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
751: Epilepsy and COVID
People who have epilepsy face the same health challenges as people who
do not have the condition and are otherwise healthy. For this reason, people
who have epilepsy should exercise the same habits and preventative measures
that healthy people would typically take, such as social distancing; avoiding
contact with sick people; washing hands regularly; disinfecting surfaces
regularly; and avoiding touching hands, eyes, nose and mouth.
However, the high fever associated with coronavirus can trigger
seizures. The increased risk is another reason people who have epilepsy should
do their best to avoid getting sick.
752: ACE inhibitors in COVID
Initial data from one Chinese center on the use of
angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers
(ARBs) in patients hospitalized with COVID-19 appear to give some further
reassurance about continued use of these drugs.
The report from one hospital in Wuhan found that among patients with
hypertension hospitalized with the COVID-19 virus, there was no difference in
disease severity or death rate in patients taking ACE inhibitors or ARBs and
those not taking such medications. The data were published online April 23 in
JAMA Cardiology.
The study adds to another recent report in a larger number of COVID-19
patients from nine Chinese hospitals that suggested a beneficial effect of ACE
inhibitors or ARBs on mortality.
753: High
incidence of VTE in anticoagulated patients with severe COVID‐19, acute
segmental pulmonary emboli associated with COVID-19
According
to a study published
in Journal of Thrombosis and Haemostasis, there is a high
incidence of venous thromboembolic events (VTE) in anticoagulated patients with
severe COVID-19.
Jean‐François
Llitjos, MD, Institut Cochin, INSERM, Paris, France, and colleagues analysed
data from 2 French intensive care units (ICUs) where complete duplex ultrasound
(CDU) is performed as a standard of care.
From March
19, 2020, to April 11, 2020, 26 consecutive patients with severe COVID‐19 who
were admitted to the ICU were screened for VTE early in admission using a CDU
from thigh to ankle at selected sites with Doppler waveforms and images.
Anticoagulation
dose was left to the discretion of the treating physician based on the
individual risk of thrombosis. Pulmonary embolism was systematically searched
in patients with persistent hypoxemia or secondary deterioration.
Of the
patients, 8 (31%) were treated with prophylactic anticoagulation and 18 (69%)
were treated with therapeutic anticoagulation.
The
overall rate of VTE was 69%. However, the proportion of VTE was significantly
higher in patients treated with prophylactic anticoagulation compared with
therapeutic anticoagulation (100% vs 56%; P = 0.03).
“Surprisingly,
we found a high rate of thromboembolic events in patients with COVID‐19 treated
with therapeutic anticoagulation, with 56% of VTE and 6 pulmonary embolisms,”
the authors wrote.
754: In a related topic, emergency department physicians
from California describe a case of acute
segmental pulmonary emboli associated with COVID-19.
Published
in the American Journal of Emergency Medicine, Kyla Casey, MD,
Naval Medical Center San Diego, San Diego, California, and colleagues presented
a case of a man aged 42 years who presented to the emergency department with
worsening chest pain, shortness of breath, and haemoptysis. He had been
previously diagnosed with mild COVID-19 infection 12 days prior and had managed
to stay at home until then.
On
presentation, he was afebrile and demonstrated a normal heart rate, blood
pressure, and oxygen saturation, but he demonstrated a respiratory rate of 30
breaths per minute. His physical exam revealed mild respiratory distress with
bibasilar rhonchi but otherwise no other acute findings.
Laboratory
evaluation was notable for a D-dimer of 4.8 μg/dl. Electrocardiography (EKG)
showed flattening of the T-waves in the inferior leads as compared to his
prior EKGs with right axis deviation and a S1Q3T3 pattern. Chest radiograph was
significant for a right lower lobe infiltrate. Given his haemoptysis, evidence
of right heart strain on his EKG and elevated D-dimer, a chest CT angiography
was obtained. The test revealed bilateral segmental pulmonary emboli and an
additional area of consolidation in the right lower lobe concerning for
infarct. Additional findings of peripheral ground glass opacities consistent
with COVID-19 pneumonia were also noted.
The
patient was admitted to a negative pressure room, started on anticoagulation
with heparin and eventually discharged to home on a novel oral anticoagulant.
SOURCE:
Journal of Thrombosis and Haemostasis and American Journal of Emergency
Medicine
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