Atypical presentation of COVID-19 in hospitalised older adults

Background

It is increasingly recognised that older patients may not present with typical symptoms of COVID-19.

Aims

This study aims to evaluate the incidence, characteristics and clinical outcome of older adults with atypical presentations of COVID-19.

Methods

A retrospective analysis of adults ≥ 65 years with confirmed COVID-19 admitted to our institution between 1 March and 24 April 2020 was performed. Patients were categorised into typical or atypical groups based on primary presenting complaint in the community.

Results

One hundred twenty-two patients (mean age 81 ± 8 years; 62 male) were included. Seventy-three (60%) were categorised into the typical group and 49 (40%) into the atypical group. In the atypical group, common presenting complaints were fall in 18 (36%), reduced mobility or generalised weakness in 18 (36%) and delirium in 11 (22%). Further assessment by paramedics and on admission found 32 (65%) to have typical features of COVID-19, fever being the most common, and 22 (44%) were hypoxic. This subset had worse outcomes than those in the typical group with a mortality rate of 50% versus 38%, respectively, although this was not statistically significant (P = 0.27). No significant difference in mortality or length of hospital stay between the groups was demonstrated.

Conclusion

Older patients with atypical presentation of COVID-19 in the community are equally susceptible to poor outcomes. Early detection may improve outcomes and limit community transmission. Primary care practitioners should be vigilant and consider prompt onward referral.

Dietary nitrate improves vascular function in patients with hypercholesterolemia: a randomized, double-blind, placebo-controlled study

BACKGROUND

The beneficial cardiovascular effects of vegetables may be underpinned by their high inorganic nitrate content.

OBJECTIVE

We sought to examine the effects of a 6-wk once-daily intake of dietary nitrate (nitrate-rich beetroot juice) compared with placebo intake (nitrate-depleted beetroot juice) on vascular and platelet function in untreated hypercholesterolemics.

DESIGN

A total of 69 subjects were recruited in this randomized, double-blind, placebo-controlled parallel study. The primary endpoint was the change in vascular function determined with the use of ultrasound flow-mediated dilatation (FMD).

RESULTS

Baseline characteristics were similar between the groups, with primary outcome data available for 67 patients. Dietary nitrate resulted in an absolute increase in the FMD response of 1.1% (an ∼24% improvement from baseline) with a worsening of 0.3% in the placebo group (P < 0.001). A small improvement in the aortic pulse wave velocity (i.e., a decrease of 0.22 m/s; 95% CI: -0.4, -0.3 m/s) was evident in the nitrate group, showing a trend (P = 0.06) to improvement in comparison with the placebo group. Dietary nitrate also caused a small but significant reduction (7.6%) in platelet-monocyte aggregates compared with an increase of 10.1% in the placebo group (P = 0.004), with statistically significant reductions in stimulated (ex vivo) P-selectin expression compared with the placebo group (P < 0.05) but no significant changes in unstimulated expression. No adverse effects of dietary nitrate were detected. The composition of the salivary microbiome was altered after the nitrate treatment but not after the placebo treatment (P < 0.01). The proportions of 78 bacterial taxa were different after the nitrate treatment; of those taxa present, 2 taxa were responsible for >1% of this change, with the proportions of Rothia mucilaginosa trending to increase and Neisseria flavescens (P < 0.01) increased after nitrate treatment relative to after placebo treatment.

CONCLUSIONS

Sustained dietary nitrate ingestion improves vascular function in hypercholesterolemic patients. These changes are associated with alterations in the oral microbiome and, in particular, nitrate-reducing genera. Our findings provide additional support for the assessment of the potential of dietary nitrate as a preventative strategy against atherogenesis in larger cohorts. This trial was registered at clinicaltrials.gov as NCT01493752.

The aging retarding effect of 'Long-Life CiLi'

'Long-Life CiLi' ('CiLi') oral liquid, is composed of superoxide dismutase (SOD), polysacchairide, vitamin C, vitamin E and trace elements which were all extracted from a natural plant fruit Cili (Rosa roxburghii Tratt) in Guizhou, China. A set of indices were evaluated after administration of 'CiLi' 10 ml Bid, for two months in 50-75 years old healthy people, the mean value of NK cell activity (22.4 +/- 10.8-->27.5 +/- 12.9%, P < 0.05), SOD (453.0 +/- 24.2-->468.6 +/- 21.3 micrograms/gHb, P < 0.001), Catalase (15.5 +/- 1.7-->17.4 +/- 3.0 U/mgHb, P < 0.001) and GSH content (2.3 +/- 0.3-->2.6 +/- 0.5 mg/gHb, P < 0.001) in erythrocytes and 'delta CO, CI, SV, SI, LVET, LVETI and AC' values increased significantly, while the serum LPO level (4.20 +/- 0.78-->3.78 +/- 0.50 nmol/ml, P < 0.001), total microcirculation weighed value (1.87 +/- 1.0-->0.92 +/- 0.5, P < 0.001), delta PVR (-241.7 +/- 733.2-->187.9 +/- 938.2, P < 0.05) and the light reaction time (Simple RT, red light: 383 +/- 128-->332 +/- 68.9 ms, P < 0.05; selective RT: red light 709 +/- 287-->566 +/- 119 ms, P < 0.05; green light 639 +/- 162-->536 +/- 80 ms, P < 0.01) decreased significantly. There were no significant differences in the control group. The mean life span of fruit flies were significantly elongated for low, medium and high concentrations 'CiLi' treatment groups than in the control group (Female: 57.6 +/- 11.3-->62.1 +/- 12.8; 69.6 +/- 14.7; 62.6 +/- 12 days; P < 0.05 approximately 0.001. Male: 56.3 +/- 9.6-->64.9 +/- 12.4; 64.5 +/- 14.5; 64.8 +/- 14.1 days, P < 0.001). It is suggested that 'CiLi' has an aging retarding and geroprotection effect.

Mucopolysaccharide histochemistry of the oviduct of the toad, Bufo melanostictus, before and during ovulation

In both non-ovulating and ovulating toads of the species, Bufo melanostictus, the fimbrium stained only weakly for mucopolysaccharides (MPs) whereas the infundibulum stained strongly for neutral MPs and also for glycogen. In the non-ovulating toad, only neutral and sulphated MPs were detected in the goblet cells of the upper magnum, whereas sulphated, neutral and sialomucins were detected in the glands. In the middle magnum, sulphated and sialic acid-containing carboxylated MPs were detected in both the goblet cells and glands. In the lower magnum, neutral, sulphated, and sialic acid-containing MPs were detected in the goblet cells and only sulphated and sialic acid-containing MPs were detected in the glands. In the isthmus and ovisac, only sulphated MPs were present in the goblet cells. During ovulation, there was no change in the distribution of sulphated MPs throughout the oviduct. Sialic acid-containing MPs could not be detected in many of the goblet cells of the upper and lower magnum nor in most of the glands of the lower magnum.