SARS-CoV-2 Transmissibility Within Day Care Centers—Study Protocol of a Prospective Analysis of Outbreaks in Germany

Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults.Methods and Analysis: COALA (“Corona outbreak-related examinations in day care centers”) is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance.Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.

Acid Base and Blood Gas Analysis in Term Neonates Immediately After Birth with Uncomplicated Neonatal Transition

Background: Acid base and blood gas measurements provide essential information, especially in critically ill neonates. After birth, rapidly changing physiology and difficulty to obtain blood samples represent unique challenges.Objectives: The aim of the present study was to establish normal values of capillary acid base and blood gas analysis immediately after birth in term neonates after uncomplicated neonatal transition.Method: This is a post-hoc- analysis of ancillary outcome parameter of a prospective observational study in term neonates immediately after caesarean section. Neonates were included after immediate neonatal transition without need of medical support and a capillary blood sample was taken by a heel-stick within 15-20 minutes after birth.Result: 132 term neonates were included with mean (SD) gestational age of 38.7±0.7 weeks. The blood was drawn mean (SD) 16±1.7 minutes after birth. The mean (SD) values of the analyses were: pH 7.30±0.04, pCO2 52.6±6.4, base excess -0.9±1.7 and bicarbonate 24.8±1.6.Conclusion: This is the first study describing acid base and blood gas analyses in term neonates immediately after birth with uncomplicated neonatal transition.

Effects of Short-Term Golden Root Extract (Rhodiola rosea) Supplementation on Resistance Exercise Performance

The purpose of this study was to examine the effects of short-term Golden Root Extract (GRE; Rhodiola rosea) supplementation on blood lactate, catecholamines, and performance during repeated bench press exercise. Resistance-trained males (n = 10) participated in this study. In a double-blinded, crossover, counterbalanced study design, participants supplemented with either 1500 mg/day of GRE or placebo (PL; gluten-free cornstarch) for 3 days prior to experimentation. An additional 500 mg dose was ingested 30 min prior to exercise testing. During each exercise trial, participants completed 2 repetitions of bench press at 75% of one-repetition maximum (1RM) as explosively as possible. A linear position transducer was used to measure mean concentric velocity. After 5 min of rest, participants completed 3 sets × repetitions to failure (RTF) at 75% 1RM separated by 2 min of rest between each set. A capillary blood sample was obtained pre- (PRE) and immediately post- (POST) exercise to measure blood concentrations lactate (LA), epinephrine (EPI), and norepinephrine (NE). Mean concentric velocity was significantly higher with GRE when compared to PL (p = 0.046). However, total RTF were significantly lower with GRE versus PL (p < 0.001). Regardless of treatment, LA was significantly higher Post versus Pre (p < 0.001), but GRE resulted in greater Post values compared to PL (p = 0.049). EPI and NE increased in both conditions Pre to Post (p < 0.001). However, Pre NE was significantly higher with GRE versus PL (p = 0.008). Findings indicate that short-term GRE supplementation increases mean bench press velocity but decreases bench press repetition volume. Furthermore, GRE resulted in higher NE levels and blood lactate following exercise. Thus, supplementing with GRE may enhance explosive resistance training performance but may also impair upper body strength-endurance.

Anemia Prevalence and Anthropometric Status of Indigenous Women and Young Children in Rural Botswana: The San People

In Botswana, there is limited data available on the health and nutritional status of the San People (also known as the Basarwa or Bushmen), an Indigenous minority group primarily living in the Ghanzi District. Our aim in this study was to assess anemia prevalence among and anthropometric indices of women and young children in Ghanzi District through a cross-sectional survey. We recruited 367 mother–child pairs (women 15–49 years and children 6–59 months) in nine randomly selected areas. A capillary blood sample was collected, and weight and height were measured. Hemoglobin (Hb) concentration was measured with use of a hemoglobinometer (HemoCue, AB), as per global recommendations. Overall, adjusted anemia prevalence was 12% in non-pregnant women (Hb < 120 g/L), 26% in pregnant women (Hb < 110 g/L), and 42% in children (Hb < 110 g/L), but it varied widely depending on whether or not the controversial factor of ethnicity was adjusted for (range of 6–26%, 22–30%, and 35–68% prevalence, respectively). Thirty-nine percent (n = 133/344) of non-pregnant women and 52% (n = 12/23) of pregnant women were underweight (BMI < 18.5 kg/m2). In children aged 6–23 months, 41% were underweight (weight-for-age z-score < −2 SD), 13% were wasted (weight-for-height z-score < −2 SD), and 65% were stunted (height-for-age z-score < −2 SD); in children aged 24–59 months, 57% were underweight, 13% were wasted, and 66% were stunted. Fifty-six percent (n = 205/367) of women self-reported smoking in any form (rolled cigarettes or snuffing). The high prevalence of smoking among women, underweight status among pregnant women, and anemia, stunting, and wasting among children is of the highest concern for public health and should be addressed in future health and nutrition programming.

The performance of point-of-care antibody test for COVID-19 diagnosis in a tertiary hospital in Bandung, Indonesia

Introduction: We aim to describe the performance of combined IgM and IgG point-of-care antibody test (POC-Ab) (Wondfo®) compared to real-time reverse transcriptase (rRT-PCR) (Allplex™ 2019-nCoV Assay) in detecting coronavirus disease 2019 (COVID-19). Methodology: We compared POC-Ab with rRT-PCR results among patients in a tertiary hospital from January to March 2020 in Bandung, Indonesia. We selected presumptive COVID-19 patients with positive rRT-PCR consecutively and 20 patients with negative rRT-PCR results were selected randomly from the same group of patients as controls. We described the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) with corresponding 95% confidence interval using serum and capillary blood samples. We also tested POC-Ab using non-COVID-19 (confirmed dengue and typhoid) patients’ sera. Results: Twenty-seven patients with positive rRT-PCR result and 20 negative controls were included (68.1% males, mean age 46 (SD: 15.4)). Using the serum, the sensitivity of the POC-Ab was 63.0% (42.4-80.6), specificity was 95.0% (75.1-99.9), PPV was 94.4% (72.7-99.8), NPV was 65.5% (45.7-82.1). A subset of 20 patients was tested using a capillary blood sample. The accuracy of the capillary blood sample is lower compared to serum (50.0% vs. 78.7%). None of the non-COVID-19 sera tested were reactive. Conclusions: POC-Ab for COVID-19 has a high specificity with no false-positive result in non-COVID-19 sera. Therefore, it can be used to guide diagnostic among symptomatic patients in resource limited settings. Given its low sensitivity, patients with high suspicion of COVID-19 but non-reactive result should be prioritized for rRT-PCR testing.

Assessment of tacrolimus and creatinine concentration collected using Mitra microsampling devices

Background Current practice requires regular venous blood samples for monitoring of tacrolimus concentrations post renal transplant requiring regular hospital visits. Mitra devices use volumetric absorptive microsampling technology and absorb a fixed amount of blood (10 μL) from a capillary blood sample. They are a viable volumetric alternative to dried blood spots and are able to be posted to the laboratory for analysis. Objective The aim was to develop and validate liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays for tacrolimus and creatinine analysis using Mitra devices. The usefulness of this approach was assessed in renal transplant patients routinely monitored for tacrolimus and creatinine. Method Routine tacrolimus samples were used to assess the utility and reliability of Mitra sampling. Shared sample preparation for both tacrolimus and creatinine was carried out in a 96-deep well plate; mass spectrometric analysis was then undertaken for tacrolimus followed by re-injection for creatinine analysis. Results Comparison of 131 Mitra samples with a routine LC-MS/MS assay for tacrolimus showed a minimal bias –5.6% (95% CI –8.5 to –2.7%). Comparison of 135 serum and Mitra samples for creatinine using a fully validated LC-MS/MS assay showed a bias –6.5% (95% CI –8.5 to –4.5%). Discussion We have developed assays for tacrolimus and creatinine on fingerprick blood using the Mitra device and believe this approach provides a viable alternative to repeated venepuncture for therapeutic drug monitoring. This method could open up the opportunity for patients to perform tacrolimus and kidney function monitoring at home.

Evaluation of performance of two SARS-CoV-2 Rapid whole-blood finger-stick IgM-IgG Combined Antibody Tests

BackgroundThe SARS-CoV-2 virus is responsible for the infectious respiratory disease called COVID-19 (COronaVIrus Disease). In response to the growing COVID-19 pandemic, Rapid Diagnostic Tests (RDTs) have been developed to detect specific antibodies, IgG and IgM, to SARS-CoV-2 virus in human whole blood. We conducted a real-life study to evaluate the performance of two RDTs, COVID-PRESTO® and COVID-DUO®, compared to the gold standard, RT-PCR.MethodsRT-PCR testing of SARS-Cov-2 was performed from nasopharyngeal swab specimens collected in adult patients visiting the infectious disease department at the hospital (Orléans, France). Fingertip whole blood samples taken at different time points after onset of the disease were tested with RDTs. The specificity and sensitivity of the rapid test kits compared to test of reference (RT-PCR) were calculated.ResultsAmong 381 patients with symptoms of COVID-19 who went to the hospital for a diagnostic, 143 patients were RT-PCR negative. Results of test with RDTs were all negative for these patients, indicating a specificity of 100% for both RDTs.In the RT-PCR positive subgroup (n=238), 133 patients were tested with COVID-PRESTO® and 129 patients were tested with COVID-DUO® (24 patients tested with both). The further the onset of symptoms was from the date of collection, the greater the sensitivity. The sensitivity of COVID-PRESTO® test ranged from 10.00% for patients having experienced their 1st symptoms from 0 to 5 days ago to 100% in patients where symptoms had occurred more than 15 days before the date of tests. For COVID-DUO® test, the sensitivity ranged from 35.71% [0-5 days] to 100% (> 15 days).ConclusionCOVID-PRESTO® and DUO® RDTs turned out to be very specific (none false positive) and to be sensitive enough after 15 days from onset of symptom. These easy to use IgG/IgM combined test kits are the first ones allowing a screening with capillary blood sample, by typing from a finger prick. These rapid tests are particularly interesting for screening in low resource settings.

Gross Efficiency and the Relationship with Maximum Oxygen Uptake in Young Elite Cyclists During the Competitive Season

This study assessed gross efficiency (GE) during a single competitive season and determined the relationship between GE and maximum oxygen uptake (V̇O2max) in young elite cyclists (n = 15, 20.1 ± 1.4 yrs, 177.5 ± 5.7 cm, 68.3 ± 6.2 kg, 45.2 ± 7.5 mm of six skinfolds) during a competitive season. Participants completed at two occasions (T1 = April; T2 = July), a progressive bike protocol (initial intensity = 100 W, 35 W increments every 3 min) until volitional exhaustion to assess V̇O2maxand submaximal variables. A single capillary blood sample was drawn from the left earlobe immediately after completion of each exercise load to determine lactate thresholds. Cyclists’ GE was calculated as ([work accomplished/energy expended] x 100). No significant differences were obtained in GE at any workload between T1 and T2 or in the mean GE between T1 (19.3%) and T2 (19.4%) testing (p = 0.93). No significant association was found between mean GE and V̇O2maxat either T1 (r = -0.28, p = 0.30), or T2 (r = -0.27, p = 0.32). GE of young elite cyclists might not vary during the most important phase of the training season and GE was not related to V̇O2max. A lower accumulated volume and intensity of training of these cyclists may account for their lower GE in comparison to older professional cyclists and might not have been enough to foster higher increases of GE in cyclists with lower V̇O2max.

P084: Substituting capillary blood for urine in point-of-care pregnancy tests

Introduction: When a female presents with abdominal pain and vaginal bleeding, a positive b-hcg level helps in the diagnosis of an ectopic pregnancy. A timely diagnosis as well as management is required for these cases. In many emergency departments, there can be delays in laboratory processing of quantitative b-hcg levels as well as qualitative urine pregnancy tests. In others, especially in rural hospitals in Canada, the laboratory closes at night and these tests cannot be processed until the morning. This may also help decrease length of stay for some patients in the emergency department. There are currently new point-of-care b-hcg tests on the market using capillary blood, but these are expensive and not readily available. The purpose of the study is to validate the most inexpensive point of care urine pregnancy tests readily available on the market for use with capillary blood samples. These point-of-care tests have only been studied with urine and whole blood. If validated with capillary blood, it would allow for a very practical, rapid, and inexpensive test which could help doctors and nurses to triage patients in a timely and more efficient fashion. Methods: In our emergency department, 385 patients between the ages of 18-50 with possible pregnancy, abdominal pain or vaginal bleeding will be included in the study. A capillary blood sample will be taken and applied to a cassette point-of-care pregnancy test with four drops of saline. Two independent investigators will assess the test. The results will be compared to a quantitative serum hCG assay and urine. If these tests are not done as part of the patients medical care, the patient will be contacted one month after to enquire if the patient is pregnant or not. The sensitivity, specificity, positive and negative predictive values will be calculated. Results: Data colleciton will begin in January 2018. Conclusion: No conclusions can yet be drawn.