Tuesday, April 21, 2020


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

With regular inputs from Dr Monica Vasudev

717: COVID Neurological manifestations

Five more cases of Guillain–BarrĂ© syndrome (GBS) in association with COVID-19 have been identified.  The cases from Italian researchers, comes a little more than 2 weeks following the first reported case of COVID-19 presenting as GBS. The article, with lead author Gianpaolo Toscano, MD, IRCCS C. Mondino Foundation, Pavia, Italy, was published online April 17 in the New England Journal of Medicine.

718: COVID high sugar link

Diabetes and hyperglycemia among people without prior diabetes are strong predictors of mortality among hospitalized patients with COVID-19. The data suggest that although glycemic control may not be at the forefront of most clinicians' minds when it comes to COVID-19, it is important, and paying more attention to it could save lives, say the researchers, led by Bruce Bode, MD, of Atlanta Diabetes Associates, Georgia, and colleagues, including employees of Glytec, an insulin management software company. The results were published online April 17 in the Journal of Diabetes Science and Technology.

719:  Gating criteria before phasing-in elective procedures.

1.      A downward trajectory of influenza-like illnesses reported within a 14-day period

2.      A downward trajectory of documented COVID-19 cases or a downward trajectory of positive tests as a percentage of total tests within a 14-day period

3.      A "robust" testing program in place for at-risk healthcare workers, including emerging antibody testing

720:  According to a study published in the Journal of Infection, saliva is a reliable tool to detect SARS-CoV-2.

Lorenzo Azzi, MD, University of Insubria, Varese, Italy, and colleagues analysed salivary samples of 25 patients with COVID-19 and compared the results with their clinical and laboratory data.  SARS-CoV-2 was detected in all 25 patients’ first salivary swab. Eight patients underwent a second salivary swab after 4 days, and the results were consistent with the first analysis, without relevant differences in variable threshold cycles (Ct). A striking feature was highlighted in 2 patients who showed positive salivary results on the same days when their pharyngeal or bronchoalveolar swabs proved to be negative.

721: A study, published in Clinical Infectious Diseases, showed that detectable serum SARS-Cov-2 RNA (RNAaemia) in patients with COVID-19 was associated with elevated IL-6 concentration and poor prognosis.

According to Xiaohua Chen, General Hospital of Central Theater Command, Wuhan, China, and colleagues RNAaemia was diagnosed only in critically ill patients with COVID-19, and seemed to reflect the severity of the disease. Furthermore, the level of inflammatory cytokine IL-6 in critically ill patients increased significantly, almost 10 times that in other patients. More importantly, the extremely high IL-6 level was closely correlated with the detection of RNAaemia (R = 0.902). The extremely high level of IL-6 is a hallmark and important driving force of cytokine storm, which may cause multiple organ dysfunction in critically ill patients.

722: A study published in Journal of Thrombosis and Haemostasis showed that thrombocytopenia is common in patients with COVID‐19, and is associated with increased risk of in‐hospital mortality.

Xiaobo Yang, MD, Tongji Medical College, Wuhan, and colleagues retrospectively analysed data from 1,476 patients with COVID-19 treated at Jinyintan Hospital in Wuhan. Of the patients, 238 (16.1%) died. Compared with survivors, non‐survivors were older, were more likely to have thrombocytopenia, and had lower nadir platelet counts. Among the patients, 306 (20.7%) had thrombocytopenia. The in‐hospital mortality was 92.1% for patients with nadir platelet count 0 to 50, 61.2% for patients with counts 50 to 100, 17.5% for patients with platelet count 100 to 150, and 4.7% for patients with platelet counts ≥150.  Thrombocytopenia is common in patients with COVID‐19, and it is associated with increased risk of in‐hospital mortality,” the authors concluded. “The lower the platelet count is, the higher the mortality becomes. [DG]

723:  Universal testing: in pregnant women?

A policy of universal screening of pregnant women for the COVID-19 virus identified a high proportion of women who tested positive and were asymptomatic, based on data from 215 pregnant women in New York City.

In a letter published in the New England Journal of Medicine, the researchers reviewed their experiences with 215 pregnant women who delivered infants during March 22–April 4, 2020, at the New York–Presbyterian Allen Hospital and Columbia University Irving Medical Center. All the women were screened for symptoms of the COVID-19 infection on admission.

Overall, four women (1.9%) had fevers or other symptoms on admission, and all of these women tested positive. The other 211 women were afebrile and asymptomatic at admission, and 210 of them were tested via nasopharyngeal swabs. A total of 29 asymptomatic women (13.7%) tested positive for COVID-19 infection.

Thus, 29 of the 33 patients who were positive for SARS-CoV-2 at admission (87.9%) had no symptoms of COVID-19 at presentation.

Three of the 29 COVID-19-positive women who were asymptomatic on admission developed fevers before they were discharged from the hospital after a median stay of 2 days. Of these, two received antibiotics for presumed endomyometritis and one patient with presumed COVID-19 infection received supportive care. In addition, one patient who was initially negative developed COVID-19 symptoms after delivery and tested positive 3 days after her initial negative test.

Our use of universal SARS-CoV-2 testing in all pregnant patients presenting for delivery revealed that at this point in the pandemic in New York City, most of the patients who were positive for SARS-CoV-2 at delivery were asymptomatic,” Dr. Sutton and colleagues said.

724: Most fine-needle aspiration procedures for thyroid nodules can be safely delayed

Most fine-needle aspiration procedures for thyroid nodules can be safely delayed  for 6 months or longer during the COVID-19 pandemic; data show such delays do not influence the long-term prognosis for common forms of thyroid cancer, according to an editorial published in Clinical Thyroidology.

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