Comparative evaluation of cost effective extraction free molecular technique for detection of SARS-CoV-2 with reference to standard VTM based RT-qPCR method.

BACKGROUND AND OBJECTIVES: The entire globe is undergoing an unprecedented challenge of COVID-19. Considering the need of rapid and accurate diagnostic tests for SARS-CoV-2, this study was planned to evaluate the cost effective extraction free RT-PCR technique in comparison to the standard VTM based RT-qPCR method. MATERIALS AND METHODS: Paired swabs from nasopharynx and oropharynx were collected for SARS-CoV-2 testing, from 211 adult patients (≥18 years) in VTM and plain sterile tubes (dry swabs). These samples were processed and RT-qPCR was carried out as per standard protocols. RESULTS: 54.5% of the patients were females and 45.5% were males with sex ratio 1:1.19 (M: F). 38.86% were symptomatic, of which fever (86.59%), cough (79.23%) and breathlessness (46.34%) were the most common symptoms. The positivity by VTM based method and index method was 31.27% and 13.27% respectively. Of the 27 inconclusive results from index method, 37.04% were positive, 48.15% were negative by VTM based method. However, in 40 inconclusive results by VTM based method, 90% were negative and rest remained inconclusive by index method. The sensitivity and specificity of the index method were 39.39% and 85.71% respectively. The overall agreement between VTM based method and index method was 49.59% with estimated Kappa value of 0.19. CONCLUSION: VTM based method showed higher sensitivity compared to the index method. The higher positivity by VTM based method, suggests that VTM based method could plausibly be a better detection method of SARS-CoV-2. Still, the index method might add value in a resource limited setups for detection of SARS-CoV-2.

Assessment of anti-CarP antibodies, disease activity and quality of life in rheumatoid arthritis patients on conventional and biological disease-modifying antirheumatic drugs.

OBJECTIVE: Good biomarkers are important to guide decisions in the clinical management of rheumatoid arthritis (RA). RA patients harbor antibodies directed against carbamylated proteins which may predict joint damage. This study investigated whether antibodies against carbamylated proteins (anti-CarP) may serve as surrogate prognostic markers. MATERIAL AND METHODS: Fifty-three patients with a diagnosis of rheumatoid arthritis according to ACR 1987 criteria were included. Blood samples were analyzed for CarP antibody levels using the ELISA method. Quality of life (QoL) was assessed by the WHO SF-36 questionnaire, and disease activity was assessed using the DAS28 calculator. Newly diagnosed patients were assessed at the first visit and at 12 weeks of treatment, while a single assessment was made for patients already on maintenance therapy. RESULTS: Out of 53 patients, 22 had titers of anti-CarP above the cut-off range and considered as positive for anti-CarP antibodies. Anti-CarP antibody serum level was significantly higher in patients with deformity of joints and with erosions in comparison to those without any destructive changes (p < 0.05). There was a weak positive correlation between anti-CarP and DAS 28 (p > 0.05). Also there was a weak negative correlation in all domains of quality of life with anti-CarP antibody titers (p > 0.05). There was no significant correlation between titers of anti-CarP antibodies and presence or absence of rheumatoid factor. CONCLUSIONS: Serum levels of anti-CarP antibodies in RA patients with joint erosions/deformities were much higher than in those without any joint damage. Anti-CarP antibodies may have good prognostic value in RA patients with erosions. Disease activity and QoL of RA patients improved during treatment, but no correlation was found between DAS 28/QoL and anti-CarP antibody serum levels.

A common medical error: lung cancer misdiagnosed as sputum negative tuberculosis.

OBJECTIVE: To emphasize that delay in diagnosis of lung cancer can be caused by the wrong diagnosis of tuberculosis (TB) in TB endemic countries. This is of major concern as early-diagnosis of lung cancer can increase the chance of tumor resectability and timely chemo-radiotherapy may provide better quality of life. METHODS: Proven lung cancer patients, who had received anti-tubercular treatment (ATT) since onset of current symptoms, were studied retrospectively during the period of Nov-07 to Nov-08. DATA-SOURCE: Patient interview and medical records. RESULTS: Total of 14 out of 70 patients received wrong diagnosis of TB and had received ATT (male-12, female-2; mean age 58.07-/+6.81; Non Small Cell Lung Cancer (NSCLC) -12, Small Cell Lung Cancer (SCLC) -2), 12 were smokers with median smoking pack-years of 44(15 to 112). Pre-referral sputum acid fast bacilli (AFB) was done in only 3 out of these 14 patients and sputum AFB was negative in these 3 patients. ATT was started on the basis of chest X-ray finding and clinical symptoms. Mean duration of ATT taken was 4.46-/+3.15 months. CONCLUSION: Due to high TB prevalence and radiological similarities, a large number of lung cancer patients initially get wrongly treated for TB. Also, clinicians associate lung cancer with high case-fatality and start ATT without detailed investigation. Altogether, this leads to delay in diagnosis and progression of disease.