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PATI ENT SAFE T Y


The device has been in use for over three years for blood clot prevention in immobile, high-risk acute stroke patients, with over 700,000 individual units sold. To date, 4,700 pair of devices have been purchased by the Supply Chain specifically for use in the treatment of COVID-19 patients. Initially these were for use in the London Nightingale Hospital at the peak of the crisis and have since been distributed to ICU units in other hospitals across the country.


Recent data and COVID-19 as an endothelial disease Following the NHS purchase of Geko devices in April, new papers and data have emerged every day.


Now emerging with pace, is the high incidence of lower limb Deep Vein Thrombosis (DVT) and resultant Pulmonary Embolism (PE) in hospitalised patients with


COVID-19. A compelling study by Zhang et al assessed a cohort of 143 hospitalised COVID-19 patients and found that 46.1% had DVT in their lower limbs. Those with DVT had a worse prognosis, with fewer discharges and a high death rate. The study concludes that the clotting is due to multiple comorbidities, invasive tests and treatments, and prolonged immobilisation, and again calls for improved lower limb VTE prevention strategies to combat the lower limb DVT. Following the extensive data and papers in relation to COVID-19, VTE and DVT, the widespread opinion is now that inflammation of the endothelium, or endotheliitis, can explain the systemic impaired macro and microcirculatory function (the lethal micro- clotting) that is causing multi-organ failure. This hypothesis is, in turn, driving the rationale to identify and test therapies that will help stabilise and protect the endothelium,


such as use of anti-inflammatory, anti-cytokine drugs, currently hailed as a break-though, as well as ACE inhibitors and statins – all used along-side blood thinners for clot prevention. A study published in the The Lancet has been among the first to report that COVID-19 infects the endothelial cells lining the blood vessels that release protective substances, influencing everything from blood clotting to the immune response.1


The study reported


damage to endothelial cells in the lungs, heart, kidneys, liver and intestines in critically ill patients, and has influenced the concept that COVID-19 is not a respiratory illness alone. It is now viewed as a respiratory illness that can quickly become vascular. Impaired blood flow mechanics is also recognised as a mechanism that can trigger endothelial dysfunction. Normal blood flow is known to exert shear stress on the vascular endothelium thereby releasing the


Brain complications found in some patients with severe COVID-19


A study of 153 patients treated in UK hospitals during the acute phase of the COVID-19 pandemic has described a range of neurological and psychiatric complications that may be linked to the disease. All of the patients included in the study were selected for inclusion by expert doctors and therefore likely represent the most severe cases. It is not possible to draw conclusions about the total proportion of COVID-19 patients likely to be affected based on this study and in light of these findings further research is now needed, the authors commented. The researchers said their report offers the first detailed snapshot of the breadth of neurological complications in COVID-19 patients and should help to direct future research to establish the mechanisms of such complications so that potential treatments can be developed. Dr. Benedict Michael, lead-author of


the study, from The University of Liverpool, said: “There have been growing reports of an association between COVID-19 infection and possible neurological or psychiatric complications, but until now these have typically been limited to studies of ten patients or fewer. Ours is the first nation-wide study of neurological complications associated with COVID-19, but it is important to note that it is focused on cases that are severe enough to require hospitalisation.” To investigate the breadth of COVID-19 complications that affect the brain, researchers set up a secure, UK-wide online network for specialist doctors to report details of specific cases. These portals were hosted by professional bodies


SEPTEMBER 2020


representing specialists in neurology, stroke, psychiatry and intensive care. Data was collected between 2 April and 26 April 2020, during the exponential phase of the pandemic. Professor Sarah Pett co-author of the


study, from University College London, UK, said: “This data represents an important snapshot of the brain-related complications of COVID-19 in hospitalised patients. It is critically important that we continue to collect this information to really understand this virus fully. We also need to understand brain-complications in people in the community who have COVID-19 but were not sick enough to be hospitalised. Our study provides the foundations for larger, hospital and community-based studies. These studies will help inform on the frequency of these brain complications, who is most at risk of getting them, and ultimately how best to treat." Some 153 cases were reported during the study period, of which full clinical details were available for 125 patients. The study included patients with confirmed COVID-19 infection by PCR test (114 people), probable infection as diagnosed


from chest X-rays or CT scans (6 people), and possible infection, where patients had symptoms consistent with disease but diagnostic tests were either negative or not done (five people).


The most common brain complication


observed was stroke, which was reported in 77 of 125 patients. Of these, 57 patients had a stroke caused by a blood clot in the brain, known as an ischaemic stroke, nine patients had a stroke caused by a brain haemorrhage, and one patient had a stroke caused by inflammation in the blood vessels of the brain. Age data was available for 74 of the patients who experienced a stroke and the majority were over 60 years of age (82%, 61/77). Thirty-nine patients showed signs of confusion or changes in behaviour reflecting an altered mental state. Of these, nine patients had unspecified brain dysfunction, known as encephalopathy, and seven patients had inflammation of the brain, medically termed encephalitis. Long- term follow-up studies to assess duration and severity of these complications are needed.The study findings were published in The Lancet Psychiatry journal.


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