d’Incendie et de Secours des Yvelines (Fire and Rescue Service), Versailles, France
| | - Caroline Jean-Baptiste
- Ecole Nationale Vétérinaire d’Alfort (Alfort School of Veterinary Medicine), University Paris-Est, Maisons-Alfort, France
| | - Sebastien Petitjean
- Service Départemental d’Incendie et de Secours des Yvelines (Fire and Rescue Service), Versailles, France
| | - Katia Hamon
- Service Départemental d’Incendie et de Secours des Yvelines (Fire and Rescue Service), Versailles, France
| | - Jean-Michel Duquesne
- Service Départemental d’Incendie et de Secours des Yvelines (Fire and Rescue Service), Versailles, France
| | - Chantal Coudert
- Service Départemental d’Incendie et de Secours des Yvelines (Fire and Rescue Service), Versailles, France
| | - Jean-Pierre Tourtier
- Hôpital d’Instruction des Armées Begin (Begin Military Hospital), Saint-Mandé, France
| | - Christophe Billy
- Centre Hospitalier François Quesnay (François Quesnay Hospital Centre), GHT Yvelines, Mantes-la-Jolie, France
| | - Jean-Marc Wurtz
- Site d’Altkirch GHRMSA (Groupement Hospitalier Mulhouse Sud Alsace), Altkirch, France
| | - Anthony Chauvin
- Hôpital Lariboisière APHP (Lariboisière Hospital, APHP Great Paris Hospitals), Paris, France
| | - Xavier Eyer
- Hôpital Lariboisière APHP (Lariboisière Hospital, APHP Great Paris Hospitals), Paris, France
| | - Sabrina Ziani
- Hôpitaux de Saint-Maurice (Saint-Maurice Hospital), Saint-Maurice, France
| | | | - Ilaria Cherubini
- Hôpital Pitié-Salpêtrière APHP (Pitié-Salpêtrière Hospital, APHP Great Paris Hospitals), Paris, France
| | - Enfel Khelili-Houas
- Hôpital Pitié-Salpêtrière APHP (Pitié-Salpêtrière Hospital, APHP Great Paris Hospitals), Paris, France
| | - Pierre Hausfater
- Hôpital Pitié-Salpêtrière APHP (Pitié-Salpêtrière Hospital, APHP Great Paris Hospitals), Paris, France
| | | | - Loic Desquilbet
- Ecole nationale vétérinaire d’Alfort, Univ Paris Est Créteil, INSERM, IMRB, Maisons-Alfort, France
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17
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Nascimento ED, Fonseca WT, de Oliveira TR, de Correia CRSTB, Faça VM, de Morais BP, Silvestrini VC, Pott-Junior H, Teixeira FR, Faria RC. COVID-19 diagnosis by SARS-CoV-2 Spike protein detection in saliva using an ultrasensitive magneto-assay based on disposable electrochemical sensor. SENSORS AND ACTUATORS. B, CHEMICAL 2022; 353:131128. [PMID: 34866796 PMCID: PMC8626148 DOI: 10.1016/j.snb.2021.131128] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 05/03/2023]
Abstract
The outbreak of the COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome of Coronavirus 2 (SARS-CoV-2), has fueled the search for diagnostic tests aiming at the control and reduction of the viral transmission. The main technique used for diagnosing the Coronavirus disease (COVID-19) is the reverse transcription-polymerase chain reaction (RT-PCR) technique. However, considering the high number of cases and the underlying limitations of the RT-PCR technique, especially with regard to accessibility and cost of the test, one does not need to overemphasize the need to develop new and less expensive testing techniques that can aid the early diagnosis of the disease. With that in mind, we developed an ultrasensitive magneto-assay using magnetic beads and gold nanoparticles conjugated to human angiotensin-converting enzyme 2 (ACE2) peptide (Gln24-Gln42) for the capturing and detection of SARS-CoV-2 Spike protein in human saliva. The technique applied involved the use of a disposable electrochemical device containing eight screen-printed carbon electrodes which allow the simultaneous analysis of eight samples. The magneto-assay exhibited an ultralow limit of detection of 0.35 ag mL-1 for the detection of SARS-CoV-2 Spike protein in saliva. The magneto-assay was tested in saliva samples from healthy and SARS-CoV-2-infected individuals. In terms of efficiency, the proposed technique - which presented a sensitivity of 100.0% and specificity of 93.7% for SARS-CoV-2 Spike protein-exhibited great similarity with the RT-PCR technique. The results obtained point to the application potential of this simple, low-cost magneto-assay for saliva-based point-of-care COVID-19 diagnosis.
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Affiliation(s)
- Evair D Nascimento
- Department of Chemistry, Federal University of São Carlos-UFSCar, Rod. Washington Luís km 235, São Carlos, SP, 13565-905, Brazil
| | - Wilson T Fonseca
- Department of Chemistry, Federal University of São Carlos-UFSCar, Rod. Washington Luís km 235, São Carlos, SP, 13565-905, Brazil
| | - Tássia R de Oliveira
- Department of Chemistry, Federal University of São Carlos-UFSCar, Rod. Washington Luís km 235, São Carlos, SP, 13565-905, Brazil
| | - Camila R S T B de Correia
- Department of Genetics and Evolution, Federal University of Sao Carlos-UFSCar, São Carlos, SP, 13565-905, Brazil
| | - Vitor M Faça
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo-USP, Brazil
| | - Beatriz P de Morais
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo-USP, Brazil
| | - Virginia C Silvestrini
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo-USP, Brazil
| | - Henrique Pott-Junior
- Department of Medicine, Federal University of São Carlos-UFSCar, São Carlos, SP, 13565-905, Brazil
| | - Felipe R Teixeira
- Department of Genetics and Evolution, Federal University of Sao Carlos-UFSCar, São Carlos, SP, 13565-905, Brazil
| | - Ronaldo C Faria
- Department of Chemistry, Federal University of São Carlos-UFSCar, Rod. Washington Luís km 235, São Carlos, SP, 13565-905, Brazil
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18
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Nascimento ED, Fonseca WT, de Oliveira TR, de Correia CRSTB, Faça VM, de Morais BP, Silvestrini VC, Pott-Junior H, Teixeira FR, Faria RC. COVID-19 diagnosis by SARS-CoV-2 Spike protein detection in saliva using an ultrasensitive magneto-assay based on disposable electrochemical sensor. SENSORS AND ACTUATORS. B, CHEMICAL 2022; 353:131128. [PMID: 34866796 DOI: 10.1016/j.snb.2021.131148] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 05/27/2023]
Abstract
The outbreak of the COVID-19 pandemic, caused by Severe Acute Respiratory Syndrome of Coronavirus 2 (SARS-CoV-2), has fueled the search for diagnostic tests aiming at the control and reduction of the viral transmission. The main technique used for diagnosing the Coronavirus disease (COVID-19) is the reverse transcription-polymerase chain reaction (RT-PCR) technique. However, considering the high number of cases and the underlying limitations of the RT-PCR technique, especially with regard to accessibility and cost of the test, one does not need to overemphasize the need to develop new and less expensive testing techniques that can aid the early diagnosis of the disease. With that in mind, we developed an ultrasensitive magneto-assay using magnetic beads and gold nanoparticles conjugated to human angiotensin-converting enzyme 2 (ACE2) peptide (Gln24-Gln42) for the capturing and detection of SARS-CoV-2 Spike protein in human saliva. The technique applied involved the use of a disposable electrochemical device containing eight screen-printed carbon electrodes which allow the simultaneous analysis of eight samples. The magneto-assay exhibited an ultralow limit of detection of 0.35 ag mL-1 for the detection of SARS-CoV-2 Spike protein in saliva. The magneto-assay was tested in saliva samples from healthy and SARS-CoV-2-infected individuals. In terms of efficiency, the proposed technique - which presented a sensitivity of 100.0% and specificity of 93.7% for SARS-CoV-2 Spike protein-exhibited great similarity with the RT-PCR technique. The results obtained point to the application potential of this simple, low-cost magneto-assay for saliva-based point-of-care COVID-19 diagnosis.
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Affiliation(s)
- Evair D Nascimento
- Department of Chemistry, Federal University of São Carlos-UFSCar, Rod. Washington Luís km 235, São Carlos, SP, 13565-905, Brazil
| | - Wilson T Fonseca
- Department of Chemistry, Federal University of São Carlos-UFSCar, Rod. Washington Luís km 235, São Carlos, SP, 13565-905, Brazil
| | - Tássia R de Oliveira
- Department of Chemistry, Federal University of São Carlos-UFSCar, Rod. Washington Luís km 235, São Carlos, SP, 13565-905, Brazil
| | - Camila R S T B de Correia
- Department of Genetics and Evolution, Federal University of Sao Carlos-UFSCar, São Carlos, SP, 13565-905, Brazil
| | - Vitor M Faça
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo-USP, Brazil
| | - Beatriz P de Morais
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo-USP, Brazil
| | - Virginia C Silvestrini
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of São Paulo-USP, Brazil
| | - Henrique Pott-Junior
- Department of Medicine, Federal University of São Carlos-UFSCar, São Carlos, SP, 13565-905, Brazil
| | - Felipe R Teixeira
- Department of Genetics and Evolution, Federal University of Sao Carlos-UFSCar, São Carlos, SP, 13565-905, Brazil
| | - Ronaldo C Faria
- Department of Chemistry, Federal University of São Carlos-UFSCar, Rod. Washington Luís km 235, São Carlos, SP, 13565-905, Brazil
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Ember K, Daoust F, Mahfoud M, Dallaire F, Ahmad EZ, Tran T, Plante A, Diop MK, Nguyen T, St-Georges-Robillard A, Ksantini N, Lanthier J, Filiatrault A, Sheehy G, Beaudoin G, Quach C, Trudel D, Leblond F. Saliva-based detection of COVID-19 infection in a real-world setting using reagent-free Raman spectroscopy and machine learning. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-210270RR. [PMID: 35142113 PMCID: PMC8825664 DOI: 10.1117/1.jbo.27.2.025002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/20/2022] [Indexed: 05/31/2023]
Abstract
SIGNIFICANCE The primary method of COVID-19 detection is reverse transcription polymerase chain reaction (RT-PCR) testing. PCR test sensitivity may decrease as more variants of concern arise and reagents may become less specific to the virus. AIM We aimed to develop a reagent-free way to detect COVID-19 in a real-world setting with minimal constraints on sample acquisition. The machine learning (ML) models involved could be frequently updated to include spectral information about variants without needing to develop new reagents. APPROACH We present a workflow for collecting, preparing, and imaging dried saliva supernatant droplets using a non-invasive, label-free technique-Raman spectroscopy-to detect changes in the molecular profile of saliva associated with COVID-19 infection. RESULTS We used an innovative multiple instance learning-based ML approach and droplet segmentation to analyze droplets. Amongst all confounding factors, we discriminated between COVID-positive and COVID-negative individuals yielding receiver operating coefficient curves with an area under curve (AUC) of 0.8 in both males (79% sensitivity and 75% specificity) and females (84% sensitivity and 64% specificity). Taking the sex of the saliva donor into account increased the AUC by 5%. CONCLUSION These findings may pave the way for new rapid Raman spectroscopic screening tools for COVID-19 and other infectious diseases.
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Affiliation(s)
- Katherine Ember
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - François Daoust
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Myriam Mahfoud
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Frédérick Dallaire
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Esmat Zamani Ahmad
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
- Institut du cancer de Montréal, Montreal, Canada
| | - Trang Tran
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Arthur Plante
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Mame-Kany Diop
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
- Institut du cancer de Montréal, Montreal, Canada
| | - Tien Nguyen
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
- Institut du cancer de Montréal, Montreal, Canada
| | - Amélie St-Georges-Robillard
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Nassim Ksantini
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Julie Lanthier
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Antoine Filiatrault
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Guillaume Sheehy
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Gabriel Beaudoin
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
| | - Caroline Quach
- Research Center, CHU Sainte-Justine, Montreal, Canada
- University of Montreal, Faculty of Medicine, Montreal, Quebec, Canada
| | - Dominique Trudel
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
- Institut du cancer de Montréal, Montreal, Canada
- Université de Montréal, Department of Pathology and Cellular Biology, Montreal, Quebec, Canada
- Center Hospitalier de l’Université de Montréal, Department of Pathology, Montreal, Quebec, Canada
| | - Frédéric Leblond
- Polytechnique Montréal, Montreal, Canada
- Center de recherche du Center hospitalier de l’Université de Montréal, Montreal, Canada
- Institut du cancer de Montréal, Montreal, Canada
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20
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Riccobono E, Bussini L, Giannella M, Viale P, Rossolini GM. Rapid diagnostic tests in the management of pneumonia. Expert Rev Mol Diagn 2021; 22:49-60. [PMID: 34894965 DOI: 10.1080/14737159.2022.2018302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Pneumonia is one of the main causes of mortality associated with infectious diseases worldwide. Several challenges have been identified in the management of patients with pneumonia, ranging from accurate and cost-effective microbiological investigations, prompt and adequate therapeutic management, and optimal treatment duration. AREAS COVERED In this review, an updated summary on the current management of pneumonia patients is provided and the epidemiological issues of infectious respiratory diseases, which in the current pandemic situation are of particular concern, are addressed. The clinical and microbiological approaches to pneumonia diagnosis are reviewed, including discussion about the new molecular assays pointing out both their strengths and limitations. Finally, the current recommendations about antibiotic treatment are examined and discussed depending on the epidemiological contexts, including those with high prevalence of multidrug-resistant bacteria. EXPERT OPINION We claim that rapid diagnostic tests, if well-positioned in the diagnostic workflow and reserved for the subset of patients who could most benefit from these technologies, may represent an interesting and feasible tool to optimize timing of targeted treatments especially in terms of early de-escalation or discontinuation of antibiotic therapy.
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Affiliation(s)
- Eleonora Riccobono
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Linda Bussini
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant' Orsola, Bologna, Italy
| | - Maddalena Giannella
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant' Orsola, Bologna, Italy
| | - Pierluigi Viale
- Infectious Diseases Unit, Department of Medical and Surgical Sciences, Policlinico Sant' Orsola, Bologna, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Clinical Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
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21
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Hu K, Tardif JC, Huber M, Daly M, Langford AT, Kirby R, Rosenberg Y, Hochman J, Joshi A, Bassevitch Z, Pillinger MH, Shah B. Chasing the storm: Recruiting non-hospitalized patients for a multi-site randomized controlled trial in the United States during the COVID-19 pandemic. Clin Transl Sci 2021; 15:831-837. [PMID: 34953032 PMCID: PMC9010275 DOI: 10.1111/cts.13211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 11/28/2022] Open
Abstract
Randomized controlled trials (RCTs) remain the gold standard to evaluate clinical interventions, producing the highest level of evidence while minimizing potential bias. Inadequate recruitment is a commonly encountered problem that undermines the completion and generalizability of RCTs—and is even more challenging when enrolling amidst a pandemic. Here, we reflect on our experiences with virtual recruitment of non‐hospitalized patients in the United States for ColCorona, an international, multicenter, randomized, placebo‐controlled coronavirus disease 2019 (COVID‐19) drug trial. Recruitment challenges during a pandemic include constraints created by shelter‐in‐place policies and targeting enrollment according to national and local fluctuations in infection rate. Presenting a study to potential participants who are sick with COVID‐19 and may be frightened, overwhelmed, or mistrusting of clinical research remains a challenge. Strategies previously reported to improve recruitment include transparency, patient and site education, financial incentives, and person‐to‐person outreach. Active measures taken during ColCorona to optimize United States recruitment involved rapid expansion of sites, adjustment of recruitment scripts, assessing telephone calls versus text messages for initial contact with participants, institutional review board‐approved financial compensation, creating an infrastructure to systematically identify potentially eligible patients, partnering with testing sites, appealing to both self‐interest and altruism, and large‐scale media efforts with varying degrees of success.
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Affiliation(s)
- Kelly Hu
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | | | - Melanie Huber
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Maria Daly
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Aisha T Langford
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Ruth Kirby
- National Heart Lung Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Yves Rosenberg
- National Heart Lung Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Judith Hochman
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Avni Joshi
- Division of Allergy/Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Michael H Pillinger
- Division of Rheumatology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Section of Rheumatology, Department of Medicine, United States Department of Veterans Affairs, New York, New York, USA
| | - Binita Shah
- Division of Cardiology, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA.,Section of Cardiology, Department of Medicine, United States Department of Veterans Affairs, New York, New York, USA
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22
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Taylor SC. A practical approach to SARS-CoV-2 testing in a pre and post-vaccination era. JOURNAL OF CLINICAL VIROLOGY PLUS 2021; 1:100044. [PMID: 35262025 PMCID: PMC8500693 DOI: 10.1016/j.jcvp.2021.100044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/23/2021] [Accepted: 10/02/2021] [Indexed: 11/26/2022] Open
Abstract
As countries globally are in the process of planning, introducing or implementing mass vaccination strategies while continuing to deal with the ongoing SARS-CoV-2 pandemic, an evolution in testing strategies may be required to minimize spread in mixed vaccinated and non-vaccinated populations. This mini-review explores the key public health questions associated with the widely varying efficacy of commercially available vaccines and their persistence of protection in the context of a growing number of variant virus strains. A new strategy for SARS-CoV-2 testing that accommodates the current and evolving pandemic paradigm is proposed.
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Affiliation(s)
- Sean C Taylor
- GENSCRIPT USA INC. 860 Centennial Ave., Piscataway 08854, NJ, United States
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23
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Sahoo P, Roy I, Ahlawat R, Irtiza S, Khan L. Potential diagnosis of COVID-19 from chest X-ray and CT findings using semi-supervised learning. Phys Eng Sci Med 2021; 45:31-42. [PMID: 34780042 PMCID: PMC8591440 DOI: 10.1007/s13246-021-01075-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 10/30/2021] [Indexed: 12/11/2022]
Abstract
COVID-19 is an infectious disease, which has adversely affected public health and the economy across the world. On account of the highly infectious nature of the disease, rapid automated diagnosis of COVID-19 is urgently needed. A few recent findings suggest that chest X-rays and CT scans can be used by machine learning for the diagnosis of COVID-19. Herein, we employed semi-supervised learning (SSL) approaches to detect COVID-19 cases accurately by analyzing digital chest X-rays and CT scans. On a relatively small COVID-19 radiography dataset, which contains only 219 COVID-19 positive images, 1341 normal and 1345 viral pneumonia images, our algorithm, COVIDCon, which takes advantage of data augmentation, consistency regularization, and multicontrastive learning, attains 97.07% average class prediction accuracy, with 1000 labeled images, which is 7.65% better than the next best SSL method, virtual adversarial training. COVIDCon performs even better on a larger COVID-19 CT Scan dataset that contains 82,767 images. It achieved an excellent accuracy of 99.13%, at 20,000 labels, which is 6.45% better than the next best pseudo-labeling approach. COVIDCon outperforms other state-of-the-art algorithms at every label that we have investigated. These results demonstrate COVIDCon as the benchmark SSL algorithm for potential diagnosis of COVID-19 from chest X-rays and CT-Scans. Furthermore, COVIDCon performs exceptionally well in identifying COVID-19 positive cases from a completely unseen repository with a confirmed COVID-19 case history. COVIDCon, may provide a fast, accurate, and reliable method for screening COVID-19 patients.
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Affiliation(s)
- Pracheta Sahoo
- Department of Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA.
| | - Indranil Roy
- Department of Chemistry, Northwestern University, 2145 Sheridan Road, Evanston, IL, 60208-3113, USA
| | - Randeep Ahlawat
- Department of Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Saquib Irtiza
- Department of Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Latifur Khan
- Department of Computer Science, The University of Texas at Dallas, Richardson, TX, 75080, USA
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24
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Ensemble Deep Learning for the Detection of COVID-19 in Unbalanced Chest X-ray Dataset. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app112210528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The ongoing COVID-19 pandemic has caused devastating effects on humanity worldwide. With practical advantages and wide accessibility, chest X-rays (CXRs) play vital roles in the diagnosis of COVID-19 and the evaluation of the extent of lung damages incurred by the virus. This study aimed to leverage deep-learning-based methods toward the automated classification of COVID-19 from normal and viral pneumonia on CXRs, and the identification of indicative regions of COVID-19 biomarkers. Initially, we preprocessed and segmented the lung regions usingDeepLabV3+ method, and subsequently cropped the lung regions. The cropped lung regions were used as inputs to several deep convolutional neural networks (CNNs) for the prediction of COVID-19. The dataset was highly unbalanced; the vast majority were normal images, with a small number of COVID-19 and pneumonia images. To remedy the unbalanced distribution and to avoid biased classification results, we applied five different approaches: (i) balancing the class using weighted loss; (ii) image augmentation to add more images to minority cases; (iii) the undersampling of majority classes; (iv) the oversampling of minority classes; and (v) a hybrid resampling approach of oversampling and undersampling. The best-performing methods from each approach were combined as the ensemble classifier using two voting strategies. Finally, we used the saliency map of CNNs to identify the indicative regions of COVID-19 biomarkers which are deemed useful for interpretability. The algorithms were evaluated using the largest publicly available COVID-19 dataset. An ensemble of the top five CNNs with image augmentation achieved the highest accuracy of 99.23% and area under curve (AUC) of 99.97%, surpassing the results of previous studies.
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25
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Sudhan MD, Singh RK, Yadav R, Sivasankar R, Mathai SS, Shankaran R, Kulkarni SN, Shanthanu CP, Sandhya LM, Shaikh A. Neurosurgical Outcomes, Protocols, and Resource Management During Lockdown: Early Institutional Experience from One of the World's Largest COVID 19 Hotspots. World Neurosurg 2021; 155:e34-e40. [PMID: 34325030 PMCID: PMC8312048 DOI: 10.1016/j.wneu.2021.07.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND As the COVID-19 pandemic surpasses 1 year, it is prudent to reflect on the challenges faced and the management strategies employed to tackle this overwhelming health care crisis. We undertook this study to validate our institutional protocols, which were formulated to cater to the change in volume and pattern of neurosurgical cases during the raging pandemic. METHODS All admitted patients scheduled to undergo major neurosurgical intervention during the lockdown period (15 March 2020 to 15 September 2020) were included in the study. The data involving surgery outcomes, disease pattern, anesthesia techniques, patient demographics, as well as COVID-19 status, were analyzed and compared with similar retrospective data of neurosurgical patients operated during the same time period in the previous year (15 March 2019 to 15 September 2019). RESULTS Barring significant increase in surgery for stroke (P = 0.008) and hydrocephalus (P <0.001), the overall case load of neurosurgery during the study period in 2020 was 42.75% of that in 2019 (P < 0.001), attributable to a significant reduction in elective spine surgeries (P < 0.001). However, no significant difference was observed in the overall incidence of emergency and essential surgeries undertaken during the 2 time periods (P = 0.482). There was an increased incidence in the use of monitored anesthesia care techniques during emergency and essential neurosurgical procedures by the anesthesia team in 2020 (P < 0.001). COVID-19 patients had overall poor outcomes (P = 0.003), with significant increase in mortality among those subjected to general anesthesia vis-a-vis monitored anesthesia care (P = 0.014). CONCLUSIONS Despite a significant decrease in neurosurgical workload during the COVID-19 lockdown period in 2020, the volume of emergency and essential surgeries did not change much compared with the previous year. Surgery in COVID-19 patients is best avoided, unless critical, as the outcome in these patients is not favorable. The employment of monitored anesthesia care techniques like awake craniotomy and regional anesthesia facilitate a better outcome in the ongoing COVID-19 era.
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Affiliation(s)
| | | | - Rahul Yadav
- Department of Neuroanaesthesiology, INHS Asvini, Colaba, Mumbai, India,To whom correspondence should be addressed: Rahul Yadav, D.M
| | - Rajeev Sivasankar
- Department of Radiodiagnosis and Interventional Radiology, INHS Asvini, Colaba, Mumbai, India
| | - Sheila Samanta Mathai
- Commanding Officer and Chairperson, COVID-19 Protocol Committee, INHS Asvini, Colaba, Mumbai, India
| | - Ramakrishnan Shankaran
- Department of Surgery and Senior Member, COVID-19 Protocol Committee, INHS Asvini, Colaba, Mumbai, India
| | | | | | | | - Azimuddin Shaikh
- Department of Neuroanaesthesiology, INHS Asvini, Colaba, Mumbai, India
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26
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International comparisons of COVID-19 case and mortality data and the effectiveness of non-pharmaceutical interventions: a plea for reconsideration. J Biosoc Sci 2021; 54:735-741. [PMID: 34702386 DOI: 10.1017/s0021932021000547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
International comparisons of the effectiveness of coronavirus disease 2019 (COVID-19) non-pharmaceutical interventions (NPIs) based on national case and mortality data are fraught with underestimated complexity. This article calls for stronger attention to just how extensive is the multifactorial nature of national case and mortality data, and argues that, unless a globally consistent benchmark of measurement can be devised, such comparisons are facile, if not misleading. This can lead to policy decisions and public support for the adoption of potentially harmful NPIs that are ineffective in combating the COVID-19 pandemic and damaging to mental health, social cohesion, human rights and economic development. The unscientific use of international comparisons of case and mortality data in public discourse, media reporting and policymaking on NPI effectiveness should be subject to greater scrutiny.
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27
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High Seroprevalence of SARS-CoV-2 (COVID-19)-Specific Antibodies among Healthcare Workers: A Cross-Sectional Study in Guilan, Iran. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2021; 2021:9081491. [PMID: 34691195 PMCID: PMC8536443 DOI: 10.1155/2021/9081491] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 12/23/2022]
Abstract
Background This study was conducted to evaluate the anti‐SARS‐CoV‐2 IgM and IgG antibodies among healthcare workers in Guilan. Methods This cross-sectional study was conducted on 503 healthcare workers. Between April and May 2020, blood samples were collected from the healthcare workers of Razi Hospital in Rasht, Guilan, Iran. Enzyme-linked immunosorbent assay (ELISA) was used for the detection and quantitation of anti‐SARS‐CoV‐2 IgM/IgG antibodies by using kits made by Pishtaz Teb Company, Tehran, Iran. Results From a total of 503 participants, the result of the anti‐SARS‐CoV‐2 IgM antibody test was positive in 28 subjects (5.6%) and the anti‐SARS‐CoV‐2 IgG antibody test was positive in171 subjects (34%). Participants in the age group of 35–54 years were significantly more likely to have a positive anti‐SARS‐CoV‐2 antibody test than the age group of 20–34 years (odds ratio = 1.53, 95% CI: 1.04–2.25, P=0.029). Also, physicians were significantly more likely to have a positive antibody test than office workers (odds ratio = 1.92, 95% CI: 1.04–3.54, P=0.037). The wide range of symptoms was significantly associated with the positive anti‐SARS‐CoV‐2 antibody test. The most significant association was observed between fever and a positive anti‐SARS‐CoV‐2 antibody test (odds ratio = 3.03, 95% CI: 2.06–4.44, P < 0.001). Conclusion The results of the current study indicated that the seroprevalence of COVID-19 was high among healthcare workers of Guilan Province. It seems that this finding was due to the earlier exposure to COVID-19 and the lack of awareness and preparedness to deal with the pandemic in Iran, compared to other countries.
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28
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Kanwar N, Banerjee D, Sasidharan A, Abdulhamid A, Larson M, Lee B, Selvarangan R, Liesman RM. Comparison of diagnostic performance of five molecular assays for detection of SARS-CoV-2. Diagn Microbiol Infect Dis 2021; 101:115518. [PMID: 34481324 PMCID: PMC8343369 DOI: 10.1016/j.diagmicrobio.2021.115518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/26/2021] [Accepted: 08/01/2021] [Indexed: 12/01/2022]
Abstract
We compared the performance of the Abbott Real Time SARS-CoV-2 assay (Abbott assay), Aptima™ SARS-CoV-2 assay (Aptima assay), BGI Real-Time SARS-CoV-2 assay (BGI assay), Lyra® SARS-CoV-2 assay (Lyra assay), and DiaSorin Simplexa™ COVID assay for SARS-CoV-2 detection. Residual nasopharyngeal samples (n = 201) submitted for routine SARS-CoV-2 testing by Simplexa assay during June-July 2020 and January 2021 were salvaged. Aliquots were tested on other assays and compared against the CDC 2019-nCoV Real-Time RT-PCR assay. Viral load in positive samples was determined by droplet digital PCR. Among 201 samples, 99 were positive and 102 were negative by the CDC assay. The Aptima and Abbott assays exhibited the highest positive percent agreement (PPA) at 98.9% while the BGI assay demonstrated the lowest PPA of 89.9% with 10 missed detections. Negative percent agreement for all 5 platforms was comparable, ranging from 96.1% to 100%. The performance of all five assays was comparable.
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Affiliation(s)
- Neena Kanwar
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, MO, USA; School of Medicine, University of Missouri- Kansas City, MO, USA
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, MO, USA; School of Medicine, University of Missouri- Kansas City, MO, USA
| | - Anjana Sasidharan
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, MO, USA
| | - Ayah Abdulhamid
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, MO, USA
| | - Marissa Larson
- Department of Pathology and Laboratory Medicine, University of Kansas Health System, Kansas City, KS, USA
| | - Brian Lee
- School of Medicine, University of Missouri- Kansas City, MO, USA; Division of Health Services and Outcomes Research, Children's Mercy, Kansas City, MO, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy, Kansas City, MO, USA; School of Medicine, University of Missouri- Kansas City, MO, USA; Department of Pathology and Laboratory Medicine, University of Kansas Health System, Kansas City, KS, USA.
| | - Rachael M Liesman
- Department of Pathology and Laboratory Medicine, University of Kansas Health System, Kansas City, KS, USA.
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Khasawneh N, Fraiwan M, Fraiwan L, Khassawneh B, Ibnian A. Detection of COVID-19 from Chest X-ray Images Using Deep Convolutional Neural Networks. SENSORS (BASEL, SWITZERLAND) 2021; 21:5940. [PMID: 34502829 PMCID: PMC8434649 DOI: 10.3390/s21175940] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/19/2021] [Accepted: 09/01/2021] [Indexed: 12/24/2022]
Abstract
The COVID-19 global pandemic has wreaked havoc on every aspect of our lives. More specifically, healthcare systems were greatly stretched to their limits and beyond. Advances in artificial intelligence have enabled the implementation of sophisticated applications that can meet clinical accuracy requirements. In this study, customized and pre-trained deep learning models based on convolutional neural networks were used to detect pneumonia caused by COVID-19 respiratory complications. Chest X-ray images from 368 confirmed COVID-19 patients were collected locally. In addition, data from three publicly available datasets were used. The performance was evaluated in four ways. First, the public dataset was used for training and testing. Second, data from the local and public sources were combined and used to train and test the models. Third, the public dataset was used to train the model and the local data were used for testing only. This approach adds greater credibility to the detection models and tests their ability to generalize to new data without overfitting the model to specific samples. Fourth, the combined data were used for training and the local dataset was used for testing. The results show a high detection accuracy of 98.7% with the combined dataset, and most models handled new data with an insignificant drop in accuracy.
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Affiliation(s)
- Natheer Khasawneh
- Department of Software Engineering, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
| | - Mohammad Fraiwan
- Department of Computer Engineering, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan;
| | - Luay Fraiwan
- Department of Biomedical Engineering, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan;
| | - Basheer Khassawneh
- Department of Internal Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan; (B.K.); (A.I.)
| | - Ali Ibnian
- Department of Internal Medicine, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan; (B.K.); (A.I.)
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30
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Taher J, Randell EW, Arnoldo S, Bailey D, De Guire V, Kaur S, Knauer M, Petryayeva E, Poutanen SM, Shaw JLV, Uddayasankar U, White-Al Habeeb N, Konforte D. Canadian Society of Clinical Chemists (CSCC) consensus guidance for testing, selection and quality management of SARS-CoV-2 point-of-care tests. Clin Biochem 2021; 95:1-12. [PMID: 34048776 PMCID: PMC8144094 DOI: 10.1016/j.clinbiochem.2021.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/02/2021] [Accepted: 05/22/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVES A consensus guidance is provided for testing, utility and verification of SARS-CoV-2 point-of-care test (POCT) performance and implementation of a quality management program, focusing on nucleic acid and antigen targeted technologies. DESIGN AND METHODS The recommendations are based on current literature and expert opinion from the members of Canadian Society of Clinical Chemists (CSCC), and are intended for use inside or outside of healthcare settings that have varied levels of expertise and experience with POCT. RESULTS AND CONCLUSIONS Here we discuss sampling requirements, biosafety, SARS-CoV-2 point-of-care testing methodologies (with focus on Health Canada approved tests), test performance and limitations, test selection, testing utility, development and implementation of quality management systems, quality improvement, and medical and scientific oversight.
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Affiliation(s)
- Jennifer Taher
- Pathology and Laboratory Medicine, Sinai Health System, Toronto, Canada; University of Toronto, Laboratory Medicine and Pathobiology, Toronto, Canada
| | - Edward W Randell
- Department of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, Newfoundland, Canada
| | - Saranya Arnoldo
- University of Toronto, Laboratory Medicine and Pathobiology, Toronto, Canada; William Osler Health System, Brampton, Canada
| | | | - Vincent De Guire
- Clinical Biochemistry, Maisonneuve-Rosemont Hospital, Optilab-CHUM Laboratory Network, Montreal, Canada; Biochemistry, Maisonneuve-Rosemont Hospital Research Centre, University of Montreal, Montreal, Canada
| | - Sukhbir Kaur
- Fraser Health Authority, Vancouver, Canada; Pathology and Laboratory Medicine, University of British Columbia, Canada
| | - Michael Knauer
- Pathology and Laboratory Medicine, London Health Sciences Center, London, Canada; Pathology and Laboratory Medicine, University of Western Ontario, London, Canada
| | - Eleonora Petryayeva
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Canada
| | - Susan M Poutanen
- University of Toronto, Laboratory Medicine and Pathobiology, Toronto, Canada; University of Toronto, Medicine, Toronto, Canada; University Health Network/Sinai Health Department of Microbiology, Toronto, Canada
| | - Julie L V Shaw
- Eastern Ontario Regional Laboratory Association, Canada; Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
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31
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Evaluating tests for diagnosing COVID-19 in the absence of a reliable reference standard: pitfalls and potential solutions. J Clin Epidemiol 2021; 138:182-188. [PMID: 34358639 PMCID: PMC8330140 DOI: 10.1016/j.jclinepi.2021.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/22/2021] [Accepted: 07/29/2021] [Indexed: 01/12/2023]
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32
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García-Ruiz NS, Ramirez-Caban L, Malekzadeh M, Padilla PF. Perioperative management for gynecologic minimally invasive surgery during the COVID-19 pandemic. Curr Opin Obstet Gynecol 2021; 33:262-269. [PMID: 34183549 DOI: 10.1097/gco.0000000000000718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW This article will review current guidelines regarding surgical protocols for elective and nonelective surgeries during the severe acute respiratory syndrome coronavirus 2 pandemic. RECENT FINDINGS Perioperative management for surgical patients should be modified to promote the safety and wellbeing of patients and caregivers amidst the COVID-19 pandemic. COVID-19 testing should be performed preoperatively with subsequent preprocedure quarantine. Nonemergent or nonlife-threatening surgery should be postponed for COVID-19 positive patients. The consensus of surgical societies is to use a laparoscopic surgical approach for COVID-19 positive patients when appropriate and to avoid port venting at the end of procedures. For COVID-19 positive patients requiring an emergent procedure, the use of personal protective equipment is strongly recommended. SUMMARY After over a year of the COVID-19 pandemic, effective protocols and precautions have been established to decrease the morbidity and mortality of patients undergoing surgery and to promote the safety of healthcare personnel. Continued investigations are necessary as cases of new, possibly more virulent, strains of the virus arise.
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33
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Misra R, Acharya S, Sushmitha N. Nanobiosensor-based diagnostic tools in viral infections: Special emphasis on Covid-19. Rev Med Virol 2021; 32:e2267. [PMID: 34164867 PMCID: PMC8420101 DOI: 10.1002/rmv.2267] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/10/2021] [Indexed: 01/09/2023]
Abstract
The rapid propagation of novel human coronavirus 2019 and its emergence as a pandemic raising morbidity calls for taking more appropriate measures for rapid improvement of present diagnostic techniques which are time‐consuming, labour‐intensive and non‐portable. In this scenario, biosensors can be considered as a means to outmatch customary techniques and deliver point‐of‐care diagnostics for many diseases in a much better way owing to their speed, cost‐effectiveness, accuracy, sensitivity and selectivity. Besides this, these biosensors have been aptly used to detect a wide spectrum of viruses thus facilitating timely delivery of correct therapy. The present review is an attempt to analyse such different kinds of biosensors that have been implemented for virus detection. Recently, the field of nanotechnology has given a great push to diagnostic techniques by the development of smart and miniaturised nanobiosensors which have enhanced the diagnostic procedure and taken it to a new level. The portability, hardiness and affordability of nanobiosensor make them an apt diagnostic agent for different kinds of viruses including SARS‐CoV‐2. The role of such novel nanobiosensors in the diagnosis of SARS‐CoV‐2 has also been addressed comprehensively in the present review. Along with this, the challenges and future position of developing such ultrasensitive nanobiosensors which should be taken into consideration before declaring these nano‐weapons as the ideal futuristic gold standard of diagnosis has also been accounted for here.
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Affiliation(s)
- Ranjita Misra
- Centre for Molecular and Nanomedical Sciences, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
| | - Sarbari Acharya
- Department of Life Science, School of Applied Sciences, Kalinga Institute of Industrial Technology, Bhubaneswar, Odisha, India
| | - Nehru Sushmitha
- Centre for Molecular and Nanomedical Sciences, Sathyabama Institute of Science and Technology, Chennai, Tamil Nadu, India
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34
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Yu F, Xie G, Zheng S, Han D, Bao J, Zhang D, Feng B, Wang Q, Zou Q, Wang R, Yang X, Chen W, Lou B, Chen Y. Assessment of the Diagnostic Ability of Four Detection Methods Using Three Sample Types of COVID-19 Patients. Front Cell Infect Microbiol 2021; 11:685640. [PMID: 34164346 PMCID: PMC8216554 DOI: 10.3389/fcimb.2021.685640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/19/2021] [Indexed: 12/18/2022] Open
Abstract
Background Viral nucleic acid detection is considered the gold standard for the diagnosis of coronavirus disease 2019 (COVID-19), which is caused by SARS-CoV-2 infection. However, unsuitable sample types and laboratory detection kits/methods lead to misdiagnosis, which delays the prevention and control of the pandemic. Methods We compared four nucleic acid detection methods [two kinds of reverse transcription polymerase chain reactions (RT-PCR A: ORF1ab and N testing; RT-PCRB: only ORF1ab testing), reverse transcription recombinase aided amplification (RT-RAA) and droplet digital RT-PCR (dd-RT-PCR)] using 404 samples of 72 hospitalized COVID-19 patients, including oropharyngeal swab (OPS), nasopharyngeal swabs (NPS) and saliva after deep cough, to evaluate the best sample type and method for SARS-CoV-2 detection. Results Among the four methods, dd-RT-PCR exhibited the highest positivity rate (93.0%), followed by RT-PCR B (91.2%) and RT-RAA (91.2%), while the positivity rate of RT-PCR A was only 71.9%. The viral load in OPS [24.90 copies/test (IQR 15.58-129.85)] was significantly lower than that in saliva [292.30 copies/test (IQR 20.20-8628.55)] and NPS [274.40 copies/test (IQR 33.10-2836.45)]. In addition, if OPS samples were tested alone by RT-PCR A, only 21.4% of the COVID-19 patients would be considered positive. The accuracy of all methods reached nearly 100% when saliva and NPS samples from the same patient were tested simultaneously. Conclusions SARS-CoV-2 nucleic acid detection methods should be fully evaluated before use. High-positivity rate methods such as RT-RAA and dd-RT-PCR should be considered when possible. Furthermore, saliva after deep cough and NPS can greatly improve the accuracy of the diagnosis, and testing OPS alone is not recommended.
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Affiliation(s)
- Fei Yu
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Guoliang Xie
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Shufa Zheng
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Dongsheng Han
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Jiaqi Bao
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Dan Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Baihuan Feng
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Qi Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Qianda Zou
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Ruonan Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Xianzhi Yang
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Weizhen Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Bin Lou
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China
| | - Yu Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.,Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Hangzhou, China.,Institute of Laboratory Medicine, Zhejiang University, Hangzhou, China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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35
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Stang A, Robers J, Schonert B, Jöckel KH, Spelsberg A, Keil U, Cullen P. The performance of the SARS-CoV-2 RT-PCR test as a tool for detecting SARS-CoV-2 infection in the population. J Infect 2021; 83:237-279. [PMID: 34081958 PMCID: PMC8166461 DOI: 10.1016/j.jinf.2021.05.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany; School of Public Health, Department of Epidemiology, Boston University, Boston, USA.
| | - Johannes Robers
- MVZ Labor Münster Hafenweg GmbH, Hafenweg 9-11; 48155, Münster, Germany.
| | - Birte Schonert
- MVZ Labor Münster Hafenweg GmbH, Hafenweg 9-11; 48155 Münster, Germany.
| | - Karl-Heinz Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany.
| | - Angela Spelsberg
- Tumorzentrum Aachen e.V., Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Ulrich Keil
- Institute of Epidemiology and Social Medicine, University of Münster, Albert Schweitzer Campus 1, 48149 Münster.
| | - Paul Cullen
- MVZ Labor Münster Hafenweg GmbH, Hafenweg 9-11; 48155, Münster, Germany.
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36
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Kirkley K, Benedetto U, Caputo M, Angelini GD, Vohra HA. The ongoing impact of COVID-19 on adult cardiac surgery and suggestions for safe continuation throughout the pandemic: a review of expert opinions. Perfusion 2021; 37:340-349. [PMID: 33985387 PMCID: PMC9069655 DOI: 10.1177/02676591211013730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To establish the impact of the COVID-19 pandemic on adult cardiac surgery by reviewing current data and use this to establish methods for safely continuing to carry out surgery. Methods: Conduction of a literature search via PubMed using the search terms: ‘(adult cardiac OR cardiothoracic OR surgery OR minimally invasive OR sternotomy OR hemi-sternotomy OR aortic valve OR mitral valve OR elective OR emergency) AND (COVID-19 or coronavirus OR SARS-CoV-2 OR 2019-nCoV OR 2019 novel coronavirus OR pandemic)’. Thirty-two articles were selected. Results: Cardiac surgery patients have an increased risk of complications from COVID-19 and require vital finite resources such as intensive care beds, also required by COVID-19 patients. Thus reducing their admission and potential hospital-acquired infection with COVID-19 is paramount. During the peak, only emergencies such as acute aortic dissections were treated, triaging patients according to surgical priority and cancelling all elective procedures. Screening and 2-week quarantine prior to admission were essential changes, alongside additional levels of PPE. Focus was on reducing length of stay and switching to day-cases to reduce post-operative transmission risk, whilst several hospitals adopted ‘hot’ and ‘cold’ operating theatres for covid-confirmed and covid-negative patients. Conclusions: This paper suggests a ‘CARDIO’ approach for reintroducing elective procedures: ‘Care, Assess, Re-Evaluate, Develop, Implement, Overcome’; prioritising the mental and physical health of the workforce, learning from and sharing experiences and objectively prioritising patients to improve case load.
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Affiliation(s)
- Kirstie Kirkley
- Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Umberto Benedetto
- Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Massimo Caputo
- Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Gianni D Angelini
- Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
| | - Hunaid A Vohra
- Department of Cardiac Surgery/Cardiovascular Sciences, Bristol Heart Institute, University of Bristol, Bristol, UK
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37
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Suklan J, Cheaveau J, Hill S, Urwin SG, Green K, Winter A, Hicks T, Boath AE, Kernohan A, Price DA, Allen AJ, Moloney E, Graziadio S. Utility of Routine Laboratory Biomarkers to Detect COVID-19: A Systematic Review and Meta-Analysis. Viruses 2021; 13:803. [PMID: 33946171 PMCID: PMC8147047 DOI: 10.3390/v13050803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 12/21/2022] Open
Abstract
No routine laboratory biomarkers perform well enough in diagnosing COVID-19 in isolation for them to be used as a standalone diagnostic test or to help clinicians prioritize patients for treatment. Instead, other diagnostic tests are needed. The aim of this work was to statistically summarise routine laboratory biomarker measurements in COVID-19-positive and -negative patients to inform future work. A systematic literature review and meta-analysis were performed. The search included names of commonly used, routine laboratory tests in the UK NHS, and focused on research papers reporting laboratory results of patients diagnosed with COVID-19. A random effects meta-analysis of the standardized mean difference between COVID-19-positive and -negative groups was conducted for each biomarker. When comparing reported laboratory biomarker results, we identified decreased white blood cell, neutrophil, lymphocyte, eosinophil, and platelet counts; while lactate dehydrogenase, aspartate aminotransferase, and alanine aminotransferase were elevated in COVID-19-positive compared to COVID-19-negative patients. Differences were identified across a number of routine laboratory biomarkers between COVID-19-positive and -negative patients. Further research is required to identify whether routine laboratory biomarkers can be used in the development of a clinical scoring system to aid with triage of patients.
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Affiliation(s)
- Jana Suklan
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, William Leech Building, Medical School, Newcastle University, Newcastle NE2 4HH, UK; (K.G.); (D.A.P.); (A.J.A.)
| | - James Cheaveau
- Department of Infectious Diseases, Royal Victoria Infirmary, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK;
| | - Sarah Hill
- Health Economics Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (S.H.); (A.E.B.); (A.K.); (E.M.)
| | - Samuel G. Urwin
- NIHR Newcastle In Vitro Diagnostics Co-operative, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, William Leech Building, Medical School, Newcastle upon Tyne NE2 4HH, UK; (S.G.U.); (A.W.); (T.H.); (S.G.)
| | - Kile Green
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, William Leech Building, Medical School, Newcastle University, Newcastle NE2 4HH, UK; (K.G.); (D.A.P.); (A.J.A.)
| | - Amanda Winter
- NIHR Newcastle In Vitro Diagnostics Co-operative, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, William Leech Building, Medical School, Newcastle upon Tyne NE2 4HH, UK; (S.G.U.); (A.W.); (T.H.); (S.G.)
| | - Timothy Hicks
- NIHR Newcastle In Vitro Diagnostics Co-operative, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, William Leech Building, Medical School, Newcastle upon Tyne NE2 4HH, UK; (S.G.U.); (A.W.); (T.H.); (S.G.)
| | - Anna E. Boath
- Health Economics Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (S.H.); (A.E.B.); (A.K.); (E.M.)
| | - Ashleigh Kernohan
- Health Economics Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (S.H.); (A.E.B.); (A.K.); (E.M.)
| | - D. Ashley Price
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, William Leech Building, Medical School, Newcastle University, Newcastle NE2 4HH, UK; (K.G.); (D.A.P.); (A.J.A.)
- Department of Infectious Diseases, Royal Victoria Infirmary, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK;
- NIHR Newcastle In Vitro Diagnostics Co-operative, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, William Leech Building, Medical School, Newcastle upon Tyne NE2 4HH, UK; (S.G.U.); (A.W.); (T.H.); (S.G.)
| | - A. Joy Allen
- NIHR Newcastle In Vitro Diagnostics Co-operative, Translational and Clinical Research Institute, William Leech Building, Medical School, Newcastle University, Newcastle NE2 4HH, UK; (K.G.); (D.A.P.); (A.J.A.)
| | - Eoin Moloney
- Health Economics Group, Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Baddiley-Clark Building, Newcastle University, Newcastle upon Tyne NE2 4AX, UK; (S.H.); (A.E.B.); (A.K.); (E.M.)
| | - Sara Graziadio
- NIHR Newcastle In Vitro Diagnostics Co-operative, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, William Leech Building, Medical School, Newcastle upon Tyne NE2 4HH, UK; (S.G.U.); (A.W.); (T.H.); (S.G.)
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38
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Stockdale AJ, Fyles F, Farrell C, Lewis J, Barr D, Haigh K, Abouyannis M, Hankinson B, Penha D, Fernando R, Wiles R, Sharma S, Santamaria N, Chindambaram V, Probert C, Ahmed MS, Cruise J, Fordham I, Hicks R, Maxwell A, Moody N, Paterson T, Stott K, Wu MS, Beadsworth M, Todd S, Joekes E. Sensitivity of SARS-CoV-2 RNA polymerase chain reaction using a clinical and radiological reference standard. J Infect 2021; 82:260-268. [PMID: 33892014 PMCID: PMC8057690 DOI: 10.1016/j.jinf.2021.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/02/2021] [Accepted: 04/14/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Diagnostic tests for SARS-CoV-2 are important for epidemiology, clinical management, and infection control. Limitations of oro-nasopharyngeal real-time PCR sensitivity have been described based on comparisons of single tests with repeated sampling. We assessed SARS-CoV-2 PCR clinical sensitivity using a clinical and radiological reference standard. METHODS Between March-May 2020, 2060 patients underwent thoracic imaging and SARS-CoV-2 PCR testing. Imaging was independently double- or triple-reported (if discordance) by blinded radiologists according to radiological criteria for COVID-19. We excluded asymptomatic patients and those with alternative diagnoses that could explain imaging findings. Associations with PCR-positivity were assessed with binomial logistic regression. RESULTS 901 patients had possible/probable imaging features and clinical symptoms of COVID-19 and 429 patients met the clinical and radiological reference case definition. SARS-CoV-2 PCR sensitivity was 68% (95% confidence interval 64-73), was highest 7-8 days after symptom onset (78% (68-88)) and was lower among current smokers (adjusted odds ratio 0.23 (0.12-0.42) p < 0.001). CONCLUSIONS In patients with clinical and imaging features of COVID-19, PCR test sensitivity was 68%, and was lower among smokers; a finding that could explain observations of lower disease incidence and that warrants further validation. PCR tests should be interpreted considering imaging, symptom duration and smoking status.
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Affiliation(s)
- Alexander J Stockdale
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom.
| | - Fred Fyles
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Catriona Farrell
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Joe Lewis
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
| | - David Barr
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
| | - Kathryn Haigh
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
| | - Michael Abouyannis
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Beth Hankinson
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Diana Penha
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Rashika Fernando
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Rebecca Wiles
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Sheetal Sharma
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Nuria Santamaria
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Vijay Chindambaram
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Cairine Probert
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Muhammad Shamsher Ahmed
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - James Cruise
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Imogen Fordham
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Rory Hicks
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Alice Maxwell
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Nick Moody
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Tamsin Paterson
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Katharine Stott
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom
| | - Meng-San Wu
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Michael Beadsworth
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Stacy Todd
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Elizabeth Joekes
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, United Kingdom
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Deulofeu M, García-Cuesta E, Peña-Méndez EM, Conde JE, Jiménez-Romero O, Verdú E, Serrando MT, Salvadó V, Boadas-Vaello P. Detection of SARS-CoV-2 Infection in Human Nasopharyngeal Samples by Combining MALDI-TOF MS and Artificial Intelligence. Front Med (Lausanne) 2021; 8:661358. [PMID: 33869258 PMCID: PMC8047105 DOI: 10.3389/fmed.2021.661358] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 03/11/2021] [Indexed: 12/20/2022] Open
Abstract
The high infectivity of SARS-CoV-2 makes it essential to develop a rapid and accurate diagnostic test so that carriers can be isolated at an early stage. Viral RNA in nasopharyngeal samples by RT-PCR is currently considered the reference method although it is not recognized as a strong gold standard due to certain drawbacks. Here we develop a methodology combining the analysis of from human nasopharyngeal (NP) samples by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) with the use of machine learning (ML). A total of 236 NP samples collected in two different viral transport media were analyzed with minimal sample preparation and the subsequent mass spectra data was used to build different ML models with two different techniques. The best model showed high performance in terms of accuracy, sensitivity and specificity, in all cases reaching values higher than 90%. Our results suggest that the analysis of NP samples by MALDI-TOF MS and ML is a simple, safe, fast and economic diagnostic test for COVID-19.
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Affiliation(s)
- Meritxell Deulofeu
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain.,ICS-IAS Girona Clinical Laboratory, Santa Caterina Hospital, Parc Sanitari Martí i Julià, Salt, Spain
| | - Esteban García-Cuesta
- Science, Computation, and Technology Department, School of Architecture, Design, and Engineering, European University of Madrid, Madrid, Spain.,Instant Biosensing Technologies, Carson, NV, United States
| | - Eladia María Peña-Méndez
- Analytical Chemistry Division, Department of Chemistry, Faculty of Science, University of La Laguna, La Laguna, Spain
| | - José Elías Conde
- Analytical Chemistry Division, Department of Chemistry, Faculty of Science, University of La Laguna, La Laguna, Spain
| | - Orlando Jiménez-Romero
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain.,ICS-IAS Girona Clinical Laboratory, Santa Caterina Hospital, Parc Sanitari Martí i Julià, Salt, Spain
| | - Enrique Verdú
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain
| | - María Teresa Serrando
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain.,ICS-IAS Girona Clinical Laboratory, Santa Caterina Hospital, Parc Sanitari Martí i Julià, Salt, Spain
| | - Victoria Salvadó
- Department of Chemistry, Faculty of Science, University of Girona, Girona, Spain
| | - Pere Boadas-Vaello
- Research Group of Clinical Anatomy, Embryology and Neuroscience (NEOMA), Department of Medical Sciences, University of Girona, Girona, Spain.,ICS-IAS Girona Clinical Laboratory, Santa Caterina Hospital, Parc Sanitari Martí i Julià, Salt, Spain
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Martínez Redondo J, Comas Rodríguez C, Pujol Salud J, Crespo Pons M, García Serrano C, Ortega Bravo M, Palacín Peruga JM. Higher Accuracy of Lung Ultrasound over Chest X-ray for Early Diagnosis of COVID-19 Pneumonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3481. [PMID: 33801638 PMCID: PMC8037158 DOI: 10.3390/ijerph18073481] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/24/2021] [Accepted: 03/25/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic rapidly strained healthcare systems worldwide. The reference standard for diagnosis is a positive reverse transcription polymerase chain reaction (RT-PCR) test, but results are not immediate and sensibility is variable. AIM To evaluate the diagnostic accuracy of lung ultrasound compared to chest X-ray for COVID-19 pneumonia. DESIGN AND SETTING A retrospective analysis of symptomatic patients admitted into one primary care centre in Spain between March and September 2020. METHOD Patients' chest X-rays and lung ultrasounds were categorized as normal or pathologic. RT-PCR confirmed COVID-19 infection. Pathologic lung ultrasound images were further categorized as showing either local or diffuse interstitial disease. McNemar and Fisher tests were used to compare diagnostic accuracy. RESULTS Most of the 212 patients presented fever at admission, either as a standalone symptom (37.74% of patients) or together with others (72.17% of patients). The positive predictive value of the lung ultrasound was 90% for the diffuse interstitial pattern and 46.92% for local pattern. The lung ultrasound had a significantly higher sensitivity (82.75%) (p < 0.001), but lower specificity (71%) than the chest X-ray (54.02% and 86%, respectively) (p = 0.008) for identifying interstitial lung disease. Moreover, sensitivity of the lung ultrasound for severe interstitial disease was 100%, and was significantly higher than the chest X-ray (58.33%) (p = 0.002). CONCLUSION The lung ultrasound is more accurate than the chest X-ray for identifying patients with COVID-19 pneumonia and it is especially useful for those presenting diffuse interstitial disease.
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Affiliation(s)
- Javier Martínez Redondo
- Balaguer Primary Care Center, Institut Català de la Salut (ICS), 25600 Lleida, Spain; (J.M.R.); (J.P.S.); (M.C.P.); (C.G.S.)
| | | | - Jesús Pujol Salud
- Balaguer Primary Care Center, Institut Català de la Salut (ICS), 25600 Lleida, Spain; (J.M.R.); (J.P.S.); (M.C.P.); (C.G.S.)
- Biomedical Research Institute (IRB Lleida), Universitat de Lleida (UdL), 25198 Lleida, Spain
| | - Montserrat Crespo Pons
- Balaguer Primary Care Center, Institut Català de la Salut (ICS), 25600 Lleida, Spain; (J.M.R.); (J.P.S.); (M.C.P.); (C.G.S.)
| | - Cristina García Serrano
- Balaguer Primary Care Center, Institut Català de la Salut (ICS), 25600 Lleida, Spain; (J.M.R.); (J.P.S.); (M.C.P.); (C.G.S.)
- Research Group in Therapies in Primary Care (GRETAPS), 25007 Lleida, Spain
| | - Marta Ortega Bravo
- Research Group in Therapies in Primary Care (GRETAPS), 25007 Lleida, Spain
- Research Support Unit Lleida, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 25007 Lleida, Spain
| | - Jose María Palacín Peruga
- Onze de Setembre Primary Care Center, Institut Català de la Salut (ICS), Passeig Onze de Setembre, 10, 25005 Lleida, Spain
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Chatzimichail T, Hatjimihail AT. A Software Tool for Calculating the Uncertainty of Diagnostic Accuracy Measures. Diagnostics (Basel) 2021; 11:406. [PMID: 33673466 PMCID: PMC7997227 DOI: 10.3390/diagnostics11030406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/17/2021] [Accepted: 02/23/2021] [Indexed: 01/14/2023] Open
Abstract
Screening and diagnostic tests are applied for the classification of people into diseased and non-diseased populations. Although diagnostic accuracy measures are used to evaluate the correctness of classification in clinical research and practice, there has been limited research on their uncertainty. The objective for this work was to develop a tool for calculating the uncertainty of diagnostic accuracy measures, as diagnostic accuracy is fundamental to clinical decision-making. For this reason, the freely available interactive program Diagnostic Uncertainty has been developed in the Wolfram language. The program provides six modules with nine submodules for calculating and plotting the standard measurement, sampling and combined uncertainty and the resultant confidence intervals of various diagnostic accuracy measures of screening or diagnostic tests, which measure a normally distributed measurand, applied at a single point in time in samples of non-diseased and diseased populations. This is done for differing sample sizes, mean and standard deviation of the measurand, diagnostic threshold and standard measurement uncertainty of the test. The application of the program is demonstrated with an illustrative example of glucose measurements in samples of diabetic and non-diabetic populations, that shows the calculation of the uncertainty of diagnostic accuracy measures. The presented interactive program is user-friendly and can be used as a flexible educational and research tool in medical decision-making, to calculate and explore the uncertainty of diagnostic accuracy measures.
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Diagnostic value of using a combination of nucleic acid and specific antibody tests for SARS-CoV-2 in coronavirus disease 2019. Epidemiol Infect 2021; 149:e62. [PMID: 33594967 PMCID: PMC7985888 DOI: 10.1017/s0950268821000406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a newly emerged disease with various clinical manifestations and imaging features. The diagnosis of COVID-19 depends on a positive nucleic acid amplification test by real-time reverse transcription-polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, the clinical manifestations and imaging features of COVID-19 are non-specific, and nucleic acid test for SARS-CoV-2 can have false-negative results. It is presently believed that detection of specific antibodies to SARS-CoV-2 is an effective screening and diagnostic indicator for SARS-CoV-2 infection. Thus, a combination of nucleic acid and specific antibody tests for SARS-CoV-2 will be more effective to diagnose COVID-19, especially to exclude suspected cases.
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A Risk Model of Admitting Patients With Silent SARS-CoV-2 Infection to Surgery and Development of Severe Postoperative Outcomes and Death: Projections Over 24 Months for 5 Geographical Regions. Ann Surg 2021; 273:208-216. [PMID: 33156071 PMCID: PMC7805555 DOI: 10.1097/sla.0000000000004583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To model the risk of admitting silent COVID-19-infected patients to surgery with subsequent risk of severe pulmonary complications and mortality. Summary Background Data: With millions of operations cancelled during the COVID-19 pandemic, pressure is mounting to reopen and increase surgical activity. The risk of admitting patients who have silent SARS-Cov-2 infection to surgery is not well investigated, but surgery on patients with COVID-19 is associated with poor outcomes. We aimed to model the risk of operating on nonsymptomatic infected individuals and associated risk of perioperative adverse outcomes and death. Methods: We developed 2 sets of models to evaluate the risk of admitting silent COVID-19-infected patients to surgery. A static model let the underlying infection rate (R rate) and the gross population-rate of surgery vary. In a stochastic model, the dynamics of the COVID-19 prevalence and a fixed population-rate of surgery was considered. We generated uncertainty intervals (UIs) for our estimates by running low and high scenarios using the lower and upper 90% uncertainty limits. The modelling was applied for high-income regions (eg, United Kingdom (UK), USA (US) and European Union without UK (EU27), and for the World (WORLD) based on the WHO standard population. Results: Both models provided concerning rates of perioperative risk over a 24-months period. For the US, the modelled rates were 92,000 (UI 68,000–124,000) pulmonary complications and almost 30,000 deaths (UI 22,000–40·000), respectively; for Europe, some 131,000 patients (UI 97,000–178,000) with pulmonary complications and close to 47,000 deaths (UI 34,000–63,000) were modelled. For the UK, the model suggested a median daily number of operations on silently infected ranging between 25 and 90, accumulating about 18,700 (UI 13,700–25,300) perioperative pulmonary complications and 6400 (UI 4600–8600) deaths. In high-income regions combined, we estimated around 259,000 (UI 191,000–351,000) pulmonary complications and 89,000 deaths (UI 65,000–120,000). For the WORLD, even low surgery rates estimated a global number of 1.2 million pulmonary complications and 350,000 deaths. Conclusions: The model highlights a considerable risk of admitting patients with silent COVID-19 to surgery with an associated risk for adverse perioperative outcomes and deaths. Strategies to avoid excessive complications and deaths after surgery during the pandemic are needed.
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Iqbal P, Laswi B, Jamshaid MB, Shahzad A, Chaudhry HS, Khan D, Qamar MS, Yousaf Z. The Role of Anticoagulation in Post-COVID-19 Concomitant Stroke, Myocardial Infarction, and Left Ventricular Thrombus: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e928852. [PMID: 33446625 PMCID: PMC7816663 DOI: 10.12659/ajcr.928852] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Patient: Male, 65-year-old Final Diagnosis: Heart failure • myocardial infarction • stroke Symptoms: Right sided weakness Medication:— Clinical Procedure: CT scan • echocardiography Specialty: Cardiology • Infectious Diseases • Medicine, General and Internal • Neurology
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Affiliation(s)
- Phool Iqbal
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Bushra Laswi
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Aamir Shahzad
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Dawlat Khan
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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45
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Guefrechi S, Jabra MB, Ammar A, Koubaa A, Hamam H. Deep learning based detection of COVID-19 from chest X-ray images. MULTIMEDIA TOOLS AND APPLICATIONS 2021; 80:31803-31820. [PMID: 34305440 PMCID: PMC8286881 DOI: 10.1007/s11042-021-11192-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 05/19/2021] [Accepted: 06/24/2021] [Indexed: 05/08/2023]
Abstract
The whole world is facing a health crisis, that is unique in its kind, due to the COVID-19 pandemic. As the coronavirus continues spreading, researchers are concerned by providing or help provide solutions to save lives and to stop the pandemic outbreak. Among others, artificial intelligence (AI) has been adapted to address the challenges caused by pandemic. In this article, we design a deep learning system to extract features and detect COVID-19 from chest X-ray images. Three powerful networks, namely ResNet50, InceptionV3, and VGG16, have been fine-tuned on an enhanced dataset, which was constructed by collecting COVID-19 and normal chest X-ray images from different public databases. We applied data augmentation techniques to artificially generate a large number of chest X-ray images: Random Rotation with an angle between - 10 and 10 degrees, random noise, and horizontal flips. Experimental results are encouraging: the proposed models reached an accuracy of 97.20 % for Resnet50, 98.10 % for InceptionV3, and 98.30 % for VGG16 in classifying chest X-ray images as Normal or COVID-19. The results show that transfer learning is proven to be effective, showing strong performance and easy-to-deploy COVID-19 detection methods. This enables automatizing the process of analyzing X-ray images with high accuracy and it can also be used in cases where the materials and RT-PCR tests are limited.
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Affiliation(s)
- Sarra Guefrechi
- Faculty of Engineering, University of Moncton, Moncton, NB Canada
| | - Marwa Ben Jabra
- Charisma University, British Overseas Territories, Englewood, UK
- Robotics and Internet- of-Things Unit (RIoT) Lab, Riyadh, Saudi Arabia
| | - Adel Ammar
- Prince Sultan University, Riyadh, Saudi Arabia
| | - Anis Koubaa
- Prince Sultan University, Riyadh, Saudi Arabia
- Gaitech Robotics, Shanghai, China
- INESC- TEC, ISEP, Polytechnic Institute of Porto, Porto, Portugal
| | - Habib Hamam
- Faculty of Engineering, University of Moncton, Moncton, NB Canada
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Ana Laura GO, Abraham Josué NR, Briceida LM, Israel PO, Tania AF, Nancy MR, Lourdes JB, Daniela DLRZ, Fernando OR, Carlos Mauricio JE, Sergio René BP, Irineo RT, Horacio MG, Oscar MC, Héctor Q. Sensitivity of the Molecular Test in Saliva for Detection of COVID-19 in Pediatric Patients With Concurrent Conditions. Front Pediatr 2021; 9:642781. [PMID: 33912522 PMCID: PMC8071854 DOI: 10.3389/fped.2021.642781] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 03/17/2021] [Indexed: 01/27/2023] Open
Abstract
Background: The reference standard for the molecular diagnostic testing for COVID-19 is the use of nasopharyngeal or combined nasopharyngeal and oropharyngeal (NP/OP) swabs. Saliva has been proposed as a minimally invasive specimen whose collection reduces the risks for health care personnel. Objective: To assess the suitability of saliva for COVID-19 diagnosis as a replacement of the reference standard NP/OP swab in the setting of a tertiary care pediatric unit. Study design: A paired study based in the prospective cohort design in patients suspected of having COVID-19. Methods: RT-PCR was used to detect SARS-CoV-2 in paired samples of saliva and NP/OP swab collected from May through August 2020 from 156 pediatric participants, of whom 128 has at least one comorbidity and 91 showed clinical symptoms related to SARS-CoV-2 infection. Additionally, we studied a group of 326 members of the hospital staff, of whom 271 had symptoms related to SARS-CoV-2 infection. Results: In the group of pediatric participants the sensitivity of the diagnostic test in saliva was 82.3% (95% CI 56.6-96.2) and the specificity 95.6% (95% CI 90.8-98.4). The prevalence of COVID-19 was 10.9% (17/156). In 6 of the 23 participants who tested positive for SARS-CoV-2 in at least one specimen type, the virus was detected in saliva but not in NP/OP swab, while in 3 participants the NP/OP swab was positive and saliva negative. In the group of adults, the sensitivity of the test in saliva was 77.8% (95% CI 67.2-86.3) and prevalence 24.8% (81/326). Discordant results between the two types of specimens showed a significant association with low viral load in the pharynx of adults but not of pediatric participants. Interpretation: In the context of a pediatric tertiary care hospital, the sensibility of the test in saliva is not high enough to replace the use of NP/OP swab for COVID-19 diagnosis. Neither NP/OP swab nor saliva could detect all the participants infected with SARS-CoV-2.
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Affiliation(s)
- Guzmán-Ortiz Ana Laura
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Nevárez-Ramírez Abraham Josué
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Parra-Ortega Israel
- Laboratorio Clínico, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - Martínez-Rodríguez Nancy
- Unidad de Investigación Epidemiológica en Endocrinología y Nutrición, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | - De la Rosa-Zamboni Daniela
- Departamento de Epidemiología Hospitalaria, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | | | | | | | - Reyna-Trinidad Irineo
- Departamento de Enfermería, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Márquez-González Horacio
- Departamento de Investigación Clínica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Medina-Contreras Oscar
- Unidad de Investigación Epidemiológica en Endocrinología y Nutrición, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Quezada Héctor
- Laboratorio de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
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47
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Plante TB, Blau AM, Berg AN, Weinberg AS, Jun IC, Tapson VF, Kanigan TS, Adib AB. Development and External Validation of a Machine Learning Tool to Rule Out COVID-19 Among Adults in the Emergency Department Using Routine Blood Tests: A Large, Multicenter, Real-World Study. J Med Internet Res 2020; 22:e24048. [PMID: 33226957 PMCID: PMC7713695 DOI: 10.2196/24048] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/14/2020] [Accepted: 11/19/2020] [Indexed: 12/21/2022] Open
Abstract
Background Conventional diagnosis of COVID-19 with reverse transcription polymerase chain reaction (RT-PCR) testing (hereafter, PCR) is associated with prolonged time to diagnosis and significant costs to run the test. The SARS-CoV-2 virus might lead to characteristic patterns in the results of widely available, routine blood tests that could be identified with machine learning methodologies. Machine learning modalities integrating findings from these common laboratory test results might accelerate ruling out COVID-19 in emergency department patients. Objective We sought to develop (ie, train and internally validate with cross-validation techniques) and externally validate a machine learning model to rule out COVID 19 using only routine blood tests among adults in emergency departments. Methods Using clinical data from emergency departments (EDs) from 66 US hospitals before the pandemic (before the end of December 2019) or during the pandemic (March-July 2020), we included patients aged ≥20 years in the study time frame. We excluded those with missing laboratory results. Model training used 2183 PCR-confirmed cases from 43 hospitals during the pandemic; negative controls were 10,000 prepandemic patients from the same hospitals. External validation used 23 hospitals with 1020 PCR-confirmed cases and 171,734 prepandemic negative controls. The main outcome was COVID 19 status predicted using same-day routine laboratory results. Model performance was assessed with area under the receiver operating characteristic (AUROC) curve as well as sensitivity, specificity, and negative predictive value (NPV). Results Of 192,779 patients included in the training, external validation, and sensitivity data sets (median age decile 50 [IQR 30-60] years, 40.5% male [78,249/192,779]), AUROC for training and external validation was 0.91 (95% CI 0.90-0.92). Using a risk score cutoff of 1.0 (out of 100) in the external validation data set, the model achieved sensitivity of 95.9% and specificity of 41.7%; with a cutoff of 2.0, sensitivity was 92.6% and specificity was 59.9%. At the cutoff of 2.0, the NPVs at a prevalence of 1%, 10%, and 20% were 99.9%, 98.6%, and 97%, respectively. Conclusions A machine learning model developed with multicenter clinical data integrating commonly collected ED laboratory data demonstrated high rule-out accuracy for COVID-19 status, and might inform selective use of PCR-based testing.
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Affiliation(s)
- Timothy B Plante
- Larner College of Medicine at the University of Vermont, Colchester, VT, United States.,University of Vermont Medical Center, Burlington, VT, United States
| | - Aaron M Blau
- University of Vermont Medical Center, Burlington, VT, United States
| | - Adrian N Berg
- Larner College of Medicine at the University of Vermont, Burlington, VT, United States.,Biocogniv Inc, South Burlington, VT, United States
| | | | - Ik C Jun
- Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | | | | | - Artur B Adib
- Biocogniv Inc, South Burlington, VT, United States
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48
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Chan RWY, Chan KC, Chan KYY, Lui GCY, Tsun JGS, Wong RYK, Yu MWL, Wang MHT, Chan PKS, Lam HS, Li AM. SARS-CoV-2 detection by nasal strips: A superior tool for surveillance of paediatric population. J Infect 2020; 82:84-123. [PMID: 33189771 PMCID: PMC7658621 DOI: 10.1016/j.jinf.2020.11.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Renee W Y Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong.; CUHK-UMCU Joint Research Laboratory of Respiratory Virus & Immunobiology, Faculty of Medicine, The Chinese University of Hong Kong; Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong
| | - Kate C Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong
| | - Kathy Y Y Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong
| | - Grace C Y Lui
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong
| | - Joseph G S Tsun
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong.; CUHK-UMCU Joint Research Laboratory of Respiratory Virus & Immunobiology, Faculty of Medicine, The Chinese University of Hong Kong
| | - Rity Y K Wong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong
| | - Michelle W L Yu
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong.; Department of Paediatrics, Prince of Walres Hospital, Hong Kong
| | - Maggie H T Wang
- Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong
| | - Paul K S Chan
- Department of Microbiology, Faculty of Medicine, The Chinese University of Hong Kong
| | - Hugh Simon Lam
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong
| | - Albert M Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong.; CUHK-UMCU Joint Research Laboratory of Respiratory Virus & Immunobiology, Faculty of Medicine, The Chinese University of Hong Kong.
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