scholarly journals SARS-CoV-2 Infection in Asymptomatic Patients Hospitalized for Cardiac Emergencies: Implications for Patient Management

2020 ◽  
Vol 7 ◽  
Author(s):  
Thorsten Kessler ◽  
Jens Wiebe ◽  
Tobias Graf ◽  
Heribert Schunkert ◽  
Adnan Kastrati ◽  
...  
Keyword(s):  
Patient Management ◽  
Nasopharyngeal Swab ◽  
Protective Equipment ◽  
Optimal Care ◽  
Emergency Admissions ◽  
Emergency Procedures ◽  
Asymptomatic Patients ◽  
Cardiology Department ◽  
Cardiac Emergencies ◽  
Cardiac Emergency

Background: The coronavirus disease (COVID-19) pandemic imposed diverse challenges on the health care system. Morbidity and mortality of non-COVID-19 emergencies might also have changed because hospitals may not be able to provide optimal care due to restructured resources and uncertainties how to deal with potentially infected patients. It has been recommended to stratify treatment of cardiovascular emergencies according to cardiovascular risk. However, data on the prevalence of asymptomatic SARS-CoV-2 infection in patients presenting with cardiac emergencies remain scarce.Methods: We retrospectively analyzed patients' data from a tertiary cardiology department between April 15 and May 31, 2020. All patients were screened on admission for COVID-19 symptoms using a questionnaire and body temperature measurements. All hospitalized patients were routinely screened using nasopharyngeal swab testing.Results: In total, we counted 710 urgent and emergency admissions. Nasopharyngeal swab tests were available in 689 (97%) patients, 409 and 280 of which presented as urgent and emergency admissions, respectively. Among 280 emergency admissions, none tested positive for SARS-CoV-2.Conclusion: In cardiac emergency patients which were screened negative for COVID-19 symptoms, the prevalence of SARS-CoV-2 infection in regions with a modest overall prevalence is low. This finding might be helpful to better determine timing of emergency procedures and reasonable usage of protective equipment during the COVID-19 crisis and the future.

scholarly journals Perioperative challenges in managing a patient with COVID-19 undergoing debridement for massive scalp myiasis

2021 ◽  
Vol 14 (2) ◽  
pp. e241189
Author(s):  
Shiu Yin Lo ◽  
Ming Kai Teah ◽  
Yan Zheng Ho ◽  
Tat Boon Yeap
Keyword(s):  
Real Time ◽  
Personal Protective Equipment ◽  
Real Time Pcr ◽  
Healthcare Workers ◽  
Patient Management ◽  
Cross Infection ◽  
Nasopharyngeal Swab ◽  
Protective Equipment ◽  
Test Result ◽  
Pcr Test

A young man presented to our centre needing an urgent debridement of his postcraniotomy wound due to massive myiasis during the COVID-19 pandemic in October 2020. Prior to the surgery, his nasopharyngeal swab real-time PCR test result was unknown. One day later, it returned as SARS-CoV-2 positive. All healthcare workers who were involved in the patient management avoided cross infection as they wore appropriate personal protective equipment. This article depicts the importance of adequate preparations when handling potentially infectious patients and the perioperative issues associated with it.

scholarly journals Retinal microvascular signs in COVID-19

2021 ◽  
pp. bjophthalmol-2020-318236
Author(s):  
Ralene Sim ◽  
Gemmy Cheung ◽  
Daniel Ting ◽  
Edmund Wong ◽  
Tien Yin Wong ◽  
...  
Keyword(s):  
Medical History ◽  
Vital Signs ◽  
Plexiform Layer ◽  
Nasopharyngeal Swab ◽  
Inner Plexiform Layer ◽  
Cross Sectional ◽  
Imaging Device ◽  
Asymptomatic Patients ◽  
Significant Difference ◽  
Retinal Microvascular Signs

Background/aimsTo explore if retinal findings are associated with COVID-19 infection.MethodsIn this prospective cross-sectional study, we recruited participants positive for COVID-19 by nasopharyngeal swab, with no medical history. Subjects underwent retinal imaging with an automated imaging device (3D OCT-1 Maestro, Topcon, Tokyo, Japan) to obtain colour fundus photographs (CFP) and optical coherence tomographic (OCT) scans of the macula. Data on personal biodata, medical history and vital signs were collected from electronic medical records.Results108 patients were recruited. Mean age was 36.0±5.4 years. 41 (38.0%) had symptoms of acute respiratory infection (ARI) at presentation. Of 216 eyes, 25 (11.6%) had retinal signs—eight (3.7%) with microhaemorrhages, six (2.8%) with retinal vascular tortuosity and two (0.93%) with cotton wool spots (CWS). 11 eyes (5.1%) had hyper-reflective plaques in the ganglion cell-inner plexiform layer layer on OCT, of which two also had retinal signs visible on CFP (CWS and microhaemorrhage, respectively). There was no significant difference in the prevalence of retinal signs in symptomatic versus asymptomatic patients (12 (15.0%) vs 13 (9.6%), p=0.227). Patients with retinal signs were significantly more likely to have transiently elevated blood pressure than those without (p=0.03).ConclusionOne in nine had retinal microvascular signs on ocular imaging. These signs were observed even in asymptomatic patients with normal vital signs. These retinal microvascular signs may be related to underlying cardiovascular and thrombotic alternations associated with COVID-19 infection.

scholarly journals Comparison of saliva with healthcare workers- and patient-collected swabs in the diagnosis of COVID-19 in a large cohort

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mitnala Sasikala ◽  
Yelamanchili Sadhana ◽  
Ketavarapu Vijayasarathy ◽  
Anand Gupta ◽  
Sarala Kumari Daram ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Early Stage ◽  
Cost Effective ◽  
Hospitalized Patients ◽  
Detection Sensitivity ◽  
Nasopharyngeal Swab ◽  
Predictive Values ◽  
Qrt Pcr ◽  
Asymptomatic Patients ◽  
Sensitivity Specificity

Abstract Background A considerable amount of evidence demonstrates the potential of saliva in the diagnosis of COVID-19. Our aim was to determine the sensitivity of saliva versus swabs collected by healthcare workers (HCWs) and patients themselves to assess whether saliva detection can be offered as a cost-effective, risk-free method of SARS-CoV-2 detection. Methods This study was conducted in a hospital involving outpatients and hospitalized patients. A total of 3018 outpatients were tested. Of these, 200 qRT-PCR-confirmed SARS-CoV-2-positive patients were recruited for further study. In addition, 101 SARS-CoV-2-positive hospitalized patients with symptoms were also enrolled in the study. From outpatients, HCWs collected nasopharyngeal swabs (NPS), saliva were obtained. From inpatients, HCWs collected swabs, patient-collected swabs, and saliva were obtained. qRT-PCR was performed to detect SARS-CoV-2 by TAQPATH assay to determine the sensitivity of saliva detection. Sensitivity, specificity and positive/negative predictive values (PPV, NPV) of detecting SARS-CoV-2 were calculated using MedCalc. Results Of 3018 outpatients (asymptomatic: 2683, symptomatic: 335) tested by qRT-PCR, 200 were positive (males: 140, females: 60; aged 37.9 ± 12.8 years; (81 asymptomatic, 119 symptomatic). Of these, saliva was positive in 128 (64%); 39 of 81 asymptomatic (47%),89 of 119 symptomatic patients (74.8%). Sensitivity of detection was 60.9% (55.4–66.3%, CI 95%), with a negative predictive value of 36%(32.9–39.2%, CI 95%).Among 101 hospitalized patients (males:65, females: 36; aged 53.48 ± 15.6 years), with HCW collected NPS as comparator, sensitivity of saliva was 56.1% (47.5–64.5, CI 95%), specificity 63.5%(50.4–75.3, CI95%) with PPV of 77.2% and NPV of 39.6% and that of self-swab was 52.3%(44–60.5%, CI95%), specificity 56.6% (42.3–70.2%, CI95%) with PPV 77.2% and NPV29.7%. Comparison of positivity with the onset of symptoms revealed highest detection in saliva on day 3 after onset of symptoms. Additionally, only saliva was positive in 13 (12.8%) hospitalized patients. Conclusion Saliva which is easier to collect than nasopharyngeal swab is a viable alternate to detect SARS-COV-2 in symptomatic patients in the early stage of onset of symptoms. Although saliva is currently not recommended for screening asymptomatic patients, optimization of collection and uniform timing of sampling might improve the sensitivity enabling its use as a screening tool at community level.

scholarly journals SARS-CoV-2 in peritoneal swabs from asymptomatic patients undergoing emergency abdominal surgery

2021 ◽  
Vol 2021 (4) ◽  
Author(s):  
Jasim AlAradi ◽  
Rawan A Rahman AlHarmi ◽  
Mariam AlKooheji ◽  
Sayed Ali Almahari ◽  
Mohamed Abdulla Isa ◽  
...  
Keyword(s):  
Peritoneal Fluid ◽  
Case Series ◽  
Rapid Test ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Protective Measures ◽  
The Public ◽  
Asymptomatic Patients ◽  
Number Of Patients ◽  
Viral Transfer

Abstract This is a case series of five patients with acute abdomen requiring surgery who tested positive for coronavirus disease 2019 (COVID-19) and were asymptomatic, with the purpose of detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in peritoneal fluid. Nasopharyngeal swab was done as a prerequisite for admission or prior to admission as part of random testing. Two methods of viral testing were employed: Xpert® Xpress SARS-CoV-2 (rapid test) and real-time reverse transcription polymerase chain reaction (RT-PCR). Either or both tests were done, with the former performed for patients requiring surgery immediately. Surgery was performed within 24–36 h from admission. Peritoneal fluid swabs were obtained for the detection of SARS-CoV-2 using RT-PCR test. Swabs were immediately placed in viral transfer media and delivered to the public health laboratory in an ice bag. SARS-CoV-2 was not detected in peritoneal swabs. Due to the limited number of patients, further studies are required; yet, protective measures should still be taken by surgeons when dealing with COVID-19 cases.

scholarly journals Cost-effectiveness analysis of SARS-CoV-2 infection prevention strategies including pre-endoscopic virus testing and use of high risk personal protective equipment

Endoscopy ◽  
2020 ◽  
Author(s):  
Alanna Ebigbo ◽  
Christoph Römmele ◽  
Christina Bartenschlager ◽  
Selin Temizel ◽  
Elisabeth Kling ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
High Risk ◽  
Personal Protective Equipment ◽  
Infection Prevention ◽  
High Volume ◽  
Protective Equipment ◽  
Prevalence Rates ◽  
Prevention Strategies ◽  
Universal Testing ◽  
Asymptomatic Patients

Abstract Background Infection prevention strategies to protect healthcare workers in endoscopy units during the post-peak phase of the COVID-19 pandemic are currently under intense discussion. In this paper, the cost-effectiveness of routine pre-endoscopy testing and high risk personal protective equipment (PPE) is addressed. Method A model based on theoretical assumptions of 10 000 asymptomatic patients presenting to a high volume center was created. Incremental cost-effectiveness ratios (ICERs) and absolute costs per endoscopy were calculated using a Monte Carlo simulation. Results ICER values for universal testing decreased with increasing prevalence rates. For higher prevalence rates (≥ 1 %), ICER values were lowest for routine pre-endoscopy testing coupled with use of high risk PPE, while cost per endoscopy was lowest for routine use of high risk PPE without universal testing. Conclusion In general, routine pre-endoscopy testing combined with high risk PPE becomes more cost-effective with rising prevalence rates of COVID-19.

scholarly journals Transmission dynamics of the delta variant of SARS-CoV-2 infections in Daejeon, South Korea

2021 ◽  
Author(s):  
Hari Hwang ◽  
Jun-Sik Lim ◽  
Sun-Ah Song ◽  
Chiara Achangwa ◽  
Woobeom Sim ◽  
...  
Keyword(s):  
South Korea ◽  
Symptom Onset ◽  
Credible Interval ◽  
Transmission Dynamics ◽  
Contact Tracing ◽  
Nasopharyngeal Swab ◽  
Strict Adherence ◽  
Virus Shedding ◽  
Viral Shedding ◽  
Asymptomatic Patients

Abstract Background The delta variant of SARS-CoV-2 is now the predominant variant worldwide. However, its transmission dynamics remain unclear. Methods We analyzed all case patients in local clusters and temporal patterns of viral shedding using contact tracing data from 405 cases associated with the delta variant of SARS-CoV-2 between 22 June and 31 July 2021 in Daejeon, South Korea. Results Overall, half of the cases were aged under 19 years, and 20% were asymptomatic at the time of epidemiological investigation. We estimated the mean serial interval as 3.26 days (95% credible interval 2.92, 3.60), and 12% of the transmission occurred before symptom onset of the infector. We identified six clustered outbreaks, and all were associated with indoor facilities. In 23 household contacts, the secondary attack rate was 63% (52/82). We estimated that 15% (95% confidence interval, 13–18%) of cases seeded 80% of all local transmission. Analysis of the nasopharyngeal swab samples identified virus shedding from asymptomatic patients, and the highest viral load was observed two days after symptom onset. The temporal pattern of viral shedding did not differ between children and adults (P = 0.48). Conclusions Our findings suggest that the delta variant is highly transmissible in indoor settings and households. Rapid contact tracing, isolation of the asymptomatic contacts, and strict adherence to public health measures are needed to mitigate the community transmission of the delta variant.

scholarly journals Assessment of Risk and Emergency Knowledge Level - Cardiovascular Emergencies in Rural Communities Sungai Nagara, Margasari Village, Tapin, South Kalimantan

2021 ◽  
Vol 4 (2) ◽  
pp. 196-203
Author(s):  
Abdurahman Wahid ◽  
Hasby Prichoiruna ◽  
Ainun ◽  
Muhamad Muzakir
Keyword(s):  
Rural Communities ◽  
Rural Areas ◽  
Sampling Method ◽  
High Cholesterol ◽  
Framingham Risk ◽  
Low Hdl ◽  
Level Of Knowledge ◽  
Cardiac Emergencies ◽  
Over 40 Years ◽  
Cardiac Emergency

Background Cardiovascular disease contributes to a massive mortality rate in the world and also in Indonesia. Assessment of the risk and level of knowledge of cardiac emergency symptoms needs to be carried out, especially in rural areas where access to cardiovascular treatment is far.Purposes This study aims to assess risk stratification and the level of knowledge. The method of measuring risk and level of knowledge was carried out on 100 Margasari Ilir respondent who were over 40 years old and carried out using the stratified random sampling method during September 2020—measuring risk using the instrument Framingham Risk Score and the level of knowledge using the ACS Response Index.Result The average age of respondents was 54.98 years, 30 men (30%) and 70 women (70%), 22 smokers (22%), seven diabetes mellitus (7%), 11 people ( 11%) had high cholesterol, 41 people (41%) had hypertension, and 33 people (33%) had low HDL levels. The number of people who have a high risk of emergency - cardiovascular emergency is seven people (7%), 24 people are at moderate risk (24%), and 69 people are at low risk (69%). The level of knowledge about cardiac emergencies is in the low category of 80 people (80%), 19 people (19%), and one high (1%).Conclusion It is necessary to increase public knowledge about cardiovascular emergencies.

scholarly journals Comparison of SARS-CoV-2 detection in nasopharyngeal swab and saliva

2020 ◽  
Author(s):  
Sumio Iwasaki ◽  
Shinichi Fujisawa ◽  
Sho Nakakubo ◽  
Keisuke Kamada ◽  
Yu Yamashita ◽  
...  
Keyword(s):  
Viral Load ◽  
Healthcare Workers ◽  
Virus Detection ◽  
Pcr Detection ◽  
Concordance Rate ◽  
Nasopharyngeal Swab ◽  
Protective Equipment ◽  
Convalescent Phase ◽  
Two Samples ◽  
The Face

We prospectively compared the efficacy of PCR detection of SARS-CoV-2 between paired nasopharyngeal and saliva samples in 76 patients including ten COVID-19 patients. The overall concordance rate of the virus detection between the two samples was 97.4% (95%CI, 90.8-99.7). Viral load was equivalent in COVID-19 patients, but the virus tended to disappear earlier in saliva at convalescent phase compared to nasopharyngeal samples. These results suggest that saliva is a reliable noninvasive alternative to nasopharyngeal swabs and facilitate widespread PCR testing in the face of shortages of swabs and protective equipment without posing a risk to healthcare workers.

scholarly journals The impact of COVID-19 pandemic on dental practice in Iran: a questionnaire-based report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hanie Ahmadi ◽  
Alireza Ebrahimi ◽  
Farhad Ghorbani
Keyword(s):  
Personal Protective Equipment ◽  
Dental Health ◽  
Protective Equipment ◽  
Dental Practice ◽  
Online Questionnaire ◽  
Dental Services ◽  
Emergency Procedures ◽  
Dental Procedures ◽  
Dental Practitioners ◽  
The Impact

Abstract Background The highly contagious nature of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), besides the fact that dental procedures commonly generate blood and saliva droplets that could lead to the contagion have resulted in the closure of many dental clinics. In the present study, we aimed to evaluate the impact of coronavirus disease 2019 (COVID-19) pandemic on dental practice by conducting an online questionnaire among the Iranian dental practitioners and finding their perspectives on the subject. Methods This report is based on a questionnaire that was conducted among Iranian dentists. The survey included questions that evaluate the dentists’ perceptions and attitudes toward the COVID-19 pandemic and its effect on their personal life, financial status, and the quality of dental services for patients. Results Overall, 240 dentists contributed to this study (214 general dentists and 26 specialists). The majority of the participants (n = 170, 70%) did not perform non-emergency procedures during the pandemic. The dental practitioners have suggested several strategies to decrease the risk of contagion, such as reducing treatment sessions (n = 90, 37%), strict triage of patients (n = 156, 64%), and using personal protective equipment (n = 108, 45%). However, most of the dentists (n = 210, 87%) had problems, providing personal protective equipment during the pandemic. Moreover, 97% (n = 234) of the participants reported that they encountered a decrease in their financial income since the eruption of the pandemic. Conclusion Dental health care workers are at the highest risk of contracting COVID-19. Thus, dental practitioners ought to execute the standard protocols more cautiously during the pandemic. They could also lower their work hours and limit dental procedures to emergency treatments to reduce the risk of COVID-19 transmission. Besides, the public organizations should provide proper equipment for the dental practitioners to decrease the risk of contagion.

scholarly journals Saliva is a Promising Alternative Specimen for the Detection of SARS-CoV-2 in Children and Adults

2020 ◽  
Author(s):  
Rebecca Yee ◽  
Thao Truong ◽  
Pia S. Pannaraj ◽  
Natalie Eubanks ◽  
Emily Gai ◽  
...  
Keyword(s):  
Health Care Workers ◽  
Pediatric Patients ◽  
Lower Cost ◽  
Nasopharyngeal Swab ◽  
Protective Equipment ◽  
Promising Alternative ◽  
Care Workers ◽  
Saliva Collection ◽  
Alternative Specimen ◽  
Variable Performance

Testing efforts for SARS-CoV-2 have been burdened by the scarcity of testing materials and personal protective equipment for health care workers. The simple and painless process of saliva collection allows for widespread testing, but enthusiasm is hampered by variable performance compared to nasopharyngeal swab (NPS) samples. We prospectively collected paired NPS and saliva samples from a total of 300 unique adult and pediatric patients. SARS-CoV-2 RNA was detected in 32.2% (97/300) of the individuals using the TaqPath COVID-19 Combo Kit (Thermo Fisher). Performance of saliva and NPS were compared against the total number of positives regardless of specimen type. The overall concordance for saliva and NPS was 91.0% (273/300) and 94.7% (284/300), respectively. The positive percent agreement (PPA) for saliva and NPS was 81.4% (79/97) and 89.7% (87/97), respectively. Saliva detected 10 positive cases that were negative by NPS. In symptomatic and asymptomatic pediatric patients not previously diagnosed with COVID-19, the performances of saliva and NPS were comparable (PPA: 82.4% vs 85.3%). The overall PPA for adults were 83.3% and 90.7% for saliva and NPS, respectively, with saliva detecting 4 cases less than NPS. However, saliva performance in symptomatic adults was identical to NPS (PPA of 93.8%). With lower cost and self-collection capabilities, saliva can be an appropriate alternative sample choice to NPS for detection of SARS-CoV-2 in children and adults.

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