Asymptomatic COVID-19 Adult Outpatients identified as Significant Viable SARS-CoV-2 Shedders

Differential kinetics of RNA loads and infectious viral levels in the upper respiratory tract between asymptomatic and symptomatic SARS-CoV-2 infected adult outpatients remain unclear limiting recommendations that may guide clinical management, infection control measures and occupational health decisions. In the present investigation, 496 (2.8%) of 17,911 French adult outpatients were positive for an upper respiratory tract SARS-CoV-2 RNA detection by a quantitative RT-PCR assay, of which 180 (36.3%) were COVID-19 asymptomatic. Of these adult asymptomatic viral shedders, 75% had mean to high RNA viral loads (Ct values < 30) which median value was significantly higher than that observed in symptomatic subjects (P = 0.029), and 50.6% were positive by cell culture assays of their upper respiratory tract specimens. Our findings indicate that COVID-19 asymptomatic adult outpatients are significant viable SARS-CoV-2 shedders in their upper respiratory tract playing a major potential role as SARS-CoV-2 transmitters in various epidemiological transmission chains, promoting COVID-19 resurgence in populations.

MRI-based observation of the size and morphology of temporomandibular joint articular disc and condyle in young asymptomatic adults

Objective: To investigate the size and morphology of the temporomandibular joint (TMJ) articular disc and condyle in young asymptomatic adults by using magnetic resonance imaging (MRI) and to provide a reference for clinical diagnosis and scientific study of temporomandibular disorders (TMD). Methods: Overall, 93 undergraduate volunteers without TMD were enrolled from the freshmen pool at the Qingdao University. All participants underwent MRI of the oblique sagittal and oblique coronal TMJ planes. The articular disc and condyle were subsequently measured, and their morphology was evaluated. The obtained data were then grouped and analyzed statistically. Finally, intragroup correlation coefficient (ICC) was used to evaluate the interobserver measurement reliability. Results: We totally received 186 TMJ imaging samples. Based on our analysis, disc’s anterior band in young asymptomatic adult females were thicker than males of the same age (p = 0.024). Moreover, the media-lateral dimensions of the condylar head of adult females were shorter than males of equal age (P＜0.001). The bilateral articular disc morphology was the same in 72.4% of subjects while the condylar morphology was the same in 63.4% of participants. Finally, using measurement reliability assessment, we demonstrated that our conclusions are reliable (ICC ≥0.7). Conclusion: The thickness of the anterior band of the disc and the media-lateral dimensions of the condylar head were gender-related. Additionally, the morphology of the bilateral articular disc and condyle was different among the subset of young asymptomatic adults.

Fortuitious Diagnosis of Scimitar Syndrome in an Asymptomatic Adult

Scimitar syndrome is a rare congenital anomaly seen as one of the components of congenital pulmonary venolobar syndrome. Simple and traditional investigation tools like CXR if interpreted with vigil can aid in prompt diagnosis and management of patients even in absence of clinical symptoms.

Association between blood pressure classification defined by the 2017 ACC/AHA guidelines and coronary artery calcification progression in an asymptomatic adult population

Aims Coronary artery calcium score (CACS) is widely used for cardiovascular risk stratification in asymptomatic population. We assessed the association of new blood pressure (BP) classification using the 2017 American College of Cardiology/American Heart Association guidelines with coronary artery calcification (CAC) progression according to age in asymptomatic adults. Methods and Results Overall, 10,839 asymptomatic Korean adults (23.4% aged ≤45 years) who underwent at least two CACS evaluations for health check-up were enrolled. Participants were categorised by age (≤45 and &gt;45 years) and BP [normal (&lt;120/&lt;80 mmHg, untreated), elevated (120–129/&lt;80 mmHg, untreated), stage 1 hypertension (untreated BP 130–139/80–89 mmHg) or stage 2 hypertension (BP ≥ 140/≥90 mmHg or antihypertensive use)] groups. CAC progression was defined as a difference of ≥ 2.5 between the square root (√) of the baseline and follow-up CACS. During a mean 3.3-year follow-up, the incidence of CAC progression was 13.5% and 36.3% in individuals aged ≤45 and &gt;45 years, respectively. After adjustment for age, sex, diabetes, dyslipidaemia, obesity, current smoking and baseline CACS, hazard ratios (95% confidence interval) for CAC progression in elevated BP, stage 1 hypertension and stage 2 hypertension compared to normal BP were 1.43 (0.96–2.14)(P = 0.077), 1.64 (1.20–2.23)(P = 0.002) and 2.38 (1.82–3.12)(P &lt; 0.001) in the ≤45 years group and 1.11 (0.95–1.30)(P = 0.179), 1.17 (1.04–1.32)(P = 0.009) and 1.52 (1.39–1.66)(P &lt; 0.001) in the &gt;45 years group, respectively. Conclusion Newly defined stage 1 hypertension is independently associated with CAC progression in asymptomatic adults regardless of age.

The Emirates Oncology Task Force Clinical Practice Guideline on Screening for SARS-CoV-2 in Asymptomatic Adult Cancer Patients Prior to Anti-Cancer Therapy

The Emirates Oncology Task Force Clinical Practice Guideline on Screening for SARS-CoV-2 in Asymptomatic Adult Cancer Patients Prior to Anti-Cancer Therapy Introduction: Cancer care during this pandemic is challenging given the competing risks of death from cancer versus death or serious complications from SARS- CoV-2 infection, and the likely higher lethality of COVID-19 in immunocompromised patients. Question remains on serial screening for SARSCoV-2 in asymptomatic adult cancer patients prior to anti-cancer therapy during the COVID-19 pandemic. Methods: We conducted a systematic review to formulate a consensus statement to guide the practising oncologists. Results: Most of the current guidelines recommends RT-PCR SARS-CoV-2 testing of asymptomatic patients prior to initiating and during the anti-cancer therapy despite the lack of robust evidence. We suggested the following: If screening is indicated in adult cancer patients, we recommend using RT-PCR over serum antibody or serum antigen for adult cancer patients; we also recommend assessing the risk of exposure to and infection from SARS-CoV-2 prior to each anti-cancer cycle, to consider SARS-CoV-2 in asymptomatic adult cancer patients prior to anti-cancer therapy in high risk groups : highly cytotoxic chemotherapy with potential profound neutropenia based on the physician’s risk assessment of the chemotherapy , stem cell transplantation. For asymptomatic intermediate-high risk cancer patients, we suggest performing RT-PCR 48-72 hours prior to initiating any anti-cancer therapy. For asymptomatic low-risk cancer patients, we suggest not to routinely screen prior to initiating any anti-cancer therapy (weak recommendation, low quality evidence). Conclusion: SARS-CoV-2 screening might be indicated with higher certainty to certain cancer risk groups. There remains a need for prospective trials to assess this intervention, and the outcome of such intervention. Current recommendations may change based on new and emerging evidence.

Pelvic ultrasound scanning in asymptomatic adult-type granulosa cell tumor: A case report and review

Background: Ovarian cancer is common amongst women worldwide. In Indonesia, it is the fourth most common female cancer with a 5-year survival rate of 45%, but can reach up to 92% if treated early. Granulosa cell tumors (GCT) arise from the sex-cord and are considered malignant. This study presents a rare case of asymptomatic adult-type granulosa cell tumor in an elderly lady diagnosed during routine pelvic ultrasound scanning. Case Illustration: A 65-year-old lady, P2A0, was referred due to left ovarian mass three years before admission. A left adnexal mass was palpated with no sign of internal genital adhesion. Transvaginal ultrasound showed atrophy of uterus and thin endometrial layer. One solid adnexal mass with a cystic part was found on the left adnexal with papillary projection and low resistance index. Histopathological examination revealed adult type-granulosa cell tumor and classical Call-Exner body with grooved nuclei (coffee bean nuclei). Diagnosis of GCT was made by histological findings. Discussion: Histologically, granulosa cells of adult subtype appear round, pale, with scant cytoplasm, classic coffee bean nuclei and Call-Exner bodies. In contrast, the juvenile subtype has eosinophilic and/or vacuolated cytoplasm with macrofollicular or cystic patterns, composed of immature granulosa cells with frequent mitoses. Call-Exner bodies and coffee bean grooved nuclei are not commonly found. Conclusion: The diagnosis of GCT was made through histological findings which were consistent with previous findings. Therefore, a laparotomy frozen section can be considered in menopausal women with suspected ovarian neoplasms.

Asymptomatic COVID-19 Adult Outpatients identified as Significant Viable SARS-CoV-2 Shedders

Differential kinetics of RNA loads and infectious viral levels in the upper respiratory tract between asymptomatic and symptomatic SARS-CoV-2 infected adult outpatients remain unclear limiting recommendations that may guide clinical management, infection control measures and occupational health decisions. In the present investigation, 496 (2.5%) of 17,911 French adult outpatients were positive for an upper respiratory tract SARS-CoV-2 RNA detection by a quantitative RT-PCR assay, of which 180 (36.3%) were COVID-19 asymptomatic. Of these adult asymptomatic viral shedders, 84.4% had mean to high RNA viral loads (Ct values<30) which median value was significantly higher than that observed in symptomatic subjects (P=0.029), and 50.6% were positive by cell culture assays of their upper respiratory tract specimens. Our findings indicate that COVID-19 asymptomatic adult outpatients are significant viable SARS-CoV-2 shedders in their upper respiratory tract playing a major potential role as SARS-CoV-2 transmitters in various epidemiological transmission chains, promoting COVID-19 resurgence in populations.

Asymptomatic Adult Type ALCAPA Syndrome Coexisting with Bicuspid Aortic Valve- A Case Report

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), also known as Bland-White-Garland syndrome (BWGS) is a rare variant of the congenital anomalies of the coronary arteries. Two forms, the infantile (most common) and the adult types (rare) of these syndromic manifestations have been reported in the literature. Affected infants present with myocardial infarction and congestive heart failure. Few of them survive the first year of life, without appropriate surgical intervention. Adult type ALCAPA syndrome is one of the important causes of malignant cardiac arrhythmias, acute coronary syndromes, valvular pathologies and sudden cardiac death in young adults and adults. Asymptomatic adult type ALCAPA is uncommon, much more so its coexistence with bicuspid aortic valve (BAV). We present a 65-year-old patient with ALCAPA and BAV, who was largely asymptomatic. She had ligation of the ALCAPA, and aortic valve replacement, with a very good outcome.