Query: Laboratory

title: Clinical, laboratory and imaging features of COVID 19: A systematic review and meta analysis
abstract: An epidemic of Coronavirus Disease 2019 (COVID 19) began in December 2019 in China leading to a Public Health Emergency of International Concern (PHEIC) Clinical, laboratory, and imaging features have been partially characterized in some observational studies. No systematic reviews on COVID 19 have been published to date.  We performed a systematic literature review with meta analysis, using three databases to assess clinical, laboratory, imaging features, and outcomes of COVID 19 confirmed cases. Observational studies and also case reports, were included, and analyzed separately. We performed a random effects model meta analysis to calculate pooled prevalences and 95% confidence intervals (95%CI) Results 660 articles were retrieved for the time frame (1/1/2020 2/23/2020) After screening, 27 articles were selected for full text assessment, 19 being finally included for qualitative and quantitative analyses. Additionally, 39 case report articles were included and analyzed separately. For 656 patients, fever (88.7% 95%CI 84.5 92.9% cough (57.6% 95%CI 40.8 74.4% and dyspnea (45.6% 95%CI 10.9 80.4% were the most prevalent manifestations. Among the patients, 20.3% (95%CI 10.0 30.6% required intensive care unit (ICU) 32.8% presented with acute respiratory distress syndrome (ARDS) (95%CI 13.7 51.8) 6.2% (95%CI 3.1 9.3) with shock. Some 13.9% (95%CI 6.2 21.5% of hospitalized patients had fatal outcomes (case fatality rate, CFR) Conclusion COVID 19 brings a huge burden to healthcare facilities, especially in patients with comorbidities. ICU was required for approximately 20% of polymorbid, COVID 19 infected patients and hospitalization was associated with a CFR of >13% As this virus spreads globally, countries need to urgently prepare human resources, infrastructure and facilities to treat severe COVID 19.

title: The Guide for the Care and Use of Laboratory Animals.
abstract: Previous studies have established that gene transfer into myocardial cells in vivo is detectable after direct injection of plasmid DNA. Recently, adenovirus vectors have been shown to provide an efficient method for gene transfer into a wide range of tissues. Therefore, this study sought to assess the efficiency and stability of adenovirus mediated gene transfer into myocardium and to compare this method with that using plasmid based gene transfer techniques. Adult rats underwent myocardial injection via a subdiaphragmatic approach. Gene transfer efficiency was compared using direct injection of an adenovirus vector encoding for the marker gene f galactosidase gal) a control adenovirus vector encoding for the cystic fibrosis transmembrane conductance regulator gene, a plasmid encoding for gal, or a control plasmid. Hearts infected with an adenovirus vector containing the P gal gene showed significantly increased (3 gal enzymatic activity compared with hearts injected with ,B gal plasmid. Histological examination revealed that cardiac myocytes were the target of adenovirus mediated gene transfer. A time course of gene expression showed that gal enzymatic activity peaked during the first week following injection. Adenovirus vectors provide an efficient but transient method for in vivo gene expression in myocardium.

title: Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID 19
abstract: The role of clinical laboratory data in the differential diagnosis of the severe forms of COVID 19 has not been definitely established. The aim of this study was to look for the warning index in severe COVID 19 patients. We investigated 43 adult patients with COVID 19. The patients were classified into mild group (28 patients) and severe group (15 patients) A comparison of the hematological parameters between the mild and severe groups showed significant differences in interleukin 6 (IL 6) d dimer (d D) glucose, thrombin time, fibrinogen, and C reactive protein (P .05) The optimal threshold and area under the receiver operator characteristic curve (ROC) of IL 6 were 24.3 and 0.795 ug/L, respectively, while those of d D were 0.28 and 0.750 ug/L, respectively. The area under the ROC curve of IL 6 combined with d D was 0.840. The specificity of predicting the severity of COVID 19 during IL 6 and d D tandem testing was up to 93.3% while the sensitivity of IL 6 and d D by parallel test in the severe COVID 19 was 96.4% IL 6 and d D were closely related to the occurrence of severe COVID 19 in the adult patients, and their combined detection had the highest specificity and sensitivity for early prediction of the severity of COVID 19 patients, which has important clinical value.

title: Laboratory Diagnosis of COVID 19: Current Issues and Challenges
abstract: The COVID 19 outbreak has had a major impact on clinical microbiology laboratories in the past several months. This commentary covers current issues and challenges for the laboratory diagnosis of infections caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) In the preanalytical stage, collecting the proper respiratory tract specimen at the right time from the right anatomic site is essential for a prompt and accurate molecular diagnosis of COVID 19. Appropriate measures are required to keep laboratory staff safe while producing reliable test results.  The COVID 19 outbreak has had a major impact on clinical microbiology laboratories in the past several months. This commentary covers current issues and challenges for the laboratory diagnosis of infections caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) In the preanalytical stage, collecting the proper respiratory tract specimen at the right time from the right anatomic site is essential for a prompt and accurate molecular diagnosis of COVID 19. Appropriate measures are required to keep laboratory staff safe while producing reliable test results. In the analytic stage, real time reverse transcription PCR (RT PCR) assays remain the molecular test of choice for the etiologic diagnosis of SARS CoV 2 infection while antibody based techniques are being introduced as supplemental tools. In the postanalytical stage, testing results should be carefully interpreted using both molecular and serological findings. Finally, random access, integrated devices available at the point of care with scalable capacities will facilitate the rapid and accurate diagnosis and monitoring of SARS CoV 2 infections and greatly assist in the control of this outbreak.

title: Laboratory diagnosis of emerging human coronavirus infections the state of the art
abstract: The three unprecedented outbreaks of emerging human coronavirus (HCoV) infections at the beginning of the twenty first century have highlighted the necessity for readily available, accurate and fast diagnostic testing methods. The laboratory diagnostic methods for human coronavirus infections have evolved substantially, with the development of novel assays as well as the availability of updated tests for emerging ones. Newer laboratory methods are fast, highly sensitive and specific, and are gradually replacing the conventional gold standards. This presentation reviews the current laboratory methods available for testing coronaviruses by focusing on the coronavirus disease 2019 (COVID 19) outbreak going on in Wuhan. Viral pneumonias typically do not result in the production of purulent sputum. Thus, a nasopharyngeal swab is usually the collection method used to obtain a specimen for testing. Nasopharyngeal specimens may miss some infections; a deeper specimen may need to be obtained by bronchoscopy. Alternatively, repeated testing can be used because over time, the likelihood of the SARS CoV 2 being present in the nasopharynx increases. Several integrated, random access, point of care molecular devices are currently under development for fast and accurate diagnosis of SARS CoV 2 infections. These assays are simple, fast and safe and can be used in the local hospitals and clinics bearing the burden of identifying and treating patients.

title: Mild versus severe COVID 19: Laboratory markers
abstract: The number of COVID 19 patients is increasing dramatically worldwide and treatment in intensive care units (ICU) has become a major challenge, the early recognition of severe forms of is absolutely essential for timely triaging of patients. While the clinical status, in particular Peripheral oxygen saturation (SpO2) levels and concurrent comorbidities of COVID 19 patients largely determines the need of their admittance to ICUs, several laboratory parameters may facilitate the assessment of disease severity. In hospitalized patients, clinicians should consider low lymphocyte count as well as the serum levels of CRP, D dimers, ferritin and IL 6 which may be used in risk stratification to predict severe and fatal COVID 19. The more several or all of these parameters are altered, the more likely it is that the course of the disease will be unfavourable.

title: Catheterization Laboratory Considerations During the Coronavirus (COVID 19) Pandemic
abstract: Coronavirus disease 2019 (COVID 19) has placed an enormous strain on the health care systems of the nations where it has spread widely, with specific implications of the disease on practice in the catheterization laboratory. These implications include how we might modify practice for standard

title: The critical role of laboratory medicine during coronavirus disease 2019 (COVID 19) and other viral outbreaks
abstract: Coronavirus disease 2019, abbreviated to COVID 19 and sustained by the severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) is the latest biological hazard to assume the relevance of insidious worldwide threat. One obvious question that is now engaging the minds of many scientists and healthcare professionals is whether and eventually how laboratory medicine could efficiently contribute to counteract this and other (future) viral outbreaks. Despite there being evidence that laboratory tests are vital throughout many clinical pathways, there are at least three major areas where in vitro diagnostics can also provide essential contributions to diagnostic reasoning and managed care of patients with suspected or confirmed SARS CoV 2 infection. These include etiological diagnosis, patient monitoring, as well as epidemiologic surveillance. Nonetheless, some structural and practical aspects may generate substantial hurdles in providing timely and efficient response to this infectious emergency, which basically include inadequate (insufficient) environment and shortage of technical and human resources for facing enhanced volume of tests on many infected patients, some of whom are with severe disease. Some proactive and reactive strategies may hence be identified to confront this serious healthcare challenge, which entail major investments on conventional laboratory resources, reinforcement of regional networks of clinical laboratories, installation of mobile laboratories, as well as being proactive in establishing laboratory emergency plans.

title: The emerging spectrum of COVID 19 neurology: clinical, radiological and laboratory findings
abstract: Paterson, Brown et al. present a case series of 43 patients with neurological complications of SARS CoV 2 infection. The neurological syndromes include encephalopathies, encephalitis, acute disseminated encephalomyelitis with haemorrhagic change, transverse myelitis, ischaemic stroke, and Guillain Barre syndrome.

title: Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID 19)
abstract: A novel zoonotic coronavirus outbreak is spreading all over the world. This pandemic disease has now been defined as novel coronavirus disease 2019 (COVID 19) and is sustained by severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) As the current gold standard for the etiological diagnosis of SARS CoV 2 infection is (real time) reverse transcription polymerase chain reaction (rRT PCR) on respiratory tract specimens, the diagnostic accuracy of this technique shall be considered a foremost prerequisite. Overall, potential RT PCR vulnerabilities include general preanalytical issues such as identification problems, inadequate procedures for collection, handling, transport and storage of the swabs, collection of inappropriate or inadequate material (for quality or volume) presence of interfering substances, manual errors, as well as specific aspects such as sample contamination and testing patients receiving antiretroviral therapy. Some analytical problems may also contribute to jeopardize the diagnostic accuracy, including testing outside the diagnostic window, active viral recombination, use of inadequately validated assays, insufficient harmonization, instrument malfunctioning, along with other specific technical issues. Some practical indications can hence be identified for minimizing the risk of diagnostic errors, encompassing the improvement of diagnostic accuracy by combining clinical evidence with results of chest computed tomography (CT) and RT PCR, interpretation of RT PCR results according to epidemiologic, clinical and radiological factors, recollection and testing of upper (or lower) respiratory specimens in patients with negative RT PCR test results and high suspicion or probability of infection, dissemination of clear instructions for specimen (especially swab) collection, management and storage, together with refinement of molecular target(s) and thorough compliance with analytical procedures, including quality assurance.