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      Toma de muestras nasofaríngeas para diagnóstico de COVID-19 Translated title: Nasopharyngeal swab for the diagnosis of COVID-19

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          Abstract

          RESUMEN Introducción y objetivos: La prueba de diagnóstico directo del COVID-19 de mayor sensibilidad es la toma de muestras de nasofaringe mediante un hisopo para estudio posterior mediante RT-PCR. El objetivo de nuestro trabajo es exponer pormenorizadamente la forma más adecuada de realizar dicha técnica. Método: Descripción de los diferentes pasos necesarios para la toma de muestras nasofaríngeas en pacientes con COVID-19. Resultados: Los pasos a tener en cuenta son: 1. Previamente se descarta que no existan contraindicaciones para la toma de muestra. 2.Etiquetado de la muestra y preparación del volante de petición. 3. Colocación de EPI según los estándares de la institución en la que se trabaja. 4. Explicación al paciente del proceso a realizar. 5. Técnica para la toma de muestra nasofaríngea 6. Retirada del EPI. 7. Manipulación y transporte de la muestra al laboratorio Discusión y conclusiones: Dado que la sensibilidad de las muestras nasofaríngeas para diagnóstico de COVID-19 depende en gran parte de una adecuada técnica, es muy importante la formación adecuada del personal implicado en la recogida de esta. La persona formada a tal efecto debe conocer el objetivo claro de la misma, como se debe poner y quitar el EPI, conocer cómo se realiza la técnica y como se manipula la muestra.

          Translated abstract

          ABSTRACT Introduction and objective: The diagnostic test of COVID-19 with the highest sensitivity is a nasopharyngeal sample using a swab for subsequent study using RT-PCR. The objective of our work is to explain in detail the most appropriate way to perform this technique. Method: Description of the different steps necessary for taking a nasopharyngeal sample in patients with covid-19. Results: The steps to take into account to get a nasopharyngeal sample in a patient with COVID-19 are: 1. Previously, it is necessary to rule out that there are no contraindications for sampling. 2. Sample labeling and preparation of the petition form. 3. Placement of PPE according to the institution rules. 4. Explanation to the patient of the process to be performed. 5. Procedure for taking a nasopharyngeal sample. 6. Withdrawal of the EPI. 7. Handling and tranportation of the sample to the laboratory. Discussion and Conclusions: Given that the sensitivity of the nasopharyngeal simples for the diagnosis of COVID-19 depends largely on a correct technique, the adequate training of the personnel involved in this collection is very important. The examiner must know the objetive of the procedure, how top ut on and take off the PPE, know how the technique is performed and how the sample is handled.

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          Detection of SARS-CoV-2 in Different Types of Clinical Specimens

          This study describes results of PCR and viral RNA testing for SARS-CoV-2 in bronchoalveolar fluid, sputum, feces, blood, and urine specimens from patients with COVID-19 infection in China to identify possible means of non-respiratory transmission.
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            Detection and analysis of nucleic acid in various biological samples of COVID-19 patients

            COVID-19 (corona virus disease 2019) is a kind of acute severe pneumonia caused by 2019-nCoV (2019-nCoV) infection. Since December 2019, it has been found in Wuhan, Hubei Province, and then spread to the whole country. Some parts of the world also showed an outbreak trend [1–3]. Real-time fluorescence quantitative reverse transcriptase polymerase chain reaction (reverse transcriptase-polymerase chain reaction,RT-PCR) and viral gene sequencing are the gold standard for the diagnosis of COVID-19. At present, upper respiratory tract nasopharyngeal swabs are mostly used as nucleic acid detection samples in China, but the positive rate is low. However, there are few reports on clinical application of 2019-nCoV nucleic acid detection in other biological samples. Methods | The East Section of Renmin Hospital of Wuhan University is a designated COVID-19 hospital in Wuhan City, Hubei Province, China. This observation study included 132 patients diagnosed with COVID-19 in the infectious disease areas of the East Section of Renmin Hospital of Wuhan University from 2020.1.31 to 2020.2.29. COVID-19 diagnostic criteria: according to China's 《pneumonia diagnosis and treatment Program of novel coronavirus infection (trial version 7) 》, in accordance with the relevant epidemiological and clinical manifestations, nasopharyngeal swabs real-time fluorescence RT-PCR detection of 2019-nCoV nucleic acid positive, COVID-19 cases were divided into mild, ordinary, severe and severe [4]. The nasopharyngeal swabs of 132 cases of COVID-19 were positive for 2019-nCoV nucleic acid on admission, including 72 males and 60 females, with an average age of 66.7 ± 9.1 years, including 80 cases of common type, 44 cases of severe type and 8 cases of critical type. During the period of admission, under the condition of tertiary protection, nasopharyngeal swabs, sputum, blood, feces and anal swabs of COVID-19 cases were collected many times in the isolation ward for 2019-nCoV nucleic acid detection. All biological samples are sealed and transferred to the laboratory in strict accordance with the standard process. The RT-PCR test kits (BioGerm) were recommended by the Chinese Center for Disease Control and Prevention. The same technician and brand of test kit was used for all RT-PCR testing reported; both internal controls and negative controls were routinely performed with each batch of tests. Results | 132 the results of 2019-nCoV nucleic acid test of various biological samples during the treatment of confirmed COVID-19 cases are as follows: the positive rate of 2019-nCoV nucleic acid test of nasopharyngeal swab is 38.13% (180/472 times), the positive rate of 2019-nCoV nucleic acid test of sputum is 48.68% (148/304 times), the positive rate of blood 2019-nCoV nucleic acid test is 3.03% (4/132 times), and the positive rate of 2019-nCoV nucleic acid test of feces is 9.83% (24/244 times). The positive rate of 2019-nCoV nucleic acid detection in anal swabs is 10.00% (12/120 times). Discussion| In this study, it was found that the positive rate of 2019-nCoV nucleic acid in sputum of 132 patients with COVID-19 was higher than that of nasopharyngeal swabs, and viral nucleic acids were also detected in blood and digestive tract (fecal/anal swabs). Simple detection of nasopharyngeal swab 2019-nCoV nucleic acid detection positive rate is not high, multi-sample 2019-nCoV nucleic acid detection can improve the accuracy, reduce the false negative rate, better guide clinical treatment and evaluate the therapeutic effect.
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              Comparison between nasopharyngeal swab and nasal wash, using culture and PCR, in the detection of potential respiratory pathogens

              Background Nasopharyngeal carriage of potential pathogens is important as it is both the major source of transmission and the prerequisite of invasive disease. New methods for detecting carriage could improve comfort, accuracy and laboratory utility. The aims of this study were to compare the sensitivities of a nasopharyngeal swab (NPS) and a nasal wash (NW) in detecting potential respiratory pathogens in healthy adults using microbiological culture and PCR. Results Healthy volunteers attended for nasal washing and brushing of the posterior nasopharynx. Conventional and real-time PCR were used to detect pneumococcus and meningococcus. Statistical differences between the two nasal sampling methods were determined using a nonparametric Mann-Whitney U test; differences between culture and PCR methods were determined using the McNemar test. Nasal washing was more comfortable for volunteers than swabbing (n = 24). In detection by culture, the NW was significantly more likely to detect pathogens than the NPS (p < 0.00001). Overall, there was a low carriage rate of pathogens in this sample; no significant difference was seen in the detection of bacteria between culture and PCR methods. Conclusions Nasal washing and PCR may provide effective alternatives to nasopharyngeal swabbing and classical microbiology, respectively.
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                Author and article information

                Journal
                orl
                Revista ORL
                Rev. ORL
                Ediciones Universidad de Salamanca (Salamanca, Salamanca, Spain )
                2444-7986
                December 2020
                : 11
                : 4
                : 389-394
                Affiliations
                [1] Santander orgnameIDIVAL orgdiv1Hospital Universitario Marqués de Valdecilla orgdiv2Universidad de Cantabria España
                Article
                S2444-79862020000400001 S2444-7986(20)01100400001
                efafa89d-be89-4ed7-8175-8ba63af34074

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 27 May 2020
                : 14 May 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 9, Pages: 6
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                SciELO Spain

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                Artículo original

                diagnóstico,COVID-19,SARS-CoV-2,nasopharynx,nasopharyngeal swab,diagnostic,nasofaringe,frotis nasofaríngeo

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