Bloodstream infections after solid-organ transplantation

Solid-organ transplantation (SOT) has become the preferred strategy to treat a number of end-stage organ disease, because a continuous improvement in survival and quality of life. While preventive strategies has decreased the risk for classical opportunistic infections (such as viral, fungal and parasite infections), bacterial infections, and particularly bloodstream infections (BSIs) remain the most common and life-threatening complications in SOT recipients. The source of BSI after transplant depends on the type of transplantation, being urinary tract infection, pneumonia, and intraabdominal infections the most common infections occurring after kidney, lung and liver transplantation, respectively. The risk for candidemia is higher in abdominal-organ than in thoracic-organ transplantation. Currently, the increasing prevalence of multi-drug resistant (MDR) Gram-negative pathogens, such as extended-spectrum betalactamase-producing Enterobacteriaciae and carbapenem-resistant Klebsiella pneumoniae, is causing particular concerns in SOT recipients, a population which presents several risk factors for developing infections due to MDR organisms. The application of strict preventive policies to reduce the incidence of post transplant BSIs and to control the spread of MDR organisms, including the implementation of specific stewardship programs to avoid the overuse of antibiotics and antifungal drugs, are essential steps to reduce the impact of post transplant infections on allograft and patient outcomes.

Attention for action: coordinating bimanual reach-to-grasp movements

Theories of attention have frequently pointed to the finding that there is a significant performance decrement ('cost') to responding to two different objects concurrently. However, much of the research aimed at investigating how attention is 'divided' in such circumstances has adopted response time (RT) as the measure of interest. In this paper we investigate how attention is 'divided' during the execution of concurrent motor responses, by studying bimanual reach-to-grasp movements directed towards two separate target objects. Furthermore, a key aspect of our study is that each hand is required to perform either the same action (congruent reaches) or a different action (incongruent reaches). Thus in Expt 1 we manipulated the movement amplitude of each hand, while in Expt 2 we manipulated object size. The results of this study suggest that while there is an overall cost associated with carrying out two movements simultaneously, kinematic measures are unaffected by whether the actions required of each hand are the same (congruent) or different (incongruent). The problem of executing incongruent bimanual movements appears to be solved by synchronizing each limb to a common movement duration, while movement velocity and grip aperture are independently scaled. These findings are discussed in relation to theories developed to explain the coordination of the reach-and-grasp phases of unimanual prehension, and in the context of recent theories of attention for action.

Implementing SARS-CoV-2 Rapid Antigen Testing in the Emergency Ward of a Swiss University Hospital: The INCREASE Study

Following the Swiss Federal Office of Public Health (FOPH) authorization of the rapid antigen test (RAT), we implemented the use of the RAT in the emergency ward of our university hospital for patients' cohorting. RAT triaging in association with RT-PCR allowed us to promptly isolate positive patients and save resources. Among 532 patients, overall sensitivities were 48.3% for Exdia and 41.2% for Standard Q®, PanbioTM and BD Veritor™. All RATs exhibited specificity above 99%. Sensitivity increased to 74.6%, 66.2%, 66.2% and 64.8% for Exdia, Standard Q®, PanbioTM and BD Veritor™, respectively, for viral loads above 105 copies/mL, to 100%, 97.8%, 96.6% and 95.6% for viral loads above 106 copies/mL and 100% for viral loads above 107 copies/mL. Sensitivity was significantly higher for patients with symptoms onset within four days (74.3%, 69.2%, 69.2% and 64%, respectively) versus patients with the evolution of symptoms longer than four days (36.8%, 21.1%, 21.1% and 23.7%, respectively). Among COVID-19 asymptomatic patients, sensitivity was 33%. All Immunoglobulin-A-positive patients resulted negative for RAT. The RAT might represent a useful resource in selected clinical settings as a complementary tool in RT-PCR for rapid patient triaging, but the lower sensitivity, especially in late presenters and COVID-19 asymptomatic subjects, must be taken into account.

Emerging echinocandin-resistant Candida albicans and glabrata in Switzerland

Echinocandins represent the first-line therapy of candidemia. Echinocandin resistance among Candida spp. is mainly due to acquired FKS mutations. In this study, we report the emergence of FKS-mutant Candida albicans/glabrata in Switzerland and provide the microbiological and clinical characteristics of 9 candidemic episodes. All patients were previously exposed to echinocandins (median 26 days; range 15–77). Five patients received initial echinocandin therapy with persistent candidemia in 4 of them. Overall mortality was 33%.

Epidemiology, risk factors and clinical course of SARS-CoV-2 infected patients in a Swiss university hospital: An observational retrospective study

Background

This study aims to describe the epidemiology of COVID-19 patients in a Swiss university hospital.

Methods

This retrospective observational study included all adult patients hospitalized with a laboratory confirmed SARS-CoV-2 infection from March 1 to March 25, 2020. We extracted data from electronic health records. The primary outcome was the need to mechanical ventilation at day 14. We used multivariate logistic regression to identify risk factors for mechanical ventilation. Follow-up was of at least 14 days.

Results

145 patients were included in the multivariate model, of whom 36 (24.8%) needed mechanical ventilation at 14 days. The median time from symptoms onset to mechanical ventilation was 9·5 days (IQR 7.00, 12.75). Multivariable regression showed increased odds of mechanical ventilation with age (OR 1.09 per year, 95% CI 1.03–1.16, p = 0.002), in males (OR 6.99, 95% CI 1.68–29.03, p = 0.007), in patients who presented with a qSOFA score ≥2 (OR 7.24, 95% CI 1.64–32.03, p = 0.009), with bilateral infiltrate (OR 18.92, 3.94–98.23, p<0.001) or with a CRP of 40 mg/l or greater (OR 5.44, 1.18–25.25; p = 0.030) on admission. Patients with more than seven days of symptoms on admission had decreased odds of mechanical ventilation (0.087, 95% CI 0.02–0.38, p = 0.001).

Conclusions

This study gives some insight in the epidemiology and clinical course of patients admitted in a European tertiary hospital with SARS-CoV-2 infection. Age, male sex, high qSOFA score, CRP of 40 mg/l or greater and a bilateral radiological infiltrate could help clinicians identify patients at high risk for mechanical ventilation.

Contingent and non-contingent auditory cueing in Parkinson's disease

Parkinson's disease (PD) patients and their normal controls performed two experiments involving a sequential movement task, depressing a series of buttons at choice points along a response board. Visual or auditory cues were presented prior to each move according to various contingencies. PD, a disorder characterised by degeneration of the basal ganglia (BG), typically manifests with poor execution of motor sequences. We found that external cueing facilitated motor sequencing in PD patients. In particular, auditory cues which occurred late in the movement cycle maximally facilitated switching between subcomponents of a sequence. Based on physiological findings reported in the primate literature [Brotchie et al., Brain 114, 1685-1702, 1978; Schultz and Romo, Exp. Brain Res. 1, 363-384, 1992], it is suggested that external cues enhance performance by replacing defective, internally generated cues (discharges) of the BG. This has implications for the use of physical training strategies in the treatment of PD.

Effects of norepinephrine infused in the paraventricular hypothalamus on energy expenditure in the rat

The metabolic effects of norepinephrine (NE), when infused into the paraventricular nucleus of the hypothalamus (PVN), were examined using indirect calorimetry. In two separate experiments, it was found that NE infused into the PVN reduced energy expenditure in freely moving rats. While NE also reduced motor activity, these reductions were not statistically significant. Reductions in voluntary motor activity were not necessary for a reduction in energy expenditure, as NE still reduced energy expenditure in rats that were lightly sedated. Clonidine, but not L-phenylephrine, mimicked the hypometabolic effect of NE, suggesting an action at alpha 2 receptors. Infusions of NE were also found to increase blood glucose shortly after infusion, although the specificity of this effect is questionable. Taken together, these data suggest that activation of noradrenergic neurons within the PVN results in a metabolic shift towards energy conservation.

Ability of quantitative PCR to discriminate Pneumocystis jirovecii pneumonia from colonization

Introduction.

Pneumocystis jirovecii pneumonia (PCP) is a severe disease affecting immunocompromised patients. Diagnosis is difficult due to the low sensitivity of direct examination and inability to grow the pathogen in culture. Quantitative PCR in bronchoalveolar lavage fluid (BAL) has high sensitivity, but limited specificity for distinguishing PCP from colonization.

Aim.

To assess the performance of an in-house quantitative PCR to discriminate between PCP and colonization.

Methodology.

This was a single-centre retrospective study including all patients with a positive PCR result for P. jirovecii in BAL between 2009 and 2017. Irrespective of PCR results, PCP was defined as the presence of host factors and clinical/radiological criteria consistent with PCP and (i) the presence of asci at direct examination of respiratory sample or (ii) anti-PCP treatment initiated with clinical response and absence of alternative diagnosis. Colonization was considered for cases who did not receive anti-PCP therapy with a favourable outcome or an alternative diagnosis. Cases who did not meet the above mentioned criteria were classified as ‘undetermined’.

Results.

Seventy-one patients with positive P. jirovecii PCR were included (90 % non-HIV patients). Cases were classified as follows: 37 PCP, 22 colonization and 12 undetermined. Quantitative PCR values in BAL were significantly higher in patients with PCP versus colonization or undetermined (P<0.0001). The cut-off of 5×10³ copies/ml was able to discriminate PCP cases from colonization with 97 % sensitivity, 82 % specificity, 90 % positive predictive value and 95 % negative predictive value.

Conclusions.

Our quantitative PCR for P. jirovecii in BAL was reliable to distinguish PCP cases from colonization in this predominantly non-HIV population.

Interference from distractors in reach-to-grasp movements

Descriptions of interference effects from non-relevant stimuli are extensive in visual target detection and identification paradigms. To explore the influence of features of non-relevant objects on reach-to-grasp movements, we instructed healthy normal controls to reach for and pick up a cylinder (target) placed midsagittally 30 cm from the starting position of the hand. In Experiment 1, the target was presented alone, or accompanied by a narrower, wider, or same-size distractor positioned to the left or right of the target. In Experiment 2, the target was presented alone or accompanied by a distractor, which was slanted at a different orientation to the target. Reflective markers were placed on the wrist, thumb, and index finger of the right hand, and infra-red light-detecting cameras recorded their displacement through a calibrated 3-dimensional working space. Kinematic parameters were derived and analysed. Consistent changes in the expression of peak velocity, acceleration, and deceleration were evident when the distractor was narrower or wider than the target. The impact of the orientation of the distractor, conversely, was not marked. We discuss the results in the context of physiological findings and models of selective attention.

Accuracy of Sensititre YeastOne echinocandins epidemiological cut-off values for identification of FKS mutant Candida albicans and Candida glabrata: a ten year national survey of the Fungal Infection Network of Switzerland (FUNGINOS)

OBJECTIVES

Echinocandins represent the first-line treatment of candidaemia. Acquired echinocandin resistance is mainly observed among Candida albicans and Candida glabrata and is associated with FKS hotspot mutations. The commercial Sensititre YeastOne™ (SYO) kit is widely used for antifungal susceptibility testing, but interpretive clinical breakpoints are not well defined. We determined echinocandins epidemiological cut-off values (ECV) for C. albicans/glabrata tested by SYO and assessed their ability to identify FKS mutants in a national survey of candidaemia.

METHODS

Bloodstream isolates of C. albicans and C. glabrata were collected in 25 Swiss hospitals from 2004 to 2013 and tested by SYO. FKS hotspot sequencing was performed for isolates with an MIC≥ECV for any echinocandin.

RESULTS

In all, 1277 C. albicans and 347 C. glabrata were included. ECV 97.5% of caspofungin, anidulafungin and micafungin were 0.12, 0.06 and 0.03 μg/mL for C. albicans, and 0.25, 0.12 and 0.03 μg/mL for C. glabrata, respectively. FKS hotspot sequencing was performed for 70 isolates. No mutation was found in the 52 'limit wild-type' isolates (MIC=ECV for at least one echinocandin). Among the 18 'non-wild-type' isolates (MIC>ECV for at least one echinocandin), FKS mutations were recovered in the only two isolates with MIC>ECV for all three echinocandins, but not in those exhibiting a 'non-wild-type' phenotype for only one or two echinocandins.

CONCLUSION

This 10-year nationwide survey showed that the rate of echinocandin resistance among C. albicans and C. glabrata remains low in Switzerland despite increased echinocandin use. SYO-ECV could discriminate FKS mutants from wild-type isolates tested by SYO in this population.

Sensitivity of Rapid Antigen Testing and RT-PCR Performed on Nasopharyngeal Swabs versus Saliva Samples in COVID-19 Hospitalized Patients: Results of a Prospective Comparative Trial (RESTART)

Saliva sampling could serve as an alternative non-invasive sample for SARS-CoV-2 diagnosis while rapid antigen tests (RATs) might help to mitigate the shortage of reagents sporadically encountered with RT-PCR. Thus, in the RESTART study we compared antigen and RT-PCR testing methods on nasopharyngeal (NP) swabs and salivary samples. We conducted a prospective observational study among COVID-19 hospitalized patients between 10 December 2020 and 1 February 2021. Paired saliva and NP samples were investigated by RT-PCR (Cobas 6800, Roche-Switzerland, Basel, Switzerland) and by two rapid antigen tests: One Step Immunoassay Exdia® COVID-19 Ag (Precision Biosensor, Daejeon, Korea) and Standard Q® COVID-19 Rapid Antigen Test (Roche-Switzerland). A total of 58 paired NP-saliva specimens were collected. A total of 32 of 58 (55%) patients were hospitalized in the intensive care unit, and the median duration of symptoms was 11 days (IQR 5-19). NP and salivary RT-PCR exhibited sensitivity of 98% and 69% respectively, whereas the specificity of these RT-PCRs assays was 100%. The NP RATs exhibited much lower diagnostic performance, with sensitivities of 35% and 41% for the Standard Q® and Exdia® assays, respectively, when a wet-swab approach was used (i.e., when the swab was diluted in the viral transport medium (VTM) before testing). The sensitivity of the dry-swab approach was slightly better (47%). These antigen tests exhibited very low sensitivity (4% and 8%) when applied to salivary swabs. Nasopharyngeal RT-PCR is the most accurate test for COVID-19 diagnosis in hospitalized patients. RT-PCR on salivary samples may be used when nasopharyngeal swabs are contraindicated. RATs are not appropriate for hospitalized patients.

The influence of initial hand posture on the expression of prehension parameters

This paper describes the transport and grasp kinematic parameters associated with four initial hand postures (palm flat and thumb against the hand, palm flat and thumb extended laterally, index and thumb in opposition, and index and thumb in opposition and elbow flexed 90 degrees). A group of healthy adult subjects reached for and picked up a wooden dowel placed midsagittally, at one of three distances (20 cm, 25 cm and 30 cm). The initial posture of the hand and arm altered transport (peak velocity and peak negative acceleration) as well as grasp (peak angle and time to peak angle) parameters, particularly when the elbow was flexed 90 degrees. The pattern of results was reproduced in a pointing paradigm. The findings are discussed in the context of joint space models of reaching.

Modulation of unilateral neglect as a function of direction of object motion

Unilateral neglect is a disorder involving difficulty in attending to the side of space contralesional to brain injury. Two recent experiments have shown that task-irrelevant background motion reduces neglect on line bisection tasks; however, task-relevant motion has not been assessed. We investigated the effect of task-relevant object motion on left neglect using a moving cube presented on a computer screen. Subjects responded to cued corners of the cube as it moved across the screen. Direction of cube motion had a significant impact on the magnitude of neglect. Responses to left hemispace targets appearing on a leftward moving cube were equal to patients' fastest responses. In contrast, responses to left hemispace targets appearing on a rightward moving cube were the slowest of all responses. These results demonstrate that contralesional object motion is capable of normalising neglect patients' detection of contralesional targets.

Modulation of reach-to-grasp parameters: semantic category, volumetric properties and distractor interference?

In the two experiments of this study, we assessed the influence of target size and semantic category on the expression of reach-to-grasp kinematic parameters. Moreover, we investigated the influence of size and semantic category of distractors on reaches to the target. The experimental objects represented living and non-living categories and wide and narrow grasp sizes. Participants reached for and picked up mid-sagittally placed targets, which were either alone or flanked by distractors congruent or incongruent to semantic category and size of the target. In experiment 1, movement duration was faster to living objects. We could not replicate this, however, in experiment 2. Conversely, significant and reliable Category x Size interactions for grasp were obtained in experiment 1 and replicated in experiment 2. The pattern of the means in these interactions coincided with the absolute volumetric properties of the stimuli, indicating that the size of the stimuli was the main determinant of the expression of kinematic parameters. We conclude that volumetric properties such as size, rather than semantic category, are the crucial features in the programming and execution of movement to targets. As regards the category and size of the distractor, interference effects were evident: both category and size exerted a comparable influence on reaches to the target. The direction of interference, however, was not systematic. The interference effects are discussed in the context of visual search models of attention.

Identification of Propionibacterium avidum from a breast abscess: an overlooked etiology of clinically significant infections

We report the case of a 37-year-old previously healthy woman diagnosed with a breast abscess due to Propionibacterium avidum after breast reduction surgery. This case emphasizes the potential pathogenicity and morbidity associated with this commensal skin organism.

Meningitis due to non-steroidal anti-inflammatory drugs: an often-overlooked complication of a widely used medication

A 40-year-old man developed aseptic meningitis after ibuprofen consumption for tension-type headaches. After a thorough diagnostic workup and lack of improvement on empirical therapy for common aetiologies of meningitis (bacterial and viral infections), we suspected non-steroidal anti-inflammatory drug (NSAID) induced meningitis due to the temporal relationship between drug administration and symptom onset. Two days after NSAID suppression, the evolution was progressively favourable with complete resolution of fever and symptoms. On follow-up, symptoms did not recur and there was no neurological sequela. This article summarises the clinical picture and the complementary exams that led to the difficult-to-make diagnosis of NSAID-induced acute meningitis, in parallel with a brief review of the literature.

Temporal changes in fecal microbiota of patients infected with COVID-19: a longitudinal cohort

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a multifaceted disease potentially responsible for various clinical manifestations including gastro-intestinal symptoms. Several evidences suggest that the intestine is a critical site of immune cell development, gut microbiota could therefore play a key role in lung immune response. We designed a monocentric longitudinal observational study to describe the gut microbiota profile in COVID-19 patients and compare it to a pre-existing cohort of ventilated non-COVID-19 patients.

METHODS

From March to December 2020, we included patients admitted for COVID-19 in medicine (43 not ventilated) or intensive care unit (ICU) (14 ventilated) with a positive SARS-CoV-2 RT-PCR assay in a respiratory tract sample. 16S metagenomics was performed on rectal swabs from these 57 COVID-19 patients, 35 with one and 22 with multiple stool collections. Nineteen non-COVID-19 ICU controls were also enrolled, among which 14 developed ventilator-associated pneumonia (pneumonia group) and five remained without infection (control group). SARS-CoV-2 viral loads in fecal samples were measured by qPCR.

RESULTS

Although similar at inclusion, Shannon alpha diversity appeared significantly lower in COVID-19 and pneumonia groups than in the control group at day 7. Furthermore, the microbiota composition became distinct between COVID-19 and non-COVID-19 groups. The fecal microbiota of COVID-19 patients was characterized by increased Bacteroides and the pneumonia group by Prevotella. In a distance-based redundancy analysis, only COVID-19 presented significant effects on the microbiota composition. Moreover, patients in ICU harbored increased Campylobacter and decreased butyrate-producing bacteria, such as Lachnospiraceae, Roseburia and Faecalibacterium as compared to patients in medicine. Both the stay in ICU and patient were significant factors affecting the microbiota composition. SARS-CoV-2 viral loads were higher in ICU than in non-ICU patients.

CONCLUSIONS

Overall, we identified distinct characteristics of the gut microbiota in COVID-19 patients compared to control groups. COVID-19 patients were primarily characterized by increased Bacteroides and decreased Prevotella. Moreover, disease severity showed a negative correlation with butyrate-producing bacteria. These features could offer valuable insights into potential targets for modulating the host response through the microbiota and contribute to a better understanding of the disease's pathophysiology.

TRIAL REGISTRATION

CER-VD 2020-00755 (05.05.2020) & 2017-01820 (08.06.2018).

Pictures of you: Dot stimuli cause motor contagion in presence of a still human form

In this study, we investigate which visual cues induce participants to encode a non-human motion stimulus in their motor system. Participants performed reach-to-grasp actions to a target after observing a dot moving in a direct or higher-arcing path across a screen. Dot motion occurred in the presence of a meaningless (scrambled human model) stimulus, a still human model, or a human model performing a direct or exaggeratedly curved reach to a target. Our results show that observing the dot displacement causes motor contagion (changes in the height of the observer's hand trajectory) when a human form was visually present in the background (either moving or still). No contagion was evident, however, when this human context was absent (i.e., human image scrambled and not identifiable). This indicates that visual cues suggestive of human agency can determine whether or not moving stimuli are encoded in the motor system.

Verbal social primes alter motor contagion during action observation

We investigated whether prosocial and nonsocial word primes prior to action observation modify subsequent initiation and execution of the observer's own reach-to-grasp actions. Participants observed a model performing exaggeratedly curved (vertical deviation) or natural straight reaches to a vertical dowel and always performed a straight reach to a dowel themselves. Observing curved movements slowed initiation times and increased the vertical deviation of the participants' movements. Observing curved movements enhanced vertical deviation only in the prosocial word primes condition. We suggest that social context priming can modulate initiation of movement as well as the extent of motor contagion (in this case, the extent of vertical deviation) between model and observer.

Investigating nanomotion-based technology (Resistell AST) for rapid antibiotic susceptibility testing among adult patients admitted to a tertiary-care hospital with Gram-negative bacteraemia: protocol for a prospective, observational, cross-sectional, single-arm study

INTRODUCTION

Effective treatment of bloodstream infections (BSIs) is relying on rapid identification of the causing pathogen and its antibiotic susceptibility. Still, most commercially available antibiotic susceptibility testing (AST) methods are based on monitoring bacterial growth, thus impacting the time to results. The Resistell AST is based on a new technology measuring the nanomotion caused by physiologically active bacterial cells and detecting the changes in nanomotion caused by the exposure to a drug.

METHODS AND ANALYSIS

This is a single-centre, prospective, cross-sectional, single-arm diagnostic accuracy study to determine the agreement of the Resistell AST on Gram-negative bacteria isolated from blood cultures among patients admitted to a tertiary-care hospital with the reference method. Up to 300 patients will be recruited. Starting with a pilot phase, enrolling 10%-20% of the subjects and limited to Escherichia coli BSI tested for ceftriaxone susceptibility, the main phase will follow, extending the study to Klebsiella pneumoniae and ciprofloxacin.

ETHICS AND DISSEMINATION

This study has received ethical approval from the Swiss Ethics Committees (swissethics, project 2020-01622). All the case report forms and clinical samples will be assigned a study code by the local investigators and stored anonymously at the reference centre (Lausanne University Hospital). The results will be broadly distributed through conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT05002413).

Comparison of Nasopharyngeal and Saliva Swab Nucleic Acid Amplification and Rapid Antigen Testing To Detect Omicron SARS-CoV-2 Variant of Concern: a Prospective Clinical Trial (OMICRON)

In November 2021, the World Health Organization declared the Omicron variant (B.1.1.519) a variant of concern. Since then, worries have been expressed regarding the ability of usual diagnostic tests to detect the Omicron variant. In addition, some recently published data suggested that the salivary reverse transcription (RT)-PCR might perform better than the current gold standard, nasopharyngeal (NP) RT-PCR. In this study, we aimed to compare the sensitivities of nasopharyngeal and saliva RT-PCR and assess the diagnostic performances of rapid antigen testing (RAT) in nasopharyngeal and saliva samples. We conducted a prospective clinical study among symptomatic health care professionals consulting the occupational health service of our hospital for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening and hospitalized patients in internal medicine/intensive care wards screened for SARS-CoV-2 with COVID-19-compatible symptoms. A composite outcome considering NP PCR and/or saliva PCR was used as a reference standard to define COVID-19 cases. A total of 475 paired NP/saliva specimens have been collected with a positivity rate of 40% (n = 192). NP and salivary RT-PCR exhibited sensitivities of 98% (95% CI, 94 to 99%) and 87% (95% CI, 81 to 91%), respectively, for outpatients (n = 453) and 94% (95% CI, 72 to 99%) and 69% (95% CI, 44 to 86%), respectively, for hospitalized patients (n = 22). Nasopharyngeal rapid antigen testing exhibited much lower diagnostic performances (sensitivity of 66% and 31% for outpatients and inpatients, respectively), while saliva RAT showed a sensitivity of less than 5% in both groups. Nasopharyngeal RT-PCR testing remains the gold standard for SARS-CoV-2 Omicron variant screening. Salivary RT-PCR can be used as an alternative in case of contraindication to perform NP sampling. The use of RAT should be limited to settings where access to molecular diagnostic methods is lacking. IMPORTANCE The Omicron variant of concern spread rapidly since it was first reported in November 2021 and currently accounts for the vast majority of new infections worldwide. Recent reports suggest that saliva sampling might outweigh nasopharyngeal sampling for the diagnosis of the Omicron variant. Nevertheless, data investigating the best diagnostic strategy specifically for the Omicron variant of concern remain scarce. This study fills this gap in current knowledge and elucidates the question of which strategy to use in which patient. It provides a new basis for further improving COVID-19 screening programs and managing patients suspected to have COVID-19.

Effects of oral prajmaline bitartrate on exercise test responses in patients with coronary artery disease

The safety, tolerability and haemodynamic effects of oral prajmaline bitartrate were assessed in a double-blind, randomized, placebo-controlled, crossover trial in 21 patients with stable angina pectoris and coronary artery disease. No serious side-effects occurred. Prajmaline bitartrate produced no statistically significant changes in resting heart rate or systolic blood pressure or in work capacity on the treadmill, or in heart rate or systolic blood pressure at maximum exercise compared to placebo values. No new arrhythmias or conduction abnormalities were produced in any patient. We conclude that oral prajmaline bitartrate is well tolerated and can be given safely to patients with coronary artery disease without producing deleterious haemodynamic effects or changes in exercise capacity.