Thursday, April 16, 2020



Dr K K Aggarwal

President Confederation of Medical Associations of Asia and Oceania, HCFI and Past National President IMA

588: BCG can it flatten the curve

report—titled “Mandated Bacillus Calmette-Guérin (BCG) vaccination predicts flattened curves for the spread of COVID-19″—is an analysis of daily reports of COVID-19 cases and related deaths in more than 50 countries.
Researchers say countries that have current policy mandating BCG vaccination, TB vaccine, have significantly slower growth of both cases and deaths, as compared to all other countries.

Berg and colleagues analyzed daily reports of confirmed cases and deaths during a 30-day period, modeling differences between growth curves in countries that have mandated BCG policies at least until very recently (such as Brazil, Ireland, France and India) and countries that do not (such as the U.S., Italy and Lebanon).

Study (PDF): Mandated Bacillus Calmette-Guérin (BCGvaccination predicts flattened curves for the spread of COVID-19

589:  As per USA Was WHO slow in its action OBSERVATIONS

WHO denied human-to-human spread of COVID-19 till 23rd January. On January 14, 2020, the WHO tweeted that “[p]reliminary investigations conducted by Chinese authorities have found no clear evidence of human-to-human transmission of the novel coronavirus. These preliminary investigations included China jailing any doctor that disseminated any information about COVID-19 not first cleared through state-run media. Furthermore, the WHO ignored Taiwanese warnings of human-to-human transmission in December 2019, because Taiwan is not currently recognized by the WHO as an independent nation.

Delayed naming COVID-19 a Public Health Emergency of International Concern (PHEIC) and pandemic because China had the spread under control. By the time the WHO declared COVID-19 a PHEIC on January 30, 2020, the disease had infected almost 10,000 and killed almost 1,000 people in 19 different countries.

Despite declaring COVID-19 a PHEIC and extensive evidence of transmission through travel, the WHO insisted other countries not restrict travel or trade to China. The WHO has not issued updated travel restrictions since February 29 and has still not recommended restricting international travel.

590: what is the prognosis of in-hospital cardiac arrest
In-hospital cardiac arrest outcomes in COVID-19 are poor: just 2.9% survived to 30 days and less than 1% survived with good neurological outcome at that point in a series from Wuhan, China. (Resuscitation)

591: Five months on, what scientists now know about the coronavirus

A spiky ball of genetic material coated in fatty chemicals called lipids, and which measures 80 billionths of a metre in diameter which has brought the whole world for a halt.

592: Cath lab activations for STEMI down 38% during COVID-19 pandemic

Yes: The number of STEMI activations in U.S. cardiac catheterization laboratories has decreased during the COVID-19 pandemic, according to research published in the Journal of the American College of Cardiology.

Anecdotal reports suggested a decline in primary percutaneous coronary intervention volumes in the U.S. and around the world during the early phase of the pandemic. Current guidelines recommend primary percutaneous coronary interventions for patients presenting with ST-elevation myocardial infarction even during the pandemic.

Researchers analyzed STEMI activations from nine high-volume cardiac catheterization laboratories in the U.S. from January 2019 to March 2020.

March 1, 2020, was determined to be the start of the “after COVID-19” period. The “before COVID-19” period was defined as the 14 months before the pandemic, or from January 2019 to February 2020.

STEMI activation at nine high-volume U.S. cath labs before and during the COVID-19 pandemic.

Researchers observed a 38% decrease in STEMI activations from before the pandemic to after it started to affect life in the U.S. (95% CI, 26-49). Before the pandemic, the sites from the study reported more than 180 STEMI activations per month, with a mean of 23.6 activations per month per center. This decreased to 138 activations per month, with a mean of 15.3 activations per month per center, for the period beginning March 1, 2020.

593: What can be the reasons for fewer heart attacks

Fewer heart attacks due to less stressful life

Avoidance of medical care due to social distancing

Concerns of contracting COVID-19 in the hospital

STEMI misdiagnosis

Increased use of pharmacological reperfusion due to COVID-19

594:  Can blood transfusion be effective

Dr Keerthika Sundaram: COVID 19 patients not responding to a ventilator and who have a hypoxemic hypoxia-like picture. We should give blood transfusion, packed cells, cord blood cells.

595: Journal of Infection published study showed that arbidol monotherapy is superior to lopinavir/ritonavir in the treatment of COVID-19.
Zhen Zhu, MD, Third People’s Hospital of Changzhou, Changzhou, China, and colleagues analyzed data from 34 patients with laboratory-confirmed COVID-19 who received lopinavir/ritonavir 400 mg/100 mg and 16 patients with COVID-19 who received arbidol monotherapy (0.2 g tid). The cycle threshold values of open reading frame 1ab and nucleocapsid genes by RT-PCR assay were monitored during antiviral therapy. 
None of the patients developed severe pneumonia or acute respiratory distress syndrome. On day 14 after the admission, no viral load was detected in the arbidol group compared with 15 (44.1%) patients in the lopinavir/ritonavir group. In addition, patients in the arbidol group had a shorter duration of positive RNA test compared with those in the lopinavir/ritonavir group (P< 0.01). 
“Our data suggest that arbidol monotherapy is more effective than lopinavir/ritonavir in treating COVID-19,” the authors concluded.

596: what is NL ratio [neutrophil-to-lymphocyte ratio]

A study published in the Journal of Infection, provides evidence that NLR is an independent risk factor for in-hospital mortality in patients with COVID-19, especially for male patients. 
Yuwei Liu, MD, Zhongnan Hospital of Wuhan University, Wuhan, China, and colleagues retrospectively analysed 245 patients with COVID-19 admitted to the Zhongnan Hospital of Wuhan University from January 1, 2020, to February 29, 2020. 
In-hospital mortality was 13.47%. Multivariate analysis demonstrated that there was 8% higher risk of in-hospital mortality for each unit increase in NLR (odds ratio [OR] = 1.08; 95% confidence interval [CI], 1.01-1.14; P = 0.0147). Compared with patients in the lowest tertile, the NLR of patients in the highest tertile had a 15.04-fold higher risk of death (OR = 16.04; 95% CI, 1.14-224.95; P = 0.0395) after adjustment for potential confounders. Notably, the fully adjusted OR for mortality was 1.10 in males for each unit increase of NLR (OR = 1.10; 95% CI, 1.02-1.19; P = 0.016).
Assessment of NLR may help identify high-risk individuals with COVID-19.

597:  Can late treatment in COVID helpful

A case report published in Pharmacotherapy describes the successful treatment of a patient with COVID-19 with remdesivir antiviral therapy 13 days after symptom onset. 

598:  What are the findings if nature article

“We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector–infectee transmission pairs.
We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset.
We estimated that 44% (95% confidence interval, 25–69%) of secondary cases were infected during the index cases’ presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission. SARS-CoV-2,”

599: And now a saliva test
US FDA has granted emergency approval for an approach that uses saliva as the primary test biomaterial. The Rutgers Clinical Genomics Laboratory TaqPath SARS-CoV-2 Assay is intended for the qualitative detection of nucleic acid from SARS-CoV-2 in oropharyngeal (throat) swab, nasopharyngeal swab, anterior nasal swab, mid-turbinate nasal swab from individuals suspected of COVID-19 by their health care clinicians.

To expand on this assay, Rutgers University-based RUCDR Infinite Biologics developed a saliva collection method in partnership with Spectrum Solutions and Accurate Diagnostic Labs.

600: Diabetes and cytokine storm

COVID-19 infection in patients with type 2 diabetes is associated with a greater increase in inflammatory and coagulation markers, compared with COVID-19 patients without diabetes, according to preliminary findings from a retrospective analysis of COVID-19 patients in Wuhan, China.

The results, though preliminary, could help explain why patients with diabetes and COVID-19 are at greater risk for more severe disease and death.

The results also suggest that more severe disease in patients with diabetes may be the result of a cytokine storm, in which the patient’s immune system overreacts to the virus and inflicts collateral damage on its own organs, according to Herbert I. Rettinger, MD, a clinical endocrinologist in Orange County, Calif., and member of the editorial advisory board for Clinical Endocrinology News. “Understanding the mechanism might help us understand the best way to treat,” COVID-19 in patients with diabetes, he said in an interview.

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