NEWS
Post-mortems show blood clots and lung injuries in COVID patients
A post-mortem study of patients who have died from COVID-19 found severe damage to the lungs and signs of blood clotting in major organs. Ten post-mortem examinations performed on patients with confirmed COVID-19 found that all patients had lung injuries and early scarring of the lungs as a result of the virus, as well as injury to their kidneys. Nine patients also had thrombosis in at least one major organ (heart, lung or kidney). The team were unable to investigate thrombosis in the tenth patient. The research team behind the study believe that the findings could help guide clinicians on treating complications as a result of COVID-19, such as using blood thinners to prevent blood clots from developing. They also hope that better understanding of the key complications in severe cases could help clinicians develop new ways to monitor and treat the disease. The study, published in The Lancet
Microbe, was led by researchers at Imperial College London and Imperial College Healthcare NHS Trust. Although the numbers of patients examined is small, this is the largest study to date of post-mortem examinations on COVID-19 patients in England.
Dr Michael Osborn, honorary clinical senior lecturer at Imperial College London, consultant pathologist at Imperial College Healthcare NHS Trust and co-author of the study, said: “Our study is the first of its kind in the
country to support existing theories from researchers and doctors on the wards that lung injuries, thrombosis and immune cell depletion are the most prominent features
in severe cases of COVID-19. In the patients we looked at, we also saw evidence of kidney injuries and in some cases pancreatitis and these with our other findings will help clinicians develop new strategies to manage patients.”
In the patients studied, high blood pressure and chronic obstructive pulmonary disease were the most common contributing factors to death. All patients developed a fever and had at least two respiratory symptoms such as cough and shortness of breath during the early stages of the disease. Most patients died within three weeks of presenting with symptoms and treatments varied across the cohort. The study team also reported six main findings: All patients had diffuse alveolar damage
(DAD). DAD is a term used to describe a pattern of lung injury which can be seen as a result of viral infection. This type of lung injury can affect both gas exchange (oxygen and carbon dioxide) and blood flood in the lungs. Nine of the ten patients had some form
Breath test for Coronavirus trialled by NHS
Ancon Medical has announced the trial of its Nanotechnology Biomarker Tagging (NBT) system, to provide a breath test to diagnose Coronavirus in 10-15 minutes. The system, if successful, will provide a rapid, accurate, safe and non-invasive test for Coronavirus.
The trial is taking place at Ashford & St
Peter’s Hospitals NHS Foundation Trust. It is using samples from both positive and negative confirmed COVID-19 cases and, if successful, the artificial intelligence and machine learning could determine the unique biomarker profile of a COVID-19 positive breath. The system being tested involves collecting and analysing exhaled breath in swab containers. Breath contains
a mixture of substances which changes depending on diet and health. Ancon’s system measures the levels and patterns of the different substances in the air sample; it is extremely sensitive and can detect very low concentrations. The samples are analysed immediately without the need to be sent to a lab. Sample collection is safe and non-invasive. Dr. Stephen Winchester, consultant in medical virology said: “As the coronavirus pandemic develops, it’s clear that our response should be long-term and pre- emptive and advances in research, diagnosis, treatment and technology will be absolutely key to managing future outbreaks and protecting communities.”
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of thrombosis in at least one major organ (it was not possible to investigate thrombosis in the tenth patient). The researchers found thrombi in the lungs of eight patients, the heart of five patients and the kidneys of four patients. They believe that this supports the theory that COVID-19 causes circulatory complications and that patient treatment could be augmented with blood thinning medication to prevent blood clots. All patients had evidence of acute renal tubular injury, a kidney injury that can lead to kidney failure or damage. The main causes are low blood flow to the kidneys and severe infections. It often affects patients who are in hospital and intensive care units T-Lymphocyte Depletion (TLD) in the spleen and the lymph nodes was another consistent finding. T-lymphocytes (white blood cells) are a major component of the immune system and play a role in destroying infections. TLD is a reduction in T-lymphocytes, which alters the immune system and its response. Haemophagocytosis is another consistent finding in this group, which occurs when the immune system overreacts to an infection and destroys some of its own cells. The researchers found evidence of acute pancreatitis in two of the patients. Acute pancreatitis is a condition where the pancreas becomes inflamed. It can be treated with fluids into the veins but in some cases can develop into serious complications and cause organ failure. Damage to the pancreas in COVID-19 patients has not been reported before but it is not clear in this study whether the pancreatitis was related to COVID-19 infection or other causes.
Assay accuracy
Data presented at the ESCMID Conference on Coronavirus Disease shows that, in a comparison of five tests used to detect SARS-CoV-2 antibodies, an assay manufactured by Siemens and one developed by the University of Oxford had the most accurate results. The best results were delivered by the Siemens assay (sensitivity 98·1% / specificity 99·9%) and the Oxford immunoassay (sensitivity 99·1% / specificity 99·0%). For the Abbott assay sensitivity was 92·7% and specificity was 99·9%; for the DiaSorin assay sensitivity was 95·0% and specificity was 98·7%; for the Roche assay sensitivity was 97·2% and specificity was 99·8%.
OCTOBER 2020
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