Diagnostic Performance and Usability of the Genedrive® HCV ID Kit in Two Decentralized Settings in Cameroon and Georgia

Point-of-care diagnostics have the potential to increase diagnosis and linkage to care and help reach the WHO targets to eliminate hepatitis C virus (HCV) by 2030. Here, we evaluated the diagnostic accuracy of Genedrive HCV ID assay for the qualitative detection of HCV RNA in decentralized settings in two low- and middle-income countries using fresh plasma specimens from 426 participants. The Abbott RealTime HCV assay was used as the gold standard. Genedrive HCV ID assay was conducted by different users. Users also completed questionnaires to assess the usability of Genedrive. At detection thresholds of 12 IU/mL or 30 IU/mL, 1000 IU/mL, and 2362 IU/mL, the sensitivity was 96.2% (95% CI: 92.7–98.4), 100% (98.2–100), and 100% (98.2–100), respectively; the specificity was 99.5% (95% CI: 97.4–100), 99.5% (97.5–100), and 98.7% (96.1–100), respectively. All genotypes detected using the gold-standard assay were also detected with Genedrive. Users found Genedrive easy to use. Genedrive is a simple and accurate test to confirm chronic HCV infection in decentralized, real-life, resource-limited settings. This novel diagnostic tool could contribute to closing the current gap in HCV diagnosis.

Assessment of anti SARS-CoV-2 antibodies present in convalescent plasma donors aimed at being used in COVID-19 treatment

Introduction. Currently, COVID-19 treatment includes several options, including the use of convalescent plasma. Therefore, the presence of anti-SARS-CoV-2 in blood donors after the clinical recovery of COVID-19, depending on their place of residence, age and the clinical manifestation of the disease is of scientific-practical interest. Material and methods. A total of 119 donors among patients were examined, namely males aged 18-60 years, having a past history of COVID-19 disease, being confirmed by PCR and treated, showing a negative PCR-based test result, which was performed at least 14 days after clinical recovery. The presence/absence of anti-SARS-CoV-2 was assessed by enzyme-linked immunosorbent assay. Results. The obtained data showed that 87.4% of plasma donors responded to COVID-19 infection by anti-SARS-CoV-2 IgG expression, being predominantly found in the 26-35 age group. Most donors experienced mild and medium clinical forms. It is important to note that all severe clinical manifestations of the infection were followed by formation of anti-SARS-CoV-2 IgG. Urban living environment was predominantly found in convalescent donors (75.0%), which indicates that they are better informed by medical institutions. Conclusions. The study shows that male blood donors aged 18-60 years, subsequently cured and being positive to anti-SARS-CoV-2 IgG can serve as a source of fresh plasma used for the treatment of COVID-19 patients.

Radiotherapy for Esophageal Squamous Cell Carcinoma Concomitant With Hypoproteinemia: a Case Report

Background: Malignant tumors frequently combined with hyperfibrinogenemia, rarely with hypofibrinogenemia.Case presentation: This study reports a 60-year-old male patient of mid-thoracic esophageal squamous cell carcinoma (ESCC) with hypofibrinogenemia who presented at our hospital because of a swallowing disorder and dull pain in the upper abdomen. An initial test indicated his plasma fibrinogen (FIB) level was 0.88 g/L (reference range: 2.38–4.98 g/L). After multiple infusions of fresh plasma and supplements of FIB and cryoprecipitate, he maintained a FIB level above 1.0 g/L. We administered radical radiotherapy (RT) for the ESCC, and his FIB level gradually normalized during the RT period. The symptoms from ESCC gradually resolved, and we classified the patient as having stable disease at the end of the RT period. After 10 months follow-up, the patient have achieved partial response (PR). At that time, the patient had no increased tendency for bleeding and his FIB level was 0.97 g/L. At the last follow-up, the patient has survival about 18 months. Conclusions: it was considered the hypofibrinogenemia in this ESCC patient to be a consequence of paraneoplastic syndrome.

Sub-milliarcsecond imaging of a bright flare and ejection event in the extragalactic jet 3C 111

Context. Flares in radio-loud active galactic nuclei are thought to be associated with the injection of fresh plasma into the compact jet base. Such flares are usually strongest and appear earlier at shorter radio wavelengths. Hence, very long baseline interferometry (VLBI) at millimeter(mm)-wavelengths is the best-suited technique for studying the earliest structural changes of compact jets associated with emission flares. Aims. We study the morphological changes of the parsec-scale jet in the nearby (z = 0.049) γ-ray bright radio galaxy 3C 111 following a flare that developed into a major radio outburst in 2007. Methods. We analyse three successive observations of 3C 111 at 86 GHz with the Global mm-VLBI Array (GMVA) between 2007 and 2008 which yield a very high angular resolution of ∼45 μas. In addition, we make use of single-dish radio flux density measurements from the F-GAMMA and POLAMI programmes, archival single-dish and VLBI data. Results. We resolve the flare into multiple plasma components with a distinct morphology resembling a bend in an otherwise remarkably straight jet. The flare-associated features move with apparent velocities of ∼4.0c to ∼4.5c and can be traced also at lower frequencies in later epochs. Near the base of the jet, we find two bright features with high brightness temperatures up to ∼1011 K, which we associate with the core and a stationary feature in the jet. Conclusions. The flare led to multiple new jet components indicative of a dynamic modulation during the ejection. We interpret the bend-like feature as a direct result of the outburst which makes it possible to trace the transverse structure of the jet. In this scenario, the components follow different paths in the jet stream consistent with expectations for a spine-sheath structure, which is not seen during intermediate levels of activity. The possibility of coordinated multiwavelength observations during a future bright radio flare in 3C 111 makes this source an excellent target for probing the radio-γ-ray connection.

Pre-hospital blood transfusion – a survey of European practice

Background Blood products are a lifesaving commodity in the treatment of major trauma. Although there is little evidence for use of pre-hospital blood products (PHBP) in seriously injured patients, an increasing number of emergency medical services have started using PHBP for treatment of major haemorrhage. Aim of this survey was to establish the degree of prehospital blood product use throughout Europe and discover main indications. The second aim was to evaluate opinions about PHBP and also the experience and the personal views of its users. Methods The subcommittee for Critical Emergency Medicine of the European Society of Anaesthesiology (ESA) held an online survey of European Helicopter Emergency Services (HEMS) and all French Services d’Aide Médicale Urgente (SAMU) regions. It contained 13 questions both open and multiple-choice about the frequency transfusions are carried out, the PHBP used and the perceived benefit. The survey was distributed to the corresponding HEMS leads in 14 European countries. Results In total there were 172 valid responses; overall 48% of all respondents have prehospital access to packed red cells, 22% to fresh plasma and 14% use lyophilised plasma. Besides blood product administration, 94% of all services use tranexamic acid. Sixty five percent of all replies came from French and from German services (37% and 28% respectively). PHBP were mainly used for trauma related emergencies. France has the highest uptake of use of blood products at 89%, whereas the rate in Germany was far lower at 6%. Fifty five percent of the service leads felt that PHBP are beneficial, and even lifesaving in individual cases despite being needed infrequently. Conclusions We found remarkable dissimilarities in practice between the different European countries. Even if there is not an absolute consensus amongst providers on the benefit of PHBP, the majority feel they are beneficial. The difference in practice is possibly related to the perceived lack of evidence on prehospital blood transfusion. We suggest to include the use of PHBP in trauma registries in order to consolidate the existing evidence.

MO079SECURITY OF THERAPEUTIC APHERESIS IN PEDIATRICS. PROSPECTIVE STUDY DURING 2018 IN 171 APHERESIS SESSSIONS

Background and Aims Identify hypocalcemia and hemodynamic disorders related to apheresis in pediatrics either complications in vascular access or related to anticoagulation and adverse reactions with replacement fluid. Method Prospective and descriptive study of 171 sessions for therapeutic apheresis in pediatrics during 2018. Inclusion criteria was based on the 2016 Clinical-Practice-of-Therapeutic-Apheresis-guidelines(ASFA). The apheresis technique was selected also based on the 2016 ASFA Guidelines and the expertise in our center. Results The 171 sessions were distributed as follows: 73% were immunoadsorption(IA), 12% were cytoapheresis, 10.5% were LDL-apheresis and 4.5% therapeutic plasma exchange(TPE). The average age was 9 years and 58% were women. 50, 33 and 17% were due to Nephrological, Neurological and Digestive pathology respectively. 83% of the nephrological indications correspond to a category I of the ASFA Guidelines, as well as 25% of the neurological indications and all indications of Digestive pathology correspond to a category II. 58, 25 and 17% used temporary catheter, permanent catheter and needles respectively. Only one patient is accidentally removed from the temporary jugular catheter and it has not been related to vascular access or by the apheresis technique itself. Sixty-six percent had individual anticoagulation with citrate/calcium plus heparin and the remaining 33%, only once. Any case of bleeding related to catheter or others. Only 3 sessions of IA in the hypocalcemia objective, being symptomatic in only one of them. Of all 8 sessions of TPE, we performed 6 with frozen fresh plasma as replacement fluid with no adverse reactions. Conclusion The apheresis techniques in pediatrics had been presented with few complications in our center, none derived from vascular access, anticoagulation, infections or adverse effects due to use of replacement fluid. The training of medical and nursing staff is essential to identify risk situations. The use of protocols and international guidelines ensure safety in pediatrics.

Pre-hospital blood transfusion – a survey on European practice

Background Blood products are a lifesaving commodity in the treatment of major trauma. Although there is little evidence for use of pre-hospital blood products (PHBP) in seriously injured patients, an increasing number of emergency medical services have started using PHBP for treatment of major haemorrhage. Aim of this survey was to establish the degree of prehospital blood product use throughout Europe and discover main indications. The second aim was to evaluate opinions about PHBP and also the experience and the personal views of its users. Methods The subcommittee for Critical Emergency Medicine of the European Society of Anaesthesiology (ESA) held an online survey of European Helicopter Emergency Services (HEMS) and all French Services d’Aide Médicale Urgente (SAMU) regions. It contained 13 questions both open and multiple-choice about the frequency transfusions are carried out, the PHBP used and the perceived benefit. The survey was distributed to the corresponding HEMS leads in 14 European countries. Results In total there were 172 valid responses; overall 48% of all respondents have prehospital access to packed red cells, 22% to fresh plasma and 14% use lyophilised plasma. Besides blood product administration, 94% of all services use tranexamic acid. Sixty five percent of all replies came from French and from German services (37% and 28% respectively). PHBP were mainly used for trauma related emergencies. France has the highest uptake of use of blood products at 89%, whereas the rate in Germany was far lower at 6%. Fifty five percent of the service leads felt that PHBP are beneficial, and even lifesaving in individual cases despite being needed infrequently. Conclusions We found remarkable dissimilarities in practice between the different European countries. Even if there is not an absolute consensus amongst providers on the benefit of PHBP, the majority feel they are beneficial. The difference in practice is possibly related to the perceived lack of evidence on prehospital blood transfusion. We suggest to include the use of PHBP in trauma registries in order to consolidate the existing evidence.