1056:  Second sero-survey suggests 28% in city have antibodies

1. The previous serological survey conducted by the National Centre for Disease Control among 21,387 individuals demonstrated that 22.86% of the people surveyed had been exposed to the novel coronavirus.
2. The second serological survey, conducted in the first week of August across Delhi, has shown that 28.35% of the people surveyed have developed antibodies.
3. Over 15,000 samples were obtained across 11 districts in the national capital to check for the spread of the virus.
4. The data collated by researchers at Maulana Azad Medical College was submitted to Principal Health Secretary, Vikram Dev Dutt.
5. The central district has reported the highest prevalence.
6. Sampling taken: 25% less than 18 years, 50% ages 18-49 years and 25% over 50 years of age.
7. Antibodies in males: 28.3%
8. Antibodies in females: 32.2%
9. Less than 18 years: antibodies in 34.7%
10. 18-49 years: antibodies in 28.5%
11. Over 50 years: antibodies in 31.2%

1057: A top ICMR official has informed a parliamentary panel that Phase 2 clinical trial of two indigenously developed COVID-19 vaccine candidates are almost complete and emergency authorization of a vaccine could be considered if the Center decides so. (Times Now News)

1058: Vaccine nationalism: The wealthier countries that have more money are entering into pre-purchase deals with pharmaceutical companies to purchase a coronavirus vaccine once the trials prove to be successful. With several companies across the globe conducting research on a COVID-19 vaccine, the wealthier nations have already placed orders worth millions to obtain the first shots.

1059: Cohort isolation: Patients should be placed in a well-ventilated single-occupancy room with a closed door and a dedicated bathroom. If not possible, patients with confirmed COVID-19 can be accommodated together. Additionally, patients with confirmed COVID-19 infection should not be placed in a positive-pressure room. An airborne infection isolation room (AII; ie, a single-patient, negative-pressure room) should be used for patients undergoing aerosol-generating procedures. (Uptodate)

1060: Kidney a Bystander in COVID-19: A study from Canada has shown that there is enhanced expression of angiotensin-converting enzyme 2 (ACE2) receptors in the kidneys of patients with diabetic nephropathy. This could possibly explain why these patients have an increased risk of COVID-19 and have severe outcomes. However, the SARS-CoV-2 virus directly infects the kidneys has not been proven so far. Kidney damage may be the by-product of COVID-19 impact elsewhere in the body. The new study was published as a journal preproof in the Canadian Journal of Diabetes. (Medscape)

1061: Additional data obtained from observational studies, particularly in hospitalized patients, has shown that famotidine, a drug used to treat heartburn, was linked with improved clinical outcomes in COVID-19 patients. Use of famotidine in 83 patients was shown to be associated with a reduced risk of in-hospital mortality and a combined outcome of death and intubation, reported researchers in the American Journal of Gastroenterology. (Medpage Today)

1062:  SARS-CoV-2 causes a specific dysfunction of the kidney proximal, says study tubule: A study published in Kidney International suggest that SARS-CoV-2 leads to an early and specific dysfunction of the kidney proximal tubule (PT), which is marked by low molecular weight (LMW) proteinuria, neutral aminoaciduria, and defective handling of uric acid and phosphate. ACE2 receptor for SARS-CoV-2 is known to be highly expressed in the PT cells.

In the study, around 67% had raised urinary levels of β2-microglobulin, 85% had a urinary protein to creatinine ratio (UPCR) of >0.2 g/g, and 98% reported having a urinary albumin to protein ratio (UAPR) <0.5.

Electrophoresis of urine samples from the patients showed multiple protein bands below 70 kDa (LMW proteinuria), which included the vitamin D-binding protein (DBP) and Clara cell secretory protein (CC16).  

About 47% and 56% of the patients had hypouricemia and/or hypophosphatemia, respectively.

About 46% had defective tubular handling of uric acid (hypouricemia with inappropriate uricosuria; FE_UA >10%).  Hypophosphatemia with inappropriate phosphaturia (FE_P >20%) was seen in 19%.

Around 46% of the patients had aminoaciduria, which was restricted to neutral amino acids.

PT dysfunction was shown to be independent of pre-existing comorbidities, glomerular proteinuria, nephrotoxic medications or viral load among the cohort. 

Over a median follow-up of 44 days, 39% of patients needed invasive mechanical ventilation, 29% died, 22% developed AKI and 4% required kidney replacement therapy. Hypouricemia with inappropriate uricosuria had an independent association with disease severity and with a significant increase in the risk of respiratory failure requiring invasive mechanical ventilation.

The study reveals that PT dysfunction develops in a subset of patients with COVID-19 and is marked by LMW proteinuria, hypophosphatemia and hypouricemia due to inappropriate urinary loss of phosphate and uric acid, and neutral aminoaciduria.

Hypouricemia was common and associated with poor outcome in patients with SARS.

Potential mechanisms that link PT dysfunction and respiratory failure may include loss of vital solutes, including uric acid, which may impact the defense against oxidative stress and respiratory function. (DG Alerts)

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA