Performance Evaluation of SARS-CoV-2 Rapid Antigen Test Among Symptomatic and Asymptomatic Patients in the Emergency Department of a Tertiary Care Hospital.

The aim of this study was to evaluate the diagnostic performance of the SARS-CoV-2 rapid antigen test (RAT) for the diagnosis of COVID-19 among symptomatic and asymptomatic patients. This retrospective study was done from 15th November 2021 to 15th December 2021, at National Medical Centre, Karachi, Pakistan. Two parallel nasopharyngeal swabs were collected from each patient, and SARS-CoV-2 RAT and SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) were done. A total of 719 patients were included, mean age was 46.03+17.74 years with 378 (52.6%) males. The sensitivity was higher in symptomatic patients i.e. 95.18%, while RAT was found to be more specific in asymptomatic patients with a specificity of 99.83%. High diagnostic accuracy of 91.81% and 96.29% were noted in symptomatic and asymptomatic patients, respectively. SARS-CoV-2 RAT (Roche) can be used for early diagnosis of SARS-CoV-2 patients in busy emergency departments. Key Words: COVID-19, Diagnosis, Rapid antigen test, RT-PCR, Emergency service.

Reporting Practices of Serum Protein Electrophoresis in Pakistan - a Multicenter Survey.

BACKGROUND: Serum Protein Electrophoresis (SPE) is crucial for the diagnosis and follow-up of monoclonal gammopathy (MG), as it helps to separate and identify these paraproteins. Currently, Pakistan lacks standardized guidelines for SPE reporting and analytical performance. This survey aims to analyze reporting variations from Consultant Chemical Pathologists in Pakistani laboratories. METHODS: This cross-sectional survey was conducted by the section of Chemical Pathology, Department of Pathology and Laboratory Medicine, at Aga Khan University Hospital, Karachi. A previously validated and published tool was used with some modifications to assess analytical techniques, reporting patterns, and interpretations provided with SPE by different laboratories. Frequency and percentages were calculated for each response and descriptive results were also evaluated. Differences between laboratories were also assessed qualitatively. RESULTS: Out of the eight laboratories contacted, seven participated in the survey, yielding a response rate of 87.5%. Immunofixation Electrophoresis (IFE) was used by all labs for serum immunotyping. All labs reported a new small abnormal band in patients with no known monoclonal gammopathy or with a known M-protein. Variations were found in terminologies used to label paraprotein, terminologies used to report normal and pathological SPE patterns, electrophoretic technique, methods for quantifying paraprotein in the gamma region on SPE and for albumin quantification. Similarly, the number of decimal places reported, reporting of multiple monoclonal proteins and small paraprotein in the beta region or monoclonal proteins less than 1 g/L, approach for screening, number of fractions reported in gamma region and reporting of interferences were also not standardized and var-iations were noticed. CONCLUSIONS: Our survey highlighted variations in practices of SPE reporting. These differences in laboratory practices could result in inconsistent test results, which could adversely affect patient care.

The Mighty Metabolomics: Emerging Tool for Disease Diagnostics.

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COVID-19 Antibody Testing: Facts vs. Fallacies.

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Prolonged jaundice in hepatitis-E patients: Going beyond the optics.

Hepatitis E virus (HEV) is an RNA virus that is transmitted faeco-orally. Due to unhygienic living conditions and unsatisfactory treatment of drinking water, it is a major cause of acute viral hepatitis in Pakistan. Hepatitis E infection in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency may cause prolonged jaundice resulting in serious complications like, severe haemolysis, acute renal failure, encephalopathy and even demise. Although both these diseases occur frequently in our country there is a dearth of literature on the effect of Hepatitis E infection in G6PD deficient patients, leading to higher rate of complications in such patients. We report the case of a 37 years old male who was referred to our hospital with worsening jaundice. Patient had HEV infection with concomitant G6PD deficiency. This case had a different prospect, since it resulted in prolonged jaundice and severe haemolysis. However the patient's condition improved with conservative management.

Therapeutic Plasmapheresis: A Treatment Modality in Severe Hypertriglyceridemia in Adolescence.

Severe hypertriglyceridemia (SHTG) is defined as plasma triglycerides >1000 mg/dl. It is a rare and understudied condition in children and adolescents. SHTG in pediatric patients may occur as a result of certain genetic disorders of enzymes involved in triglyceride synthesis and metabolism, or it may be seen secondary to uncontrolled diabetes, obesity, metabolic syndrome, or certain medications. SHTG can cause recurrent abdominal pain and acute pancreatitis. Rapid lowering of triglycerides is needed in SHTG to prevent these complications. However, there are no specific guidelines for the treatment of severe hypertriglyceridemia in children and adolescents. Here we report a case of a 16-year-old boy, who was diagnosed with metabolic syndrome three years back. He had a family history of diabetes type 2 and dyslipidemia. In the current case presentation, the patient presented with SHTG-induced acute pancreatitis, who was successfully treated using plasmapheresis. To our knowledge, no such case has ever been reported in Pakistan. Our case findings highlight the use of a less conventional method for the treatment of hypertriglyceridemia in children.

Diagnostic Accuracy of Electro-Chemiluminescence Immunoassay Anti-SARS-CoV-2 Serological Test.

OBJECTIVE: To determine the diagnostic accuracy of fully automated electro-chemiluminescence immunoassay (ECLIA) anti-SARS-CoV-2 serological test for detection of past SARS-CoV-2 infection and to be used in seroprevalence surveys. METHOD:  A total of 426 patients who had tested for anti-SARS-CoV-2 from August 1 to 31, 2020 were selected for the study. Informed consent was obtained and a questionnaire including the patient's age, gender, symptoms, and past polymerase chain reaction (PCR) status was filled by the patient. Samples were analyzed for anti-SARS-CoV-2 antibodies on Roche Cobas e601. RESULTS: The mean age of the patients was 42.43±16.67 years. One hundred and five (24.6%) were PCR positive, while 321 (75.4%) were PCR negative. Most patients were males 241 (56.6%) while 185(43.3%) were females. Over 185(43.3%) patients presented with symptoms, and the rest of the patients 241 (56.6%) were asymptomatic. Anti-SARS-CoV-2 had sensitivity 89.5%, specificity 99.06%, positive predictive value (PPV) 96.90%, negative predictive value (NPV) 96.6%, and positive likelihood ratio 4.26, while negative likelihood ratio 0.1. Diagnostic accuracy of anti-SARS-CoV-2 was 96.7% based on receiver-operating characteristic (ROC) curve analysis. CONCLUSION: Anti-SARS-CoV-2 is very useful for the detection of past COVID-19 infection; it can be proved helpful in the identification of post-COVID complications and actual disease burden in a population.