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September 10 | Daily COVID-19 LST Report

Epidemiology

Understanding the Pathology

· An observational study of 67 COVID-19 non-ICU patients (45 male, 22 female) admitted to COVID Hospital of Policlinico of Bari, Italy investigating the role of IL-6 levels in loss of taste/smell found a statistically significant correlation between decreased IL-6 and improvement in smell (p<0.05) and taste (p=0.047) (Table 3). The authors believe these results highlight the local inflammatory actions of IL-6 on chemosensory receptors, resulting in taste and smell disorders in COVID-19.

· A neuropathology research group affiliated with Harvard Medical School in Boston report on autopsy and clinical neurologic findings in 18 patients who died within 32 days of COVID-19 symptom onset. All patients had confusion and decreased arousal prior to death, and all brains showed signs of acute hypoxic injury with loss of neurons in cerebral cortex, hippocampus, and cerebellar Purkinje cells, but without thrombi, vasculitis, or viral staining on immunohistochemistry. Authors suggest these findings indicate neuropathological damage associated with COVID-19 cannot be specifically attributed to the virus alone.

Adjusting Practice During COVID-19

· Researchers from the Radiology department at University Hospitals Cleveland Medical Center/Case Western Reserve University conducted a retrospective study to assess imaging utilization in the emergency departments of a multicenter health system. They found a 46% reduction in imaging utilization (p less than 0.0001) with the exception to non-contrast chest CT (increased during this period, p = 0.0053), and non-trauma chest/abdomen/pelvis CT (largely unchanged in imaging use, p = 0.0633). The authors suggest that their findings shed light on how the pandemic has influenced ED imaging utilization, encouraging other institutions to publish data on their imaging practices for a comprehensive picture of the pandemic’s impact. · Healthcare professionals affiliated with the Universidade Federal de São Paulo in Brazil performed a comparative cohort study at their institution of pregnant women admitted in spontaneous labor (n=41 in 2019; n=40 in 2020). They found that in 2020 there were more deliveries within 3 hours of admission (11/41 or 26.8% in 2019; 16/40 or 40% in 2020), more nulliparous women (9% in 2019; 12.5% in 2020), fewer women with multiple pregnancies (54.5% vs 43.7%), and a lower percentage of newborns weighing less than 2500g (18.1% vs 12.5%). The authors suggest that gravid patients are presenting to the hospital in advanced stages of labor due to decreased public transportation and fear of COVID-19 infection and urge hospitals to encourage these patients to seek care.

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