Author Interviews, Clots - Coagulation, COVID -19 Coronavirus, JAMA / 12.08.2020
Lupus Anticoagulant and Blood Clots Common in COVID-Hospitalized Patients
MedicalResearch.com Interview with:
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Dr. Reyes Gil[/caption]
Morayma Reyes Gil M.D., Ph.D.
Director of hematology and Coagulation Labs
Associate Professor, Pathology
Montefiore Medical Center and Albert Einstein School of Medicine
Bronx, NY 10467
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Antiphospholipid Syndrome is an entity caused by autoantibodies that cause arterial and venous thrombosis as well as miscarriages. During the COVID-19 pandemic, we tested 187 patients for Lupus anticoagulant (LA); 68 turned out to be COVID positive. 30 of the 68 COVID-positive patients were found to be positive for LA by the DRVVT test, and 17 of them were also determined to be positive by the hexagonal phospholipid neutralization STACLOT-LA test. Importantly, of the 30 patients who were LA positive, 19 had documented thrombosis (arterial and venous), an event rate of 63%, as compared with a rate of 34% (p = .03) for LA-negative patients.
We also checked CRP, an inflammatory marker known to affect the hexagonal phospholipid neutralization STACLOT-LA test. Although the mean CRP level was higher in patients testing positive for LA by DRVVT (14.4 vs 7.5 mg/dL; P < .01), patients with thrombosis did not have significantly higher CRP levels than those with no thrombosis. Hence, we adjusted for CRP, and LA was found to be independently associated with thrombosis (odds ratio, 4.39; 95% CI, 1.45-14.57; p= .01). No statistically significant difference was found by anticoagulation at the time of thrombosis, gender, race, ethnicity, ventilation, and mortality between patients who tested LA positive vs. negative.
Dr. Reyes Gil[/caption]
Morayma Reyes Gil M.D., Ph.D.
Director of hematology and Coagulation Labs
Associate Professor, Pathology
Montefiore Medical Center and Albert Einstein School of Medicine
Bronx, NY 10467
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Antiphospholipid Syndrome is an entity caused by autoantibodies that cause arterial and venous thrombosis as well as miscarriages. During the COVID-19 pandemic, we tested 187 patients for Lupus anticoagulant (LA); 68 turned out to be COVID positive. 30 of the 68 COVID-positive patients were found to be positive for LA by the DRVVT test, and 17 of them were also determined to be positive by the hexagonal phospholipid neutralization STACLOT-LA test. Importantly, of the 30 patients who were LA positive, 19 had documented thrombosis (arterial and venous), an event rate of 63%, as compared with a rate of 34% (p = .03) for LA-negative patients.
We also checked CRP, an inflammatory marker known to affect the hexagonal phospholipid neutralization STACLOT-LA test. Although the mean CRP level was higher in patients testing positive for LA by DRVVT (14.4 vs 7.5 mg/dL; P < .01), patients with thrombosis did not have significantly higher CRP levels than those with no thrombosis. Hence, we adjusted for CRP, and LA was found to be independently associated with thrombosis (odds ratio, 4.39; 95% CI, 1.45-14.57; p= .01). No statistically significant difference was found by anticoagulation at the time of thrombosis, gender, race, ethnicity, ventilation, and mortality between patients who tested LA positive vs. negative. 
Dr. Walline[/caption]
Jeffrey J. Walline, OD PhD
Associate Dean for Research
The Ohio State University
Columbus, OH 43210-1240
MedicalResearch.com: What is the background for this study?
Response: Greater amounts of nearsightedness are related to higher risks of sight-threatening complications in adulthood, so anything we can do to slow the progression of nearsightedness in childhood can have meaningful benefits in the future.
As the prevalence of nearsightedness increases worldwide and affects approximately 1/3 of the people in the United States, a treatment that provides clear vision AND slows the progression of nearsightedness can have a profound effect.
Dr. Heald-Sargent[/caption]
Taylor Heald-Sargent, M.D., Ph.D.
Ann & Robert H. Lurie Children’s Hospital
Chicago
MedicalResearch.com: What is the background for this study?
Response: Given the ongoing debate around the ability of children to transmit SARS-CoV-2, we noticed that our clinical data could address one of the prevalent assumptions. Some people postulated that the reason children have less severe infections with SARS-CoV-2 is because they are not able to replicate virus as much as adults and therefore may not transmit as readily. 
Dr. Jensen[/caption]
Majken K. Jensen, Ph.D.
Adjunct Professor of Nutrition
Harvard T.H. Chan School of Public Health &
Professor in the Department of Public Health
University of Copenhagen, Copenhagen, Denmark
MedicalResearch.com: What is the background for this study?
Response: Alzheimer’s disease and other dementias are highly prevalent conditions. According to the Alzheimer’s Association, 50 million people are currently living with Alzheimer’s disease or other dementias worldwide. Lower apolipoprotein E in plasma is a risk factor for dementia, but the underlying biological mechanisms are not fully understood. Thus, we investigated the role of apolipoprotein E overall and in lipoproteins with distinct metabolic functions in relation to cognitive function and dementia risk..
Dr. Brantley[/caption]
Erin Brantley, PhD, MPH
Senior Research Associate
Department of Health Policy and Management
Milken Institute School of Public Health
Preferred pronouns: she/her/hers
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We looked at what happened when work requirements for the Supplemental Nutrition Assistance Program Participation, or SNAP, were turned on in many places after the Great Recession.
We found large drops in participation in SNAP benefits due to work requirements, and that black recipients were more likely to lose benefits than white recipients. We think this is driven by the fact that black workers face higher unemployment rates than white workers, and work requirement policies do not take this into account.
We also found that some people who report having disabilities lost benefits, even though the intent of work requirements is that they apply to people without disabilities. ![MedicalResearch.com Interview with: Dr Herman Anne Service de Dermatologie Cliniques Universitaires Saint-Luc Avenue Hippocrate, 10 1200 Bruxelle MedicalResearch.com: What is the background for this study? Response: In the context of the COVID-19 pandemic, several cases of acro-located lesions (on foot or hands) suggestive of chilblains have been reported and were possibly related to COVID-19. We wanted to determine if chilblains, observed in many patients recently referred to our department, are indicative of COVID-19. MedicalResearch.com: Would you briefly explain what is meant by chilblains? Response: Chilblains are frequent cold induced inflammatory lesions. Chilblains are typically seen in winter and occur after repeated exposure to cold temperatures. Clinical presentation includes erythema and swelling on toes and/or digits followed by red-purple macules or patches. However, given the large number of patients affected, and the exceptionally high outdoor temperatures for the spring season over the past month and at the time of case-observation, cold-exposure seemed unlikely. These lesions were, therefore, suspected to be associated with COVID-19. However, to date, no study has proven a pathological link between these lesions and COVID-19. MedicalResearch.com: What are the main findings? Response: In our series of 31 patients who recently developed chilblains, negative nasopharyngeal swabs and the absence of anti-SARS-CoV-2 blood immunoglobulin (Ig)M and IgG antibodies in all patients included in your study suggested that these patients had not been infected with COVID-19. These lesions appeared not to be directly related to COVID-19. MedicalResearch.com: What should readers take away from your report? Response: One hypothesis points to an indirect consequence of the COVID-19 pandemic due to imposed community containment and lockdown measures. Indeed, all patients in this study had either been working from home or were home-schooled since the beginning of containment measures in Belgium (March 11, 2020) or were temporarily unemployed. As a result of containment measures, the majority (64.5%) of patients reported a decrease in their physical activity and significantly more time spent in sedentary positions in front of screens. Most of the patients declared that they remained barefoot or in socks most of the day. All these lifestyle changes can be considered as risk factors for developing chilblains. Therefore, it seems plausible that containment, through its collateral effects, may induce chilblains. Interestingly also, the mean BMI of the patients included was relatively low, suggesting that thin people may be more at risk of developing chilblains. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: During the current pandemic, several reports have suggested a possible link between cutaneous manifestations including aural lesions such as chilblains, and COVID-19, however, only few patients were tested for SARS-CoV-2 by RT-PCR and no serologic tests were performed. Therefore, reliable testings (RT-PCR and serologic testing) are essential to confirm a potential association with COVID-19. Citation: Herman A, Peeters C, Verroken A, et al. Evaluation of Chilblains as a Manifestation of the COVID-19 Pandemic. JAMA Dermatol. Published online June 25, 2020. doi:10.1001/jamadermatol.2020.2368 https://jamanetwork.com/journals/jamadermatology/fullarticle/2767774 [subscribe] Last Modified: [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.](https://medicalresearch.com/wp-content/uploads/2020/06/chilblain-example-dermnet-nz.jpg)
Response: It is well known that marijuana usage impairs driving ability, yet the early studies of the effects of recreational marijuana legalization on traffic fatalities were inconclusive.
MedicalResearch.com: What are the main findings?
Response: By analyzing data over a longer time period, we found that the legalization of recreational marijuana increased traffic deaths in the first four states to legalize. Traffic fatalities increased about 20% in those states. If we apply these numbers to the nation as a whole, nationwide legalization would be associated with about 7,000 excess traffic fatalities each year.
Dr. Desai[/caption]
Nimesh D. Desai, MD, PhD
Director, Thoracic Aortic Surgery Research Program
Associate Professor of Surgery
Hospital of the University of Pennsylvania
MedicalResearch.com: What is the background for this study?
Dr. Chase Brown: Opioid use in the United States is a public health emergency. We know that opioids prescribed after general surgery operations to patients who never received them within the year prior to their surgery are at increased risk for continuing to take opioids months later. However, this has not been studied in patients undergoing cardiac surgery, who often times have more severe post-operative pain.
Our goal in this study was to determine how many patients after cardiac surgery and are opioid naive are continuing to take opioids within 90-180 days after their surgery. 
