Assessment of the detection accuracy of SARS-CoV-2 rapid antigen test in children and adolescents: An updated meta-analysis.

BACKGROUND: Real-time and appropriate antigen tests play a pivotal role in preventing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. However, a previous meta-analysis reported that the antigen test had lower sensitivity for the detection of SARS-CoV-2 in children. To provide a comprehensive evaluation of diagnostic efficiency, we performed an updated meta-analysis to assess the detection accuracy of SARS-CoV-2 antigen tests stratified by days after symptom onset and specimen type in children and adolescents. METHODS: We comprehensively searched for appropriate studies in the PubMed, Embase, and Cochrane Library databases. Studies on the diagnostic accuracy of antigen tests for SARS-CoV-2 in children and adolescents were included. The relevant data of the included studies were extracted to construct a 2 × 2 table on a per-patient basis. The overall sensitivity and specificity of the SARS-CoV-2 antigen tests were estimated using a bivariate random-effects model. RESULTS: Seventeen studies enrolling 10 912 patients were included in the present meta-analysis. For the detection accuracy of SARS-CoV-2 antigen tests, the meta-analysis generated a pooled sensitivity of 77.9% (95% confidence interval [CI]: 67.3%-85.8%) and a pooled specificity of 99.6% (95% CI: 98.9%-99.8%). The subgroup analysis of studies that examined antigen tests in symptomatic participants ≦7 days after symptom onset generated a pooled sensitivity of 79.4% (95% CI: 47.6%-94.2%) and a pooled specificity of 99.4% (95% CI: 98.2%-99.8%). Another subgroup analysis of studies that evaluated nasal swab specimens demonstrated a pooled sensitivity of 80.1% (95% CI: 65.0%-89.7%) and a pooled specificity of 98.5% (95% CI: 97.3%-9.2%). CONCLUSION: Our findings demonstrated that the antigen test performed using nasal swab specimens exhibited high sensitivity for the detection of SARS-CoV-2 within 7 days after symptom onset. Therefore, antigen testing using nasal swabs may be effective in blocking SARS-CoV-2 transmission in children.

Accuracy of antigen tests for meningococcal meningitis in cerebrospinal fluid: A diagnostic meta-analysis.

OBJECTIVES: Neisseria meningitidis is one of the major pathogens of meningitis in children worldwide and causes invasive meningococcal disease (IMD), which is a critical illness that mainly presents as meningitis and/or septicemia in children. Identification of N. meningitidis in cerebrospinal fluid (CSF) is the gold standard for the diagnosis of meningococcal meningitis, but antigen tests have advantages such as timely results, relatively low cost, and convenience. Yet, the diagnostic accuracy of antigen tests remains uncertain. Therefore, the aim of this meta-analysis was to evaluate the diagnostic accuracy of antigen tests for N. meningitidis in CSF. METHODS: We searched the PubMed, Embase, and Cochrane Library databases for studies evaluating the diagnostic accuracy of antigen tests for N. meningitidis in CSF. We included studies that provided sufficient data to construct a 2 × 2 table on a per-sample basis. To determine the overall sensitivity and specificity of the antigen tests, we used polymerase chain reaction (PCR) as the reference standard and employed the hierarchical summary receiver operating characteristic model. RESULTS: Nine studies with 4533 CSF samples were included. The meta-analysis yielded a pooled sensitivity of 91.2% (95% confidence interval [CI]: 80.0%-100.0%) and a pooled specificity of 93.8% (95% CI: 83.9%-100.0%). A subgroup analysis of 2 studies that reported the outcomes of MeningoSpeed yielded a pooled sensitivity of 93.4% (95% CI: 90.0%-95.8%) and a pooled specificity of 91.9% (95% CI: 88.6%-94.4%). Antigen testing for the N. meningitidis serogroup X had a pooled sensitivity of 92.4% (95% CI: 85.2%-96.2%) and a pooled specificity of 99.2% (95% CI: 78.7%-100.0%). CONCLUSIONS: The studied antigen tests had high sensitivity and specificity for the diagnosis of meningococcal meningitis in CSF specimens. Antigen testing could serve as an accurate diagnostic method for assessing patients who have a suspected N. meningitidis infection.

Diagnostic accuracy of SARS-CoV-2 antigen test in the pediatric population: A systematic review and meta-analysis.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has caused the global coronavirus disease 2019 (COVID-19) pandemic. Rapid identification and isolation of patients infected with SARS-CoV-2 are critical methods for blocking COVID-19 transmission. The advantages of antigen tests, such as their relatively low cost and short turnaround time, can contribute to the prompt identification of infectious individuals. However, the diagnostic accuracy of antigen tests for COVID-19 in children remains inconclusive. This meta-analysis aimed to evaluate the diagnostic performance of antigen tests for SARS-CoV-2 in the pediatric population. METHODS: We conducted a literature search for relevant studies in the PubMed, Embase, Google Scholar, and Biomed Central databases. Studies evaluating the diagnostic accuracy of antigen tests for SARS-CoV-2 in pediatric patients were included. In addition, we included studies that provided sufficient data to construct a 2 × 2 table on a per-patient basis. The final literature search was performed on October 10, 2021. Days after symptom onset, asymptomatic and symptomatic individuals may have been potential sources of heterogeneity. The overall sensitivity and specificity of the antigen tests were generated using a bivariate random-effects model. RESULTS: Five studies with 4400 participants were included. The meta-analysis of antigen tests generated a pooled sensitivity of 65.9% (95% CI: 52.8%-77.0%) and pooled specificity of 99.9% (95% CI: 98.9%-100.0%). A subgroup analysis of studies reporting antigen test data for symptomatic patients showed a pooled sensitivity of 64.5% and a pooled specificity of 99.7%. The subgroup analysis of studies that included 881 asymptomatic participants generated a pooled sensitivity of 48.4% and a pooled specificity of 99.5%. CONCLUSION: Antigen tests exhibit moderate sensitivity and high specificity for detecting SARS-CoV-2 in children. Antigen tests might have moderate sensitivity for detecting SARS-CoV-2 in symptomatic children, and serial testing might effectively prevent further SARS-CoV-2 transmission.

Diagnostic accuracy of rotavirus antigen tests in children: A systematic review and meta-analysis.

OBJECTIVES: Rotavirus infection is the leading cause of acute gastroenteritis (AGE) in children. Children with rotavirus infection may have symptoms such as diarrhoea or vomiting. Diarrheal diseases caused by rotavirus and other enteric pathogens cannot be differentiated on the basis of clinical symptoms. Therefore, diagnostic testing is essential to confirm a diagnosis of rotavirus infection. The aim of the meta-analysis is to evaluate the diagnostic accuracy of immunochromatographic rotavirus antigen tests in children. METHODS: We searched the PubMed, Embase, Cochrane Library and Google Scholar databases for studies evaluating the diagnostic accuracy of antigen tests for rotavirus in children. We included studies that provided sufficient data to construct a 2 × 2 table on a per patient basis. The overall sensitivity and specificity of the antigen tests were determined using a bivariate random-effects model. RESULTS: In total, 12 studies with 4407 participants were included in the study. The meta-analysis yielded a pooled sensitivity of 89.2% (95% confidence interval [CI]: 77.4%-95.3%) and pooled specificity of 93.2% (95% CI: 83.8%-97.3%). A subgroup analysis of such tests in children aged ≤5 years yielded a pooled sensitivity of 87.1% and pooled specificity of 91.8%. Another subgroup analysis of high-quality studies involving 820 participants yielded a pooled sensitivity of 92.3% and pooled specificity of 95.2%. CONCLUSIONS: Rotavirus antigen tests have high sensitivity for the diagnosis of rotavirus infection in children with AGE. In addition, such tests may be effective for the identification and clinical management of rotavirus infection in children and the prevention of disease progression.

Investigation of the diagnostic performance of the SARS-CoV-2 saliva antigen test: A meta-analysis.

BACKGROUND: The COVID-19 pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Rapid identification and isolation of patients with COVID-19 are critical strategies to contain COVID-19. The saliva antigen test has the advantages of noninvasiveness and decreased transmission risk to health-care professionals. This meta-analysis investigated the diagnostic accuracy of the saliva antigen test for SARS-CoV-2. METHODS: We searched for relevant studies in PubMed, Embase, Cochrane Library, and Biomed Central. Studies evaluating the diagnostic accuracy of saliva antigen tests for SARS-CoV-2 were included. The data of the included studies were used to construct a 2 × 2 table on a per patient basis. The overall sensitivity and specificity of saliva antigen tests were determined using a bivariate random-effects model. RESULTS: Nine studies enrolling 9842 patients were included. The meta-analysis generated a pooled sensitivity of 65.3% and a pooled specificity of 99.7%. A subgroup analysis of the studies performing the chemiluminescent enzyme immunoassay (CLEIA) for participants from airports and public health centers revealed a pooled sensitivity of 93.6%. CONCLUSION: Our findings demonstrated that the saliva antigen test performed using CLEIA exhibited higher sensitivity for the detection of SARS-CoV-2. Therefore, the saliva antigen test performed using CLEIA might be an effective and noninvasive screening tool for SARS-CoV-2.

Diagnostic Accuracy of SARS-CoV-2 Antigen Tests for Community Transmission Screening: A Systematic Review and Meta-Analysis.

Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) caused the global pandemic of coronavirus disease 2019 (COVID-19). Rapid identification and isolation of infectious patients are critical methods to block COVID-19 transmission. Antigen tests can contribute to prompt identification of infectious individuals. This meta-analysis aims to evaluate the diagnostic accuracy of antigen tests for SARS-CoV-2. We conducted a literature search in PubMed, Embase, the Cochrane Library, and Biomed Central databases. Studies evaluating the diagnostic accuracy of antigen tests for SARS-CoV-2 in community participants were included. Only English-language articles were reviewed. We included eligible studies that provided available data to construct a 2 × 2 table on a per-patient basis. Overall sensitivity and specificity for antigen tests were generated using a bivariate random-effects model. Eighteen studies with 34,865 participants were retrieved. The meta-analysis for SARS-CoV-2 antigen tests generated a pooled sensitivity of 0.82 and a pooled specificity of 1.00. A subgroup analysis of ten studies that reported outcomes for 5629 symptomatic participants generated a pooled sensitivity of 0.87 and a pooled specificity of 1.00. Antigen tests might have higher sensitivity in detecting SARS-CoV-2 in symptomatic patients in the community and may be an effective tool to identify patients to be quarantined to prevent further SARS-CoV-2 transmission.

Evaluation of the diagnostic accuracy of COVID-19 antigen tests: A systematic review and meta-analysis.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic continues to affect countries worldwide. To inhibit the transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), testing of patients, contact tracing, and quarantine of their close contacts have been used as major nonpharmaceutical interventions. The advantages of antigen tests, such as low cost and rapid turnaround, may allow for the rapid identification of larger numbers of infectious persons. This meta-analysis aimed to evaluate the diagnostic accuracy of antigen tests for SARS-CoV-2. METHODS: We searched PubMed, Embase, Cochrane Library, and Biomed Central databases from inception to January 2, 2021. Studies evaluating the diagnostic accuracy of antigen testing for SARS-CoV-2 with reference standards were included. We included studies that provided sufficient data to construct a 2 × 2 table on a per-patient basis. Only articles in English were reviewed. Summary sensitivity and specificity for antigen tests were generated using a random-effects model. RESULTS: Fourteen studies with 8624 participants were included. The meta-analysis for antigen testing generated a pooled sensitivity of 79% (95% CI, 66%-88%; 14 studies, 8624 patients) and a pooled specificity of 100% (95% CI, 99%-100%; 14 studies, 8624 patients). The subgroup analysis of studies that reported specimen collection within 7 days after symptom onset showed a pooled sensitivity of 95% (95% CI, 78%-99%; four studies, 1342 patients) and pooled specificity of 100% (95% CI, 97%-100%; four studies, 1342 patients). Regarding the applicability, the patient selection, index tests, and reference standards of studies in our meta-analysis matched the review title. CONCLUSION: Antigen tests have moderate sensitivity and high specificity for the detection of SARS-CoV-2. Antigen tests might have a higher sensitivity in detecting SARS-CoV-2 within 7 days after symptom onset. Based on our findings, antigen testing might be an effective method for identifying contagious individuals to block SARS-CoV-2 transmission.

Evaluation of the diagnostic accuracy of bronchial brushing cytology in lung cancer: A meta-analysis.

BACKGROUND: Flexible bronchoscopy is commonly used to examine patients suspected to have lung cancer. Bronchial brushing is one of the cytological technologies for lung specimens obtained through a bronchoscope. However, the accuracy of bronchial brushing cytology (BBC) for lung cancer diagnosis is still inconclusive. The aim of this study was to evaluate the diagnostic accuracy of BBC. METHODS: A literature search was conducted with PubMed, Embase, the Cochrane Library, Web of Science, Biomed Central, Clinical Key, and ClinicalTrials.gov. Studies that assessed the efficacy of BBC in detecting lung cancer were included. Articles that estimated the accuracy on a per-patient basis were included. Review articles, case reports, and research that provided insufficient data to construct a 2 × 2 table were excluded. Both prospective trials and retrospective studies were included. English language studies were reviewed. Data synthesis was performed with a random-effects model. RESULTS: Seventeen studies with 2538 patients were included in the study. The meta-analysis for BBC generated a pooled sensitivity of 0.67 (95% confidence interval [CI], 0.65-0.70) and a pooled specificity of 0.91 (95% CI, 0.89-0.93). The pooled diagnostic odds ratio for BBC was 24.55 (95% CI, 12.39-48.66). The subgroup analysis for studies using liquid-based cytology (LBC) generated a pooled sensitivity of 0.68 and a pooled specificity of 0.92. The pooled diagnostic odds ratio of studies using LBC was 114.18. CONCLUSIONS: These findings indicate that BBC is a discriminative diagnostic approach with moderate sensitivity and high specificity for diagnosing peripheral pulmonary lesions. BBC using LBC has higher diagnostic performance.

The Diagnostic Value of p16/Ki67 Dual Immunostaining for Anal Intraepithelial Neoplasia: A Meta-Analysis.

The p16/Ki67 dual immunostaining was performed on anal cytology specimens; this is an anal cancer screening method. A literature search was performed in the BioMed Central, Cochrane Library, Embase, Google Scholar, and PubMed electronic databases for relevant articles. We included studies that discussed the efficacy of p16/Ki67 dual immunostaining for detecting anal intraepithelial neoplasia (AIN). Studies that calculated the diagnostic efficacy on a per-patient basis were included. We excluded review articles, case series, and studies that did not provide sufficient information. We extracted data on true positive, true negative, false positive, and false negative from the included studies to generate pooled sensitivity, specificity, and diagnostic odds ratio (DOR). All analyses were performed with a random-effects model using MetaDiSc 1.4 and MetaDTA. The meta-analysis produced a pooled sensitivity of 0.63 (95% CI: 0.34, 0.86) and specificity of 0.65 (95% CI: 0.46, 0.81) for p16/Ki67 dual immunostaining in detecting AIN. The pooled DOR was 3.26 (95% CI: -0.29, 6.82). A subgroup analysis of HIV-infected men who have sex with men (MSM) demonstrated a pooled sensitivity of 0.75 (95% CI: 0.28, 0.96). p16/Ki67 dual immunostaining might have a higher sensitivity for detecting AIN in HIV-infected MSM. p16/Ki67 dual immunostaining might be more sensitive in HIV-infected MSM and has higher specificity compared to human papillomavirus testing among this high-risk group. p16/Ki67 dual immunostaining might be an adjuvant and potential triage test for anal cytology in anal cancer screening.

Predictive value of the anal cytology for detecting anal intraepithelial neoplasia or worse: A systematic review and meta-analysis.

BACKGROUND: Anal intraepithelial neoplasia (AIN) refers to a precancerous lesion of anal squamous cell carcinoma (SCC). Human papillomavirus (HPV) is considered a crucial risk factor for AIN. Individuals with high-risk sexual behaviour, such as receptive anal intercourse and multiple sexual partners, as well as men who have sex with men exhibit a relatively high rate of AIN. The anal cytology is a screening method for AIN in high-risk individuals, and patients with abnormal anal cytology may benefit from high-resolution anoscopy. This study explored the predictive value of the anal cytology for the detection of AIN or worse (AIN+). METHODS: We searched the databases of PubMed, BioMed Central, Cochrane Library, and Google Scholar for relevant studies. Studies on the diagnostic efficacy of the anal cytology for predicting anal cancer on a per-patient basis were included. We excluded review articles. Either prospective trials or retrospective studies were included. We performed the meta-analysis by using a random-effects model to generate a pooled sensitivity, specificity, and diagnostic odds ratio (DOR). All analyses were performed using the MetaDiSc version 1.4 software (Universidad Complutense, Madrid, Spain). RESULTS: Twelve studies with 2541 participants were retrieved. The meta-analysis of the studies assessing the predictive value of the anal cytology for detecting AIN+ generated a pooled sensitivity of 0.79 (95% confidence interval [CI], 0.77-0.82) and a pooled specificity of 0.66 (95% CI, 0.64-0.69). The pooled DOR for the anal cytology was 5.31 (95% CI, 3.31-8.49). CONCLUSIONS: Our results revealed that the anal cytology might be effective in diagnosing AIN+.

Predictive value of p16/Ki-67 immunocytochemistry for triage of women with abnormal Papanicolaou test in cervical cancer screening: a systematic review and meta-analysis.

BACKGROUND: The Papanicolaou (Pap) test is one screening strategy used to prevent cervical cancer in developed countries. The p16/Ki-67 immunocytochemistry is a triage test performed on Pap smears in women with atypical squamous cells of undetermined significance (ASCUS) or low grade squamous intraepithelial lesion. OBJECTIVE: Our objective was to review studies investigating the diagnostic performance of p16/Ki-67 dual stain for triage of women with abnormal Pap tests. DESIGN: We conducted a systematic review and meta-analysis of diagnostic test accuracy studies. SETTINGS: We followed the protocol of systematic review of diagnostic accuracy studies. PATIENTS AND METHODS: We searched PubMed, The Cochrane Library, BioMed Central, and ClinicalTrials.gov for relevant studies. We included research that assessed the accuracy of p16/Ki-67 dual stain and high risk human papillomavirus testing for triage of abnormal Pap smears. Review articles and studies that provided insufficient data to construct 2.2 tables were excluded. Data synthesis was conducted using a random-effects model. MAIN OUTCOME MEASURES: Sensitivity and specificity. RESULTS: In seven studies encompassing 2628 patients, the pooled sensitivity and specificity of p16/Ki-67 for triage of abnormal Pap smear results were 0.91 (95% CI, 0.89 to 0.93) and 0.64 (95% CI, 0.62 to 0.66), respectively. No study used a case-control design. A subgroup analysis involving liquid-based cytology showed a sensitivity of 0.91 (95%CI, 0.89 to 0.93) and specificity of 0.64 (95%CI, 0.61 to 0.66). CONCLUSIONS: Our meta-analysis of p16/Ki-67 dual stain studies showed that the test achieved high sensitivity and moderate specificity for p16/Ki-67 immunocytochemistry for high-grade squamous intraepi.thelial lesion and cervical cancer. We suggest that p16/Ki-67 dual stain might be a reliable ancillary method identifying high-grade squamous intraepithelial lesions in women with abnormal Pap tests. LIMITATIONS: No study in the meta-analysis examined the accuracy of the p16/Ki-67 dual stain for inter.pretation of glandular neoplasms.

Inhibition of Staphylococcus aureus PriA Helicase by Flavonol Kaempferol.

Staphylococcus aureus is an important etiological agent responsible for healthcare-associated infections. In this study, the effect of flavonoids on the inhibition of S. aureus PriA (SaPriA), an essential helicase for DNA replication restart, which is critical for bacterial survival, was investigated. Using vanadate-sensitive colorimetric assay, the concentration of phosphate, from ATP hydrolysis by SaPriA, was decreased to 37 and 69%, respectively, in the presence of 35 µM kaempferol and myricetin. The effect of quercetin, galangin, dihydromyricetin, and myricitrin was insignificant. From titration curve, IC50 of kaempferol for SaPriA was determined to be 22 ± 2 µM. Using fluorescence quenching, we identified that kaempferol can bind to SaPriA with K(d) of 9.1 ± 3.2 µM. To our knowledge, these preliminary results constituted the first study regarding that naturally occurring product such as flavonols kaempferol and myricetin can be potent inhibitors targeting PriA.

Inhibition of Klebsiella pneumoniae DnaB helicase by the flavonol galangin.

Klebsiella pneumoniae is a ubiquitous opportunistic pathogen that colonizes at the mucosal surfaces in humans and causes severe diseases. Many clinical strains of K. pneumoniae are highly resistant to antibiotics. Here, we used fluorescence quenching to show that the flavonols galangin, myricetin, quercetin, and kaempferol, bearing different numbers of hydroxyl substituent on the aromatic rings, may inhibit dNTP binding of the primary replicative DnaB helicase of K. pneumoniae (KpDnaB), an essential component of the cellular replication machinery critical for bacterial survival. The binding affinity of KpDnaB to dNTPs varies in the following order: dCTP ~ dGTP > dTTP > dATP. Addition of 10 µM galangin significantly decreased the binding ability of KpDnaB to dATP, whereas the binding affinity of KpDnaB to dGTP that was almost unaffected. Our analyses suggest that these flavonol compounds may be used in the development of new antibiotics that target K. pneumoniae and other bacteria.

Impact of age on FDG uptake in the liver on PET scan.

PURPOSE: The intensity of physiological 18F-2-deoxy-D-glucose (FDG) uptake in the liver varies. It is important to be familiar with the varying degree of FDG accumulation in the liver that represents normal distribution and physiological changes, before attempting to interpret whole-body positron emission tomography (PET) imaging for malignancy detection. The aim of this study is to evaluate the possible factors influencing the intensity of physiological FDG uptake in the liver on FDG PET imaging. MATERIALS AND METHODS: From 2005 to 2007, a total of 339 consecutive healthy subjects, referred from the Department of Community Medicine and Health Examination Center of our hospital for health screening, were retrospectively recruited for analysis. Demographic data were collected from chart records. Whole body FDG PET imaging and serologic determination of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection status were performed on all subjects. The mean and maximum standard uptake values (SUVs) of the liver were calculated. The relationships between sex, age, HBV and HCV infection status, and SUVmax and SUVmean of the liver on FDG PET imaging were evaluated. RESULTS: There was no statistically significant relationship between sex, HBV and HCV infection status and maximum standard uptake value (SUVmax) or mean standard uptake value (SUVmean) of the liver. After adjusting for covariables, age was a statistically significant predictor of SUVmax (B=0.18; P= .001) and SUVmean (B=0.16; P= .004) of the liver on FDG PET imaging. CONCLUSION: Age has a significant and positive impact on both maximum and mean standard uptake values of the liver on FDG PET imaging. High physiological background FDG uptake will reduce diagnostic sensitivity and accuracy for malignancy detection in the liver.