scholarly journals A Large Cohort Study of SARS-CoV-2 Detection in Saliva: A Non-Invasive Alternative Diagnostic Test for Patients with Bleeding Disorders

Viruses ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2361
Author(s):  
Josiane Iole França Lopes ◽  
Carlos Alexandre da Costa Silva ◽  
Rodrigo Guimarães Cunha ◽  
Alexandra Martins Soares ◽  
Maria Esther Duarte Lopes ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Hospitalized Patients ◽  
Bleeding Disorders ◽  
Hematological Diseases ◽  
Non Invasive ◽  
Qrt Pcr ◽  
Large Cohort Study ◽  
The Mean ◽  
Sensitivity Specificity ◽  
Higher Sensitivity

Diagnosis of SARS-CoV-2 infections is mostly based on the nasopharyngeal swabs (NPS). However, this collection is invasive and uncomfortable, especially for children and patients with coagulopathies, whose NPS collection often causes bleeding. Thus, the aim of this study was to evaluate the usefulness and accuracy of saliva for the diagnosis of COVID-19 in patients presenting bleeding disorders. Samples of NPS, oropharyngeal swabs (OPS), and saliva were collected simultaneously from 1159 hospitalized patients with hematological diseases and from 524 healthcare workers, both symptomatic and asymptomatic for SARS-CoV-2. All samples were evaluated for SARS-CoV-2 by qRT-PCR. SARS-CoV-2 was detected in NPS, OPS and saliva from 16.9%, 14.4% and 15.6% individuals, respectively. Tests in saliva showed sensitivity, specificity, and overall agreement of 73.3%, 96.9% and 92.7% (=0.74), respectively. Salivary tests had good accuracy (AUC = 0.7) for discriminating negative and positive qRT-PCR for SARS-CoV-2. Higher sensitivity was observed in symptomatic than in non-symptomatic patients, as well as in healthy subjects than in patients with hematological disease, in both OPS and saliva. The mean viral load in NPS was significantly higher than in OPS and in saliva samples (p < 0.001). Saliva is a good diagnostic tool to detect SARS-CoV-2, especially among patients symptomatic for COVID-19, and is a valuable specimen for mass screening of hospitalized patients with hematological diseases, especially for those that with bleeding disorders.

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 Comparison of Saliva with Healthcare Workers- and Patient-Collected Swabs in the Diagnosis of COVID-19 in a Large Cohort

2020 ◽  
Author(s):  
Mitnala Sasikala ◽  
Yelamanchili Sadhana ◽  
Ketavarapu Vijayasarathy ◽  
Anand Gupta ◽  
Sarala kumari Daram ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Screening Tool ◽  
Cost Effective ◽  
Hospitalized Patients ◽  
Detection Sensitivity ◽  
Nasopharyngeal Swab ◽  
Predictive Values ◽  
Qrt Pcr ◽  
Lower Detection ◽  
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 (asymptomatic: 2683, symptomatic: 335) were screened. Of these, 200 qRT-PCR-confirmed SARS-CoV-2-positive patients were recruited (81 asymptomatic, 119 symptomatic). 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 outpatient swabs tested by qRT-PCR, 200 were positive (males: 140, females: 60; aged 37.85±12.76 years). Of these, saliva was positive in 128 (64%); 39 of 81 asymptomatic (47%),89 of 119 symptomatic patients (74.78%). 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 53.43±15.58 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: Our results demonstrate the use of saliva to detect SARS-COV-2 in symptomatic patients early after the onset of symptoms. Additionally, these results suggest that saliva may not be recommended as a screening tool at the community level due to the lower detection rate than that for swabs. Saliva testing in symptomatic patients whose nasopharyngeal swab does not detect SARS-CoV-2 reduces false negativity.

scholarly journals Comparative study of colour Doppler vs. FNNAC findings in WHO grade II thyroid enlargement in adult females

2019 ◽  
Vol 5 (4) ◽  
pp. 1025
Author(s):  
Sudhakar Rao M. S. ◽  
Navneeth T. P. ◽  
John C. J.
Keyword(s):  
Pulsatility Index ◽  
Low Cost ◽  
Resistive Index ◽  
Colour Doppler ◽  
Who Grade ◽  
Predictive Values ◽  
Non Invasive ◽  
Adult Females ◽  
The Mean ◽  
Sensitivity Specificity

<p class="abstract"><strong>Background:</strong> Thyroid gland disorders form one of the most common endocrinal and surgical problems encountered in clinical practice. FNNAC is widely accepted as the primary and better method than FNAC for investigation but has its disadvantages. Colour Doppler is a non-invasive, low cost, easily available and repeatable investigation with least patient discomfort and can be valuable in detection of benign and malignant thyroid enlargements.</p><p class="abstract"><strong>Methods:</strong> Forty cases of adult females with WHO grade 2 thyroid enlargement attending the department of otorhinolaryngology selected on simple random basis were included in this study. Following written consent, Colour Doppler scanning and FNNAC test were done on the thyroid swelling and the results were analysed.  </p><p class="abstract"><strong>Results:</strong> The mean age of patients was 32.44 years. The mean age of malignancy was 44.66 years and showed statistically significant association. The Resistive and Pulsatility index and combination of both were found to have statistically significant results in detecting malignant and benign lesions The sensitivity, specificity, positive and negative predictive values of RI and PI were 83.33%, 94.12%, 71.43%, 96.97% and 50%, 94.12%, 60% and 91.43% respectively. On combining both the indices, the sensitivity was 91.67% and the positive predictive value was 97.06%.</p><p class="abstract"><strong>Conclusions:</strong> Colour Doppler can differentiate between benign and malignant thyroid enlargements using Resistive index (of&gt;0.75) and Pulsatility Index (of&gt;1.5) and can be a complementary diagnostic tool in the thyroid enlargement lesions, considering its accuracy, cost-effectiveness, easy availability and non-invasive repeatable nature.</p>

scholarly journals Diffusion tensor imaging of dorsal stream language areas in patients with post-stroke aphasia

2022 ◽  
Vol 53 (1) ◽  
Author(s):  
Azza Elmongui ◽  
Ahmed AbdelRazek ◽  
Tamer Abou-Elsaad ◽  
Tamer Belal ◽  
Noha Ibrahim ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Diffusion Tensor ◽  
Mean Diffusivity ◽  
Dorsal Stream ◽  
Functional Independence ◽  
Post Stroke ◽  
Non Invasive ◽  
The Mean ◽  
Sensitivity Specificity ◽  
Language Areas

Abstract Background Aphasia complicating stroke occurs due to language deficits that decrease communication abilities and functional independence. Our study aims to assess fractional anisotropy (FA) and mean diffusivity (MD) parameters of diffusion tensor imaging (DTI) of the dorsal stream language areas in patients with post-stroke aphasia. It was conducted on 27 patients with post-stroke aphasia and 27 age- and sex-matched controls who underwent DTI of the brain. FA and MD values of Broca's area (BA), Wernick's area (WA), superior longitudinal fasciculus (SLF), and arcuate fasciculus (AF), and number of tract fibers (TF) of AF and SLF were calculated. Results were correlated with National Institutes of Health Stroke Scale (NIHSS), Arabic version of Comprehensive Aphasia Test (Arabic CAT), and Mansoura Arabic Screening Aphasia Test (MASAT). Results FA of AF and SLF in patients was significantly lower (P = 0.001) than controls. MD of AF and SLF in patients was significantly higher (P = 0.001) than controls. The mean volume TF of AF and SLF in patients was significantly (P = 0.001) lower than the mean volume in controls for AF and SLF. FA cutoff for AF was 0.34 and for SLF, it was 0.35 with sensitivity, specificity, and accuracy (85.2%, 62.1%, 73.2%) for AF, (74.1%, 69%, 71.4%) for SLF, respectively. MD cutoff value for AF was 0.87, and 0.84 for SLF with sensitivity, specificity, and accuracy (63%, 72.4%, 67.8%) for AF, (81.5%, 79.3%, 80.4%) for SLF, respectively. Cutoff TF of AF was 1728 and for SLF it was 601 with sensitivity, specificity, and accuracy (88.9%, 72.4%, 80.4%) for AF and (85.2%, 85.2%, 78.6%) for SLF, respectively. Conclusions DTI is a non-invasive promising method that can be used to assess language areas in patients with post-stroke aphasia.

scholarly journals COVID-19 in patients hospitalized and healthcare workers: what have changed after the first wave in a university hospital

2021 ◽  
Author(s):  
Luiz Vinicius Leao Moreira ◽  
Gabriela Barbosa ◽  
Luciano Kleber de Souza Luna ◽  
Alberto Fernando Oliveira Justo ◽  
Ana Paula Cunha Chaves ◽  
...  
Keyword(s):  
Viral Load ◽  
Healthcare Workers ◽  
Sao Paulo ◽  
Hospitalized Patients ◽  
University Hospital ◽  
São Paulo ◽  
The Mean ◽  
Wave Methods ◽  
The Impact ◽  
Pandemic Wave

Objective: To assess the COVID-19 frequency rates in hospitalized patients (HP) and healthcare workers (HCW), viral load inference, and the impact of vaccination and variants of concern (VOC) during the first pandemic wave. Methods: We evaluated the COVID-19 diagnostics at Hospital Sao Paulo, Brazil, from March 2020 to April 2021, in 10,202 samples (6,502 HP and 3,700 HCW) tested by RT-qPCR, inferring viral load by cycle threshold (Ct) values, and frequency rates. Results: SARS-CoV-2 was detected in 31.27% of individuals (32.23% HP and 29.80% HCW). The mean age of HP positives was 57.26 +/- 18.29 years (median = 59), with a mean Ct value of 25.55 +/- 6.07. Neither age nor Ct values in both groups have significantly differed during the first and second waves or even since the predominance of VOC P.1 on March 2021. Conclusions: The COVID-19 epidemic curves of HP and HCW accompanied the variations reported in Sao Paulo city, as well as the variation of hospitalization and occupancy of ICU beds. The VOC P.1 has no impact on the viral load, since its predominance in March 2021. The vaccination of HCW may have contributed to a decrease in the positivity rates, although more studies will provide a better understanding of the impact of immunization on the COVID-19 pandemic.

Stenosi carotidea: Confronto tra angio-RM e angio-TC spirale

1997 ◽  
Vol 10 (2_suppl) ◽  
pp. 93-95 ◽  
Author(s):  
T. Scarabino ◽  
G.M. Giannatempo ◽  
A. Simeone ◽  
F. Florio ◽  
N. Magarelli ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Internal Carotid ◽  
Three Dimensional ◽  
Clinical Signs ◽  
Spiral Ct ◽  
Non Invasive ◽  
Spiral Ct Angiography ◽  
Preliminary Study ◽  
Sensitivity Specificity ◽  
Higher Sensitivity

A preliminary study comparing three dimensional time of flight (TOF 3D) Magnetic Resonance angiography (MRA) and spiral CT angiography (SCTA) in the detection and evaluation of internal carotid stenosis. Digital subtraction angiography (DSA) was the gold standard. Twenty patients with clinical signs of cerebrovascular insufficiency underwent MRA, SCTA and DSA within a three day period. Both internal carotid arteries were evaluated for absence or degree of stenosis. Sensitivity, specificity, diagnostic accuracy, concordance, overstimation and understimation were assessed. MRA showed a higher sensitivity, specificity, diagnostic accuracy and concordance compared to SCTA (92% versus 80%, 98,2% versus 96,4%, 96,3% versus 88%, respectively). MRA demonstrated a 5% overstimation rate whereas SCTA demonstrated a 7,5% understimation rate. These differences are not statistically significant. These results suggest that MRA is the more useful, non invasive modality for the detection and evaluation of the internal carotid artery with a greater than 70% stenoses.

scholarly journals COVID-19 in hospitalized patients and healthcare workers: what have changed after the first wave in a university hospital

2021 ◽  
Author(s):  
Luiz Moreira ◽  
Gabriela Rodrigues Barbosa ◽  
Luciano Kleber de Souza Luna ◽  
Alberto Fernando Oliveira Justo ◽  
Ana Paula Cunha Chaves ◽  
...  
Keyword(s):  
Viral Load ◽  
Healthcare Workers ◽  
Sao Paulo ◽  
Hospitalized Patients ◽  
University Hospital ◽  
São Paulo ◽  
Cycle Threshold ◽  
Ct Value ◽  
The Mean ◽  
The Impact

Abstract ObjectiveTo assess the COVID-19 frequency rates in hospitalized patients (HP) and healthcare workers (HCW), viral load inference, and the impact of vaccination and variants of concern (VOC) during the COVID-19 pandemic.Materials and methodWe evaluated the COVID-19 diagnostics at Hospital São Paulo, Brazil, from March 2020 to April 2021, in 10,202 samples (6,502 HP and 3,700 HCW) tested by RT-qPCR, inferring viral load by cycle threshold (Ct) values, and frequency rates.ResultsSARS-CoV-2 was detected in 31.27% of individuals (32.23% HP and 29.80% HCW). The mean age of HP positives was 57.26 ± 18.29 years (median = 59), with a mean Ct value of 25.55 ± 6.07. Neither age nor Ct values in both groups have significantly differed during the first and second waves or even since the predominance of VOC P.1 on March 2021.ConclusionsThe COVID-19 epidemic curves of HP and HCW accompanied the variations reported in São Paulo city, as well as the variation of hospitalization and occupancy of ICU beds. The VOC P.1 has no impact on the viral load, since its predominance in March 2021. The vaccination of HCW may have contributed to a decrease in the positivity rates, although more studies will provide a better understanding of the impact of immunization on the COVID-19 pandemic.

Simultaneous Determination of Alogliptin, Linagliptin, Saxagliptin, and Sitagliptin in Bulk Drug and Formulation by UPLC Q-TOF-MS

2020 ◽  
Vol 17 (1) ◽  
pp. 95-105
Author(s):  
Ramji Rathod ◽  
Faraat Ali ◽  
Amrish Chandra ◽  
Robin Kumar ◽  
Meenakshi Dahiya ◽  
...  
Keyword(s):  
Internal Standard ◽  
Gradient Elution ◽  
Ultra Performance Liquid Chromatography ◽  
Pharmaceutical Dosage Forms ◽  
Sensitivity And Selectivity ◽  
The Mean ◽  
Bulk Drug ◽  
Positive Ion ◽  
Higher Sensitivity

Background: A simple and sensitive Ultra Performance Liquid Chromatography-Mass Spectrometry method was developed and validated to measure the concentrations of Alogliptin (ALO), Linagliptin (LIN), Saxagliptin (SAX), and Sitagliptin (SIT) using Pioglitazone (PIO) as an internal standard. Methods: Chromatographic separation of six gliptins was achieved on a C-18 column (100×2.1 mm, 2.7 μm) using a mobile phase consisting of formic acid in water, 0.1%v/v: acetonitrile in gradient elution. Electrospray ionization (ESI) source was operated in the positive ion mode. Targeted MS/MS mode on a QTOF MS was used to quantify the drug utilizing the transitions of 340.1(m/z), 473.2 (m/z), 316.2 (m/z), 408.1 (m/z), and 357.1 (m/z) for ALO, LIN, SAX, SIT and PIO respectively. Results: As per ICH Q2R1 guidelines, a detailed validation of the method was carried out and the standard curves were found to be linear over the concentration ranges of 1516.0-4548.1 ng mL-1, 519.8- 1559.4 ng mL-1, 1531.4-4594.3 ng mL-1and 1519.6-4558.8 ng mL-1 for ALO, LIN, SAX and SIT respectively. Precision and accuracy results were within the acceptable limits. The mean recovery was found to be 98.8 _ 0.76 % (GEM), 102.2 _ 1.59 % (LIN), 95.3 _ 2.74 % (SAX) and 99.2 _ 1.75 % (SIT) respectively. Conclusions: The optimized validated UPLC QTOF-MS/MS method offered the advantage of shorter analytical times and higher sensitivity and selectivity. The optimized method is suitable for application in quantitative analysis of pharmaceutical dosage forms for QC laboratory.

Can the Expiratory Disproportion Index Distinguish PVFMD from Subglottic Stenosis in Obese Patients?

2021 ◽  
pp. 000348942199015
Author(s):  
Kevin Calamari ◽  
Stephen Politano ◽  
Laura Matrka
Keyword(s):  
Vocal Fold ◽  
Forced Expiratory Volume ◽  
Subglottic Stenosis ◽  
Obese Patients ◽  
Level Of Evidence ◽  
Prior Literature ◽  
The Mean ◽  
Sensitivity Specificity ◽  
Paradoxical Vocal Fold Movement ◽  
Rule Out

Objectives: Expiratory disproportion index (EDI) is the ratio of forced expiratory volume in 1 second (FEV1) divided by peak expiratory flow rate (PEFR) multiplied by 100. Prominent EDI (>50) values can differentiate subglottic stenosis (SGS) from paradoxical vocal fold movement disorder (PVFMD), but this has not been verified when considering body habitus. We hypothesize that the predictive value of elevated EDI in differentiating SGS from PVFMD will be lower in obese patients than non-obese patients. Methods: Patients ≥ 18 years old with recorded PFT values, BMI, and airway imaging were reviewed retrospectively from 01/2011 to 10/2018. EDI was recorded for 4 cohorts: non-obese/SGS, non-obese/ PVFMD, obese/SGS, and obese/ PVFMD, to determine the mean EDI and the sensitivity/specificity of an elevated EDI. Results: Mean EDI values were 69.32 and 48.38 in the non-obese SGS and PVFMD groups, respectively ( P < .01). They were 58.89 and 47.67 in the obese SGS and PVFMD groups, respectively ( P < .05). At a threshold of >50, EDI had a sensitivity of 90.0% and specificity of 51.6% in differentiating between SGS and PVFMD cases in non-obese patients and 51.6% and 63.6% in obese patients. Conclusion: Prior literature has established that EDI can distinguish SGS from PVFMD in the general population. Our results show that the mean EDI values were significantly different in both cohorts, but an elevated EDI was not as sensitive at identifying SGS cases in obese patients. This suggests that the EDI should be used with caution in obese patients and should not be relied upon to rule out SGS. Level of Evidence: 3.

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