SARS-CoV-2 RNA identification in nasopharyngeal swabs: issues in pre-analytics.

Abstract Objectives The direct identification of SARS-CoV-2 RNA in nasopharyngeal swabs is recommended for diagnosing the novel COVID-19 disease. Pre-analytical determinants, such as sampling procedures, time and temperature storage conditions, might impact on the end result. Our aim was to evaluate the effects of sampling procedures, time and temperature of the primary nasopharyngeal swabs storage on real-time reverse-transcription polymerase chain reaction (rRT-PCR) results. Methods Each nasopharyngeal swab obtained from 10 hospitalized patients for COVID-19 was subdivided in 15 aliquots: five were kept at room temperature; five were refrigerated (+4 °C); five were immediately mixed with the extraction buffer and refrigerated at +4 °C. Every day and for 5 days, one aliquot per condition was analyzed (rRT-PCR) for SARS-CoV-2 gene E and RNaseP and threshold cycles (Ct) compared. To evaluate manual sampling, 70 nasopharyngeal swabs were sampled twice by two different operators and analyzed separately one from the other. Results A total of 6/10 swabs were SARS-CoV-2 positive. No significant time or storage-dependent variations were observed in SARS-CoV-2 Ct. Re-sampling of swabs with SARS-CoV-2 Ct lower than 33 resulted in highly reproducible results (CV=2.9%), while a high variability was observed when Ct values were higher than 33 (CV=10.3%). Conclusions This study demonstrates that time and temperature of nasopharyngeal swabs storage do not significantly impact on results reproducibility. However, swabs sampling is a critical step, and especially in case of low viral load, might be a potential source of diagnostic errors

A Randomized Trial of Pharmacogenetic Warfarin Dosing in Naive Patients with Non-Valvular Atrial Fibrillation

Genotype-guided warfarin dosing have been proposed to improve patient's management. This study is aimed to determine whether a CYP2C9- VKORC1- CYP4F2-based pharmacogenetic algorithm is superior to a standard, clinically adopted, pharmacodynamic method. Two-hundred naive patients with non-valvular atrial fibrillation were randomized to trial arms and 180 completed the study. No significant differences were found in the number of out-of-range INRs (INR3.0) (p = 0.79) and in the mean percentage of time spent in the therapeutic range (TTR) after 19 days in the pharmacogenetic (51.9%) and in the control arm (53.2%, p = 0.71). The percentage of time spent at INR>4.0 was significantly lower in the pharmacogenetic (0.7%) than in the control arm (1.8%) (p = 0.02). Genotype-guided warfarin dosing is not superior in overall anticoagulation control when compared to accurate clinical standard of care

Chest X-ray in intensive care unit patients: what there is to know about thoracic devices

5noCritically ill patients admitted to the intensive care unit require continuous monitoring of vital functions as well as mechanical and pharmacological support, provided through different devices. Chest radiographs play a fundamental role in monitoring the conditions of these patients and assessing the intensive-care devices after their insertion; therefore, the radiologist needs to know their normal appearance and their correct position and should be aware of the possible complications that may occur after their placement. This pictorial review illustrates the radiographic appearance of non-cardiological devices commonly used in clinical practice (central venous catheters, tunneled catheters, Swan-Ganz catheters, chest tubes, endotracheal tubes, and nasogastric tubes), their correct position and the most common complications that may occur after their placement.openopenBaratella, Elisa; Marrocchio, Cristina; Bozzato, Alessandro Marco; Roman-Pognuz, Erik; Cova, Maria AssuntaBaratella, Elisa; Marrocchio, Cristina; Bozzato, Alessandro Marco; Roman-Pognuz, Erik; Cova, Maria Assunt

CT Urography Findings of Upper Urinary Tract Carcinoma and Its Mimickers: A Pictorial Review

Urothelial carcinoma (UC) is the fourth most frequent tumor in Western countries and upper tract urothelial carcinoma (UTUC), affecting pyelocaliceal cavities and ureter, accounts for 5-10% of all UCs. Computed tomography urography (CTU) is now considered the imaging modality of choice for diagnosis and staging of UTUC, guiding disease management. Although its specificity is very high, both benign and malignant diseases could mimic UTUCs and therefore have to be well-known to avoid misdiagnosis. We describe CTU findings of upper urinary tract carcinoma, features that influence disease management, and possible differential diagnosis

Y-chromosome haplotypes and clan structure of the Sherpa of the Solukhumbu (Nepal): preliminary ethnogenetic considerations.

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Severity of lung involvement on chest X-rays in SARS-coronavirus-2 infected patients as a possible tool to predict clinical progression: an observational retrospective analysis of the relationship between radiological, clinical, and laboratory data

Objective: To investigate the diagnostic accuracy of a chest X-ray (CXR) score and of clinical and laboratory data in predicting the clinical course of patients with SARS coronavirus 2 (SARS-CoV-2) infection. Methods: This is a pilot multicenter retrospective study including patients with SARS-CoV-2 infection admitted to the ERs in three hospitals in Italy between February and March of 2020. Two radiologists independently evaluated the baseline CXR of the patients using a semi-quantitative score to determine the severity of lung involvement: a score of 0 represented no lung involvement, whereas scores of 1 to 4 represented the first (less severe) to the fourth (more severe) quartiles regarding the severity of lung involvement. Relevant clinical and laboratory data were collected. The outcome of patients was defined as severe if noninvasive ventilation (NIV) or intubation was necessary, or if the patient died. Results: Our sample comprised 140 patients. Most of the patients were symptomatic (132/138; 95.7%), and 133/140 patients (95.0%) presented with opacities on CXR at admission. Of the 140 patients, 7 (5.0%) showed no lung involvement, whereas 58 (41.4%), 31 (22.1%), 26 (18.6%), and 18 (12.9%), respectively, scored 1, 2, 3, and 4. In our sample, 66 patients underwent NIV or intubation, 37 of whom scored 1 or 2 on baseline CXR, and 28 patients died. Conclusions: The severity score based on CXR seems to be able to predict the clinical progression in cases that scored 0, 3, or 4. However, the score alone cannot predict the clinical progression in patients with mild-to-moderate parenchymal involvement (scores 1 and 2)

Diagnostic Accuracy of Chest Digital Tomosynthesis in Patients Recovering after COVID-19 Pneumonia

12Purpose: To assess the diagnostic accuracy of traditional chest X-ray (CXR) and digital tomosynthesis (DTS) compared to computed tomography (CT) in detecting pulmonary interstitial changes in patients having recovered from severe COVID-19. Materials and Methods: This was a retrospective observational study, and received local ethics committee approval. Patients suspected of having COVID-19 pneumonia upon emergency department admission between 1 March and 31 August 2020, and who underwent CXR followed by DTS and CT, were considered. Inclusion criteria were as follows: (1) patients with previous SARS-CoV-2 infection proven by a positive RT-PCR on nasopharyngeal swabs performed upon admission to the hospital, and with complete clinical recovery; (2) a diagnosis of SARS-CoV-2-related ARDS, according to the Berlin criteria, during hospitalization; (3) no recent history of other lung disease; and (4) complete imaging follow-up by CXR, DTS, and CT for at least 6 months and up to one year. Analysis of DTS images was carried out independently by two radiologists with 16 and 10 years of experience in chest imaging, respectively. The following findings were evaluated: (1) ground-glass opacities (GGOs); (2) air-space consolidations with or without air bronchogram; (3) reticulations; and (4) linear consolidation. Indicators of diagnostic performance of RX and digital tomosynthesis were calculated using CT as a reference. All data were analyzed using R statistical software (version 4.0.2, 2020). Results: Out of 44 patients initially included, 25 patients (17 M/8 F), with a mean age of 64 years (standard deviation (SD): 12), met the criteria and were included. The overall average numbers of findings confirmed by CT were GGOs in 11 patients, lung consolidations in 8 patients, 7 lung interstitial reticulations, and linear consolidation in 20 patients. DTS showed a significantly higher diagnostic accuracy compared to CXR in recognizing interstitial lung abnormalities—especially GGOs (p = 0.0412) and linear consolidations (p = 0.0009). The average dose for chest X-ray was 0.10 mSv (0.07–0.32), for DTS was 1.03 mSv (0.74–2.00), and for CT scan was 3 mSv. Conclusions: According to our results, DTS possesses a high diagnostic accuracy, compared with CXR, in revealing lung fibrotic changes in patients who have recovered from COVID-19 pneumonia.openopenBaratella, Elisa; Ruaro, Barbara; Marrocchio, Cristina; Poillucci, Gabriele; Pigato, Caterina; Bozzato, Alessandro Marco; Salton, Francesco; Confalonieri, Paola; Crimi, Filippo; Wade, Barbara; Quaia, Emilio; Cova, Maria AssuntaBaratella, Elisa; Ruaro, Barbara; Marrocchio, Cristina; Poillucci, Gabriele; Pigato, Caterina; Bozzato, Alessandro Marco; Salton, Francesco; Confalonieri, Paola; Crimi, Filippo; Wade, Barbara; Quaia, Emilio; Cova, Maria Assunt

AESKULISA and H-TTG/DGP screen for celiac disease diagnosis.

Serum testing is recommended as the first step for celiac disease (CD) diagnosis and IgA class anti- transglutaminase (tTG) is actually the test of choice, although limited in sensitivity in patients with total IgA deficit. New screen tests for CD are now available, which allow to recognize IgA and IgG antibodies anti different CD associated antigens in one step. The aim of this study was to verify the clinical performance of two screen tests, one provided by Inova (IL, Italy) which identifies IgA and IgG anti DGP (deamidated gliadin peptides) and tTG (h-tTG/DGP), and another provided by Aesku.Diagnostics (Grifols, Italy), which identifies IgA and IgG anti neo-epitopes of tTG, resulting from the cross linking of tTG and gliadin specific peptides (Aeskulisa). We retrospectively analysed a series of 500 children (173 M, 327 F) consecutively subjected to EGD for abdominal symptoms. Based on duodenal histological findings, CD was diagnosed (n=232) or ruled out (n=268). In all sera collected immediately before endoscopy and stored at -20 \ub0C. h-tTG/DGP and Aeskulisa screen tests were performed using an automated ELISA system (DSX, Technogenetics, Italy). The areas under the ROC curves \ub1 SE were 0.96\ub10.09 for h-tTG/DGP and 0.94\ub10.011 for Aeskulisa. 32.66 U/mL and 45.1 U/mL were identified as best cut-off (delta positive rate method) for h-tTG/DGP and Aeskulisa respectively. The following results were found for h-tTG/DGP and Aeskulisa respectively: 94.8% and 94.3% sensitivity; 89.1% and 85.8% specificity; 90.7% and 88.3% PPV; 93.8% and 93.0% NPV. On considering CD children only, both h-tTG/DGP and Aeskulisa screen test results were correlated with the degree of duodenal atrophy (Marsh Oberhuber criteria), the highest levels being recorded among those with type IIIa-c than those with type I-II (F=18.8, p 11 yrs. In conclusion the new screen tests appear sensitive and specific enough to be proposed as first step in the flow-chart of CD diagnosis in children of any age