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Hydroxychloroquine or chloroquine with or without macrolides is linked to in-hospital mortality and arrhythmia.

Hydroxychloroquine Plus Macrolides No Benefit in COVID-19

TUESDAY, May 26, 2020 (HealthDay News) -- For patients with COVID-19 requiring hospitalization, there is no evidence of benefit for use of hydroxychloroquine or chloroquine with or without a macrolide, according to a study published online May 22 in The Lancet.

Mandeep R. Mehra, M.D., from the Brigham and Women's Hospital Heart and Vascular Center in Boston, and colleagues conducted a multinational registry analysis of the use of hydroxychloroquine or chloroquine with or without macrolides for COVID-19 treatment. A total of 96,032 patients hospitalized at 671 hospitals in six continents between Dec. 20, 2019, and April 14, 2020, were included. They were classified into four treatment groups (1,868 received chloroquine; 3,783 received chloroquine with a macrolide; 3,016 received hydroxychloroquine; and 6,221 received hydroxychloroquine with a macrolide) and a control group (81,144 patients).

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Right ventricular enlargement significantly linked to in-hospital mortality in multivariable analysis.

Right Ventricular Dilation Linked to Mortality in COVID-19

TUESDAY, May 26, 2020 (HealthDay News) -- Right ventricular dilation is associated with in-hospital mortality among patients hospitalized with COVID-19, according to a study published online May 15 in JACC: Cardiovascular Imaging.

Edgar Argulian, M.D., M.P.H., from the Icahn School of Medicine at Mount Sinai in New York City, and colleagues enrolled consecutive patients hospitalized due to COVID-19 who underwent clinically indicated echocardiograms from March 26 to April 22, 2020. The associations between clinical and echocardiographic variables and mortality were explored.

Echocardiograms of 110 patients were reviewed, with five excluded due to inadequate study quality. The researchers found that at the time of echocardiographic examination, 31 patients were intubated and mechanically ventilated. Thirty-two patients (31 percent) had right ventricular dilation. Patients with right ventricular dilation were more likely to have renal dysfunction than those without right ventricular dilation, but there were no significant differences noted in the prevalence of major comorbidities, laboratory markers of inflammation, or myocardial infarction. Patients with right ventricular enlargement had a higher prevalence of right ventricular hypokinesis and moderate or severe tricuspid regurgitation. Five of 10 patients with right ventricular enlargement who underwent computed tomography angiography of the chest had evidence of pulmonary embolism. During the study period, 21 patients died: 13 and eight (41 and 11 percent) patients with and without right ventricular dilation, respectively. Right ventricular enlargement was the only variable significantly associated with mortality in a multivariable analysis (odds ratio, 4.5).

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The only factors independently associated with time to extubation are age and body mass index.

Age, Sex, History of Diabetes Predict Intubation in COVID-19

FRIDAY, May 22, 2020 (HealthDay News) -- Older age, male sex, and history of diabetes are factors predictive of intubation among hospitalized patients with COVID-19, while age and body mass index are associated with time to extubation, according to a study published online May 19 in Otolaryngology-Head and Neck Surgery.

Kevin Hur, M.D., from the Feinberg School of Medicine at Northwestern University in Chicago, and colleagues examined sociodemographic and clinical characteristics associated with intubation and prolonged intubation for acute respiratory failure secondary to COVID-19 infection among 486 patients admitted between March 1 and April 8, 2020.

The researchers found that 55.8 percent of the patients were male and the median body mass index was 30.6 kg/m². Overall, 28.4 percent of patients were intubated during the hospitalization; 56.5 percent of these patients were eventually extubated, while 15.2 percent died and 28.3 percent remained intubated at a median follow-up of 19.6 days. Compared with nonintubated patients, intubated patients had a significantly higher median age (65 versus 57 years) and higher rate of diabetes (40.6 versus 29.9 percent). Age, sex, respiratory rate, oxygen saturation, history of diabetes, and shortness of breath were identified as factors predictive of intubation. The only factors independently associated with time to extubation were age and body mass index.

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Corita Grudzen, M.D., of the Ronald O. Perelman Department of Emergency Medicine, spoke with HealthDay Live! about the trial.

Convalescent Plasma Trial for COVID-19 Patients Underway at NYU Langone

THURSDAY, May 21, 2020 (HealthDay News) -- Researchers at the NYU Grossman School of Medicine are conducting a phase II clinical trial to determine the efficacy of convalescent plasma in hospitalized patients with COVID-19. Corita R. Grudzen, M.D., vice chair for research in the Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health, wrote the study protocol and recently spoke with HealthDay Live! about the trial.

"What we hope to see is that convalescent plasma used in this stage of disease prevents patients from dying, going on a mechanical ventilator," or being admitted to the intensive care unit, Grudzen said.

The controlled, randomized trial, which started April 17 and is also being led by researchers from Montefiore Health System and Albert Einstein College of Medicine, will enroll 300 hospitalized patients ages 18 years or older from seven hospital centers. The researchers are enrolling patients within three to seven days after symptom onset. While other studies across the country are focusing on sicker populations, Grudzen said the research team felt strongly about enrolling hospitalized patients. "We know the earlier, the better," she said. As an emergency physician, she said, "many of us were seeing hundreds and now thousands of patients hospitalized, and so we really wanted to focus on that group. We know historically [that] the antibody binds to the virus in some way to prevent it from either entering the cells or from destroying whomever it's attacking. And so, the idea is to do that before there's an onslaught of the body's own inflammatory response."

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Per-patient delay of three or six months would result in an estimated 92,214 or 208,275 life-years lost.

Delays in Cancer Surgery Due to COVID-19 Could Harm Survival

FRIDAY, May 22, 2020 (HealthDay News) -- Modest delays in cancer surgery due to the COVID-19 pandemic could have a significant impact on survival, according to a study published online May 19 in the Annals of Oncology.

Amit Sud, M.B.Ch.B., Ph.D., from the Institute of Cancer Research in London, and colleagues generated per-day hazard ratios of cancer progression from observational studies and applied these to age- and stage-specific cancer survival for England in 2013 to 2017. Per-patient delay of three months and six months was modeled, as were periods of disruption of one and two years.

The researchers found that 94,912 resections for major cancers result in 80,406 long-term survivors and 1,717,051 life-years gained per year. Per-patient delay of three or six months would result in attributable deaths of 4,755 or 10,760 of these individuals, with 92,214 or 208,275 life-years lost. The average life-years gained (LYGs) for cancer surgery are 18.1 per patient under standard conditions and 17.1 or 15.9 with a delay of three or six months (average loss of 0.97 or 2.19 LYG per patient). Per patient, surgery results in 2.25 resource-adjusted life-years gained (RALYGs) under standard conditions and 2.12 or 1.97 RALYGs following delay of three or six months, taking into account units of health care resource (HCRUs). There were 482,022 LYGs requiring 1,052,949 HCRUs for 94,912 hospital COVID-19 admissions. On average, per patient, 5.08 LYGs and 0.46 RALYGs were yielded with hospitalization of community-acquired COVID-19 patients.

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Each week, HealthDay's Physician's Briefing division rounds up the most important COVID-19 developments in the medical field. See this week's edition below for May 18-May 22.

CDC: COVID-19 Not Spread Easily From Contaminated Surfaces

FRIDAY, May 22, 2020 (HealthDay News) -- COVID-19 spreads swiftly between people but is not easily caught from contaminated surfaces, according to updated information from the U.S. Centers for Disease Control and Prevention.

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U.S. Government Seeks Deal With Private Industry to Boost Supply of Medical Equipment

FRIDAY, May 22, 2020 (HealthDay News) -- In an effort to prevent the United States from again struggling to have enough medical supplies in a pandemic, the federal government is seeking to make a five-year deal with U.S. manufacturers.

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U.S. Offers $1.2 Billion to Drug Company for COVID-19 Vaccine Research

FRIDAY, May 22, 2020 (HealthDay News) -- The U.S. Department of Health and Human Services said Thursday it would provide up to $1.2 billion to AstraZeneca to develop a potential COVID-19 vaccine from a lab in Oxford, England.

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Age, Sex, History of Diabetes Predict Intubation in COVID-19

FRIDAY, May 22, 2020 (HealthDay News) -- Older age, male sex, and history of diabetes are factors predictive of intubation among hospitalized patients with COVID-19, while age and body mass index are associated with time to extubation, according to a study published online May 19 in Otolaryngology-Head and Neck Surgery.

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SARS-CoV-2 Antibodies Detected in 4.65 Percent in Los Angeles County

FRIDAY, May 22, 2020 (HealthDay News) -- In recent serologic tests, the weighted prevalence of severe acute respiratory syndrome coronavirus 2 antibodies was 4.65 percent among adult residents of Los Angeles County, California, after adjustment for test sensitivity and specificity, according to a research letter published online May 18 in the Journal of the American Medical Association.

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Delays in Cancer Surgery Due to COVID-19 Could Harm Survival

FRIDAY, May 22, 2020 (HealthDay News) -- Modest delays in cancer surgery due to the COVID-19 pandemic could have a significant impact on survival, according to a study published online May 19 in the Annals of Oncology.

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No SARS-CoV-2 ID'd in Asymptomatic Pregnant Women in Los Angeles

FRIDAY, May 22, 2020 (HealthDay News) -- At the Cedars-Sinai Medical Center in Los Angeles, none of 80 asymptomatic women admitted to the labor and antepartum units tested positive for severe acute respiratory syndrome coronavirus 2, according to a research letter published online May 19 in Obstetrics & Gynecology.

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Incidence of AMI Hospitalization Down During COVID-19

FRIDAY, May 22, 2020 (HealthDay News) -- In Northern California, the incidence of hospitalization for acute myocardial infarction decreased during the COVID-19 pandemic period, according to a letter to the editor published online May 19 in the New England Journal of Medicine.

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Cardiac Decompensation Seen in Children Following COVID-19

FRIDAY, May 22, 2020 (HealthDay News) -- Children may experience acute cardiac decompensation due to a severe inflammatory state (multisystem inflammatory syndrome in children or MIS-C) following infection with severe acute respiratory syndrome coronavirus 2, according to a study published online May 17 in Circulation.

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ED Chest X-Ray Score Predicts COVID-19 Outcomes in Adults <50

FRIDAY, May 22, 2020 (HealthDay News) -- A chest X-ray severity score can predict outcomes among young and middle-aged adults with COVID-19 on presentation to the emergency department, according to a study published online May 14 in Radiology.

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CDC Says Test All Newborns of Mothers With Confirmed, Suspected COVID-19

THURSDAY, May 21, 2020 (HealthDay News) -- All babies born to women with confirmed or suspected COVID-19 should be tested, according to U.S. Centers for Disease Control and Prevention guidelines issued Wednesday.

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Convalescent Plasma Trial for COVID-19 Patients Underway at NYU Langone

THURSDAY, May 21, 2020 (HealthDay News) -- Researchers at the NYU Grossman School of Medicine are conducting a phase II clinical trial to determine the efficacy of convalescent plasma in hospitalized patients with COVID-19. Corita R. Grudzen, M.D., vice chair for research in the Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health, wrote the study protocol and recently spoke with HealthDay Live! about the trial.

Read Full Article

Rate of Stroke Low in Hospitalized Patients With COVID-19

THURSDAY, May 21, 2020 (HealthDay News) -- The rate of imaging-confirmed stroke is low in hospitalized patients with COVID-19, but mortality is higher than in contemporary controls without COVID-19 and historical controls, according to a study published online May 20 in Stroke.

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Factors Linked to COVID-19 In-Hospital Mortality ID'd in NYC

THURSDAY, May 21, 2020 (HealthDay News) -- Factors associated with in-hospital mortality include older age, chronic cardiac disease, and chronic pulmonary disease in a cohort of hospitalized patients with COVID-19 in New York City, according to a study published online May 19 in The Lancet.

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Asthma Tied to Longer COVID-19 Intubation Time

THURSDAY, May 21, 2020 (HealthDay News) -- Among COVID-19 patients who develop severe respiratory symptoms requiring intubation, asthma is associated with a significantly longer intubation time, according to a study published online May 14 in the Journal of Allergy and Clinical Immunology: In Practice.

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Clinical Performance of SARS-COV-2 Antibody Tests Varies

THURSDAY, May 21, 2020 (HealthDay News) -- The diagnostic specificity of severe acute respiratory syndrome coronavirus 2 serologic assays varies, and sensitivity is poor during the first 14 days of symptoms, according to a study published online May 13 in Clinical Chemistry.

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Some Children With COVID-19 Require Admission, PICU Care

WEDNESDAY, May 20, 2020 (HealthDay News) -- Some children with COVID-19 require admission and intensive care, according to a study published online May 11 in The Journal of Pediatrics.

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Decrease Seen in Child Vaccination Coverage During COVID-19

WEDNESDAY, May 20, 2020 (HealthDay News) -- There has been a decrease in child vaccination coverage in almost all milestone age cohorts during the COVID-19 pandemic, according to research published in the May 18 early-release issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report.

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Review Highlights Neuropsychiatric Presentations of COVID-19

WEDNESDAY, May 20, 2020 (HealthDay News) -- COVID-19 may cause delirium in some patients, according to a review published online May 18 in The Lancet Psychiatry.

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Odds of Pulmonary Embolism Up for Obese COVID-19 Patients

WEDNESDAY, May 20, 2020 (HealthDay News) -- Patients with COVID-19 with a body mass index >30 kg/m² have increased odds of developing pulmonary embolism, according to a research letter published online May 14 in Radiology.

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Age, CRP Up Risk for Mortality in Diabetes With COVID-19

WEDNESDAY, May 20, 2020 (HealthDay News) -- For patients with diabetes and COVID-19, risk factors for mortality include older age and elevated C-reactive protein, and insulin usage is associated with poor prognosis, according to a study published online May 14 in Diabetes Care.

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11.2 Percent of Pediatric Cancer Patients Positive for SARS-CoV-2

WEDNESDAY, May 20, 2020 (HealthDay News) -- Among pediatric cancer patients, overall morbidity of COVID-19 is low, according to a research letter published online May 13 in JAMA Pediatrics.

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15 Percent of Pregnant Women With COVID-19 Experience Severe Disease

TUESDAY, May 19, 2020 (HealthDay News) -- Fifteen percent of pregnant women with COVID-19 have severe disease, according to a case series published online May 18 in the American Journal of Obstetrics & Gynecology.

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Mental Health Symptoms Up for Medics Dealing With COVID-19

TUESDAY, May 19, 2020 (HealthDay News) -- The scores for mental health symptoms in medical personnel responding to COVID-19 pneumonia are generally higher than the norm in China, according to a study published online May 19 in PLOS ONE.

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Obesity Tied to Increased Risk for Progression to Severe COVID-19

TUESDAY, May 19, 2020 (HealthDay News) -- Obesity is associated with a significantly increased risk for progression to severe COVID-19, according to a study published online May 14 in Diabetes Care.

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CMS: Use 'Extreme Caution' in Reopening Nursing Homes

TUESDAY, May 19, 2020 (HealthDay News) -- State governors should use "extreme caution" in deciding when to allow visits to nursing homes to resume, the U.S. Centers for Medicare & Medicaid Services said Monday.

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Factors ID'd for Positive SARS-CoV-2 Test Result in Primary Care

TUESDAY, May 19, 2020 (HealthDay News) -- Sociodemographic factors associated with the risk for a positive severe acute respiratory syndrome coronavirus 2 test result include deprivation, population density, and ethnicity, according to a study published online May 15 in The Lancet Infectious Diseases.

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28 Million-Plus Surgeries Could Be Canceled Due to COVID-19

TUESDAY, May 19, 2020 (HealthDay News) -- Worldwide, more than 28 million elective surgeries could be canceled or postponed during the 12 weeks of peak disruption due to COVID-19, according to a study published online May 12 in the British Journal of Surgery.

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Hydroxychloroquine Does Not Improve COVID-19 Pneumonia Outcomes

TUESDAY, May 19, 2020 (HealthDay News) -- Hydroxychloroquine does not improve outcomes in COVID-19, according to two studies published online May 14 in The BMJ.

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Corticosteroids for IBD May Up Risk for Severe COVID-19

TUESDAY, May 19, 2020 (HealthDay News) -- For patients with inflammatory bowel disease and COVID-19, risk factors for severe disease include increasing age, comorbidities, and systemic corticosteroids, according to a study published online May 18 in Gastroenterology.

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Experimental COVID-19 Vaccine Appears Safe, Triggers Immune Response

MONDAY, May 18, 2020 (HealthDay News) -- An experimental vaccine against COVID-19 appears to be safe and to trigger an immune response, according to results of the first human clinical trial of a COVID-19 vaccine.

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Social Distancing Policies Reduced COVID-19 Growth Rate

MONDAY, May 18, 2020 (HealthDay News) -- The impact of four widely adopted social distancing policies reduced the daily growth rate of COVID-19 across U.S. counties, according to a report published online May 14 in Health Affairs.

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Most Physicians Have Seen False-Negative COVID-19 Test Results

MONDAY, May 18, 2020 (HealthDay News) -- Most physicians believe they have seen false-negative results for a COVID-19 diagnostic test, according to the results of a recent survey.

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Convalescent Plasma Appears Promising for Severe COVID-19

MONDAY, May 18, 2020 (HealthDay News) -- Administration of convalescent plasma seems safe and results in improvement in clinical status for patients with severe or life-threatening COVID-19, according to a study not yet peer reviewed and posted on medRxiv.org.

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Cough May Not Appear in Young Children With COVID-19

MONDAY, May 18, 2020 (HealthDay News) -- Young children with COVID-19 may not present with respiratory symptoms, according to a case report published online May 12 in Frontiers in Pediatrics.

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Hydroxychloroquine No Aid for COVID-19-Related Mortality

MONDAY, May 18, 2020 (HealthDay News) -- Treating hospitalized COVID-19 patients with hydroxychloroquine, azithromycin, or both is not associated with improvements in in-hospital mortality, according to a study published online May 11 in the Journal of the American Medical Association.

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Use of Imaging to Assess Stroke Down in Early COVID-19 Epoch

MONDAY, May 18, 2020 (HealthDay News) -- From a prepandemic to early-pandemic epoch, there was a decrease in the use of imaging for the evaluation of stroke, according to a research letter published online May 8 in the New England Journal of Medicine.

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The diagnostic specificity of SARS-CoV-2 serologic assays varies, and sensitivity is poor during the first 14 days of symptoms, according to a new study.

Clinical Performance of SARS-COV-2 Antibody Tests Varies

THURSDAY, May 21, 2020 (HealthDay News) -- The diagnostic specificity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serologic assays varies, and sensitivity is poor during the first 14 days of symptoms, according to a study published online May 13 in Clinical Chemistry.

Mei San Tang, M.D., from the Washington University School of Medicine in St. Louis, and colleagues compared two commercial SARS-CoV-2 immunoglobulin G assays. A total of 103 specimens from 48 patients with polymerase chain reaction-confirmed SARS-CoV-2 infections and 153 control specimens were analyzed using serologic assays by Abbott and EUROIMMUN.

The researchers found that the Abbott SARS-CoV-2 assay had diagnostic specificity of 99.4 percent and sensitivity of 0.0, 30.0, 47.8, and 93.8 percent at less than three, three to seven, eight to 13, and ≥14 days post-symptom onset. On the EUROIMMUN assay, diagnostic specificity was 94.8 and 96.7 percent if borderline results were considered positive and negative, respectively. If borderline results were considered positive, the diagnostic sensitivity was 0.0, 25.0, 56.5, and 85.4 percent at less than three, three to seven, eight to 13, and ≥14 days, respectively. The qualitative concordance was 0.83 between the assays.

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Updated information from the agency also outlines what is not considered to pose a high risk for infection.

CDC: COVID-19 Not Spread Easily From Contaminated Surfaces

FRIDAY, May 22, 2020 (HealthDay News) -- COVID-19 spreads swiftly between people but is not easily caught from contaminated surfaces, according to updated information from the U.S. Centers for Disease Control and Prevention.

Revised guidance of the CDC website says the virus "is spreading very easily and sustainably between people," the Washington Post reported.

The updated information also outlines what is not considered to pose a high risk for infection.

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