• Many Covid-19 patients present with blood clots that can be deadly
• These blood clots are linked to the endothelial cells that line the inside of blood vessels 
• Researchers are trying to find strategies to safeguard the endothelial layer and prevent blood clots from forming

Covid-19 is linked to potentially fatal blood clots. Researchers now believe they’ve found out how they occur, which potentially could lead to better treatment.

“While many forms of illness can generate blood clots, the endothelial cells that line the inside of blood vessels play a surprisingly large role in Covid-19 clotting,” said researcher Dr Alfred Lee, an associate professor of medicine at Yale Cancer Center.

“Endothelial damage is a central component in the entire spectrum of Covid-19 disease. Our study is the first to demonstrate that this process of endothelial damage is present in a wide range of Covid-19 patients, particularly as people become critically ill,” Lee said in a Yale news release.

For the study, Lee and his team examined the blood of 68 patients with Covid-19. Of these patients, 48 were critically ill in an ICU. The other 20 were hospitalised but not in the ICU.

Therapeutic strategies

The researchers found that some markers of endothelial cell and blood platelet activation were nearly twice as high in the ICU patients compared to those not in the ICU.

One marker, called thrombomodulin, was linked with survival among all patients. Measuring thrombomodulin might help doctors better treat patients, the researchers say.

“If we have a marker to identify which patients are most likely to progress towards critical illness and possibly death, that would be hugely helpful, as these patients might benefit from closer monitoring and possibly earlier intervention,” Lee said.

Study co-author Dr Hyung Chun is trying to develop a test based on thrombomodulin, which is elevated in other life-threatening diseases as well.

“The other goal we’re pursuing in parallel is to find therapeutic strategies that could safeguard the endothelial layer and may prevent the blood clots from forming,” said Chun, an associate professor of medicine and pathology at Yale School of Medicine. “Are there approved drugs we could potentially repurpose for this context?”

One possible candidate is the drug dipyridamole, used to prevent stroke.

The report was published late in June in the journal The Lancet Haematology.

^{Image credit:}

Antibody tests suggest similar exposure to the virus in the two capitals, despite different strategies.

An NHS Confederation report predicts a 20% increase in demand for services in the coming months.

Northwestern University researchers have uncovered a new vulnerability in the novel coronavirus’ infamous spike protein — illuminating a relatively simple, potential treatment pathway.

A team of medical researchers has found that in human milk, pasteurisation inactivates the virus that causes COVID-19, confirming milk bank processes have been safe throughout the pandemic, and will remain safe going forward, too.

Uncertainties in the evolutionary tree of birds and their closest relatives have impeded deeper understanding of early flight in theropods, the group of dinosaurs that includes birds. To help address this, an international study led by HKU Research Assistant Professor Dr. Michael Pittman (Vertebrate Palaeontology Laboratory, Division of Earth and Planetary Science & Department of Earth Sciences) and co-first-authored by his former Postdoctoral Fellow Dr. Rui Pei (now an Associate Professor at the Institute of Vertebrate Paleontology and Paleoanthropology, Beijing), produced an updated evolutionary tree of early birds and their closest relatives to reconstruct powered flight potential, showing it evolved at least three times. Many ancestors of the closest bird relatives neared the thresholds of powered flight potential, suggesting broad experimentation with wing-assisted locomotion before flight evolved.

Health minister Edward Argar says it is “evolving and flexing”, amid plans to cut 6,000 contact tracers.

• A new class of diabetes drugs has many positive effects, but also has some serious side effects
• SGLT2s may lead to infections and a higher risk of diabetic ketoacidosis (DKA)
• Staying hydrated is, however, a good way of preventing DKA

People taking a class of diabetes medications called SGLT2s have up to three times the risk for a serious complication called diabetic ketoacidosis (DKA) compared to people taking another drug, new research reveals.

SGLT2 (sodium-glucose cotransporter-2) inhibitors – such as Farxiga, Jardiance and Invokana – are a newer type of oral diabetes medicine. This class of medications is known to have many positive effects, including lowering a patient’s risk of heart attack, heart failure, kidney disease and death from heart disease.

But several troubling side effects, including infections and a possible increased risk of DKA, have emerged.

An adverse effect

“There was some uncertainty about how much the risk of DKA was, so we wanted to get a more precise estimate of the risk. We found a threefold increased risk,” said senior author Kristian Filion. He’s an investigator in clinical epidemiology at the Lady Davis Institute at Jewish General Hospital in Montreal, Canada.

“DKA appears to be a side effect of SGLT2s,” he said. “It’s an adverse effect that physicians need to be aware of, and alert their patients to.”

SGLT2 inhibitors cause the kidneys to remove blood sugar through urination, which lowers overall blood sugar levels, according to the US Food and Drug Administration.

Dr Akankasha Goyal, an endocrinologist at NYU Langone Health in New York City, explained that when SGLT2s lower blood sugar levels, insulin production slows. Insulin is a hormone that is necessary for moving sugar from the blood into the body’s cells.

If you don’t have enough insulin to let your blood sugar fuel your cells, the body turns to stored fat for energy. A by-product of this process is ketones, according to the American Diabetes Association (ADA).

If ketones build up in the blood, it becomes more acidic and causes diabetic ketoacidosis, Goyal explained.

There is good news

“DKA is a diabetic emergency. Someone in DKA needs to be hospitalised,” she said. The condition is usually rare in people with type 2 diabetes because they usually make enough insulin to prevent it, she added.

Untreated, DKA can lead to death, the ADA said.

The new study included more than 200 000 people with type 2 diabetes who started using SGLT2 inhibitors between 2013 and 2018. They were compared to a matched group of people who took a different class of diabetes medications called DPP-4 inhibitors.

During the study, 521 people were diagnosed with DKA.

For people taking SGLT2 inhibitors, the risk of DKA was nearly three times higher, the study found. And, risk varied with the type of SGLT2 inhibitor used.

Dapagliflozin (Farxiga) was linked to an 86% increase in DKA risk, while patients using empagliflozin (Jardiance) had 2.5 times the risk of DKA compared to those on DPP-4s, the study found. Canagliflozin (Invokana) was associated with 3.6 times higher odds of DKA.

The good news, however, is that you can take steps to prevent DKA and get the benefits of SGLT2 inhibitors.

Potent and effective medications

Goyal said the risk of DKA is highest when someone begins taking an SGLT2 inhibitor. Staying hydrated is a good way to help prevent it. It’s also important to check with your diabetes doctor before taking any new medications. And, find out how often you should check your blood sugar levels.

She said it’s also important to be aware of the DKA symptoms so you can seek treatment without delay if needed.

Symptoms include dry mouth, frequent thirst and urination, fatigue, nausea and vomiting, trouble concentrating and fruity-smelling breath, according to the ADA.

Goyal said SGLT2 inhibitors are a potent and effective class of medications.

“They really help with diabetes and heart failure, and can even help with cardiovascular risk in people who don’t yet have heart disease,” she said. “These medications are really good for people with kidney disease, too. And they’re easy. One pill, once a day.”

Benefit for heart and kidneys

Filion said all drugs have benefits and risks that should be brought to patients’ attention.

“These drugs have been shown to lower blood glucose levels and have benefits for the heart and kidneys. They also have some risks,” he said. “Patients and physicians need to discuss the benefits and risks, particularly the risk factors for DKA.”

The report was published online in the Annals of Internal Medicine.

^{Image credit: iStock}

• Like humans, cats are also prone to disease, including heart disease
• Most heart diseases in cats are caused by heart muscle disorders, called cardiomyopathies
• Many human medications for heart problems also work for cats

As evidenced by the countless adoring posts, cute videos and laugh-out-loud memes on social media, people love their furry feline friends. But keeping cats happy and healthy isn’t always easy.

Indeed, cats suffer many of the same health problems humans do, including heart disease.

“We can roughly break down cat heart diseases into birth defects and acquired heart defects that they develop during life,” said Dr John Bonagura, a cardiologist and member of the department of clinical sciences at North Carolina State University College of Veterinary Medicine.

Congenital conditions include septal defects, or holes in the heart, malformed heart valves and blood vessel abnormalities. Heart disease in older cats can be related to thyroid disease or high blood pressure.

Hypertrophic cardiomyopathy

However, the vast majority of heart diseases in cats are caused by cardiomyopathies, which are heart muscle disorders that make it harder for the heart to effectively pump blood. These conditions can cause heart failure or sudden death, even in younger animals, and are more common in male cats.

Maine Coon and Ragdoll cats are among the breeds prone to inherited cardiomyopathies, but any breed can develop a similar condition. The most common cardiomyopathy, called hypertrophic cardiomyopathy, causes thickening of the heart’s left ventricle.

Cats with hypertrophic cardiomyopathy are at greater risk for fast or irregular heartbeats, heart failure that causes breathing difficulties, and blood clots. A clot in the legs can cause problems walking or even paralysis, while a clot in the heart can cause a heart attack.

“They don’t have the atherosclerosis that we do,” said Dr Mark Kittleson, a professor emeritus at the School of Veterinary Medicine at the University of California, Davis.

According to Kittleson, most cats with cardiomyopathies don’t have obvious symptoms. But if your cat is breathing faster or struggling to catch its breath, take it to the vet.

Heart transplants not possible

“Cats love to hide their clinical signs until they are in dire straits and then they tip over the edge,” he said. “One second they are fine, and the next second, it’s awful. It’s an acute, devastating situation.”

There are a limited number of genetic tests to screen Maine Coon and Ragdoll cats for cardiomyopathies. In other breeds, veterinarians use an echocardiogram, which creates an image of the heart using sound waves, to make a definitive diagnosis.

People with hypertrophic cardiomyopathy sometimes require open-heart surgery or heart transplants, but that’s currently not possible in cats, which are too small to be hooked up to a heart-lung machine.

The good news is some of the medications that people take for heart problems also work in cats. For example, drugs that prevent clotting, such as aspirin or clopidogrel often are prescribed to cats with cardiomyopathies. And just as in humans, a common treatment for heart failure is a diuretic.

There also is medication to prevent heartworms, a potentially life-threatening condition for which there is no specific cure.

“Even two or three worms, which is the average number in cats, can be lethal,” Bonagura said. “Being indoors doesn’t really protect them, so people who live in areas where heartworm is prevalent should have their cats on preventative medicine as well.”

‘Cats are pretty tough’

As many cat owners know all too well, getting a kitty to take its meds isn’t always easy. Bonagura recommended cutting the pills into pieces, putting them into a clear gel cap and coating it with a little butter.

“Cats are very taste and smell adverse, so if they bite into something bitter, they may be very hard to treat,” Bonagura said. “Teach them to gradually accept things and give them rewards.”

Other potential treatments for cats with heart problems include oxygen therapy, a low-sodium diet, a specific veterinary drug that can improve heart function called pimobendan, and procedures to remove extra fluid from the chest or abdomen.

While it can be scary when your cat has heart disease and some cases are severe, Bonagura said the right treatment and home care will increase the odds they will live a longer and happy life.

“Cats are pretty tough,” he added. “They almost do have nine lives.”

^{Image credit: iStock}