Sensitivity of severe acute respiratory syndrome coronavirus type 2 rapid antigen point-of-care tests in vaccinated patients

Rapid antigen point-of-care tests (antigen POC tests) are frequently used to detect COVID-19 infections. Based on clinical impressions, we suspected that the sensitivity of antigen POC tests might be lower in vaccinated patients. OBJECTIVE: To evaluate the sensitivity of antigen POC tests in vaccinated patients. DESIGN, SETTING AND PARTICIPANTS: We retrospectively evaluated all patients over 18 years of age that tested positive for severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in November 2021 at our institution, whose antigen POC test result had been recorded. We considered patients who were either fully vaccinated or unvaccinated, as well as whether they were symptomatic. OUTCOME MEASURE AND ANALYSIS: We calculated the sensitivity of antigen POC tests in vaccinated and unvaccinated as well as in symptomatic and asymptomatic patients and compared the results. RESULTS: A total of 4080 reverse transcription PCR tests were performed in our institution in November 2021, of which 360 patients tested positive for SARS-CoV-2. Of those, 234 patients met inclusion criteria and were further evaluated. The sensitivity of the antigen POC test was only 39.4% [95% confidence interval (CI), 31.3–48.1%] in vaccinated patients and differed significantly from the sensitivity of 53.3% (95% CI, 43.9–62.4%) in unvaccinated patients (difference of sensitivities, 13.9%; 95% CI, 1.1–26.1%). In symptomatic patients, the sensitivity increased by only 11.8% from 45.7% in all patients (95% CI, 39.5–52.1%) to 57.5% in symptomatic patients (95% CI, 49.9–64.7%). In asymptomatic patients, the antigen POC test was only able to detect SARS-CoV-2 positive patients in 16.4% of the cases (95% CI, 9.4–27.1%). CONCLUSION: Point-of-care antigen tests are likely not useful for ruling out SARS-CoV-2 infection, especially in vaccinated and asymptomatic patients, potentially due to lower viral load. Moreover, the use of these tests might lead to a false sense of security, especially when used by the public as part of a public health testing strategy

„B-Probleme“ des nichttraumatologischen Schockraummanagements

In the primary survey of resuscitation room management in critically ill nontrauma patients, the ABCDE (airway, breathing, circulation, disability, exposure) approach is used for immediate recognition and treatment of life-threatening conditions. “B problems” are associated with respiratory failure and require immediate treatment. The pathogenesis is diverse, especially in the nontrauma resuscitation room. Clinical examination, emergency sonography and knowledge of oxygenation techniques and ventilation are important components of diagnosis and therapy. Standardized procedures and regular training in the emergency room are of fundamental importance

Porosity and herbicide leaching in soils amended with olive-mill wastewater

Organic amendments used to enrich soils of low organic matter contents can affect sorption and movement of pesticides in soils. In this work we studied the effect of olive oil mill wastewater (OOW) soil amendment on so porosity and on leaching of the herbicides clopyralid (3,6-dichloropicolinic acid) and metamitron (4-amino-3-methyl-6-phenyl- 1,2,4-triazine-5(4H)-one) in clay soil columns. OOW amendment resulted in an increase in the organic carbon content of the soils and a reduction in soil porosity, the latter confirmed by mercury intrusion porosimetry (MIP) and scanning electron microscopy (SEM) studies. MIP and SEM data showed the reduction in porosity is basically due to a reduction in large pores (radius > 0.1 μm) and an important increase in finer pores (radius < 0.1 μm). These changes in porosity are produced by the combined effect of the suspended and soluble organic matter and salts in the OOW and the solubilization-insolubilization of the soil carbonate minerals promoted by OOW. Soil columns were handpacked with the unamended clay soil and with the same soil which had been treated for 3 yrs with two different doses of OOW (low dose: 300 ml/m2 a year and high dose: 600 ml/m2 a year). Clopyralid moved more rapidly than metamitron in the unamended soil due to greater sorption and degradation of metamitron. Total amounts of clopyralid leached from the OOW, amended soils were significantly reduced (75 and 25% for the lower and higher dose respectively) when compared with the unamended soil (100%) whereas metamitron did not each at all from the amended soils. Sorption and degradation studies with soil slurry suggested this reduction may be mainly due to an increase in sorption and degradation processes in amended soils, as a consequence of the increase in the organic carbon content. However the decrease in mobility produced by OOW amendment is greater than that suggested from the sorption and degradation increases. The reduction in large size conducting pores and the increase in the small non-conducting pores, induced by OOW amendment, produce an increase in the residence nine of the herbicides in the immobile water phase, enhancing diffusion, sorption and degradation processes, thereby retarding mobility. The retarding effect was more pronounced for metamitron than for clopyralid due to the higher sorptivity and degradability of the former herbicide. These results suggest the possible use of the OOW or similar wastewater amendment in reducing the contamination of groundwater by pesticide drainage.Peer Reviewe

„C-Probleme“ des nichttraumatologischen Schockraummanagements

&lt;jats:title&gt;Zusammenfassung&lt;/jats:title&gt;&lt;jats:p&gt;Im Rahmen des nichttraumatologischen Schockraummanagements zur Versorgung kritisch kranker Patienten werden akute Störungen der Vitalfunktionen rasch detektiert und behandelt. Beim „primary survey“ (Erstversorgung) dient das etablierte ABCDE-Schema der strukturierten Untersuchung aller relevanten Vitalparameter. Akute Störungen werden hierbei unmittelbar detektiert und therapiert. „C-Probleme“ stellen den größten Anteil der ABCDE-Störungen bei nichttraumatologischen Schockraumpatienten dar und zeichnen sich durch eine hämodynamische Instabilität infolge hypovolämischer, obstruktiver, distributiver oder kardiogener Schockformen aus. Abhängig von den lokalen Versorgungsstrukturen umfasst die nichttraumatologische Schockraumversorgung hierbei auch die Stabilisierung von Patienten mit akutem Koronarsyndrom oder nach prähospitaler Reanimation (Cardiac Arrest Center).&lt;/jats:p&gt