Anticoagulation is the answer in treating noncritical COVID-19 patients.

All autopsy studies demonstrated widespread thrombosis and alveolar-capillary microthrombi as the cause of death among patients with COVID-19. The autopsy studies are the gold-standard for diagnostic accuracy and therapeutic strategies for any clinical scenarios. The author initially observed that patients already taking therapeutic dose of oral direct factor Xa inhibitors for an unrelated reason, have significantly better survival rates than those not taking any anticoagulants. This influenced the author to conduct a retrospective chart review of the hospitalized patients in Jackson Hospital (Alabama) to evaluate the effect of variable doses of anticoagulation among COVID-19 patients. The study found that serum inflammatory bio-marker D-dimer trends are associated with changes in oxygen requirement among patients with COVID-19, if patients present at an early stage, and titration of Enoxaparin (anticoagulation) dose based on D-dimer trends leads to increased patient survival.

Association between depression and intima-media thickness of carotid bulb in asymptomatic young adults.

OBJECTIVE: Although there is growing evidence that symptoms of depression influence the development of coronary artery disease, information on the underlying subclinical atherosclerotic process is scant in young adults. The study examined the association between symptoms of depression and subclinical atherosclerosis, determined by carotid intima-media thickness in asymptomatic young individuals. METHODS: A cross-sectional study was performed in Bogalusa, Louisiana, a semi-rural biracial (black-white) community. A sample of 996 individuals aged 24 to 44 years (71% were white and 43% were male) enrolled in the Bogalusa Heart Study. The variables included symptoms of depression measured by the Center for Epidemiological Studies-Depression Scale; intima-media thickness of different segments of carotid artery by B-mode ultrasonography; measures of adiposity and glucose homeostasis, lipoproteins, and blood pressure; and cigarette smoking status. RESULTS: Both the adjusted and the unadjusted associations between depression score and carotid bulb intima-media thickness were significant, whereas similar associations with internal carotid and common carotid thickness were nonsignificant. In the multivariable regression model, after adjusting for all covariates, a positive effect of depression scores (Center for Epidemiological Studies-Depression score) and a negative effect of interaction between depression score ratio of total cholesterol (TC)/high-density lipoprotein (HDL) were significant. In a subgroup analysis (among individuals with a ratio of TC/HDL < or = 5) a positive effect of depression on carotid bulb intima-media thickness was significant, whereas the interaction between depression and ratio of TC/HDL was nonsignificant. In subsequent analysis, if individuals with a higher ratio of TC/HDL were included, both depression and negative interaction term were significant. CONCLUSION: The observations show the detrimental effect of depression on subclinical vascular changes in asymptomatic young individuals. The findings underscore the need for considering depression in risk factor profiling. Further study is recommended to investigate the basis of a lower carotid bulb intima-media thickness among subjects with a high depression score and a high ratio of TC/HDL.

Racial differences in cesareans: an analysis of U.S. 2001 National Inpatient Sample Data.

OBJECTIVE: To evaluate racial differences in potentially unnecessary cesareans in the United States. METHODS: The 2001 Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to analyze various maternal demographic and clinical parameters among women having cesarean deliveries. For the purpose of our study, if there were no diagnoses related to cesarean delivery on the discharge certificate, the cesarean was classified as potentially unnecessary RESULTS: Using our methodology, 11% of 540,174 primary and 65% of 371,863 repeat cesareans for the year 2001 in the United States were classified as potentially unnecessary. After controlling for age, payment source, ZIP income, admission day, region of the country, and hospital size, location, and teaching status, black women had a higher likelihood of having potentially unnecessary primary cesareans when compared with white (P < .001) or Hispanic women (P < .001). White women had a higher likelihood of having potentially unnecessary repeat cesareans than black women (P < .001), although the magnitude of the odds ratio for race was not as striking as in primary cesarean. Potentially unnecessary primary cesareans were also more likely to occur in women aged 35 years or older, Medicare patients, weekend admissions, or those residing in the South or Northeast. Potentially unnecessary repeat cesareans were more likely to occur in women younger than 35 years, in rural hospitals, and in weekday admissions. CONCLUSION: In the United States, racial differences exist in the proportion of cesarean deliveries that are potentially unnecessary. Further exploration of these differences is warranted. LEVEL OF EVIDENCE: III.

Unnecessary cesarean delivery in Louisiana: an analysis of birth certificate data.

OBJECTIVE: The purpose of this study was to explore the temporal trends and factors that are associated with cesarean deliveries and potentially unnecessary cesarean deliveries. STUDY DESIGN: The Louisiana birth certificate database was evaluated to identify a total of 57 potential indications/risk factors and maternal demographic factors that are associated with methods of delivery over the period from January 1993 to December 2000. A cesarean delivery without any potential indications/risk factors in the birth certificate was classified as unnecessary. RESULTS: The primary cesarean delivery rate decreased and the repeat cesarean delivery rate increased significantly during the study period. But neither the absence nor the presence of potential indications/risk factors accounted for these changes. The average potentially unnecessary primary and repeat cesarean deliveries in Louisiana were 17 and 43, respectively, per 100 cesarean deliveries over the years 1993 through 2000. CONCLUSION: The proportions of potentially unnecessary cesarean deliveries are relatively high in Louisiana. It is important to explore the influence of nonclinical factors on unnecessary cesarean delivery to reduce the cesarean rates.