Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody testing is an important tool in assessment of pandemic progress, contact tracing, and identification of recovered coronavirus disease 2019 (COVID-19) patients. We evaluated an orthogonal testing algorithm (OTA) to improve test specificity in these use cases. Methods A two-step OTA was applied where individuals who initially tested positive were tested with a second test. The first-line test, detecting IgG antibodies to the viral nucleocapsid protein was validated in 130 samples and the second-line test, detecting IgG antibodies to the viral spike protein in 148 samples. The OTA was evaluated in 4,333 clinical patient specimens. The seropositivity rates relative to the SARS-CoV-2 PCR positivity rates were evaluated from our entire patient population data (n = 5,102). Results The first-line test resulted in a clinical sensitivity of 96.4% (95% CI; 82.3% to 99.4%), and specificity of 99.0% (95% CI; 94.7% to 99.8%), whereas the second-line test had a sensitivity of 100% (95% CI; 87.7% to 100%) and specificity of 98.4% (95% CI; 94.2% to 99.5%). Using the OTA, 78/98 (80%) of initially positive SARS-CoV-2 IgG results were confirmed with a second-line test, while 11/42 (26%) of previously diagnosed COVID-19 patients had no detectable antibodies as long as 94 days post PCR diagnosis. Conclusion Our results show that an OTA can be used to identify patients who require further follow-up due to potential SARS CoV-2 IgG false positive results. In addition, serological testing may not be sufficiently sensitive to reliably detect prior COVID-19 infection.
Cefoxitin is a second-generation cephamycin antibiotic, which at concentrations ≥100 µg/mL is known to modestly interfere, for up to 2 hours post-infusion, with serum creatinine measurement via the traditional Jaffe-based assay. We report a case of a severe serum creatinine elevation while utilizing cefoxitin as a component of an antimicrobial regimen in a critically ill patient with Mycobacterium abscessus ventriculomeningitis. Our results, both via patient serum analysis and a cefoxitin spiking experiment, demonstrate interference despite the utilization of improved modern Jaffe-based assays. In fact, the cefoxitin-creatinine interference may be clinically relevant at concentrations 3 times lower than that listed in the package insert and may display more than a modest interference at typical therapeutic concentrations.
Diffuse Large B-cell Lymphoma, the most common adult non-Hodgkin lymphoma, is a proliferative neoplasm of enlarged B cells. Patients may be asymptomatic on presentation, but if present, symptoms often correlate with direct organ dysfunction resulting from the site of involvement. While the gastrointestinal system is the most common site of extranodal involvement, virtually any part of the body can be infiltrated by malignant lymphocytes. Here, we present an unusual case of cardiac and bilateral renal involvement by Diffuse Large B-cell Lymphoma in a 78-year-old male with a relatively unremarkable medical history. This combination of organ involvement and the resulting clinical symptoms are uncommonly described in the literature. The patient was treated for his symptoms prior to death, but the underlying cause that explained his presentation was not identified until performance of an autopsy. As such, this case demonstrates the utility of the medical autopsy, a gold standard in diagnostic medicine that can provide a variety of benefits in today’s healthcare system.
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Introduction/Objective Gestational trophoblastic neoplasia (GTN) is a group of poorly understood diseases characterized by an abnormal and overtly malignant proliferation of trophoblastic tissue. Choriocarcinoma, which may also be nongestational in origin, is a particularly invasive and aggressive variant of GTN that is composed of a dimorphic trophoblast population. Many studies have attempted to define choriocarcinoma via various cytogenetic, molecular, and epigenetic means; however, the exact etiology and pathogenesis of this tumor remain unclear, in large part due to its rarity. Estimates of the incidence of choriocarcinoma range from 1 in 24,000 to 1 in 40,000 pregnancies. Intraplacental tumors are even less common with 62 reported cases and an estimated incidence of 1 in 160,000 placentas. In an effort to better understand the pathogenesis of this rare entity, four cases of choriocarcinoma (of which three are intraplacental and one is intrauterine occurring one year following an unremarkable pregnancy) diagnosed at our institution since 2010 were identified for chromosomal microarray. Methods DNA was extracted from formalin-fixed, paraffin-embedded blocks of four matched cases: tumor and normal placenta. Single nucleotide polymorphism (SNP) microarray analysis was performed to assess genomic copy number differences between the tumor and the placenta from which it arose (Infinium Global Diversity Array-8 v1.0 BeadChip with an I Scan System; Illumina, San Diego, CA). Analysis of a placenta not affected by tumor was also performed. Results Early partial data review demonstrates copy number aberrations in choriocarcinoma arising in placental tissue. Additional interpretation of the data is ongoing. Conclusion DNA chromosomal microarray analysis was performed to search for genomic copy number differences in between the tumor and the placenta from which it arose. Recent studies suggest gestational choriocarcinoma oncogenesis may differ from that of other malignancies, but this conclusion is based on a low number of recurrent DNA mutations. SNP microarray analysis may further refine the current understanding of the oncogenesis of gestational choriocarcinoma.
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