(With regular inputs from Dr Monica Vasudev)

COVID-19 Neurological manifestations

Five more cases of Guillain–Barré syndrome (GBS) in association with COVID-19 have been reported.  The cases from Italian researchers are reported 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.

COVID-19 high sugar link

Diabetes and hyperglycemia among people without previous diabetes strongly predict mortality among hospitalized patients with COVID-19. New research suggests that while glycemic control may not be at the forefront of most clinicians minds in the COVID-19 scenario, it is important. Paying more attention to it could save lives, say researchers, led by Bruce Bode, MD, of Atlanta Diabetes Associates, Georgia, and colleagues, including employees of Glytec, an insulin management software company. The results from the new research are published online April 17 in the Journal of Diabetes Science and Technology.

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

[https://www.whitehouse.gov/openingamerica/#criteria]

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 analyzed 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 patients’ first salivary swab. Eight patients underwent a second salivary swab after 4 days, and the results were found to be consistent with the first analysis, without relevant differences in variable threshold cycles (Ct). There was a striking feature in 2 patients who showed positive salivary results on the same days when their pharyngeal or bronchoalveolar swabs came out negative.

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, of General Hospital of Central Theater Command, Wuhan, China, and colleagues, RNAaemia was diagnosed only in critically ill patients with COVID-19, and appeared to reflect the severity of the disease. The level of inflammatory cytokine IL-6 in critically ill patients was found to increase significantly, almost 10-fold of that in other patients. Of note, the extremely high IL-6 level was losely correlated with the detection of RNAaemia. The extremely high level of IL-6 is a hallmark and important driving force of cytokine storm, which may result in multiple organ dysfunction in critically ill patients.

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 analyzed data from 1,476 patients with COVID-19 treated at Jinyintan Hospital in Wuhan. Of these, 238 (16.1%) patients died. In comparison with survivors, nonâ€�survivors were older, were more likely to have thrombocytopenia, and had lower nadir platelet counts. Among the patients, 306 (20.7%) were found to have thrombocytopenia. The inâ€�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.  The authors thus concluded that thrombocytopenia is common in patients with COVIDâ€�19, and it is associated with increased risk of inâ€�hospital mortality. They further stated that the lower the platelet count is, the higher the mortality becomes.

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, 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 women were screened for symptoms of the COVID-19 infection on admission.

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

Twenty none 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 fever prior to discharge from the hospital after a median stay of 2 days. Two of these received antibiotics for presumed endomyometritis and one patient with presumed COVID-19 infection received supportive care. One patient, initially negative, developed COVID-19 symptoms after delivery and tested positive 3 days following her initial negative test.

The use of universal SARS-CoV-2 testing in pregnant women presenting for delivery revealed that currently, in the pandemic in New York City, most of the patients who were positive for SARS-CoV-2 at delivery were asymptomatic, reported the authors. [MDedge]

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 suggest that such delays do not affect the long-term prognosis for common forms of thyroid cancer, revealed an editorial published in Clinical Thyroidology.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA