Saturday, April 25, 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
755:   special report published in the journal Radiology outlines prevention, diagnosis and treatment of venous thromboembolism (VTE) in patients with coronavirus disease 2019 (COVID-19). 

From the analysis of all available current medical, laboratory, and imaging data on COVID-19, it became clear that symptoms and diagnostic tests could not be explained by impaired pulmonary ventilation alone.
Recent observations suggest that respiratory failure in COVID-19 is not driven by the development of acute respiratory distress syndrome alone, but that microvascular thrombotic processes may play a role. This may have important consequences for the diagnostic and therapeutic management of these patients. There is a strong association between D-dimer levels, disease progression, and chest CT features suggesting venous thrombosis. In addition, various studies in patients with COVID-19 have shown a very strong association between increased D-dimer levels and severe disease/poor prognosis.

Imaging and pathological investigations confirmed the COVID-19 syndrome is a thrombo-inflammatory process that initially affects lung perfusion, but consecutively affects all organs of the body.

This highly thrombotic syndrome leads to macro-thrombosis and embolism. Therefore, strict thrombosis prophylaxis, close laboratory monitoring, and appropriate imaging monitoring, with early anticoagulant therapy in case of suspected venous thromboembolism, are indicated.

SOURCE: Radiological Society of North America

Wiping high-touch surfaces, like doorknobs, with tissues that have been dabbed with rubbing alcohol can also be used in place of store-bought cleaning products.

High-touch surfaces should be cleaned routinely

756: A single-centre study published in JAMA Cardiology showed that angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) had no effect on the severity or outcome of patients with hypertension hospitalised for COVID-19.

Juyi Li, MD, Tongji Medical College, Wuhan, China, and colleagues analysed data from 1,178 patients with COVID-19 hospitalised at the Central Hospital of Wuhan from January 15 to March 15, 2020. Of the patients, 362 (30.7%) had hypertension (median age, 66 years, 52.2% male), and of these, 115 (31.8%) were taking ACEI/ARBs. 
The in-hospital mortality for the overall population was 11.0%. The in-hospital mortality for patients with hypertension was 21.3%. 
The percentage of patients with hypertension taking ACEIs/ARBs did not differ between those with severe and nonsevere infections (32.9% vs 30.7%; P = 0.65) nor did it differ between nonsurvivors and survivors (27.3% vs 33.0%; P = 0.34). Similar findings were observed when data were analysed for patients taking ACEIs and those taking ARBs.
In this single-centre case series involving 362 patients with hypertension hospitalised with COVID-19 infection, there was no difference in severity of the disease, complications, and risk of death in those who were taking ACEIs/ARBs compared with those not treated with these medications.
757: Acta Pharmaceutica Sinica B showed that supplementation with dipyridamole was associated with markedly improved clinical outcomes in patients with COVID-19, particularly in patients with severe disease. 
Xiaoyan Liu, MD, Zhongnan Hospital of Wuhan University, Wuhan, and colleagues conducted an open label study involving 31 patients with COVID-19 treated at Dawu County People’s Hospital (1st hospital, 12 patients and 10 controls) and Huangpi Chinese Medicine Hospital (2nd hospital, 2 patients and 7 controls),  from February 3, 2020 to March 8, 2020. 
D-dimer concentrations were elevated in 50% of patients in the dipyridamole group and in 42% of patients in the control group. 
Patients in the dipyridamole group received 50 mg oral tablets 3 times daily (total 150 mg) for 14 consecutive days. All patients received ribavirin, glucocorticoids, and oxygen therapy, but none received antifungal treatment. 
Dipyridamole adjunctive therapy was associated with markedly improved clinical cure and remission rates in both the non-severe and severely ill patients. In particular, for the 8 severely ill patients in the dipyridamole group, 7 (87.5%) patients achieved clinical cure and were discharged from the hospitals, and the remaining 1 patient was in clinical remission. In contrast, for the 12 severely ill patients in the control group, 4 (33.3%) patients were discharged, 2 (16.7%) were in remission, and 2 (16.7%) died.
758: A study published in the American Journal of Roentgenology showed that unsuspected COVID-19 may be strongly suggested on the basis of lung findings on abdominopelvic CT.
Bari Dane, MD, New York University Langone Medical Center, New York, New York, and colleagues identified reports from abdominal (with a pelvic component) CT examinations of patients who underwent imaging from March 16, 2020, through March 26, 2020, and for whom the terms “COVID” or “pneumonia/pneumonitis” AND “atypical” appeared in the report impression. 
The search identified 23 patients with unanticipated lung base findings on abdominopelvic CT that were concerning for COVID-19. Of the patients, 17 had positive COVID-19 test results. The remaining 6 patients did not have available COVID-19 test results or additional clinical information.
For the 17 patients who had positive COVID-19 test results, the most common lung base findings on abdominopelvic CT were ground-glass opacities (n = 13), which were most commonly multilobar (n = 9), peripheral (n = 8), or peribronchovascular (n = 8) in distribution. Other patients had consolidation (n = 4) or ground-glass nodules (n = 3). No patients had any pleural effusion.
SOURCE: JAMA Cardiology, Acta Pharmaceutica Sinica B, American Journal of Roentgenolog

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