Objectives: To evaluate the diagnostic value of the rtRT-PCR test and CT in patients presenting with typical clinical symptoms of COVID-19. Methods: The study with the participation of four center in Turkey was performed retrospectively from 20 March-15 April 2020 in 203 patients confirmed for COVID-19. The initial rtRT-PCR test was positive in 142 (70.0%) of the patients (Group-I) and negative in 61 patients (Group-II). Results: The mean age of the patients in Group-I was 49.7±18.0 years and the time between the onset of symptoms and admission to the hospital was 3.6±2.0 days; whereas the same values for the patients in Group-II were 58.1±19.9 and 5.3±4.2, respectively (p=0.004; p=0.026). Initial rtRT-PCR was found positive with 83.5% sensitivity and 74.1% PPV in patients with symptom duration of less than five days. It was found that rtRT-PCR positivity correlated negatively with the presence of CT findings, age, comorbidity, shortness of breath, and symptom duration, while rtRT-PCR positivity correlated positively with headache. Presence of CT findings was positively correlated with age, comorbidity, shortness of breath, fever, and the symptom duration. Conclusions: It should be noted that a negative result in the rtRT-PCR test does not rule out the possibility of COVID-19 diagnosis in patients whose symptom duration is longer than five days, who are elderly with comorbidities and in particular who present with fever and shortness of breath. In these patients, typical CT findings are diagnostic for COVID-19. A normal chest CT is no reason to loosen up measures of isolation in patients with newly beginning symptoms until the results are obtained from the PCR test. doi: https://doi.org/10.12669/pjms.37.1.2956 How to cite this:Kostakoglu U, Kant A, Atalar S, Ertunc B, Erensoy S, Dalmanoglu E, et al. Diagnostic value of Chest CT and Initial Real-Time RT-PCR in COVID-19 Infection. Pak J Med Sci. 2021;37(1):-234-238. doi: https://doi.org/10.12669/pjms.37.1.2956 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

OBJECTIVES: Severe acute respiratory syndrome-coronovirus-2 is a global public health problem, in which early diagnosis is required to prevent the spread of infection. In this study, we aimed to reveal the diagnostic value of chest computed tomography (CT) imaging with respect to symptom duration. METHODS: This retrospective study involved patients from five centers, who were admitted with typical COVID-19 symptoms and found to be positive for COVID-19 real-time reverse transcription-polymerase chain reaction (rtRT-PCR) test. RESULTS: One hundred and five patients with positive COVID-19 rtRT-PCR test were involved in the study. Sixty percent of these patients had chest CT imaging findings consistent with COVID-19 pneumonia. The most common chest CT finding was bilateral and subpleural ground-glass opacity in middle-lower lobes of the lungs. Chest CT findings were detected in 85.1% of the patients with a symptom duration of more than 2 days. In receiver operating characteristic analysis of this parameter, area under the curve (AUC) was 0.869, while sensitivity and specificity were 90.5% and 76.2%, respectively. It was notable that chest CT findings were 7.17 times more common among the patients aged 60 years and older, with AUC, specificity, and positive predictive value of 0.768, 88.1%, and 84.8%, respectively. CONCLUSION: Chest CT imaging is a quite valuable tool in patients with longer than 2 days' duration of symptoms, in whom clinical and epidemiological data support the diagnosis of COVID-19 infection. We suggest that the diagnosis of COVID-19 pneumonia should be made with chest CT imaging when rtRT-PCR test cannot be performed or gives a negative result, which is important for public health and to prevent the spread of infection.

Amaç: İmmünosupresif tedaviler, önceki veya bilinen hepatit B virüsü (HBV) enfeksiyonu olan hastalarda reaktivasyon açısından bir risk oluşturur ve mortalite ve morbiditeye neden olabilir. Bu tedavilere başlamadan önce, hastalar HBV serolojileri test edilerek antiviral tedavi açısından değerlendirilmelidir. Gereç ve Yöntemler: Altta yatan hastalıklar nedeniyle immünosupresif tedavi planlanan veya daha önce başlanan 18 yaş üstü hepatit B yüzey antijeni (HBsAg)-pozitif veya HBsAg-negatif ve anti-HBs ve/veya anti-HBc immünoglobulin-pozitif hastalar retrospektif olarak değerlendirildi. Çalışmaya antiviral proflaksi başlanan hastalardan ilk 6 ay boyunca aylık transaminaz, sonraki takiplerinde her üç ayda bir transaminaz ve HBV-DNA seviyeleri bakılan hastalar dahil edildi. Bulgular: Altmış üç hasta çalışmaya alındı. Kırk sekiz (%76) hastaya immünosupresif tedavi ile birlikte profilaksi başlandı, 15 (%24) hastada profilaksi uygun zamanda başlanmadı. Uygun zamanda profilaksi alamayan hastaların üçünde HBV reaktivasyonu (HBVr) görüldü. Tüm hastalarımızda HBVr insidansı %4,8 idi, ancak gecikmiş profilaksi olan hastalarda %20 idi. Sonuç: İmmünsupresif tedaviler HBV reaktivasyonu açısından önemli bir risk oluşturmaktadır. Bu tedavilere başlamadan önce, hastalar HBV serolojilerini test ederek antiviral profilaksi açısından değerlendirilmelidir. Anahtar Kelimeler: Hepatit B virüs, profilaksi, immünosupresif tedavi Objectives: Immunosuppressive (IS) therapies present a risk of reactivation in patients with previous or known hepatitis B virus (HBV) infection and may cause mortality and morbidity. Before starting these therapies, patients should be tested for HBV serology and evaluated for antiviral therapy. Materials and Methods: hepatitis B surface antigen (HBsAg)positive or HBsAg-negative and Anti-HBs and/or anti-HBc immunoglobulin-positive patients aged over 18 years old who were scheduled to undergo or who were already on IS therapy due to underlying diseases were evaluated retrospectively. The study included patients who had monthly transaminase levels during the first six months of antiviral prophylaxis, and then who had transaminase and HBV-DNA levels every three months during subsequent follow-ups. Results: Sixty-three patients were included in the study. Fortyeight patients (76%) received prophylaxis with IS therapy and 15 patients (24%) did not receive prophylaxis at the appropriate time. HBV reactivation (HBVr) was observed in three patients who did not receive prophylaxis at the appropriate time. The incidence of HBVr in all our patients was 4.8%, but was 20% in patients with delayed prophylaxis. Conclusion: IS therapies represent a major risk in terms of HBVr. Before starting these therapies, patients should be evaluated for antiviral prophylaxis by testing their HBV serology.

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