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COVID-19 linked to potentially dangerous eye abnormalities

The results suggest that screening should be considered in all patients with severe COVID-19 to detect these nodules. In clinical practice, this screening could include dedicated exploration of the eyes with high-resolution MRI, the researchers said.

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Researchers using MRI have found significant abnormalities in the eyes of some people with severe COVID-19, according to a study published in the journal Radiology. The study results support the need for eye screening in these patients to provide appropriate treatment and management of potentially severe ophthalmological manifestations of COVID-19.

The COVID-19 pandemic has affected more than 100 million people since it began early in 2020. While the virus primarily attacks the lungs, it has been linked with eye abnormalities like conjunctivitis, also known as pink eye, and retinopathy, a disease of the retina that can result in a loss of vision. Eye abnormalities visible on MRI exams have been reported but there is limited research on the nature and frequency of these abnormalities.

To find out more, the French Society of Neuroradiology (SFNR) initiated a study of 129 patients with severe COVID-19 who underwent brain MRI.

Of the 129 patients, nine (7%) had abnormal MRI findings of the globe, or eyeball. The MRI scans showed one or more nodules in the back part, or posterior pole, of the eyeball. Eight of the nine patients had spent time in the intensive care unit (ICU) for COVID-19.

“We showed that a few patients with severe COVID-19 from the French COVID-19 cohort had one or several nodules of the posterior pole of the globe,” said study lead author Augustin Lecler, M.D., Ph.D., associate professor at the University of Paris and neuroradiologist from the Department of Neuroradiology at the Foundation Adolphe de Rothschild Hospital in Paris. “This is the first time these findings have been described using MRI.”

All nine patients had nodules in the macular region, the area in the back of the eye responsible for our central vision. Eight had nodules in both eyes.

The results suggest that screening should be considered in all patients with severe COVID-19 to detect these nodules. In clinical practice, this screening could include dedicated exploration of the eyes with high-resolution MRI, the researchers said. Additional recommended exams include fundoscopy, which uses a magnifying lens and a light to check the back of the inside of the eye, and optical coherence tomography, a noninvasive test that provides a 3D picture of the structure of the eye.

Dr. Lecler noted that severe eye problems might largely go unnoticed in the clinic, as COVID-19 patients hospitalized in the ICU are often being treated for much more severe, life-threatening conditions.

“Our study advocates for screening of all patients hospitalized in the ICU for severe COVID-19,” Dr. Lecler said. “We believe those patients should receive specific eye-protective treatments.”

The mechanism behind nodule formation remains unknown, the researchers said, although it could be related to inflammation triggered by the virus. Inadequate drainage of the veins of the eyes, a problem found in patients who spend time in the ICU in the prone position or intubated, may also be a factor. Seven of the nine patients with eye abnormalities in the study had been placed in a prone position in the ICU for an extended time.

The researchers are performing follow-up clinical and MRI examinations in the survivors to monitor the nodules and see if they carry any clinical consequences such as vision loss or visual field impairment.

They are also performing MRI examinations in new patients with severe COVID-19 from the second and third waves of the pandemic, using more comprehensive ophthalmological tests to correlate with the MRI results.

The effects on patients with moderate COVID-19 are currently under investigation.

“We have launched a prospective study with dedicated high-resolution MR images for exploring the eye and orbit in patients with light to moderate COVID,” Dr. Lecler said. “Therefore, we will be able to know whether our findings were specific to severe COVID patients or not.”

The findings support previous research that showed COVID-19 exacts a greater toll in people with existing health problems. Of the nine patients with eye nodules, two had diabetes, six were obese and two had hypertension.

“Ocular MRI Findings in Patients with Severe COVID-19: A Retrospective Multicenter Observational Study.” Collaborating with Dr. Lecler were François Cotton, M.D., Ph.D., François Lersy, M.D., Stéphane Kremer, M.D., Ph.D., and Françoise Héran, M.D., on behalf of the SFNR’s COVID study group.

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COVID-19 infection in pregnancy not linked with still birth or baby death

However the research, from over 4,000 pregnant women with suspected or confirmed COVID-19, also found women who had a positive test were more likely to have a premature birth.

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COVID-19 infection in pregnancy is not associated with stillbirth or early neonatal death, according to a new study.

However the research, from over 4,000 pregnant women with suspected or confirmed COVID-19, also found women who had a positive test were more likely to have a premature birth.

The research, led by scientists from Imperial College London and published in the journal Ultrasound in Obstetrics and Gynecology, used data from the UK and the USA.

The study team looked at data from 4004 pregnant women who had suspected or confirmed COVID-19. Of these women, 1606 were from the UK, from a data registry called PAN-COVID, while 2398 were from the US, from the American Academy of Pediatrics SONPM data registry.

PAN-COVID was funded by the Medical Research Council, UK National Institute for Health Research and the NIHR Imperial Biomedical Research Centre.

All the women gave birth between January-August 2020.

The research found that no babies died from COVID-19 in the study. There was also no increase in risk of stillbirth or low birth weight.

However, both the UK and US data suggested a higher risk of pre-term birth (defined as birth before 37 weeks).

In the UK data, 12 per cent of women with suspected or confirmed COVID-19 had a pre-term delivery – 60 per cent higher than the national average rate of 7.5 per cent. In the US data, 15.7 per cent of women had a pre-term birth, 57 per cent higher than the US national average of 10 per cent.

The study team say part of this association may be due to doctors deciding to deliver the baby early due to concerns about the effect of COVID-19 infection on mother and baby. The rate of spontaneous pre-term birth was lower than expected.

Professor Christoph Lees, senior author of the study from Imperial’s Department of Metabolism, Digestion and Reproduction, said: “The finding that COVID-19 infection does not increase the risk of stillbirth or baby death is reassuring. However, a suspected or confirmed COVID-19 diagnosis was linked to a higher risk of preterm birth, and it isn’t entirely clear why.”

Dr Ed Mullins, co-author from Imperial’s Department of Metabolism, Digestion and Reproduction, added: “This study supports the prioritisation of vaccination for women who are pregnant or who plan to become pregnant, and existing measures that protect women in pregnancy from infection, in order to reduce pre-term birth.”

The proportion of babies born to mothers with confirmed COVID-19, and who subsequently tested positive for the SARS-CoV-2 virus (which causes COVID-19) was 2 per cent in the UK study, and 1.8 per cent in the US study.

The majority of women in the study had no pre-existing conditions such as diabetes or a respiratory condition such as asthma.

In the UK study eight of the women died, while four women died in the US study.

The study team say that although these death rates are higher than expected for women giving birth, they are similar to the expected death rates seen among adults with a confirmed COVID-19 infection. This suggests that women in pregnancy are not at a higher risk of death from COVID-19 than non-pregnant women.

Among women in the UK arm of the study, 66.5 per cent were European or North American, 1.9 per cent were Middle Eastern, 1.1 per cent were North African, 4.2 per cent were African south of the Sahara or Caribbean, 7.5 per cent were from the Indian subcontinent, and 9.2 per cent were South East Asian. Among the US arm of the study 37 per cent were white, 25 per cent were Black or African, 4.1 per cent were Asian, 0.4 per cent were American Indian or Alaska Native American.

Professor Fiona Watt, Executive Chair of Medical Research Council, which helped fund the study, said: “It is obviously critical to understand how COVID-19 affects different groups of people. We’re proud to have funded the present study in which, for the past year, researchers have monitored the health of a substantial number of pregnant women and their babies. The study’s findings, that there is no increased risk of stillbirth and early neonatal death in women who contracted COVID-19 while pregnant, are reassuring. However, the study highlights the need for more research to determine if, or how, COVID-19 affects maternal outcomes or premature birth.”

The American Academy of Pediatrics SONPM data registry was led by Professor Mark Hudak.

The Centre for Trials Research at Cardiff University was responsible for building the online database, data management and the statistical analyses. Julia Townson, Senior Research Fellow and co-author from Cardiff University said: “I am delighted that the Centre for Trials Research at Cardiff University has been able to collaborate with Imperial College London on this important research. It has been a mammoth undertaking by the team, requiring a rapid build of the database and web page, as well as cleaning and analysing the data.”

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TB vaccine may protect newborns against other infectious diseases

Infants who had been vaccinated with BCG at birth presented to doctors with any kind of infection 25% less often than infants who had not. Protection from BCG didn’t seem to be against one specific type of infection, but for all types, such as common colds, chest infections, and skin infections.

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The tuberculosis (TB) vaccine Bacillus Calmette-Guerin (BCG) could protect newborns against a variety of common infections, such as upper respiratory tract infections, chest infections and diarrhoea, according to a new study in The Lancet Infectious Diseases.

The research is the first of its kind to rigorously investigate the full range of illnesses BCG could protect infants against. It suggests that vaccinating all babies on the day of birth with BCG could reduce neonatal infections and death in areas with high infectious disease rates, potentially saving thousands of lives a year. The results also increase the possibility that the vaccine might be used to protect children and adults against COVID-19 and other new infectious diseases.

Led by the London School of Hygiene & Tropical Medicine (LSHTM) through the MRC/UVRI & LSHTM Uganda Research Unit, and funded by the Wellcome Trust, the study involved a randomized control trial of 560 newborns in Uganda, who were monitored for a range of illnesses.

After six weeks, infection rates from any disease were 25% lower in the group who received the vaccine at birth, compared to the group that had not yet received the vaccination. Particularly vulnerable groups such as low birth weight babies, and boys, seemed to be protected the most. Importantly, BCG appeared to protect against mild, moderate and severe types of infections.

Sarah Prentice, lead author from LSHTM, said: “Nearly a million babies die every year of common infections so we urgently need better ways to protect them. Our research suggests that ensuring that BCG is given at birth could make a big difference in low income countries, potentially saving many lives.”

In the study, healthy Ugandan infants were randomly assigned to receive BCG at birth or at six weeks of age. The infants were followed-up by doctors, blinded to the intervention, for 10 weeks to look for episodes of any type of illness or infection.

The research team then compared how often infants in the two groups presented to doctors with infections of any kind, except TB, to see whether having BCG made a difference. They also took blood samples from both groups, to look at differences in their innate immune system, the body’s first line of defence against infections.

Infants who had been vaccinated with BCG at birth presented to doctors with any kind of infection 25% less often than infants who had not. Protection from BCG didn’t seem to be against one specific type of infection, but for all types, such as common colds, chest infections, and skin infections.

After the group receiving BCG at six weeks had been vaccinated, there was no difference in the rates of infection between the two groups – the delayed group’s immunity ‘caught-up’ once they’d received BCG.

Hazel Dockrell, Professor of Immunology at LSHTM and one of the co-authors of the study, adds: “It’s very exciting to think that BCG vaccination might help keep newborns safe against other dangerous infections, in addition to providing protection against TB. Although BCG is recommended at birth in many countries, it is often delayed due to logistical difficulties. Ensuring that the vaccine is given on day one, in areas with high rates of infectious disease, could have a major impact on infections and deaths in the newborn period.”

The team can’t definitively say why BCG offered this additional non-specific protection, but the research showed evidence of changes in the innate immune system of vaccinated infants, which may suggest that BCG boosts the immune system to work better against any infection.

This has led the researchers to suggest that it could provide protection in the early stages of novel outbreaks, such as COVID-19 or Ebola, before specific vaccines have been developed.

Further studies are already underway to explore whether BCG could play a role in the response to COVID-19, with large trials involving health care workers and the elderly. The Director General of WHO Dr Tedros Ghebreyesus has co-authored an article expressing interest in the possible use of BCG for protection against COVID-19.

Dr Prentice said: “Since the findings show that BCG seems to offer wider protection against a range of infections, our study also raises hopes it might be useful in protecting the general population against COVID-19 and future pandemics – though we will need to see the results of other, more specific studies to know for sure.”

The researchers also believe it is worth investigating whether reintroduction of BCG in countries where it is no longer in routine use, such as the UK, is beneficial, not for its effects against TB, but to protect vulnerable infants in neonatal units against other infections.

The authors acknowledge limitations of their study. As it was relatively small, it was not possible to show an effect of BCG on numbers of deaths from infections in the study participants. Also, because the study was only conducted in Uganda, it cannot be certain that these extra, beneficial effects of BCG would be seen in other settings. However, previous studies conducted in West Africa have shown a reduction in neonatal deaths following BCG at birth, to a similar extent as the reduction in infection rates seen in this study.

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Partners’ company helps us stay connected during pandemic

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Living with a romantic partner helps people feel more socially connected during COVID-19, new research stated. But no other pandemic-era social dynamic carries notable benefits: not your kids, not kibitzing with your bestie on Facetime, and not your adorable-adoring pets.

“Research prior to the pandemic has long shown that partners are one of the strongest predictors of social connection and well-being,” said UCR researcher Karynna Okabe-Miyamoto, lead co-author of the study, published recently in the journal Plos One. “And our research during the current COVID-19 pandemic has shown the same. Living with a partner uniquely buffered declines in social connection during the early phases of the pandemic.” By April 2020, many workplaces and stores had been shuttered, and social distancing measures had been implemented. The social existence of many people was relegated to the four walls of their homes, and their families became their only social connections.

The effectiveness of social distancing in reducing virus transmission had been established even before COVID-19. Researchers were curious about how to protect psychological health when such measures are in place.

The first study was conducted in Canada and included 548 undergraduate students. The second was conducted in the United State and United Kingdom and included 336 participants.

In the studies, participants reported their perceived social connection before and during the pandemic. They were asked to rate statements such as “I felt close and connected with other people who are important to me” and “People are around me, but not with me.” They were also asked to declare their social distancing adherence and whether they travel outside of the home for work.

Looking at participants before and during the pandemic, the authors wrote that people living with a romantic partner were most likely to improve in social connection after social distancing measures.

But the size of one’s household during the pandemic made little difference in feelings of social connectedness. Nor did being in the company of one’s children, or one’s pets. Working outside the home did nothing to help people feel socially connected, nor did video calls with friends and family.

“Living with a partner – but not how many people or who else one lives with – appeared to confer benefit during these uncertain and unprecedented times,” the authors wrote.

Researchers wrote the finding is consistent with past research that affirms romantic relationships lead to a greater sense of wellbeing and feeling connected. “In part,” the authors wrote, “because happier people are more likely to find partners.”

The researchers say policy makers should consider measures that place a priority on maintaining social connection, balanced against transmission risk.

In addition to Okabe-Miyamoto, who is a UCR graduate student, authors include UCR psychology professor Sonja Lyubomirsky and student researcher Dunigan Folk and social psychologist Elizabeth Dunn, both of University of British Columbia. The article in Plos One is titled “Changes in social connection during COVID-19 social distancing: It’s not (household) size that matters; it’s who you’re with.”

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