No abstract

The global pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is having a tremendous impact on the global economy, health care systems and the lives of almost all people in the world. The Central European country of Slovakia reached one of the highest daily mortality rates per 100,000 inhabitants in the first 3 months of 2021, despite implementing strong prophylactic measures, lockdowns and repeated nationwide antigen testing. The present study reports a comparison of the performance of the Standard Q COVID-19 antigen test (SD Biosensor) with three commercial RT-qPCR kits (vDetect COVID-19-MultiplexDX, gb SARS-CoV-2 Multiplex-GENERI BIOTECH Ltd. and Genvinset COVID-19 [E]-BDR Diagnostics) in the detection of infected individuals among employees of the Martin University Hospital in Slovakia. Health care providers, such as doctors and nurses, are classified as “critical infrastructure”, and there is no doubt about the huge impact that incorrect results could have on patients. Out of 1231 samples, 14 were evaluated as positive for SARS-CoV-2 antigen presence, and all of them were confirmed by RT-qPCR kit 1 and kit 2. As another 26 samples had a signal in the E gene, these 40 samples were re-isolated and subsequently re-analysed using the three kits, which detected the virus in 22, 23 and 12 cases, respectively. The results point to a divergence not only between antigen and RT-qPCR tests, but also within the “gold standard” RT-qPCR testing. Performance analysis of the diagnostic antigen test showed the positive predictive value (PPV) to be 100% and negative predictive value (NPV) to be 98.10%, indicating that 1.90% of individuals with a negative result were, in fact, positive. If these data are extrapolated to the national level, where the mean daily number of antigen tests was 250,000 in April 2021, it points to over 4700 people per day being misinterpreted and posing a risk of virus shedding. While mean Ct values of the samples that were both antigen and RT-qPCR positive were about 20 (kit 1: 20.47 and 20.16 for Sarbeco E and RdRP, kit 2: 19.37 and 19.99 for Sarbeco E and RdRP and kit 3: 17.47 for ORF1b/RdRP), mean Ct values of the samples that were antigen-negative but RT-qPCR-positive were about 30 (kit 1: 30.67 and 30.00 for Sarbeco E and RdRP, kit 2: 29.86 and 31.01 for Sarbeco E and RdRP and kit 3: 27.47 for ORF1b/RdRP). It confirms the advantage of antigen test in detecting the most infectious individuals with a higher viral load. However, the reporting of Ct values is still a matter of ongoing debates and should not be conducted without normalisation to standardised controls of known concentration.

Physiological data are presented that are necessary for the correct interpretation of neonatal Doppler US.

The first case of VATER syndrome was described by Quan and Smith in 1973. 1 The syndrome represents a complex anomaly of skeletal structures and internal organs, an association of vertebral defects with anal atresia, tracheoesophageal fistula (TEF), and radial limb dysplasia.2 Generally, TEF may occur with or without esophageal atresia. In 85% of the VATER syndrome cases, TEF results from a fistulation of the distal esophagus to the trachea by an atretic proximal blind end of the esophagus. Polyhydramnion and excessive salivation are early clinical manifestations of TEF, followed by choking, coughing and cyanosis after the first feeding. These symptoms can even appear before the first feeding due to a saliva and gastric content aspiration.3 Therefore, surgical repair of this anomaly within the first 24 hours after delivery presents the treatment of choice and may be of vital importance. 4Our case report deals with a rare secondary aortoesophageal fistula (AEF) which developed after continuous nasogastric intubation of a child with VATER syndrome, who was operated on for congenital esophageal atresia associated with TEF. Case ReportA premature male infant was born at 1730 g in the 35th week of gestation by Cesarean section, which was indicated due to a placental abruption and early amniotic fluid escape. The delivery was complicated by severe asphyxia, cyanosis and bradycardia with the Apgar score of 1/6/8. After complete resuscitation normal vital parameters were restored.A series of clinical, laboratory (including genetic) examinations were done and a complex polymalformation was proved. It consisted of hypoplastic left thumb, 3rd and 5th thoracic hemivertebral malformation, presence of thirteen pairs of ribs, stenosis of penile urethra, proximal esophageal atresia with fistulation of the distal esophageal part to the trachea (type IIIb sec Vogt), 4 and stenosis of the penile urethra. To prevent possible stomach content pulmonary aspiration and to open a feeding passage, it was vital to operate on the newborn on the second day of his life. Dorsal mediastinum was reached surgically via the right-side thoracotomy. In addition to atresia, the situation before the reconstruction was complicated by a pathological position of the proximal esophageal part to the left, and the descending aorta to the right side. The division of fistula and reconstruction of the esophagus by means of end-to-end anastomosis on a nasogastric tube were performed. The postoperative location of these structures was crossbreeding, with an intimate neighboring of their walls.After the operation, the newborn was mechanically ventilated, and on the 2nd postoperative day, a punction epicystotomy was done for a bilateral ureterohydro-nephrosis. The postoperative course was further complicated by a persisting thrombocytopenia, as well as the development of bacterial pneumonia. Pneumonia was treated successfully with an appropriate antibiotic therapy which commenced after sensitivity had been micro-biologically verified.On the 48th day of the infant...