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Older people with COVID-19 who call 911 don’t have ‘classic’ symptoms, study finds

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July 8 (UPI) — A study published Wednesday urges emergency medical workers to take greater care in treating possible cases of COVID-19, as many patients don’t exhibit the conventional symptoms.

The analysis showed that just over half of adults infected with coronavirus in King County, Wash. in February and March who called 911, received care from rescuers and went to an emergency room had a fever or breathing difficulties.

“Instead, there was a wide range of presenting complaints,” Dr. Tom Rea, who co-authored the JAMA Network Open study, told UPI.

Forty percent reported severe fatigue, nearly 28 percent had signs of “altered mental status” — or confusion — and up to 10 percent experienced severe nausea and vomiting, the researchers said.

“Hence, there needs to be a wide net of suspicion for COVID,” particularly among older adults, said Rea, a professor of medicine at the University of Washington.

The findings are based on an analysis of 775 confirmed cases of COVID-19 in King County, which includes Seattle, and was one of the early outbreak hot spots in the United States. The cases were reported between Feb. 1 and March 18.

Researchers said 124 — or 16 percent — of the cases included an EMS response. Patients who called 911 and received EMS care were roughly 75 years old, and 47 — 38 percent — had three or more chronic health conditions, with high blood pressure and heart disease the most common.

“They can present in a variety of ways, many of them atypical,” Rea said. “EMS [needs] to be on alert and assure they are protected and that hospitals are prepared to test this group even when they do not have conventional symptoms.”

Fifty-seven — 46 percent — of the patients in the study lived in a long-term care facility, though researchers said nonspecific signs and symptoms of COVID-19 were also widely seen in others.

Just over 16 percent required breathing assistance — with CPAP or another device — when EMS arrived.

As of June 1, 65 — 52 percent — of the patients in the study had died, researchers said.



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Study: NSAID pain relievers don’t increase risk for severe COVID-19

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Sept. 8 (UPI) — People who use non-steroidal anti-inflammatory drugs, or NSAIDs, to treat pain are not at risk for more severe illness from COVID-19, according to a study published Tuesday by the journal PLOS Medicine.

Among users of NSAID pain relievers like ibuprofen and diclofenac infected with the new coronavirus, nearly 25% needed to be hospitalized, 5% required admission to the intensive care unit and 6.3% died, the data showed.

To compare, for those who did not use these drugs but tested positive for COVID-19, 21% were hospitalized, 5% needed ICU care and 6.1% died.

In the early phases of the pandemic, there were concerns that the use of the painkiller ibuprofen may lead to a more severe course of coronavirus disease, the researchers, from the University of Southern Denmark and Aarhus University Hospital in Denmark, said.

“Considering the available evidence, there is no reason to withdraw well-indicated use of NSAIDs during the pandemic,” they wrote.

“However, the well-established adverse effects of NSAIDs, particularly their renal, gastrointestinal and cardiovascular effects, should always be considered, and NSAIDs should be used in the lowest possible dose for the shortest possible duration for all patients,” they said.

Ibuprofen and other NSAIDs are some of the most commonly used medications in the United States, with an estimated 30 million doses consumed and 70 million prescriptions administered annually, according to the American College of Rheumatology.

For this study, the researchers obtained data on all 9,326 Danish residents who tested positive for COVID-19 between Feb. 27 and April 29, including NSAID use, hospitalization, ICU admission and need for mechanical ventilation and acute renal replacement therapy.

Overall, 248 people — or just under 3% — of the patients included in the analysis had filled a prescription for NSAIDs within 30 days of their positive virus test, according to the researchers.

There was no association between disease severity and NSAID use, the researchers said.

Another study published Aug. 12 had similar findings.



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Low-dose electrical stimulation helps adults with dyslexia read, study finds

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Sept. 8 (UPI) — Electrical stimulation of the brain improves reading accuracy in adults with dyslexia, according to a study published Tuesday by PLOS Biology.

Transcranial alternating current stimulation, a non-invasive procedure that delivers low-dose electricity to the brain over a period of 20 minutes, was found to improve phonological processing — or ability to discern how words sound or are pronounced — and reading accuracy in 15 adults with dyslexia, the researchers said.

The beneficial effect on phonological processing was most pronounced in those individuals who had poor reading skills, while a slightly disruptive effect was observed in very good readers, they said.

Dyslexia, known commonly as a reading disorder, affects up to 10% of the population, and is characterized by lifelong difficulties with written material,” according to the researchers, who are from the University of Geneva in Switzerland.

Although several possible causes have been proposed for dyslexia, the predominant one is a phonological deficit, or a difficulty in processing word sounds, the researchers said.

The phonological deficit in dyslexia is associated with changes in rhythmic or repetitive patterns of electrical activity in the brain, specifically “low-gamma” oscillations, measuring at 30 hertz or volts, in the left auditory cortex, they said.

However, studies have yet to prove that these these oscillations affect a person’s ability to process word sounds and cause dyslexia, the researchers said.

For this study, the researchers applied transcranial alternating current stimulation over the left auditory cortex in 15 adults with dyslexia and 15 fluent readers for 20 minutes.

At a dose of 30 hertz or volts, the approach resulted in significant improvement in reading accuracy in those with dyslexia, the researchers said.

However, the same improvements were not seen following application of a higher, 60-hertz dose, they said.

The results demonstrate for the first time that low-gamma oscillatory activity causes deficits in phonemic processing and may pave the way to non-invasive treatments aimed at normalizing oscillatory function in auditory cortex in people with dyslexia, the researchers said.

They plan “to investigate whether normalizing oscillatory function in very young children could have a long-lasting effect on the organization of the reading system [and] explore even less invasive means of correcting oscillatory activity,” study co-author Silvia Marchesotti, a post-doctural researcher at the University of Geneva, said in a press release.



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Surgery may help sleep apnea patients who struggle with CPAP

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Continuous positive airway pressure may be the go-to treatment for sleep apnea, but many people struggle to use it every night. For those who cannot tolerate CPAP, new research finds that a combination of surgical techniques may bring relief.

The “multilevel” treatment includes removing the tonsils, repositioning the palate — roof of the mouth — and using radiofrequency to slightly reduce the size of the tongue. In combination, these procedures open up the airway and reduce breathing obstruction, the researchers said.

The study found that the multilevel surgery technique reduced the number of times people stopped breathing — apnea events — during sleep and improved daytime sleepiness. People also reported better quality of life after the treatment.

“Obstructive sleep apnea is common and many people cannot use the main treatments, like CPAP masks. Surgery is a valid option when an expert surgeon is involved, and it can improve outcomes,” said the study’s lead author, Dr. Stuart MacKay. He’s an honorary clinical professor of otolaryngology, head and neck surgery at University of Wollongong, in Australia.

The researchers said that nearly one billion people worldwide suffer from sleep apnea. The airway becomes blocked during sleep, and as a result people stop breathing for short periods of time, multiple times throughout the night. People with sleep apnea have a higher risk of daytime sleepiness, motor vehicle crashes, and heart disease and stroke.

CPAP does a good job at keeping your airway open as you sleep, but the treatment — including a mask and a long tube — can be hard to get used to. The study authors said only about half of people with sleep apnea try CPAP.

For the new study, the researchers recruited 102 overweight or obese people with sleep apnea from six clinical centers in Australia, who were in their 40s, on average. The goal was to see if surgery could help adults with moderate or severe obstructive sleep apnea who weren’t able to tolerate or adhere to CPAP devices.

Half of the volunteers were randomly assigned to receive the sleep apnea surgery, while the other 51 continued with medical treatment. Medical management consisted of encouraging weight loss, drinking less alcohol, changing sleep posture and medical treatment for nasal obstruction.

MacKay said the multilevel surgical technique is widely available in many parts of the world. For the patients in this study, surgeries were performed by seven experienced surgeons.

Six months after the surgical procedures, volunteers in the surgery group had about a 27% decrease in the number of apnea events at night. Those on medical treatment had just a 10% decrease.

People in the surgical group also had major improvements in levels of snoring and daytime sleepiness, as well as a boost to quality of life.

As with any surgical procedure, there are risks.

“The main risks of pain and bleeding are confined to the two weeks after surgery. Bleeding occurs in about one in every 25 patients. Long-term risks related to taste disturbance, feeling of sticking in the throat, swallow dysfunction are very rare, although they do occur transiently in some,” MacKay said.

Dr. Steven Feinsilver is director of the Center for Sleep Medicine at Lenox Hill Hospital in New York City. He said, “Sleep apnea is a very common disease, about as common as diabetes, and similar to diabetes is associated with increased risk for cardiovascular events, such as stroke and heart disease.”

He added that “CPAP works, but is a difficult treatment.”

Feinsilver said that surgery that could provide a permanent cure has long been the goal for treatment.

“This study shows that relatively minor surgery, performed in a standardized fashion by skilled surgeons, can significantly improve sleep apnea compared to ‘medical treatment’ (essentially no treatment),” he said.

But he noted that even though people reported improvement, their nighttime breathing wasn’t back in the normal range.

“This is certainly a major improvement, but it remains unclear whether outcomes (such as cardiovascular risk) will be significantly impacted,” Feinsilver said. Also, he suggested that this multilevel surgery may only be an option for a select group of patients.

The report was published online Sept. 4 in the Journal of the American Medical Association.

More information

Learn more about sleep apnea treatments from the U.S. National Heart, Lung, and Blood Institute.

Copyright 2020 HealthDay. All rights reserved.



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