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Some COVID-19 survivors may have permanent nerve damage

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Placing a hospitalized COVID-19 patient in a face down position to ease breathing — or “proning” — has steadily gained traction as a pandemic lifesaver. But a small new study warns that it may lead to permanent nerve damage.

The concern is based on the experience of 83 COVID-19 patients who were placed face down while attached to a ventilator. Once they improved, all began post-COVID-19 rehabilitation at a single health care facility.

By that point, roughly 14% had developed a “peripheral nerve injury” (PNI) involving one or more major joints, such as the wrist, hand, foot or shoulder.

Despite that damage, study author Dr. Colin Franz said proning “is a lifesaving intervention, and we think it is saving lives during the COVID pandemic.”

And although placing patients face down has been known to cause skin pressure injuries in non-COVID-19 patients, he said nerve compression injuries are typically uncommon with regular repositioning and careful padding.

“So we were very surprised to find 12 out of 83 patients with nerve injuries,” said Franz, neurology director of the Regenerative Neurorehabilitation Laboratory at Northwestern University Feinberg School of Medicine, in Chicago.

He characterized the nature of the nerve damage as so severe that affected patients were “unlikely to fully recover.”

The damage included loss of hand function, frozen shoulder and foot dragging that may lead to a need for a brace, cane or wheelchair.
“Full recovery for nerve damage is estimated to occur in only about 10% of patients under the best of circumstances,” Franz explained. “And the recovery that does take place will happen over 12 to 24 months.”

In other words, the nerve damage might be the longest-lasting effect of COVID-19 for most of these patients, he suggested. And if the risk seen among the study group is any indication, thousands of patients worldwide could have the same damage, Franz said.

Franz noted that some, but not all, of the patients had pre-existing conditions such as diabetes that made them more likely to have nerve injuries from compression. Many of the patients were also old or obese.

But he and his colleagues suspect something about COVID-19 infection itself makes nerves more vulnerable to damage. Among the possible triggers: the increased inflammatory state brought on by SARS-CoV-2, the virus that causes COVID-19, as well as poor blood circulation and blood clotting.

Prone-triggered PNI may also result from “the way patients are positioned and the weight it may put on certain nerves for prolonged periods of time,” said Dr. Armeen Poor, an attending physician of pulmonary critical care medicine at Metropolitan Hospital Center in New York City, who reviewed the findings.

Another possible contributor: overworked hospital staff.

During the height of the pandemic, said Poor, “many hospitals were proning more patients at a time than usual. This excess strain on staff could have compromised the frequency of careful patient repositioning while prone, and potentially increased the risk of nerve injury.”

Dr. Nicholas Caputo, an associate chief and attending emergency physician at Lincoln Medical and Mental Health Center, Bronx, N.Y., also reviewed the findings. He said it’s important to recognize that this study focused only on patients proned while on a ventilator.

But, he noted, proning has been successfully deployed among non-ventilated patients, often in hopes of staving off ventilation. Such “self-proning” patients are awake and “instructed to change positions if they become uncomfortable.”

In the intensive care unit, however, ventilated patients are generally proned for eight to 12 hours before being turned, Caputo said. “This puts much more pressure on certain areas of the body, and places the patients at risk for complications such as peripheral neuropathies,” he added.

Hoping to reduce prone-linked PNI risk among intubated patients, Franz’s team has been “mapping” regions most vulnerable to nerve damage. That information could help doctors, nurses and physical therapists deploy modified positioning, extra padding and protection of vulnerable areas. Wearable sensors could be used to “measure and monitor [the] loading of nerves,” he said.

“In medicine we focus on ‘ABCs’ — airway, breathing and circulation — when there is an emergency,” Franz said. “Intubation and proning positioning fall within these categories and save lives. This is always the first priority. We do think these added measures will help prevent these nerve injuries, however.”

The findings have not yet been peer-reviewed but were reported online recently in medRxiv in advance of publication in The British Journal of Anaesthesia.

More information

Learn more about COVID-19 and proning at the University of Pennsylvania.

Copyright 2020 HealthDay. All rights reserved.



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Study: ‘Conscientious, agreeable’ people more likely to follow COVID-19 guidelines

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Oct. 8 (UPI) — People who are “careful and diligent” are 31% more likely to follow measures designed to contain the spread of COVID-19 than those who do not have these personality traits, according to an analysis published Thursday by the journal PLOS ONE.

Similarly, those who “have strong cooperative values and a preference for positive interpersonal relationships” are 17% more likely to comply with social distancing guidelines, the data showed.

Increasing understanding of what personality traits encourage — and discourage — compliance with COVID-19 guidelines such as social distancing and the wearing of face coverings in public can help governments determine the best way to implement health precautions, the researchers said.

“Governments are continuously trying to figure out how to maximize compliance with COVID-19 transmission mitigation behavioral guidelines, such as wearing masks, avoiding gatherings, washing hands, etc., and the truth is [that] there is no such a one-size-fits-all model,” study co-author Ahmed M. Nofal told UPI.

“We encourage governments to trigger people’s predispositions towards specific personality traits — for example, to boost citizens’ sense of belonging and obligation to their communities — which has been suggested to develop conscientiousness,” said Nofal, an assistant professor of entrepreneurship at the Emlyon Business School in France.

A study published last month, also in PLOS ONE, found that older adults in the United States were more likely to comply with social distancing measures.

Although that study also observed that the majority of Americans — 65% — were adhering to guidelines, a sizeable minority — 35% — were not.

For the new research, Nofal and his colleagues surveyed 8,548 Japanese adults aged 20 to 64 years on their compliance with measures designed to contain the spread of COVID-19.

The researchers also assessed respondents’ individual personalities using the Ten Item Personality Inventory, a tool designed to identify specific traits and characteristics based on a number of measures.

In addition to people who are careful and conscientious and more agreeable and cooperative, those more “open to experiences” — or who value “creativity, innovation and intellectual stimulation” — are 19% more likely to comply with measures designed to limit COVID-19 spread than others, the data showed.

Conversely, extraverts — those who are “assertive, dominant, energetic, active, talkative, impulsive and enthusiastic” — are 7% less likely to adhere to control measures than introverts, the researchers said.

“Assessing individuals’ personalities could also be very beneficial to identify people who tend to violate the transmission mitigation behavioral guidelines,” Nofal said.



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Depressed teens may struggle in school

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By about age 16, teens diagnosed with depression have substantially lower educational attainment, a new British study finds.

Targeted educational support might be of particular benefit to teens from poor backgrounds and boys, but all children with depression can benefit from such help, the study authors suggested.

For the study, the researchers used British health and education records to identify nearly 1,500 kids under 18 years of age with depression. Typically, their depression was diagnosed around age 15. Their educational attainment was compared with a group of young people who were not depressed.

Among students with a diagnosis of depression, 83% reached expected educational attainment at ages 6 to 7, but only 45% hit more advanced thresholds in English and math by age 15 to 16. Researchers said that’s much lower than the 53% who met the threshold locally and nationwide.

“Previous research has found that, in general, depression in childhood is linked to lower school performance,” said researcher Alice Wickersham, a doctoral student at NIHR Maudsley Biomedical Research Centre of King’s College London.

But young people who developed depression in secondary school typically showed a performance decline on the General Certificate of Secondary Education (GCSE) exams. The exams — taken by most pupils at about age 15 to 16 in England, Wales and Northern Ireland — dovetailed with the time of diagnosis for many young people.

The pattern appeared to be consistent across different genders, ethnicities and economic groups, Wickersham said in a research center news release.

“While it’s important to emphasize that this won’t be the case for all teenagers with depression, it does mean that many may find themselves at a disadvantage for this pivotal educational milestone,” Wickersham said.

“It highlights the need to pay close attention to teenagers who are showing early signs of depression. For example, by offering them extra educational support in the lead up to their GCSEs, and working with them to develop a plan for completing their compulsory education,” she added.

Researcher Dr. Johnny Downs, senior lecturer in child and adolescent psychiatry at King’s College London, said the findings have two key policy implications.

“It demonstrates just how powerful depression can be in reducing young people’s chances at fulfilling their potential, and provides a strong justification for how mental health and educational services need to work to detect and support young people prior to critical academic milestones,” he said.

The findings were published online Oct. 8 in the British Journal of Psychiatry.

More information

For more about teens and depression, head to the U.S. National Institute of Mental Health.

Copyright 2020 HealthDay. All rights reserved.



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Study: New bedside test means faster diagnosis, treatment of COVID-19

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Oct. 8 (UPI) — A rapid, bedside test for COVID-19 delivers results in less than two hours, meaning that appropriate treatment can be initiated earlier for those already hospitalized because of their symptoms, according to a study published Thursday by The Lancet Respiratory Medicine.

The standard COVID-19 test uses polymerase chain reaction, or PCR, technology, which amplifies small samples of DNA in order to identify the presence of virus in samples taken from an infected person’s nose or throat.

The PCR test requires samples to be sent to a centralized lab within the hospital for processing, typically takes more than 20 hours to produce results, the researchers said.

The enhanced speed of the bedside, or “point-of-care” tests, also means patients infected with the new coronavirus can be isolated earlier, reducing the risk for transmission to other patients and healthcare workers.

“Our findings are the first to suggest the clinical benefits of molecular point-of-care COVID-19 testing in hospitals, demonstrating reduced delays, bed moves and time in assessment areas, which all lead to better infection control,” study co-author Dr. Tristan William Clark, of Southampton General Hospital in England, said in a statement.

“We believe that [these] molecular [tests] should be urgently integrated … to reduce coronavirus transmission within hospitals to prevent the next wave of the pandemic overwhelming health services around the world,” Clark said.

Since the start of the global pandemic in March, healthcare systems worldwide have relied on PCR testing of patient samples in centralized hospital laboratories, an approach that is accurate, but also lengthy and resource intensive, according to Clark and his colleagues.

The longer time it takes to generate results with PCR testing means that patients often wait in mixed assessment rooms to be admitted to the correct COVID-19 or non-COVID ward, increasing the possibility of transmission, the researchers said.

However, with point-of-care tests, nasal and throat swab samples are collected and placed into small cartridges for analysis. Unlike PCR tests, which require specially trained lab personnel, the bedside tests can be performed by healthcare workers in the emergency room or other assessment area, they said.

For this study, Clark and his colleagues evaluated the QIA-stat-Dx point-of-care testing platform, manufactured by Dutch firm Qiagen, in 1,054 adults with COVID-19 symptoms being assessed in the acute medical unit and emergency department of Southampton General Hospital between March 20 and April 29.

Nose and throat swabs were taken from all patients and tested for COVID-19 infection, with 499 patients evaluated using the QIA-stat-Dx, while the rest were assessed using only PCR testing. All test results were confirmed using the standard PCR approach as well, the researchers said.

Among those tested with QIA-stat-Dx, 197, or 39%, were found to be positive for COVID-19, while 155, or 28%, of those evaluated by only PCR were positive for the virus, the data showed.

The point-of-care test produced results in roughly 1.7 hours on average, while PCR evaluation took approximately 21.3 hours per patient, according to the researchers.

After testing, patients were transferred to definitive COVID-positive or negative wards, a process that took eight hours in the QIA-stat-Dx group and 28.8 hours in the PCR-only group, the researchers said.

With the bedside testing, approximately 14% of patients were transferred directly to the correct ward immediately and bypassed the assessment area, they said.

In addition, the point-of-care test was found to be more than 99% accurate at correctly identifying those positive for the virus, according to the researchers.

Most of the patients found to have COVID-19 in the study were recruited into a separate clinical trial evaluating treatments for the virus, with those evaluated with QIA-stat-Dx enrolled in the second study two days faster, on average, than those assessed by PCR only, the researchers said.

“Recruiting patients into clinical trials remains an international priority throughout this pandemic and is vital to accelerating the search for effective treatments,” Clark said.

“This is especially true when researchers are investigating the potential of antivirals, which have to be administered at early disease stages to have the greatest benefit,” he said.



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