July 23, 2020 - a podcast by COVID19LST

On today's episode we discuss:

— Epidemiology: A sharp peak in rates of intestinal obstruction (IO) during the lockdown period in Kerela, India (referred to as "lockdown belly") leads authors to propose four common risk factors, 75% are modifiable with diet and physical activity. These include: 60 years of age or older, prior abdominal surgery, strict adherence to lockdown restrictions, and poor quality diet.

— Understanding the Pathology:  A cross sectional study from Columbia University that analyzed kidney biopsies of SARS-CoV-2 infected patients (n=17), revealed a spectrum of glomerular and tubular injuries, acute kidney injury (88%), and lack of SARS-CoV-2 detection in kidney cells as evidence against direct viral injury as a pathophysiologic mechanism of disease. Authors conclude that the principle nephrogenicity of SARS-CoV-2 likely results from ischemic damage and a dysregulated immune response.

'— Transmission and Prevention:  A group of psychologists found that habit reversal training (HRT) was an effective method of treating repetitive behavior problems, such as face touching, and therefore may be an effective strategy for decreasing transmission of SARS-CoV-2. The principles of HRT are centered on mindfulness and behavior modification, and authors include a practical guide to implementing these practices.

— Management: italian authors describe how the anti-coagulant Defibrotide may be the “drug of choice” for treating the hypercoagulable state associated with severe COVID-19 disease because of its profibrinolytic, antithrombotic, and anti-inflammatory effects. These would theoretically protect from the growing evidence implicating the role of endothelial damage and a hyperinflammatory state in SARS-CoV-2 infection.

'— Transmission and Prevention:describes the effect of T cell imbalance, specifically between Treg and Th17, on uncontrolled systemic inflammation in severe COVID-19 cases in pregnancy found that:  - Treg cells decreased and Th17 cells increased, with a consequent decrease in the Treg/Th17 cell ratio.  - Treg cells dysregulation in COVID-19 was shown trigger hyperinflammation and tissue damage.   - Increased Th17 is associated with fetal allograft rejection at the feto-maternal interface.  - COVID-19 infection puts pregnant persons at higher risk for pregnancy complications.

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