scholarly journals 421. If at first you do not succeed…. Repeat SARS-COV2 PCR testing

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S277-S278
Author(s):  
Stephanie M Shea ◽  
Gopi Patel ◽  
Sarah Schaefer ◽  
Michael D Nowak ◽  
Emilia Mia Sordillo ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Patient Characteristics ◽  
Nucleic Acid Amplification ◽  
Duration Of Symptoms ◽  
Radiographic Findings ◽  
Repeat Testing ◽  
Clinical Sensitivity ◽  
Viral Transport Medium ◽  
Minimum Interval ◽  
Roche Diagnostics

Abstract Background Nucleic Acid Amplification Tests (NAATs) of nasopharyngeal specimens (NPS) have become standard for diagnosis of SARS-COV2. IDSA guidelines suggest repeat testing after 24–48 h when initially negative and clinical suspicion persists. We characterized patients from whom initial NPS were NAAT-negative, but repeats were NAAT-positive, in order to identify which patients might benefit from repeat NAAT for SARS-CoV-2, and the appropriate interval. Methods We conducted an IRB-approved retrospective review of laboratory and electronic medical record data for all patients evaluated for SARS-CoV-2 infection at the Mount Sinai Health System, whose initial NAATs were done between March 16 – March 30, 2020, and who were retested within one month. NAATs were performed on NPS in viral transport medium using the Roche Diagnostics cobas® 6800 SARS-CoV-2 Test. Baseline patient characteristics, clinical and radiographic findings were identified. Results Of 235 patients eligible for inclusion, 172 (70.5%) were initially NAAT-negative, and 118 (68.6%) remained NAAT-negative over 1 month follow up. 54 (31.4%) converted to NAAT-positive over the next 1-month. Of patients who became NAAT-positive, 31 (57.4%) were inpatients who converted results within a single admission; the average interval was 6d 7h between the NAAT-negative and NAAT-positive results, and the minimum interval was 10.5 h. Symptoms examined for correlation for conversion to NAAT-positive were: fever, cough, shortness of breath, and combined nausea/vomiting/diarrhea. Duration of symptoms reported at triage did not appear to affect time to conversion to NAAT-positive. No individual symptom was more likely to be associated with conversion to NAAT- positive. However, time to conversion to NAAT-positive was shorter for patients with multiple symptoms. In general, chest radiography (CXR) findings correlated with NAAT results; interval to NAAT-positive was shorter for patients with worsening CXR findings. Conclusion Our data supports repeat testing in patients with multiple clinical symptoms suggestive of SARS CoV-2 infection and negative initial NP test results. Further studies are needed to determine the true clinical sensitivity and specificity of SARS-CoV-2 NAAT assays. Disclosures All Authors: No reported disclosures

scholarly journals Clinical, laboratory, and radiologic characteristics of patients with initial false-negative SARS-CoV-2 nucleic acid amplification test results

2020 ◽  
Author(s):  
Caitlin M Dugdale ◽  
Melis N Anahtar ◽  
John J Chiosi ◽  
Jacob E Lazarus ◽  
Suzanne M McCluskey ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Symptom Onset ◽  
Clinical Laboratory ◽  
False Negative ◽  
Patient Characteristics ◽  
Nucleic Acid Amplification ◽  
Test Results ◽  
Duration Of Symptoms ◽  
Repeat Testing ◽  
High Clinical Suspicion

Abstract Background Concerns about false-negative (FN) SARS-CoV-2 nucleic acid amplification tests (NAATs) have prompted recommendations for repeat testing if suspicion for COVID-19 infection is moderate to high. However, the frequency of FNs and patient characteristics associated with FNs are poorly understood. Methods We retrospectively reviewed test results from 15,011 adults who underwent ≥1 SARS-CoV-2 NAATs; 2,699 had an initial negative NAAT and repeat testing. We defined FNs as ≥1 negative NAATs followed by a positive NAAT within 14 days during the same episode of illness. We stratified subjects with FNs by duration of symptoms prior to the initial FN test (≤5 days versus >5 days) and examined their clinical, radiologic, and laboratory characteristics. Results Sixty of 2,699 subjects (2.2%) had a FN result during the study period. The weekly frequency of FNs among subjects with repeat testing peaked at 4.4%, coinciding with peak NAAT positivity (38%). Most subjects with FNs had symptoms (52/60; 87%) and chest radiography (19/32; 59%) consistent with COVID-19. Of the FN NAATs, 18/60 (30%) were performed early (i.e., ≤1 day of symptom onset), and 18/60 (30%) were performed late (i.e., >7 days after symptom onset) in disease. Among 17 subjects with two consecutive FNs on NP NAATs, 9 (53%) provided lower respiratory tract (LRT) specimens for testing, all of which were positive. Conclusions Our findings support repeated NAATs among symptomatic patients, particularly during periods of higher COVID-19 incidence. LRT testing should be prioritized to increase yield among patients with high clinical suspicion for COVID-19.

Case Example: Adjacent Segment Disease: What Is It, and How Is It Rated?

2011 ◽  
Vol 16 (2) ◽  
pp. 8-9
Author(s):  
Marjorie Eskay-Auerbach
Keyword(s):  
Clinical Symptoms ◽  
Lumbar Fusion ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment Disease ◽  
Adjacent Segment ◽  
Disc Space Narrowing ◽  
Disc Disease ◽  
Disc Space ◽  
Radiographic Findings ◽  
Asymptomatic Patients

Abstract The incidence of cervical and lumbar fusion surgery has increased in the past twenty years, and during follow-up some of these patients develop changes at the adjacent segment. Recognizing that adjacent segment degeneration and disease may occur in the future does not alter the rating for a cervical or lumbar fusion at the time the patient's condition is determined to be at maximum medical improvement (MMI). The term adjacent segment degeneration refers to the presence of radiographic findings of degenerative disc disease, including disc space narrowing, instability, and so on at the motion segment above or below a cervical or lumbar fusion. Adjacent segment disease refers to the development of new clinical symptoms that correspond to these changes on imaging. The biomechanics of adjacent segment degeneration have been studied, and, although the exact mechanism is uncertain, genetics may play a role. Findings associated with adjacent segment degeneration include degeneration of the facet joints with hypertrophy and thickening of the ligamentum flavum, disc space collapse, and translation—but the clinical significance of these radiographic degenerative changes remains unclear, particularly in light of the known presence of abnormal findings in asymptomatic patients. Evaluators should not rate an individual in anticipation of the development of changes at the level above a fusion, although such a development is a recognized possibility.

Etiology and clinical features of epididymo-orchitis: A single-center study in Tehran, Iran

2020 ◽  
Vol 20 ◽  
Author(s):  
Sara Abolghasemi ◽  
Mohammad Alizadeh ◽  
Ali Hashemi ◽  
Shabnam Tehrani
Keyword(s):  
Chlamydia Trachomatis ◽  
Clinical Symptoms ◽  
Urine Culture ◽  
Clinical Manifestations ◽  
Urinary Frequency ◽  
Serological Tests ◽  
Duration Of Symptoms ◽  
Two Samples ◽  
History Of ◽  
Tract Infections

Introduction: Epididymo-orchitis is a common urological disease among men. Little is known about the clinical and epidemiological aspects of the disease in Iran. Thus, the present study was aimed to investigate the etiology, clinical sequelae and risk factors of patients with epididymo-orchitis in Tehran, Iran. Materials and Methods: Patients presenting with epididymo-orchitis were prospectively analyzed in order to study the etiology and pattern of the disease. Bacteriological, molecular and serological tests were undertaken to look for Chlamydia trachomatis, Neisseria gonorrhoeae, Brucella spp., Mycoplasma spp, and other bacteria. Results: Fifty patients with epididymo-orchitis were evaluated according to their clinical symptoms, duration of symptoms, physical examination, and laboratory studies. The mean age of the patients was 53 years. Fever, dysuria, pain in the flanks, urinary frequency and discharges occurred in 58.0%, 50.0%, 50.0%, 28.0% and 6.0%, respectively. Bacterial pathogen was identified in 26% (13/50) of patients by urine culture. Escherichia coli was the etiological agent in 11/13 patients (84.6%). Two out of 50 patients (4.0%) were also positive for Chlamydia trachomatis. Two samples were serologically positive for Brucella spp. High Mean age, fever, urinary frequency, history of the underlying disease and history of urinary tract infections were found to have a significant association with the positive bacteriologic urine culture (P<0.05). Conclusions: The most common clinical manifestations were fever, dysuria, and abdominal pain. E. coli and C. trachomatis were the major causative agents. Use of a set of diagnostic approaches including clinical symptoms, urine culture and more precise techniques such as PCR should be taken into consideration for the definitive diagnosis.

scholarly journals Clinical evaluation of rapid point-of-care antigen tests for diagnosis of SARS-CoV-2 infection

2021 ◽  
Author(s):  
Johannes G. M. Koeleman ◽  
Henk Brand ◽  
Stijn J. de Man ◽  
David S. Y. Ong
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Antigen Test ◽  
Duration Of Symptoms ◽  
Large Variability ◽  
Clinical Sensitivity ◽  
Care Workers ◽  
Upper Respiratory ◽  
Antigen Tests ◽  
Respiratory Specimens

AbstractThe RT-qPCR in respiratory specimens is the gold standard for diagnosing acute COVID-19 infections. However, this test takes considerable time before test results become available, thereby delaying patients from being diagnosed, treated, and isolated immediately. Rapid antigen tests could overcome this problem. In the first study, clinical performances of five rapid antigen tests were compared to RT-qPCR in upper respiratory specimens from 40 patients with positive and 40 with negative RTq-PCR results. In the second study, the rapid antigen test with one of the best test characteristics (Romed) was evaluated in a large prospective collection of upper respiratory specimens from 900 different COVID-19-suspected patients (300 emergency room patients, 300 nursing home patients, and 300 health care workers). Test specificities ranged from 87.5 to 100.0%, and test sensitivities from 55.0 to 80.0%. The clinical specificity of the Romed test was 99.8% (95% CI 98.9–100). Overall clinical sensitivity in the study population was 73.3% (95% CI 67.9–78.2), whereas sensitivity in the different patient groups varied from 65.3 to 86.7%. Sensitivity was 83.0 to 86.7% in patients with short duration of symptoms. In a population with a COVID-19 prevalence of 1%, the negative predictive value in all patients was 99.7%. There is a large variability in diagnostic performance between rapid antigen tests. The Romed rapid antigen test showed a good clinical performance in patients with high viral loads (RT-qPCR cycle threshold ≤30), which makes this antigen test suitable for rapid identification of COVID-19-infected health care workers and patients.

scholarly journals Dual Reporting of Clostridioides difficile PCR and Predicted Toxin Result Based on PCR Cycle Threshold Reduces Treatment of Toxin-Negative Patients without Increases in Adverse Outcomes

2019 ◽  
Vol 57 (11) ◽  
Author(s):  
Matthew M. Hitchcock ◽  
Marisa Holubar ◽  
Catherine A. Hogan ◽  
Lucy S. Tompkins ◽  
Niaz Banaei
Keyword(s):  
Nucleic Acid ◽  
Chart Review ◽  
Patient Characteristics ◽  
Adverse Outcomes ◽  
Nucleic Acid Amplification ◽  
Content Type ◽  
Cycle Threshold ◽  
Clostridioides Difficile ◽  
All Cause Mortality ◽  
High Negative Predictive Value

ABSTRACT Nucleic acid amplification tests are commonly used to diagnose Clostridioides difficile infection (CDI). Two-step testing with a toxin enzyme immunoassay is recommended to discriminate between infection and colonization but requires additional resources. Prior studies showed that PCR cycle threshold (CT) can predict toxin positivity with high negative predictive value. Starting in October 2016, the predicted toxin result (CT-toxin) based on a validated cutoff was routinely reported at our facility. To evaluate the clinical efficacy of this reporting, all adult patients with positive GeneXpert PCR results from October 2016 through October 2017 underwent a chart review to measure the recurrence of or conversion to a CT-toxin+ result and 30-day all-cause mortality. There were 482 positive PCR tests in 430 unique patients, 282 CT-toxin+ and 200 CT-toxin−. Patient characteristics were similar at testing, though CT-toxin+ patients had higher white blood cell (WBC) counts (12.5 × 103 versus 9.3 × 103 cells/μl; P = 0.001). All cases (n = 21) of fulminant CDI had a CT-toxin+ result. Index CT-toxin+ patients were significantly more likely to have a CT-toxin+ result within 90 days than CT-toxin− patients (17.4% [n = 49] versus 8.0% [n = 16], respectively; P = 0.003). Thirty-day all-cause mortality was higher in CT-toxin− patients (11.1% versus 6.8%; P = 0.1), though no deaths in CT-toxin− patients were directly attributable to CDI. Of the 200 CT-toxin− patients, 51.5% (n = 103) were treated for CDI. The rates of conversion to a CT-toxin+ result (8.8% versus 7.2%; P = 0.8) and all-cause mortality (8.8% versus 13.4%; P = 0.3) were similar between treated and untreated CT-toxin− patients, respectively. CT-based toxin prediction may identify patients at higher risk for CDI-related complications and reduce treatment among CT-toxin− patients.

scholarly journals The fast-track outpatient clinic significantly decreases hospitalisation rates among polymyalgia rheumatica patients

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Stavros Chrysidis ◽  
Philip Rask Lage-Hansen ◽  
Nikoletta Svendsen ◽  
Andreas P. Diamantopoulos
Keyword(s):  
Polymyalgia Rheumatica ◽  
Fast Track ◽  
Clinical Symptoms ◽  
Classification Criteria ◽  
Duration Of Symptoms ◽  
Prednisolone Dose ◽  
South West ◽  
Hospitalised Patients ◽  
Number Of Patients ◽  
The Impact

Abstract Objectives This study aimed to investigate the hospitalisation rates and the reasons for hospitalisation in patients with polymyalgia rheumatica (PMR). Furthermore, it aimed to clarify the impact of a newly established Fast Track Clinic (FTC) approach on hospitalisation rates in connection with PMR diagnosis. Methods Patients diagnosed with PMR at South-West Jutland Hospital, Denmark, between 2013 and 2018 were included retrospectively. Only patients fulfilling the 2012 EULAR/ACR classification criteria were included in our cohort. An FTC for patients suspected of having PMR was established in the rheumatologic department of South-West Jutland Hospital in January 2018. Results Over 6 years (2013 to 2017), 254 patients were diagnosed with PMR, 56 of them while hospitalised. Hospitalised patients were more likely to have a higher initial CRP mean ± standard deviation (SD) 99.53 ± 59.36 vs 45.82 ± 36.96 mg/lt (p <  0.0001) and a shorter duration of symptoms (p = 0.0018). After implementing the FTC, a significant decrease in hospitalisation rates (from 20.4% to 3,5%) and inpatient days of care (mean ± SD 4.15 ± 3.1 vs 1 ± 0) were observed. No differences between the two groups were observed regarding clinical symptoms, laboratory values and initial prednisolone dose. Conclusion A substantial number of patients are hospitalised in connection with the PMR diagnosis. The FTC approach can decrease the hospitalisation rates significantly among these patients. Trial registration Retrospectively registered.

Abstract W P172: Prevalence of Positive Dwi Findings in Relation to Tia Etiology

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Yasufumi Gon ◽  
Manabu Sakaguchi ◽  
Syuhei Okazaki ◽  
Hideki Mochizuki ◽  
Kazuo Kitagawa
Keyword(s):  
Symptom Onset ◽  
Clinical Symptoms ◽  
Motor Symptom ◽  
Unknown Etiology ◽  
Symptom Duration ◽  
Motor Symptoms ◽  
Duration Of Symptoms ◽  
Prolonged Duration ◽  
History Of ◽  
Toast Classification

Objective: Previous studies have shown that the prolonged duration of TIA symptoms or ABCD2 score are associated with DWI abnormality, and the presence of DWI abnormality is associated with an increased early risk of stroke. However, there are few reports that show the relation between TIA clinical etiology and DWI abnormality. Our aim of this study is to clarify the prevalence of positive DWI in relation to characteristics of patients and TIA. Methods: The subjects were enrolled from patients who were admitted to our stroke unit within 7 days after symptom onset from January 2006 to July 2013. The diagnosis of TIA was done by NINDS criteria, and we classified TIA etiology by TOAST classification based on clinical symptoms, ECG monitoring, carotid ultrasound, MR angiography and transesophageal echocardiography. All patients underwent DWI-MRI within 7 days after symptom onset. We examined an association between TIA etiology, symptom, duration of symptoms and DWI abnormality. Results: A total of 141 patients (mean 64 years; 63% men) were admitted with TIA during this period. Those included lacuna TIA (n=17, 12.1%), atherothrombotic TIA (n=32, 22.7%), cardioembolic TIA (n=23, 16.3%), TIA due to other causes (n=35, 24.8%), and TIA with unknown etiology (n=34, 24.1%). Prevalence of positive DWI findings were 47.1% in lacunar TIA, 43.7% in atherothrombotic TIA, 52.1% in cardioembloic TIA, 42.8% in TIA due to other causes, and 23.5% in TIA with unknown etiology. DWI abnormality was the most frequent in cardiogenic TIA. In relation to symptom duration, the prevalence of DWI positive findings were 45.2% in less than 1 hour (N=53), 36.6% in 1-3 hour (N=41), 25.0% in 3-6 hour (N=12) and 42.9% in 6-24 hours (N=35). In relation to motor symptoms, there was no difference in prevalence of DWI abnormality between patient with motor symptoms (39.8%, N=113) and without (42.8%, N=28). There was no relation between DWI abnormalities and age, a history of stroke/TIA episode or vascular risk factors. Conclusion: Prevalence of DWI positive findings was high in cardiogenic TIA, and low in TIA with unclassified etiology. There were no relation between DWI abnormality, duration of symptom, and motor symptom.

scholarly journals MRI Analysis for Clarification of Mechanism of Ankle Osteoarthritis

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0035
Author(s):  
Hiroyuki Mitsui ◽  
Takaaki Hirano ◽  
Hisateru Niki
Keyword(s):  
Clinical Symptoms ◽  
Predictive Tool ◽  
Ankle Osteoarthritis ◽  
Talocrural Joint ◽  
Radiographic Findings ◽  
Lateral Process ◽  
Metatarsal Angle ◽  
Magnetic Resonance Imaging Mri ◽  
The Relationship ◽  
Surface Angle

Category: Ankle Arthritis Introduction/Purpose: We have previously studied the relationship between Takakura–Tanaka classification stages and bone-marrow edema (BME) in order to elucidate the pathology of ankle osteoarthritis (ankle OA) on magnetic resonance imaging (MRI). Moreover, we have investigated that BME onset on the talocrural joint can be predicted according to radiographic findings. In the present study, we focused on the changes around the subtalar joint to examine the relationship between talar lateral process impingement (TLPI) and foot and ankle joint alignment, and whether TLPI can be predicted on the basis of X-ray findings. Methods: We assessed 30 feet of 30 patients who had a diagnosis of ankle OA in our hospital and underwent MRI. Alignment was assessed radiographically by measuring the tibial anterior surface angle (TAS), the tibial lateral surface angle (TLS), the lateral talo-first metatarsal angle (LTMT), the lateral talocalcaneal angle (LTC), and the tibial axis–talar ratio (T-T ratio). MRI was obtained with the talocrural, subtalar and Chopart joints into 22 subdivided areas to examine the frequency of BME for each patient. TLPI was considered positive (+) when BME was found in the talar lateral process. The patients were divided into two groups according to TLPI positivity or negativity. Their BME frequency was examined, and significant differences in radiographically measured values were analysed with a t-test. Results: In the TLPI (+) group, BME development occurred at significantly higher frequencies in all areas except those surrounding the lateral process (p = 0.002). In addition, TLS was significantly lower (p = 0.02), and LTMT was significantly higher (p = 0.04). When the cut-off value on the ROC curve was set at TLS of =74° and LTMT of =19°, TLPI onset could be predicted with a sensitivity of 75% and a specificity of 71%. Conclusion: Our results revealed that in the TLPI (+) group, progression of the anteriorly opened talocrural joint and talar dorsiflexion may be causing the talar lateral process to hit the calcaneus. Furthermore, in the TLPI (+) group, BME in other areas also occurred at higher frequencies, and symptoms around the ankle joints may be occurring at multiple locations. The fact that TLPI could be predicted from radiography findings suggests that this may be a potential predictive tool of the severity of clinical symptoms.

scholarly journals COVID-19 in Hospitalized Adults With HIV

2020 ◽  
Vol 7 (8) ◽  
Author(s):  
Kate Stoeckle ◽  
Carrie D Johnston ◽  
Deanna P Jannat-Khah ◽  
Samuel C Williams ◽  
Tanya M Ellman ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Invasive Mechanical Ventilation ◽  
Clinical Manifestations ◽  
Supplemental Oxygen ◽  
Control Group ◽  
Electronic Health Record Data ◽  
Duration Of Symptoms ◽  
Radiographic Findings ◽  
Presenting Symptoms ◽  
And Control

Abstract Background The spread of SARS-CoV-2 and the COVID-19 pandemic have caused significant morbidity and mortality worldwide. The clinical characteristics and outcomes of hospitalized patients with SARS-CoV-2 and HIV co-infection remain uncertain. Methods We conducted a matched retrospective cohort study of adults hospitalized with a COVID-19 illness in New York City between March 3, 2020, and May 15, 2020. We matched 30 people with HIV (PWH) with 90 control group patients without HIV based on age, sex, and race/ethnicity. Using electronic health record data, we compared demographic characteristics, clinical characteristics, and clinical outcomes between PWH and control patients. Results In our study, the median age (interquartile range) was 60.5 (56.6–70.0) years, 20% were female, 30% were black, 27% were white, and 24% were of Hispanic/Latino/ethnicity. There were no significant differences between PWH and control patients in presenting symptoms, duration of symptoms before hospitalization, laboratory markers, or radiographic findings on chest x-ray. More patients without HIV required a higher level of supplemental oxygen on presentation than PWH. There were no differences in the need for invasive mechanical ventilation during hospitalization, length of stay, or in-hospital mortality. Conclusions The clinical manifestations and outcomes of COVID-19 among patients with SARS-CoV-2 and HIV co-infection were not significantly different than patients without HIV co-infection. However, PWH were hospitalized with less severe hypoxemia, a finding that warrants further investigation.

scholarly journals Herpes zoster: when do patients present and who gets antiviral treatment?

2014 ◽  
Vol 6 (2) ◽  
pp. 108 ◽  
Author(s):  
Katharine Wallis ◽  
Lynley Hood ◽  
Kavita Rao
Keyword(s):  
General Practice ◽  
Herpes Zoster ◽  
Antiviral Treatment ◽  
Signs And Symptoms ◽  
Patient Characteristics ◽  
The Elderly ◽  
Lower Percentage ◽  
Duration Of Symptoms ◽  
Late Treatment ◽  
Incident Cases

INTRODUCTION: Herpes zoster and its sequelae can have a serious impact on quality of life, particularly in the elderly. The duration and severity of herpes zoster symptoms can be reduced with antiviral treatment. Early treatment is most effective. AIM: To identify how soon after onset of herpes zoster symptoms adults presented to a suburban Dunedin general practice and to describe which patients received antiviral treatment. METHODS: Adult herpes zoster cases were identified from a large suburban general practice from 2004 to 2009. Duration of symptoms at presentation and antiviral prescription were identified from medical records and described by patient characteristics. RESULTS: We identified 278 incident cases. Approximately one-third presented within three days of symptoms, one-third after three days, and in one-third of cases the duration of symptoms was not documented. A higher percentage of patients with ophthalmic herpes zoster presented within three days (45%), while a lower percentage of men (24%) and patients from the lowest socioeconomic quintile (25%) presented within three days. Most incident cases received antiviral treatment. A higher percentage of patients with ophthalmic herpes zoster and patients who presented within three days of symptoms received antiviral treatment. Some patients who presented after seven days of symptoms also received treatment. Antiviral prescribing did not increase with patient age. DISCUSSION: Despite many adults with acute herpes zoster presenting after three days of symptoms, most received antiviral treatment. It is not known why many presented late. It is not known whether late treatment is effective. KEYWORDS: Antiviral treatment; general practice; herpes zoster virus; signs and symptoms

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