Multisystem Imaging Manifestations of COVID-19
In this article, authors discuss the effects of COVID-19 on multiple extrapulmonary systems. Widespread involvement of multiple body systems is attributed to the expression of ACE2 receptors in extrapulmonary tissues, resulting in direct tissue damage. The disproportionate severity of disease in patients with underlying cardiovascular disease is discussed. Myocardial injury occurs in 20-30% of hospitalized patients with COVID-19, with higher rates (55%) among those with preexisting cardiovascular disease. The article discusses and analyzes imaging results of COVID positive patients, and what providers should note when reviewing radiology reports and images. Neurologic manifestations are also discussed. COVID-19 is associated with acute stroke, altered mental status, and other neurologic conditions. Various pathophysiologic mechanisms are discussed as to the cause of these neurologic complications, and once again, the authors provide direct images of neurologic imaging to review presentations in COVID-19 patients who have neurologic involvement. The article goes on to discuss and provide imaging examples from patients with abdominal and intestinal manifestations, liver and biliary manifestations, and manifestations of vascular systems, solid organs, and more. Pediatric images and COVID-19 during pregnancy is discussed.
This article is the second part of a two-part series in which Part One, published in October, discusses viral pathogenesis, diagnostic imaging hallmarks, and manifestations in the pulmonary and vascular systems.
Platelet Counts and Indices to Differentiate COVID-19 from Influenza Pneumonia
In this study from the Journal of Medical Virology, authors aim to determine the clinical importance of platelet count and platelet indices when differentiating COVID-19 from influenza, and how these parameters may aid in the differential diagnoses of COVID-19. Using retrospective analysis, the study gained some valuable insight into the differences between COVID-19 and influenza. The average age of COVID-19 patients was often lower than that of influenza patients. According to the lab findings, the mean platelet volume (MPV) and MPV/platelet ratio were significantly lower, where eosinophil and platelet distribution width were higher in the COVID-19 group. The most commonly occurring symptoms in both groups was dyspnea and this symptom was more prevalent among influenza patients. The study concludes that platelet studies may be an inexpensive and important parameter in considering differentials among suspected COVID-19 vs. influenza patients.
Clinical Characteristics of Asymptomatic Carriers of COVID-19
This study aimed to analyze the characteristics of asymptomatic carriers of the SARS-CoV-2 virus and used retrospective analysis to determine how this information could be used to control the spread of the COVID-19 virus. The study evaluated 648 cases who were divided into categories based on expression of illness (asymptomatic, mild, ordinary, severe, or critical) and evaluated their impact on disease severity. The authors identified significant diagnostic predictors from asymptomatic carriers including blood cells, cytokines, and T-lymphocyte subsets. The authors recommend that providers consider the identified laboratory parameters in clinical practice and believe this study may lend insight to the prevention of virus transmission among asymptomatic individuals.
Effects of NSAID’s on COVID-19 Outcomes
In this cohort study, authors discuss the disappearance of ibuprofen and other NSAID’s from pharmacy shelves during the pandemic. During this time, it was declared that these medications could worsen COVID-19 symptoms in patients who used them. The study aimed to assess the association of acute and chronic use of NSAID’s with adverse outcomes when used during COVID-19 infection. The results of this study indicate that acute and/or chronic use of ibuprofen was not associated with a greater risk of mortality relative to non-use. In addition, acute use of ibuprofen was not associated with a higher risk of admission or longer length of illness or hospital stay in those who used this medication.
Frequency of VTE in COVID-19 Patients
In this retrospective study, authors discuss the apparent increased risk for development of venous thromboembolism, including deep vein thrombosis and pulmonary embolism, in patients infected with SARS-CoV-2. Despite anticoagulant prophylaxis, many reports claim high rates of VTE, especially among critically ill patients. The authors of this study evaluated 6,513 patients within a New Orleans-based health system who were admitted to the hospital or treated and released during a two month time period. Of these, 637 required mechanical ventilation and 206 required dialysis. Within the hospitalized cohort, the overall mortality rate was 24.5% and VTE occurred in 86 patients (3.1%). Among those who were intubated, 45 developed VTE (7.2%), and three (0.14%) of patients developed some type of VTE after leaving the hospital. This study concludes that there is not a particularly high rate of VTE among COVID-19 patients when compared with non-COVID patients. The evidence in this study supports a traditional approach to primary VTE prevention in patients with COVID-19.