Treatment of corneal ulcers and endophthalmitis caused by yeast fungi

Aim: To analyze the pathogenesis, clinical features, and treatment algorithm of fungal corneal ulcer with endophthalmitis to increase medical alertness and reduce the unjustified use of antibacterial and corticosteroid therapy in corneal diseases of various etiologies, leading to the development of secondary ophthalmomycosis. Results: The pathogenesis was analyzed, and the characteristic clinical symptoms of severe fungal corneal ulcer and endophthalmitis caused by Candida albicans were described. Intensive, long-term, unjustified antibacterial and corticosteroid therapy caused a prolonged course of herpetic corneal ulcer, as well as the addition of a secondary bacterial infection, and led to the development of severe corneal ulcer and fungal endophthalmitis in a 13-year-old child. Conclusion: The required maximum medical alertness and early, accurate clinical differential diagnosis between bacterial and fungal corneal ulcer, as well as the rapid flow of ophthalmomycosis and false-negative results of sowing content conjunctival sac entail expansion of the range and quantity of antibacterial drugs used in the absence of positive dynamics of antibiotic therapy and an increased frequency of secondary fungal infection. The clinical symptoms of a severe fungal corneal ulcer with endophthalmitis described in this report contribute to the early diagnosis of ophthalmomycosis before the type of pathogen is identified by laboratory methods, which makes it possible to start antifungal therapy earlier and avoid corneal perforation and eye loss. In most countries, due to the lack of an ocular form of antifungal drugs, for local treatment of corneal candidiasis, a 0.2% solution of fluconazole intended for intravenous administration is installed in the eyes.

Download Full-text

Scoring System for the Diagnosis of COVID-19

The Open Public Health Journal ◽

10.2174/1874944502013010413 ◽

2020 ◽

Vol 13 (1) ◽

pp. 413-414 ◽

Cited By ~ 1

Author(s):

Mohamed Farouk Allam

Keyword(s):

Scoring System ◽

Clinical Symptoms ◽

False Negative ◽

Nasopharyngeal Swab ◽

Rt Pcr ◽

Pcr Assay ◽

Negative Results ◽

False Negative Results ◽

Symptoms And Signs

Due to the international spread of COVID-19, the difficulty of collecting nasopharyngeal swab specimen from all suspected patients, the costs of RT-PCR and CT, and the false negative results of RT-PCR assay in 41% of COVID-19 patients, a scoring system is needed to classify the suspected patients in order to determine the need for follow-up, home isolation, quarantine or the conduction of further investigations. A scoring system is proposed as a diagnostic tool for suspected patients. It includes Epidemiological Evidence of Exposure, Clinical Symptoms and Signs, and Investigations (if available). This scoring system is simple, could be calculated in a few minutes, and incorporates the main possible data/findings of any patient.

Download Full-text

Analysis and Prediction of COVID-19 Patients’ False Negative Results for SARS-CoV-2 Detection with Pharyngeal Swab Specimen: A Retrospective Study

10.1101/2020.03.26.20043042 ◽

2020 ◽

Cited By ~ 4

Author(s):

Hui Xu ◽

Li Yan ◽

Chun (Martin) Qiu ◽

Bo Jiao ◽

Yanyan Chen ◽

...

Keyword(s):

Nucleic Acid ◽

Time Window ◽

Clinical Symptoms ◽

False Negative ◽

Ct Imaging ◽

Nucleic Acid Detection ◽

False Negatives ◽

Negative Results ◽

False Negative Results ◽

Blood Routine

ABSTRACTBackgroundFalse negative results of SARS-CoV-2 nucleic acid detection pose threats to COVID-19 patients and medical workers alike.ObjectiveTo develop multivariate models to determine clinical characteristics that contribute to false negative results of SARS-CoV-2 nucleic acid detection, and use them to predict false negative results as well as time windows for testing positive.DesignRetrospective Cohort Study (Ethics number of Tongji Hospital: No. IRBID: TJ-20200320)SettingA database of outpatients in Tongji Hospital (University Hospital) from 15 January 2020 to 19 February 2020.Patients1,324 outpatients with COVID-19MeasurementsClinical information on CT imaging reports, blood routine tests, and clinic symptoms were collected. A multivariate logistic regression was used to explain and predict false negative testing results of SARS-CoV-2 detection. A multivariate accelerated failure model was used to analyze and predict delayed time windows for testing positive.ResultsOf the 1,324 outpatients who diagnosed of COVID-19, 633 patients tested positive in their first SARS-CoV-2 nucleic acid test (47.8%), with a mean age of 51 years (SD=14.9); the rest, which had a mean age of 47 years (SD=15.4), tested negative in the first test. “Ground glass opacity” in a CT imaging report was associated with a lower chance of false negatives (aOR, 0.56), and reduced the length of time window for testing positive by 26%. “Consolidation” was associated with a higher chance of false negatives (aOR, 1.57), and extended the length of time window for testing positive by 44%. In blood routine tests, basophils (aOR, 1.28) and eosinophils (aOR, 1.29) were associated with a higher chance of false negatives, and were found to extend the time window for testing positive by 23% and 41%, respectively. Age and gender also affected the significantly.LimitationData were generated in a large single-center study.ConclusionTesting outcome and positive window of SARS-CoV-2 detection for COVID-19 patients were associated with CT imaging results, blood routine tests, and clinical symptoms. Taking into account relevant information in CT imaging reports, blood routine tests, and clinical symptoms helped reduce a false negative testing outcome. The predictive AFT model, what we believe to be one of the first statistical models for predicting time window of SARS-CoV-2 detection, could help clinicians improve the accuracy and efficiency of the diagnosis, and hence, optimizes the timing of nucleic acid detection and alleviates the shortage of nucleic acid detection kits around the world.Primary Funding SourceNone.

Download Full-text

Conjunctival polymerase chain reaction-tests of 2019 novel coronavirus in patients in Shenyang,China

10.21203/rs.3.rs-17648/v1 ◽

2020 ◽

Author(s):

Li Xu ◽

Xinyue Zhang ◽

Wei Song ◽

Baijun Sun ◽

Jinping Mu ◽

...

Keyword(s):

Clinical Features ◽

Clinical Symptoms ◽

False Negative ◽

Suspected Case ◽

Negative Results ◽

False Negative Results ◽

Laboratory Results ◽

Polymerase Chain ◽

Novel Coronavirus ◽

Negative Detection

Abstract Background We report the laboratory results of conjunctival PCR-tests and some clinical features of these patients infected with COVID-19 in shenyang China.Methods We collected conjunctival samples of the patients to do the laboratory tests by PCR.Medical observed patients were enrolled if they had clinical symptoms. Then we analysed the PCR results and clinical features in order to find some relationships.Results The study include 14 confirmly diagnosed cases ,16 suspected cases and some medical observed patients.1 of the identified case coverted from suspected case.22 medical observed cases were removed because none of them converted to identified cases.1 of the suspected converted to identified case recently.All the conjunctival results of PCR-test were negative.Discussion The reasons of the negative detection results of PCR in conjunctival swabs were discussed.Conclusion Conjunctiva may be a transmission way of COVID-19.And ocular conjunctival swabs could be a diagnostic method for identifying the infection of COVID-19.Emphasis on the false-negative results is vital.

Download Full-text

Artificial intelligence-enabled rapid diagnosis of COVID-19 patients

10.1101/2020.04.12.20062661 ◽

2020 ◽

Cited By ~ 11

Author(s):

Xueyan Mei ◽

Hao-Chih Lee ◽

Kai-yue Diao ◽

Mingqian Huang ◽

Bin Lin ◽

...

Keyword(s):

Artificial Intelligence ◽

Clinical Symptoms ◽

False Negative ◽

Clinical History ◽

Alternative Methods ◽

Ct Scans ◽

Rt Pcr ◽

Negative Results ◽

Radiologic Findings ◽

Pcr Test

AbstractFor diagnosis of COVID-19, a SARS-CoV-2 virus-specific reverse transcriptase polymerase chain reaction (RT-PCR) test is routinely used. However, this test can take up to two days to complete, serial testing may be required to rule out the possibility of false negative results, and there is currently a shortage of RT-PCR test kits, underscoring the urgent need for alternative methods for rapid and accurate diagnosis of COVID-19 patients. Chest computed tomography (CT) is a valuable component in the evaluation of patients with suspected SARS-CoV-2 infection. Nevertheless, CT alone may have limited negative predictive value for ruling out SARS-CoV-2 infection, as some patients may have normal radiologic findings at early stages of the disease. In this study, we used artificial intelligence (AI) algorithms to integrate chest CT findings with clinical symptoms, exposure history, and laboratory testing to rapidly diagnose COVID-19 positive patients. Among a total of 905 patients tested by real-time RT-PCR assay and next-generation sequencing RT-PCR, 419 (46.3%) tested positive for SARSCoV-2. In a test set of 279 patients, the AI system achieved an AUC of 0.92 and had equal sensitivity as compared to a senior thoracic radiologist. The AI system also improved the detection of RT-PCR positive COVID-19 patients who presented with normal CT scans, correctly identifying 17 of 25 (68%) patients, whereas radiologists classified all of these patients as COVID-19 negative. When CT scans and associated clinical history are available, the proposed AI system can help to rapidly diagnose COVID-19 patients.

Download Full-text

Complex radiologic imaging of early breast cancer (literature review)

Modern Oncology ◽

10.26442/18151434.2019.3.190469 ◽

2019 ◽

Vol 21 (3) ◽

pp. 26-32

Author(s):

Giunel S Aliyeva ◽

Galina P Korzhenkova ◽

Irina V Kolyadina

Keyword(s):

Breast Cancer ◽

Early Breast Cancer ◽

False Positive ◽

Breast Biopsy ◽

Hormone Replacement ◽

False Negative ◽

Treatment Algorithm ◽

Significant Proportion ◽

Negative Results ◽

False Negative Results

Clinicoroentgenological diagnosis of early breast cancer - BC (non-invasive or invasive small-sized cancers) is difficult due to the absence of any characteristic clinical symptoms and pathognomonic roentgenological signs of the malignant process. Screening of BC has shown to be one of the most successful projects for early diagnosis of malignancies, but the probability to receive false negative results using screening mammography reaches 12%, and, on the one hand, this is due to interval cancers, and on the other hand - to defects in the primary screening. Among the factors associated with the likelihood of ineffective screening of BC, the most authors highlight such as high breast density, preceding the breast biopsy for a benign process, young age, as well as the use of hormone replacement therapy. The main methods of instrumental BC diagnostics are mammography, ultrasound (US), magnetic resonance imaging (MRI) and positron emission tomography (PET). Mammography is the "gold standard" for both screening and best diagnostics, but is characterized by a high proportion of both false positive and false negative results, and this can be partially solved by the use of digital mammography with tomosynthesis (performing a series of mammography images obtained at different angles and producing the focused 3-D images). Contrast enhanced mammography allows to identify angiogenesis in the area of the predicted malignancy, but is characterized by a high radiation exposure. Breast ultrasound is characterized by low specificity of the method and the high dependence of the result of data interpretation depending on physician qualifications. MRI of the breast for screening is characterized by high sensitivity, but also high cost and high proportion of false positive results. The role of PET/computer tomography in the diagnosis of early BC remains unclear, and the informative value of research in patients with nonpalpable tumors is extremely low. The roentgenological picture of early BC is widely variable; characteristic features include the presence of clustered calcifications, lumps with jagged edges, rough multinodular lumps. However, in a significant proportion of women the only manifestation of early BC is the presence of microcalcinates. Careful analysis of the localization and the shape of microcalcinates and basic characteristics allows correctly interpret the roentgenological diagnosis and helps to choose the optimal diagnostic and treatment algorithm.

Download Full-text

Conjunctival polymerase chain reaction-tests of 2019 novel coronavirus in patients in Shenyang, China

10.1101/2020.02.23.20024935 ◽

2020 ◽

Cited By ~ 1

Author(s):

Li Xu ◽

Xinyue Zhang ◽

Wei Song ◽

Baijun Sun ◽

Jinping Mu ◽

...

Keyword(s):

Clinical Symptoms ◽

Randomized Study ◽

False Negative ◽

Suspected Case ◽

Cross Sectional ◽

Negative Results ◽

False Negative Results ◽

Imported Cases ◽

Novel Coronavirus ◽

Pcr Test

AbstractPurposeThe 2019 novel coronavirus(COVID-19) mainly transmitted by person-to-person through inhalation of respiratory droplets. We report the laboratory results of conjunctival PCR-tests and some clinical features of these patients in shenyang China.DesignThis is a cross-sectional non-randomized studySubjectsThe study include 14 confirmly diagnosed cases, 16 suspected cases and some medical observed patients.MethodsAll patients with diagnosed and suspected COVID-19 were admitted to a designated hospital in Shenyang, China. We collected conjunctival samples of these patients to do the laboratory tests by real time RT-PCR. Medical observed patients were enrolled if they had clinical symptoms. Then we analysed the PCR results and clinical data from eletronic medical records in order to find some relationships.Main Outcome MeasuresClinical condition and PCR results. of conjunctival swabs compared with other specimensResultsOne of the identified case coverted from suspected case without typical clinical symptoms. Twenty-two medical observed cases were removed because none of them converted to identified cases. One of the suspected converted to identified case recently. The included cases in our study are imported cases with less underlying diseases and the severity of their infection was relatively moderate. All the conjunctival results of PCR-test were negative. Two cases had typical clinical symptoms but were finally confirmed by repeated pharynxswabtests.ConclusionConjunctiva may be a transmission way of COVID-19. And ocular conjunctival swabs in combination with PCR test could be a non-invasive, convenient and feasible diagnostic method for identifying the infection of COVID-19. Emphasis on the false-negative results is vital.

Download Full-text

Detection of SARS-CoV-2 RNA in nasopharyngeal swabs from COVID-19 patients and asymptomatic cases of infection by real-time and digital PCR

Russian Clinical Laboratory Diagnostics ◽

10.18821/0869-2084-2020-65-12-785-792 ◽

2020 ◽

Vol 65 (12) ◽

pp. 785-792

Author(s):

V. A. Ternovoi ◽

R. Yu. Lutkovsky ◽

E. P. Ponomareva ◽

A. V. Gladysheva ◽

E. V. Chub ◽

...

Keyword(s):

Viral Load ◽

Real Time ◽

Real Time Pcr ◽

Clinical Symptoms ◽

False Negative ◽

Digital Pcr ◽

Viral Rna ◽

Laboratory Research ◽

Low Concentration ◽

Negative Results

In this work we tested two reagent kits developed by us for detecting SARS-CoV-2 RNA using a fragment of the ORF1ab gene in digital PCR and real-time PCR formats. Data were obtained on the detection of SARS-CoV-2 virus RNA in nasopharyngeal swabs of patients with COVID-19 and asymptomatic carriers. The developed reagent kits provided 100% sensitivity and a detection limit of 103 GE / ml for qPCR, and at least 200 copies / ml of viral RNA when performing digital PCR. These methods were tested using a panel of 1,328 samples collected from patients with suspected COVID-19 at the beginning of 2020 in the Russian Federation. It has been shown that dPCR is more sensitive and can be used to analyze samples with low viral load, including those from patients without clinical symptoms. dPCR significantly improves the accuracy of laboratory research and significantly reduces the number of false negative results in the diagnosis of SARS-CoV-2. Determination of the concentration of SARS-CoV-2 RNA in patients with different clinical course of the disease showed that the concentration of viral RNA can sharply decrease in the first days of the disease. A low concentration of viral RNA in samples from patients is also characteristic of asymptomatic disease. Digital PCR provides a higher detection rate for asymptomatic cases, which is approximately 75% of those infected, as opposed to 45% for real-time PCR. The results obtained on the use of the digital PCR method for detecting SARS-CoV-2 RNA showed that this method is especially suitable for detecting RNA in case of its low concentration in contacts, as well as for monitoring changes in viral load in convalescent patients.

Download Full-text

Diagnostic Efficacy of Rapid Antigen Testing for SARS-CoV-2: The COVid-19 AntiGen (COVAG) study

10.1101/2021.08.04.21261609 ◽

2021 ◽

Author(s):

Christoph Wertenauer ◽

Geovana Brenner-Michael ◽

Alexander Dressel ◽

Caroline Pfeifer ◽

Ulrike Hauser ◽

...

Keyword(s):

Clinical Symptoms ◽

False Negative ◽

Rapid Test ◽

Detection Methods ◽

Diagnostic Efficacy ◽

Negative Results ◽

Deutschland Gmbh ◽

Alpha Variant ◽

Asymptomatic Individuals ◽

Antigen Testing

Abstract Background: Widely available rapid testing is pivotal to the fight against COVID-19. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) remains the gold standard. We compared two frequently used commercial rapid diagnostic tests (RDTs) for SARS-CoV-2-antigens, the SD Biosensor SARS-CoV-2 Rapid Antigen Test (Roche Diagnostics) and the Panbio COVID-19 Ag Rapid Test (Abbott Diagnostics), against rRT-PCR for SARS-CoV-2 detection. Methods: We compared the tests in 2215 all-comers at a diagnostic centre between February 1 and March 31, 2021. rRT-PCR-positive samples were examined for SARS-CoV-2 variants. Findings: 338 participants (15%) were rRT-PCR-positive for SARS-CoV-2. The sensitivities of Roche-RDT and Abbott-RDT were 60.4% and 56.8% (P<0.0001) and specificities 99.7% and 99.8% (P=0.076), respectively. Sensitivity inversely correlated with rRT-PCR-derived Ct values. Unadjusted, the RDTs had higher sensitivities in individuals referred by treating physicians and health departments than those tested for other reasons, in persons without comorbidities compared to those with comorbidities, in individuals with symptoms suggesting COVID-19, and in the absence of SARS-CoV-2 variants compared to Alpha variant carriers. The associations of sensitivity with clinical symptoms and the SARS-CoV-2 genotype were robust against adjustment for Ct values. Assuming that 10 000 symptomatic individuals are tested, 500 of which are truly positive, the RDTs would generate 38 false-positive and 124 false-negative results. Assuming that 10 000 asymptomatic individuals are tested, including 50 true positives, 18 false-positives and 34 false- negatives would be generated. Interpretation: The sensitivities of the two RDTs are unsatisfactory. This calls into question whether their widespread use is effective in the ongoing SARS-CoV-2 pandemic. Funding: SYNLAB Holding Deutschland GmbH Key words COVID-19, SARS-Cov-2, antibodies, rapid detection, antigen testing

Download Full-text