scholarly journals Evaluating the Efficacy of a Screening Protocol for Severe Acute Respiratory Syndrome Coronavirus 2 Virus in Asymptomatic Preoperative/Preprocedural Patients at a Military Hospital

2021 ◽  
Author(s):  
Cooper Barber ◽  
Andrew Syski ◽  
Jennifer Leaird ◽  
R Christopher Call ◽  
Ann Williams ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Process Improvement ◽  
Positive Test ◽  
Military Hospital ◽  
False Positive Test ◽  
Asymptomatic Patients ◽  
Care Workers ◽  
Screening Protocol ◽  
Early Testing ◽  
Military Treatment Facility

ABSTRACT Introduction Facing the COVID-19 pandemic, many hospitals implemented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening protocols before aerosol-generating procedures (AGPs) in an effort to protect patients and health care workers. Given the limited prior evidence on the effectiveness of such protocols, we report the process improvement experience at a military treatment facility. Materials and Methods We evaluated the outcomes of patients undergoing AGPs from March to September 2020, divided into three cohorts: a preprotocol (PP) cohort who did not receive screening, an early testing (ET) cohort representing the early months of the screening protocol, and a late testing (LT) cohort managed under adaptive modifications to the screening protocol. We recorded identifiable post-procedure COVID-19 diagnoses. The study was approved as a process improvement protocol and was determined not to meet criteria for human subject research through an institutional approval process. Results Across the three cohorts, 4520 procedures were performed: 422 PP, 1297 ET, and 2801 LT. Among 4098 procedures in the ET and LT cohorts, 12 asymptomatic patients tested positive for SARS-CoV-2 (0.29% positivity rate). One left the health system before completing the procedure and another proceeded urgently under COVID precautions, while 10 were rescheduled and completed at a later date; 7 were cleared using a test-based strategy, while 3 were cleared using a time-based strategy. Of 445 patients who had SARS-CoV-2 tests performed within 30 days following their procedures, three patients with negative preoperative tests had a positive test within 30 days, all in the LT cohort but had evidence of acquiring the infection after the procedure or had a false-positive test. Conclusions Our strategy of preprocedural SARS-CoV-2 testing successfully identified asymptomatic infected patients before surgery. Care was delayed for most of these patients without apparent detriment. Adaptation to a time-based strategy for clearance might reduce such delays, but other considerations may still influence how soon procedures should be completed after a positive test.

scholarly journals Modeling Diagnostic Strategies to Manage Toxic Adverse Events following Cancer Immunotherapy

2021 ◽  
pp. 0272989X2110027
Author(s):  
Frederik van Delft ◽  
Mirte Muller ◽  
Rom Langerak ◽  
Hendrik Koffijberg ◽  
Valesca Retèl ◽  
...  
Keyword(s):  
Palliative Care ◽  
Adverse Events ◽  
Scenario Analysis ◽  
Real World ◽  
Model Calibration ◽  
Positive Test ◽  
Test Accuracy ◽  
Test Sensitivity ◽  
False Positive Test ◽  
Test Outcomes

Background Although immunotherapy (IMT) provides significant survival benefits in selected patients, approximately 10% of patients experience (serious) immune-related adverse events (irAEs). The early detection of adverse events will prevent irAEs from progressing to severe stages, and routine testing for irAEs has become common practice. Because a positive test outcome might indicate a clinically manifesting irAE that requires treatment to (temporarily) discontinue, the occurrence of false-positive test outcomes is expected to negatively affect treatment outcomes. This study explores how the UPPAAL modeling environment can be used to assess the impact of test accuracy (i.e., test sensitivity and specificity), on the probability of patients entering palliative care within 11 IMT cycles. Methods A timed automata-based model was constructed using real-world data and expert consultation. Model calibration was performed using data from 248 non–small-cell lung cancer patients treated with nivolumab. A scenario analysis was performed to evaluate the effect of changes in test accuracy on the probability of patients transitioning to palliative care. Results The constructed model was used to estimate the cumulative probabilities for the patients’ transition to palliative care, which were found to match real-world clinical observations after model calibration. The scenario analysis showed that the specificity of laboratory tests for routine monitoring has a strong effect on the probability of patients transitioning to palliative care, whereas the effect of test sensitivity was limited. Conclusion We have obtained interesting insights by simulating a care pathway and disease progression using UPPAAL. The scenario analysis indicates that an increase in test specificity results in decreased discontinuation of treatment due to suspicion of irAEs, through a reduction of false-positive test outcomes.

scholarly journals COVID-19: Need of the hour to revisit asymptomatic prevalence of coronavirus pandemic

2020 ◽  
Vol 1 (1) ◽  
pp. 1-4
Author(s):  
Richard Avoi ◽  
Syed Sharizman Syed Abdul Rahim ◽  
Mohammad Saffree Jeffree ◽  
Visweswara Rao Pasupuleti
Keyword(s):  
Middle East ◽  
Severe Acute Respiratory Syndrome ◽  
Respiratory Tract ◽  
Middle East Respiratory Syndrome ◽  
Control Measures ◽  
Case Detection ◽  
Viral Loads ◽  
Early Stages ◽  
Exponential Increase ◽  
Asymptomatic Patients

  Since the Coronavirus disease 2019 (COVID-19) pandemic unfolded in China (Huang et al., 2020) back in December 2019, thus far, more than five million people were infected with the virus and 333,401 death were recorded worldwide (WHO, 2020b). The exponential increase in number shows that COVID-19 spreads faster compared to Severe Acute Respiratory Syndrome (SARS) or Middle East Respiratory Syndrome (MERS). A study (Zou et al., 2020) has shown that high viral loads of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are detected in symptomatic patients soon after the onset of symptoms, wherein the load content is higher in their nose than in their throat. Furthermore, the same study has revealed similar viral loads between symptomatic and asymptomatic patients. Therefore, these findings may suggest the possibility of COVID-19 transmission earlier before the onset of symptoms itself. In the early stages of the pandemic, the control measures carried out have focused on screening of symptomatic person; at the time, the whole world thought that the spread of SARS-Cov-2 would only occur through symptomatic person-to-person transmission. In comparison, transmission in SARS would happen after the onset of illness, whereby the viral loads in the respiratory tract peaked around ten days after the development of symptoms by patients (Peiris et al., 2003). However, case detection for SARS (i.e. screening of symptomatic persons) will be grossly inadequate for the current COVID-19 pandemic, thus requiring different strategies to detect those infected with SARS-CoV-2 before they develop the symptoms.

scholarly journals Covid-19 Positive Antenatal Patients in Obstetrics and Gynea Unit, Peshawar

2021 ◽  
Vol 8 (2) ◽  
pp. 14-18
Author(s):  
Rabeea Sadaf ◽  
Muhammed Zahid ◽  
Nasreen Kishwar ◽  
Umaiyma Farhad ◽  
Behzad Khan Khalil
Keyword(s):  
Well Being ◽  
Cross Sectional Study ◽  
Positive Test ◽  
Test Results ◽  
Cross Sectional ◽  
Cesarean Birth ◽  
Asymptomatic Patients ◽  
Primary Responsibility ◽  
Polymerase Chain ◽  
Antenatal Visits

OBJECTIVES: The study aimed to determine the frequency of COVID-19 positive antenatal patients admitted in Obstetrics & Gynecology unit Hayatabad Medical Complex Peshawar with the concerns that pregnant women may be more susceptible to COVID-19 as they may be more vulnerable to respiratory infection. METHODOLOGY: This was a descriptive cross-sectional study conducted at Obstetrics & Gynecology units Hayatabad Medical Complex Peshawar from May 12th, 2020, to November 29th, 2020, screening and testing of patients admitted for childbirth was in HMC. Screening consisted of questions related to travel, contacts, and symptoms of COVID-19. All patients without a prior diagnosis of COVID-19 underwent SARS-CoV-2 polymerase chain reaction (PCR) testing of nasopharyngeal swabs, with rapid testing available. Patients scheduled for cesarean birth were screened and tested at preoperative visits RESULTS:  One hundred eighty-two patients presenting for antenatal visits were screened; 6.5% (12 out of 182) were previously diagnosed with COVID-19. The remaining 170 patients were tested at admission, and 17.6% (30 out of 170) tested positive for SARS-CoV-2. Twenty-two of the 30 who tested positive for SARS-CoV-2 (73.3%) were asymptomatic. The overall prevalence of positive test results among asymptomatic patients was 14.1% (22 out of 156). The prevalence of positive test results among asymptomatic patients increased from 1.29% (2 out of 155). CONCLUSION: The evidence on this novel infection is changing almost daily, although it will likely be many months before, we can determine the true impact it will have on both maternal and fetal well‐being. In the interim, our primary responsibility is to ensure all women have access to safe maternity services. KEYWORDS: Asymptomatic, COVID-19 Positive, Antenatal Patients, Obstetrics & Gynecology, Infection

Autoimmune Antibody in Encephalopathic Patients: A Pilot Study

2021 ◽  
Vol 104 (6) ◽  
pp. 943-950
Keyword(s):  
False Positive ◽  
Laboratory Data ◽  
Autoimmune Encephalitis ◽  
Positive Test ◽  
Thyroid Antibodies ◽  
Acute Encephalopathy ◽  
True Negative ◽  
Metabolic Encephalopathy ◽  
False Positive Test ◽  
Significant Difference

Objective: To investigate the specificity of the antibodies related to autoimmune encephalitis and to identify possible associated factors with the false-positive result. Materials and Methods: The present study was a prospective observational study, conducted at the Ramathibodi Hospital between June and December 2019. All patients, who had acute to subacute encephalopathy from any causes, were recruited to the study. Their serum or cerebrospinal fluid (CSF) were taken to analyze for autoimmune encephalitis assays and anti-thyroid antibodies. The authors did not interfere with the primary physicians on any management of the patients. Clinical and laboratory data were systematically reviewed and collected from medical records. The clinical outcome was evaluated one month after the onset. Results: Fifty-one patients were recruited. Only one patient had autoimmune encephalitis related to anti-CV2/CRMP5 antibody. Seventeen out of the remaining fifty patients had positive tests for anti-thyroid antibodies of which five had Hashimoto’s thyroiditis and one of them did not have the document of thyroid status. Eleven remaining patients appeared to have false-positive test since their medical conditions were all clearly explained by other causes. Comparison of clinical and laboratory data between patients with false-positive test and patients with true negative test did not show any significant difference except the duration of the symptoms, which was significantly shorter in the false-positive group. Conclusion: False-positive anti-thyroid antibodies appear to be common in patients with acute encephalopathy. The occurrence of serum/CSF antibody in acute encephalopathy may be a true association, but it may not be the cause of encephalopathy. Therefore, the diagnosis of autoimmune encephalopathy based on anti-thyroid antibodies should be carefully made and excluded from all other possible causes. Keywords: Autoimmune encephalitis; Metabolic encephalopathy; Hashimoto’s encephalopathy; False positive

“EPIDEMIOLOGICAL AND CLINICAL CHARACTERIZATION OF COVID19 PATIENTS: A RETROSPECTIVE OBSERVATIONAL STUDY OF 245 CASES IN A GOVERNMENT TEACHING INSTITUTE OF NORTH INDIA.”

2021 ◽  
pp. 50-53
Author(s):  
Divya Jain ◽  
Umesh Shukla ◽  
Jyotsna Madan ◽  
Bhanu K Bhakri ◽  
Devendra Kumar Gupta ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
North India ◽  
Contact Tracing ◽  
Mild Disease ◽  
Source Of Infection ◽  
Asymptomatic Patients ◽  
Care Workers ◽  
Study Population ◽  
The Mean ◽  
Novel Coronavirus

Background and objectives: Worldwide literature on presentation of patients infected with novel coronavirus shows huge variability in terms of severity and outcome depending on the demographic characteristics of the affected population. We aim to present epidemiological and clinical characteristics of COVID-19 patients admitted at our facility. Methods: Retrospective analysis of epidemiological, and clinical characteristics of patients admitted at a dedicated COVID hospital in North India. Results: Records of 245 patients were analyzed. The mean (SD) age was 32 (17.87) years ranging from 1 day to 81 years. Children <18 years of age constituted around 18% of the study population of which only about a fourth (23%) were symptomatic. About 52.4% of patients were males. Almost 40% cases were detected through contact tracing of known infected patients and in about 56% cases the source of infection was indeterminate. About 67% were asymptomatic and most of the symptomatic patients had mild disease. Among the symptomatic patients cough (19.9%) and fever (17.1%) were most common symptoms followed by throat irritation. Comorbidities were present in 32 (13.06%) patients, of which hypertension in 6.12% was the most common. There were 22 (8.97%) health care workers (HCW) among the patients. Majority of the affected HCW were working in areas with relatively low infection risk. Six (2.44%) patients required oxygen supplementation. The mean duration of stay in hospital was 9.6 ±.57 days. Interpretations & Conclusions: Our observations indicate a relatively younger age of affected population and high proportion of asymptomatic patients. Children are usually asymptomatic with relatively better prognosis.

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