Analysis of a COVID-19 Prescreening Process in an Outpatient Clinic at a University Hospital during the COVID-19 Pandemic

Background@#To minimize nosocomial infection against coronavirus disease 2019 (COVID-19), most hospitals conduct a prescreening process to evaluate the patient or guardian of any symptoms suggestive of COVID-19 or exposure to a COVID-19 patient at entrances of hospital buildings. In our hospital, we have implemented a two-level prescreening process in the outpatient clinic: an initial prescreening process at the entrance of the outpatient clinic (PPEO) and a second prescreening process is repeated in each department. If any symptoms or epidemiological history are identified at the second level, an emergency code is announced through the hospital's address system. The patient is then guided outside through a designated aisle. In this study, we analyze the cases missed in the PPEO that caused the emergency code to be applied. @*Methods@#All cases reported from March 2020 to April 2021 were analyzed retrospectively. We calculated the incidence of cases missed by the PPEO per 1,000 outpatients and compared the incidence between first-time hospital visitors and those visiting for the second time or more; morning and afternoon office hours; and days of the week. @*Results@#During the study period, the emergency code was applied to 449 cases missed by the PPEO. Among those cases, 20.7% were reported in otorhinolaryngology, followed by 11.6% in gastroenterology, 5.8% in urology, and 5.8% in dermatology. Fever was the most common symptom (59.9%), followed by cough (19.8%). The incidence of cases per 1,000 outpatients was significantly higher among first-time visitors than among those visiting for the second time or more (1.77 [confidence interval (CI), 1.44–2.10] vs. 0.59 [CI, 0.52–0.65], respectively) (P < 0.001). @*Conclusion@#Fever was the most common symptom missed by the PPEO, and otorhinolaryngology and gastroenterology most frequently reported missed cases. Cases missed by the PPEO were more likely to occur among first-time visitors than returning visitors. The results obtained from this study can provide insights or recommendations to other healthcare facilities in operating prescreening processes during the COVID-19 pandemic.

Activities of an infection control surveillance-working group for the infection control and prevention of COVID-19

The coronavirus disease 2019 (COVID-19) pandemic is unlikely to end soon, and hospitals face a high risk of exposure to COVID-19 and nosocomial infections. Therefore, strengthened infection control and prevention (ICP) strategies are crucial. Here, we share our experience of activities implemented by an infection control surveillance-working group (ICS-WG) and the introduction of a hospital emergency code for patients requiring screening for COVID-19, which were established at a university-affiliated hospital. This hospital applies multi-step processes to identify patients who must visit the outdoor screening clinic for COVID-19 testing, instead of entering the hospital building. However, some of these patients inevitably end up inside the hospital building. To solve this issue, we implemented a process to announce the emergency code (“code apple”) and have the medical personnel escort such patients to the outdoor screening clinic. This process was useful in protecting the hospital from unnecessary exposure to COVID-19. The ICS-WG was assigned to conduct the surveillance of ICP practices, patrol the hospital, and recommend improvements for any practices that did not adhere to the guidelines. The ICS-WG also developed a checklist as a monitoring tool for ICP practices. The checklists were distributed to the infection control coordinators who were assigned to monitor their team’s ICP practices and report to the ICS-WG. Overall, we believe that code apple and the ICS-WG are effective strategies in improving ICP practices of COVID-19 at hospitals.

Current laboratory diagnosis of coronavirus disease 2019

Coronavirus disease 2019 (COVID-19) emerged in December 2019 in Wuhan, China; it has since caused a pandemic, with more than 10,000 confirmed cases (> 800,000 tests) in Korea as of May 2020. Real-time reverse transcription polymerase chain reaction (RT-PCR) is currently the most commonly used method for the diagnosis of COVID-19 worldwide. The Korean Society for Laboratory Medicine and Korea Centers for Disease Prevention and Control regularly update the guidelines for COVID-19 diagnosis. Emergency use authorization for some laboratory diagnostic kits has been granted, enabling the timely diagnosis and treatment of COVID-19, and the isolation of infected patients. Due to the collective efforts of the government, medical professionals, local authorities, and the public, Korea’s response to the COVID-19 outbreak has been accepted widely as a model. Here, we summarize the currently available laboratory tests for COVID-19 diagnosis. Although RT-PCR tests are used widely to confirm COVID-19, antibody tests could provide information about immune responses to the virus.

Development of Statistical Software for the Korean Laboratory Accreditation Program Using R Language: LaboStats

BACKGROUND: In Korea, the Korean Laboratory Accreditation Program (KLAP) has set minimum standards for verification of clinical test performance. This verification process is time-consuming and labor-intensive when performed manually. We developed a free, statistical software program for KLAP, using the R language (R Foundation for Statistical Computing, Vienna, Austria). METHODS: We used CLSI guidelines for the algorithm. We built graphic user interfaces, including data input, with Embarcadero Delphi EX4 (Embarcadero Technologies, Inc., Texas, USA). The R Base Package and MCR Package for Method Comparison Regression were used to implement statistical and graphical procedures. RESULTS: Our program LaboStats has six modules: parallel test, linearity, method comparison, precision, reference interval, and cutoff. Data can be entered into the field either manually or by copying and pasting from an MS Excel worksheet. Users can print out precise reports. CONCLUSIONS: LaboStats can be useful for evaluating clinical test performance characteristics and preparing documents requested by KLAP.

Comparison of Six Commercial Diagnostic Tests for the Detection of Dengue Virus Non-Structural-1 Antigen and IgM/IgG Antibodies

ELISAs and rapid diagnostic tests (RDTs) are widely used for diagnosing dengue virus (DENV) infection. Using 138 single blood samples, we compared the ability to detect non-structural (NS)-1 antigen and anti-DENV IgM/IgG antibodies among (1) DENV Detect NS1 ELISA, DENV Detect IgM capture ELISA and DENV Detect IgG ELISA (InBios International, Inc.); (2) Anti-Dengue virus IgM Human ELISA and Anti-Dengue virus IgG Human ELISA (Abcam); (3) Dengue virus NS1 ELISA, Anti-Dengue virus ELISA (IgM) and Anti-Dengue virus ELISA (IgG) (Euroimmun); (4) Asan Easy Test Dengue NS1 Ag 100 and Asan Easy Test Dengue IgG/IgM (Asan Pharm); (5) SD BIOLINE Dengue Duo (Standard Diagnostics); and (6) Ichroma Dengue NS1 and Ichroma Dengue IgG/IgM (Boditech Med). For NS1 antigen detection, InBios and Euroimmun showed higher sensitivities (100%) than the RDTs (42.9–64.3%). All tests demonstrated variable sensitivities for IgM (38.1–90.5%) and IgG (65.7–100.0%). InBios and Boditech Med demonstrated higher sensitivity (95.6% and 88.2%, respectively) than the other tests for combined NS1 antigen and IgM antibody. Five NS1 antigen tests had good agreement (92.8–98.6%) without showing positivity for chikungunya. However, all IgG tests demonstrated potential false-positivity with variable ranges. Clinical laboratories should note performance variations across tests and potential cross-reactivity.

Clinical Application of Bone Turnover Markers in Osteoporosis in Korea

Bone turnover markers (BTMs) have important role in the management of osteoporosis. Recently the clinical application of BTMs has achieved significant progress and measurement of BTMs give us better understanding of pathogenesis of osteoporosis. However, the use of BTMs is still insufficient in Korea. We summarized the available methods and standard interval of the BTMs in Korea. Also we reviewed published literatures on pre-analytical variability in the measurement of BTMs and provided recommendations for standardized sample handling and patient preparation for reducing those pre-analytical variabilities. The clinical application of BTMs in patients with chronic kidney disease who have a higher fracture risk than the general population is summarized.

Position Statement on the Use of Bone Turnover Markers for Osteoporosis Treatment

Current evidences continue to support the clinical application of bone turnover markers (BTMs) in the management of postmenopausal osteoporosis. The limitations of bone mineral density measured by dual energy X-ray absorptiomet especially emphasize the beneficial roles of BTMs, such as serum C-terminal telopeptide of type I collagen and serum procollagen type I N-propeptide, as monitoring tools to assess the responses to treatment. Therefore, the proper application and assessment of BTM in clinical practice is very important. However, their use in Korea is still insufficient. Therefore, the BTM committee has set up by the Korean Society for Bone and Mineral Research have been constituted and provided a position statement which will suggest on the clinical application of BTM for the management of postmenopausal osteoporosis in Korea.

Use of Bone Turnover Markers in Clinical Practice for the Management of Osteoporosis in Korea: From the Survey on the Prescription Pattern of Bone Turnover Markers

BACKGROUND: There has been interest in the clinical potential of bone turnover markers (BTMs) as tools both for assessing fracture risk and for monitoring treatment. However, the practical use of BTMs has been limited by their biological variability and difficulties in the interpretation of results. We investigated the current situation of application of BTMs by clinicians in Korea for the management of osteoporosis through a survey asking the patterns of BTMs prescription in clinical practice.METHODS: The survey was conducted online using the “google survey” by the BTM committee authorized by the Korean Society for Bone and Mineral Research.RESULTS: Total 108 clinicians responded the survey. Most of the respondents prescribed BTMs (80.6%) when they prescribed anti-osteoporotic medications (AOMs). The most frequently prescribed bone resorption and formation markers were serum C-terminal telopeptide of type I collagen (90.7%) and osteocalcin (65.1%), respectively. BTMs were mostly prescribed before starting AOMs (90.8%) and used for the purpose of evaluating treatment response (74.4%). Treatment response and compliance to AOMs were evaluated according to the change of absolute value of BTMs (55.1%). The respondents complained difficulties in the interpretation of BTMs (33.3%), the choice of proper BTMs (17.2%), and the proper sample preparation and handling (13.8%).CONCLUSIONS: In Korea, most of clinicians recognized the benefit of BTMs in the management of osteoporosis. However, there are limitations in the broad use of these markers in clinical practice. Therefore, a clear recommendation for BTM in Korea enhances their use in clinical practice.

Clinical Characteristics and Antimicrobial Susceptibility Trends in Citrobacter Bacteremia: An 11-Year Single-Center Experience

BACKGROUND@#Recently, Citrobacter freundii bacteremia outbreak in a neonatal intensive care unit has attracted public attention in Korea. However, Citrobacter bacteremia is uncommon and usually occurs in patients with underlying diseases such as malignancy and hepatobiliary diseases. Increase in resistance and emerging of multidrug resistance among Citrobacter species have gradually been reported. The aim of this study was to investigate the clinical characteristics and outcome of C. freundii and non-freundii bacteremia and antimicrobial susceptibility trends.@*MATERIALS AND METHODS@#We reviewed the medical records of patients with Citrobacter bacteremia at St. Mary's Hospital, from 2007 to 2017.@*RESULTS@#A total of 43 patients with a median age of 72 (24-93) years was identified and 90.7% of them had comorbidities. Twenty-nine (67.4%) patients had C. freundii bacteremia while 14 had non-freundii bacteremia (six of C. braakii, five of C. koseri, two of C. amalonaticus and one of C. youngae). A total of 26 (51.2%) patients had community-acquired infection and intra-abdominal infection including hepatobiliary tract was the most common portal of entry (24/43, 55.8%). Moreover, hepatobiliary tract was the leading primary site of nosocomial infection (9/17, 52.9%). Polymicrobial bacteremia was observed in 21 (48.8%) patients. The percentages of Citrobacter species susceptible to ampicillin, amikacin, aztreonam, cefazolin, cefoxitin, cefotaxime, cefepime, piperacillin-tazobactam, ciprofloxacin, and imipenem were 9.5%, 97.6%, 73.8%, 9.5%, 14.3%, 71.4%, 92.9%, 83.3%, 83.3% and 100%, respectively. The resistance rate did not increase during the study period. Of 39 patients treated with antibiotics, 36 (92.3%) received appropriate empirical antibiotics. Overall mortality was 18.6%. High Charlson comorbidity index and Pitt bacteremia score were significant risk factors for death in univariate analysis and showed trends in the multivariate analysis. No significant difference in clinical features and antimicrobial susceptibility rate was observed between C. freundii and non-freundii bacteremia.@*CONCLUSION@#Citrobacter bacteremia was predominant in the elderly with comorbidities, while no pediatric case was observed. Hepatobiliary tract is the leading primary focus of bacteremia both in community-acquired and nosocomial infection. The rate of susceptibility to antibiotics has not changed in the last 11 years.

Multicenter Comparison of Four Automated Immunoassay Analyzers for Prostate Specific Antigen

No abstract available.

Intactness of Medical Nonsterile Gloves on Use of Alcohol Disinfectants

No abstract available.

Evaluation of the Vacuum Blood Collection Tube, V-Tube, a Domestic Product for Clinical Chemistry and Thyroid Hormone Assays

BACKGROUND: It is known that the blood collection tube used can cause fluctuations in laboratory test results. We compared test results obtained when blood was collected in V-tube (AB Medical, Korea), BD Vacutainer Tubes (BD, USA), and Greiner Vacuette Tubes (Greiner, USA) in clinical chemistry and thyroid hormone assays. METHODS: One hundred volunteers from three hospitals were recruited and the peripheral blood samples were collected in each of the three serum separation tubes (SSTs). These samples were used for 28 routine clinical chemistry assays and three thyroid hormone assays. The results were analyzed by the Student paired t-test and the Bland-Altman plot. For stability tests, the initial results were compared with the day 1 (24±2 hours), day 3 (72±2 hours), and day 7 (168±2 hours) results, respectively. RESULTS: The difference in the test results obtained from the samples in each tube (V-Tube vs. BD-Tube, V-Tube vs. Greiner-Tube, and BD-Tube vs. Greiner-Tube) were satisfied with the Clinical Laboratory Improvement Amendments of 1988 allowable difference ranges. Except for four analytes (low-density lipoprotein cholesterol, magnesium, potassium, and thyroid-stimulating hormone), all analytes were within the allowable critical difference range based on biological variability. The paired t-test revealed significant differences between the results of nine assays for samples in V-Tube vs. BD-Tube and seven assays for samples in V-Tube vs. Greiner-Tube, but each set of results showed good correlations. The test results on different days showed a significant difference in several assays, but they were within the allowable difference range. CONCLUSIONS: The assay results for blood samples collected in SST V-Tubes were comparable to those obtained when blood was collected in BD Tubes and Greiner Tubes, and the blood collected in V-Tubes also showed excellent results in the stability tests.

Analytical Performance of Wako and Sekisui Clinical Chemistry Assays on Hitachi LABOSPECT 008

BACKGROUND: We evaluated the analytical performance of Wako assays for albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN), complement C3 and C4, calcium, creatine kinase (CK), C-reactive protein (CRP), direct bilirubin (DBIL), iron, gamma-glutamyl transferase (GGT), HDL cholesterol (HDLC), inorganic phosphorus (IP), LDL cholesterol (LDLC), total bilirubin (TBIL), total protein (TP), and uric acid (UA), as well as the performance of Sekisui assays for albumin, BUN, calcium, CRP, HDLC, IP, LDLC, TP, and UA by using Hitachi LABOSPECT 008 (Hitachi High-Tech Co., Japan). METHODS: Liquid Assayed Multiqual Control (Bio-Rad Laboratories, USA) and pooled patients' sera were analyzed for 20 days. Wako linearity material (Wako Pure Chemical Industries, Ltd., Japan) and Sysmex Interference Check A Plus kit (Sysmex Co., Japan) were used to test linearity and interference, respectively. Concentrations of the target analytes were measured using Hitachi LABOSPECT 008 in 100 residual patient specimens and compared to those in Pureauto S series reagent (Sekisui Medical, Japan), which were measured using Hitachi 7600 (Hitachi High-Tech Co., Japan). RESULTS: Total coefficients of variation (CVs) for the tested analytes were 0.91-9.26% in Wako and 1.04-7.46% in Sekisui assays. Linearity was demonstrated up to the highest concentration within the analytical range in all the assays except for Wako albumin and Sekisui TP. Wako and Sekisui albumin, BUN, CRP, HDLC, and LDLC assays, and in Wako C3, C4, calcium, and UA assays showed no interference with the test concentrations used. All the tested assays, except for Wako AST, LDLC, and TP, and Sekisui calcium and TP, demonstrated comparability with comparative method for at least one medical decision level. CONCLUSIONS: Our study results showed that the analytical performances of Wako and Sekisui chemistry assays evaluated using Hitachi LABOSPECT 008 had appropriate analytical performance for clinical use.

Erratum

This erratum is being published to correct the errors in sequence of references and in insertion of wrong references on page 112.

Evaluation of HbA1c Levels Via the Latex Immunoturbidimetric Method by Using Chemistry Autoanalyzer

BACKGROUND: Measurement of HbA1c levels is widely used to diagnose diabetes mellitus and to evaluate and monitor plasma-glucose concentrations over 6-8 weeks. In this study, we evaluated the diagnostic performance of the newly developed latex immunoturbidimetric method by using Autolab HbA1c. METHODS: We analyzed and compared the diagnostic performance of Autolab HbA1c with that of Toshiba 200FR between April 2009 and July 2009. According to guidelines (EP5-A2, EP6-P, EP9-A2) of the clinical and laboratory standards institute (CLSI), we compared linearity, precision and correlation of Autolab HbA1c with those of G7 (Tosoh Corp., Kyoto, Japan) by using high-performance liquid chromatography (HPLC) method. RESULTS: Data obtained using Autolab HbA1c showed good linearity in mixtures of samples with low (3.1%) and high (15.1%) levels of HbA1c (r2 = 0.9997). In the analysis of within-run precision of the samples with HbA1c levels of 5.1% and 12.1%, the SDs were 0.04 and 0.06 and covariances of these samples were 0.8% and 0.5%, respectively. In the Deming regression model, the regression equation was as follows: Autolab HbA1c = 1.0859xTosoh HPLC-0.6957. CONCLUSIONS: In this study, Autolab HbA1c method showed better performance characteristics than Tosoh G7 did. In reference review, there was no interference of variant hemoglobin. The data acquisition time of Autolab HbA1c was lower than that of Tosoh G7. The advantages of Autolab HbA1c are that it can be used as an autoanlyzer in routine chemical analysis, it does not require pre-analytical treatment, and the samples are automatically treated with distilled water for hemolysis.

Current Recommendations for Laboratory Testing and Use of Bone Turnover Markers in Management of Osteoporosis

Osteoporosis is a major health problem worldwide, and is projected to increase exponentially due to the aging of the population. The absolute fracture risk in individual subjects is calculated by the use of algorithms which include bone mineral density (BMD), age, gender, history of prior fracture and other risk factors. This review describes the laboratory investigations into osteoporosis which include serum calcium, phosphate, creatinine, alkaline phosphatase and 25-hydroxyvitamin D and, additionally in men, testosterone. Parathyroid hormone (PTH) is measured in patients with abnormal serum calcium to determine its cause. Other laboratory investigations such as thyroid function testing, screening for multiple myeloma, and screening for Cushing's syndrome, are performed if indicated. Measurement of bone turnover markers (BTMs) is currently not included in algorithms for fracture risk calculations due to the lack of data. However, BTMs may be useful for monitoring osteoporosis treatment. Further studies of the reference BTMs serum carboxy terminal telopeptide of collagen type I (s-CTX) and serum procollagen type I N-terminal propeptide (s-PINP) in fracture risk prediction and in monitoring various treatments for osteoporosis may help expedite their inclusion in routine clinical practice.

Evaluation of HUBI-QUANPRO Point-of-Care Testing for Cardiac Markers / 임상검사와정도관리

BACKGROUND: Recently, quantitative point-of-care testing (POCT) for cardiac markers using colloidal gold particles was developed in Korea. We evaluated the analytical performance of the HUBI-QUANPRO (Humasis, Korea) assay in comparison with two other assays. METHODS: We evaluated the analytical precision and linearity of HUBI-QUANPRO creatine kinase (CK)-MB, cardiac troponin I (cTnI), and B-type natriuretic peptides (BNP). HUBI-QUANPRO assay was compared with ADVIA Centaur (Siemens, Germany) and Triage (Biosite Diagnostics, USA) assays by using 100 blood samples. In addition, we evaluated the interference of hemoglobin on the HUBI-QUANPRO assay. RESULTS: The coefficients of variation of HUBI-QUANPRO CK-MB, cTnI, and BNP were 7.5-9.7%, 12.0-17.4%, and 14.7-15.7%, respectively. The linearity ranges of HUBI-QUANPRO CK-MB, cTnI, and BNP were 4.7-27.8 ng/mL, 0.76-6.51 ng/mL, and 76.2-762.2 ng/mL, respectively. The comparison study showed no significant difference among them. When 0.5% hemolysis occurred, remarkable hemoglobin interference was found in the three markers resulting in underestimation of the concentrations. CONCLUSIONS: HUBI-QUANPRO CK-MB and BNP showed good analytical performances compared with the other two assays. Hemoglobin interference was noted in the HUBI-QUANPRO assay, especially more in BNP. Although the linearity range of cTnI was narrow, its agreement rate with ADVIA Centaur was good, thus the HUBI-QUANPRO assay could be useful as a quantitative POCT for cardiac markers in the emergency department.

Usefulness of Total IgE in Predicting Positive Allergen Specific IgE Tests in Korean Subjects / 대한진단검사의학회지

BACKGROUND: Total IgE levels in allergic patients tend to be higher than those in healthy individuals. We evaluated the usefulness of total IgE levels in predicting positive results of allergen specific IgEs in multiple allergen simultaneous tests. METHODS: A total of 133 patients with allergic symptoms were evaluated. Allergen specific IgEs were detected using 3 different kits: Allergy screen (R-biopharm, Germany), AdvanSure Allergy Screen (LG Life Science, Korea) and Polycheck allergy (Biocheck Co., Germany). Total IgE was measured by turbidoimmunometric assay (LX-2200, Eiken Chemical Co., Japan). The patients were divided into high (> or =170 IU/mL) and low ( or =50%. Allergen specific IgEs to these two allergens showed good correlation with total IgE (correlation coefficients >0.5). CONCLUSIONS: Total IgE appears to be useful in predicting positive results in allergen specific IgE tests to common allergens. The specific IgEs to D. farinae and D. pteronyssinus showed good correlation with total IgE. However, for other allergens, significant differences were observed among different test kits, and the standardization of allergens in multiple allergen simultaneous tests is needed.

A Significance of High Levels of Total Serum IgE in Herpes Zoster / 대한피부과학회지

BACKGROUD: Herpes zoster is caused by the reactivation of varicella zoster virus. Many factors are involved in the reactivation of viruses, but most of them are unknown, except for immunosuppression and old age. A relationship between an increased level of total serum IgE and viral infection has been observed in a few previous studies. OBJECTIVE: The purpose of this study was to evaluate the quantitative changes, as well as the role of the total serum IgE, in patients suffering with herpes zoster. METHODS: We retrospectively reviewed the medical records and laboratory data of 205 patients with herpes zoster. We evaluated the clinical findings such as the affected dermatomes, the duration of illness and the persistence of herpes zoster-associated pain. The relationships of the clinical findings and the level of total serum IgE, which was measured by competitive chemiluminescence immunoassay, were also evaluated. RESULTS: The level of total serum IgE was elevated in 95 (46.3%) of 205 patients with herpes zoster and who did not have any medical history that would influence the level of total serum IgE. The amount of elevation of the total serum IgE was higher in the younger patient group than that in the older patient group. However, there were no statistically significant relationships between the level of total serum IgE and the clinical features. CONCLUSION: The level of total serum IgE in patients with herpes zoster was increased to more than the normal level. This may contribute to an overt defect of the cellular immune system in patients with herpes zoster.

Comparison of Quantitative Results among Two Automated Rapid Plasma Reagin (RPR) Assays and a Manual RPR Test / 대한진단검사의학회지

BACKGROUND: We compared two automated Rapid Plasma Reagin (RPR) assay kits with a manual RPR assay kit to evaluate the possibility of using the two automated RPR assays as an alternative to the manual RPR assay for a quantitative monitoring. METHODS: One hundred eighty-five samples were analyzed, including 16 sera from patients with primary, secondary, and latent syphilis. Measured RPR unit (R.U.) values of two automated RPR assay kits, Mediace RPR (Sekisui Chemical Co., Ltd, Japan) and HBi Auto RPR (HBI Co., Ltd, Korea), were compared with the RPR titers of Macro-Vue RPR card test (Becton Dickinson BD Microbiology systems, USA). As a confirmatory test, Anti-Treponema pallidum EUROLINE WB (IgG) and Anti-Treponema pallidum EUROLINE WB (IgM) (Euroimmun, Germany) were used. RESULTS: There was a prozone effect with Mediace RPR at RPR titer (card test) of 1:16, but not with HBi Auto RPR. The R.U. values of the two automated RPR assays did not show proportional increase to the RPR titer. Agreement between manual RPR and two automated RPR assay kits, Mediace RPR assay and HBi Auto RPR assay, were 83.8% and 83.2%, respectively. CONCLUSIONS: The two automated RPR assay kits could not be used as an alternative to manual RPR test for quantitative analysis of RPR titer. As Mediace RPR shows a prozone effect at relatively low RPR titer, caution is needed in the interpretation of the measured values.