Sunday, April 26, 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

764: What are COVID toes

Esther E. Freeman, MD, PhD, director of global dermatology at Massachusetts General Hospital, Harvard Medical School, and a member of the American Academy of Dermatology’s COVID-19 task force

Purple or red lesions on the toes and hands, has been dubbed “COVID toes” and has gained attention over recent weeks.

765:  What should patients do if they notice them?

Pernio, a condition where you get red or purple tender bumps on the fingers or toes, also known as chilblains, is usually a reaction to cold temperatures. In COVID-19, It is called “pernio-like” rather pernio. A lot of these patients adamantly deny being exposed to any sort of cold temperatures whatsoever. These skin lesions have been dubbed “COVID toes.”

What patients are experiencing are red or purple bumps on their toes or hands, as well as a burning sensation, often with pain and tenderness. The good news is it seems to go away after about 2-3 weeks.

766: What should dermatologists do when patients report them?

People should follow CDC and local guidelines in terms of self-isolating, regardless. Some patients who develop the pernio-like lesions of their feet are still infectious and test PCR positive for the virus. This means that there is a potential risk of transmitting the virus to others. Some people may develop these lesions while they are still infectious, while others may develop them somewhat later in the disease course.

This has public health implications because if your patient is potentially still infectious when their toes are purple, that is a different story than if they are not infectious and they are already basically over the infectious stage of the virus.

We see other virally induced rashes and eruptions such as morbilliform, also known as measles-like eruptions, and urticaria, also known as hives, among many others.

767: Steam disinfection
According to Texas researchers who show in a letter published in Infection Control & Hospital Epidemiology that the masks can be safely disinfected with steam.

Steam sterilization is probably one of the safest ways to sterilize them," said study coauthor Firas Zabaneh, director of system infection prevention and control at Houston Methodist Sugarland Hospital.

You're not using any chemicals or anything that could alter the makeup or structure of the mask. And that's why we thought of steam.

768: Pulmonary embolism

A pair of letters published April 24 in Radiology report that 23% of COVID-19 patients had acute pulmonary embolus (PE) on CT angiography at a US center as did 30% seen at a French tertiary care center.

769: remdesivir as the preferred antiviral in children

In new guidance, a panel of pediatric infectious diseases physicians and pharmacists suggested that supportive care alone is sufficient to treat most children with COVID-19. Among children who develop severe or critical cases — a rare occurrence — the panel suggested the use of remdesivir as the preferred antiviral.

770: Immunotherapy with neutralizing antibodies present in convalescent plasma (CP)

NEJM: Have proven to be effective and safe for patients with SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), and the 2009 H1N1 influenza viruses. To test whether CP would benefit COVID-19 patients as well, researchers in Wuhan, China, performed a study in 10 severely ill COVID-19 patients who also received many different antivirals. Median age of the patients was 53, 4 had chronic illnesses, and 3 were on ventilators.
Within 3 days of CP therapy, most patients exhibited improved clinical symptoms, higher levels of blood oxygen and lymphocytes, lower C-reactive protein levels, undetectable viral loads, and improved chest computed tomography scans; two patients were weaned from ventilators. Treatment was particularly successful if CP was given within 14 days of symptom onset; no adverse effects were noted. The investigators assembled a historical control group of 10 COVID-19 patients in the same hospitals and of the same age, sex, and disease severity. Of the 10 CP-treated patients, 3 were discharged and 7 were much improved, whereas in the control group, 3 patients died, 6 were stable, and 1 improved.

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