(HealthDay News) — There have now been more than 40 million cases of COVID-19 recorded among Americans, according to a database maintained by The New York Times. That is nearly one-fifth of the global total of cases.

With the delta variant of the severe acute respiratory syndrome coronavirus 2 virus cutting a swathe through the United States and about 47 percent of the eligible population still not fully vaccinated, COVID-19 has roared back during a summer that began with Americans hopeful that the worst was behind them.

According to The Times, as of Sunday, there have been an average 161,000 new cases of COVID-19 in the United States each day. Hospitalizations are topping 102,000 each day, and the daily COVID-19 death toll is now at 1,560. The vast majority of people hospitalized and dying are unvaccinated, greatly burdening an already overburdened health care system. According to The Times, no state has yet gotten more than 70 percent of its population fully vaccinated.

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Things are so bad in Idaho that rationing of care is underway. Dave Jeppesen, the state’s director of the Department of Health and Welfare, said on Tuesday, “When crisis standards of care are in effect, people who need medical care may experience care that is different from what they expect. For example, patients admitted to the hospital may find that hospital beds are not available or are in repurposed rooms (such as a conference room).” Jeppesen added, “This is a decision I was fervently hoping to avoid.”

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In hard-hit West Virginia, Gov. Jim Justice read out a list of people who had died of conditions linked to COVID-19 since Friday. “We’ve got to get vaccinated for all, not just for you but for everybody — we’ve got to do this,” Justice said. “We can stop a lot of this terrible, terrible carnage.”

The New York Times Article

Patients with systemic lupus erythematosus (SLE) and cognitive impairment (CI) have distinct differences in brain functional connectivity compared with patients with SLE without CI and healthy control participants, according to study results presented at the American College of Rheumatology (ACR) Convergence 2021, held virtually from November 3 to 10, 2021.

Cognitive impairment is the most common manifestation of neuropsychiatric SLE; however, its underlying mechanisms remain poorly understood.

In the current study, the researchers sought to explore the associations between enhanced permeability of the blood-brain barrier (BBB), loss of grey matter volume, and CI in patients with SLE. Non-task-based functional connectivity between regions of the brain were examined using resting state functional magnetic resonance imaging (rsfMRI).

A total of 78 adult patients with SLE (49.4±14.3 years; 89.7% women) and 71 healthy control participants (38.9±12.9 years; 69.0% women) were enrolled in the study from a single academic medical center in Halifax, Nova Scotia, Canada. Global cognitive function and performance in 5 different domains were evaluated using standard neuropsychologic tests. Dynamic contrast-enhanced MRI was used to measure BBB permeability.

All participants underwent rsfMRI, in which blood oxygen level-dependent (BOLD) signals were obtained to exhibit neural activation. To analyze the resting-state functional connectivity (rsFC) between brain regions, mean BOLD signals were obtained from 131 regions across 5 canonic resting-state brain networks. All rsFC values were then compared among patients with SLE and CI, patients with SLE without CI, and healthy control participants, as well as among patients with SLE with extensive BBB permeability, patients with SLE without extensive BBB permeability, and healthy control participants.

Overall, 51 connections between functional brain regions were shown to differ significantly between patients with SLE with and without CI (P <.05). According to multivariate analysis of variance, significant differences were observed between patients with SLE with CI and healthy control participants (P =.006). The mean functional connectivity of affected regions differed between patients with SLE with normal BBB permeability and patients with SLE with extensive BBB leakage (P =.025).

In addition, patients with SLE with CI and those with SLE with extensive BBB leakage had more positive functional connections compared with those in the other groups. Further, the total number of brain-wide connections of specific brain regions decreased with greater BBB permeability (P =.011) and were significantly lower among patients with SLE with CI than in those with SLE without CI (P =.01).

The researchers concluded that study findings implied an association between BBB leakage and neural pathology that underlies CI in patients with neuropsychiatric SLE.

(HealthDay News) — For hospitalized adults with COVID-19, treatment with baricitinib in addition to standard of care does not reduce the frequency of disease progression overall, but it is associated with reduced mortality, according to a study published online Sept. 1 in The Lancet Respiratory Medicine.

Vincent C. Marconi, M.D., from Emory University School of Medicine in Atlanta, and colleagues conducted a phase 3, double-blind trial involving participants from 101 centers across 12 countries. Hospitalized adults with COVID-19 receiving standard of care were randomly assigned to once-daily baricitinib or matched placebo (764 and 761, respectively) for up to 14 days. The proportion of patients who progressed to high-flow oxygen, noninvasive ventilation, invasive mechanical ventilation, or death by 28 days was the composite primary end point.

The researchers found that 27.8 and 30.5 percent of participants receiving baricitinib and placebo, respectively, progressed to meet the primary end point (odds ratio, 0.85; 95 percent confidence interval, 0.67 to 1.08; P = 0.18). The 28-day all-cause mortality rate was 8 and 13 percent for baricitinib and placebo, respectively (hazard ratio, 0.57; 95 percent confidence interval, 0.41 to 0.78; nominal P = 0.0018); per 20 baricitinib-treated patients, one additional death was prevented. The 60-day all-cause mortality was 10 and 15 percent for baricitinib and placebo, respectively (hazard ratio, 0.62; 95 percent confidence interval, 0.47 to 0.83; P = 0.0050). The two groups had similar frequencies of serious adverse events, serious infections, and venous thromboembolic events.

“Baricitinib plus standard of care could be a treatment option to reduce overall deaths in the context of the global burden of mortality during the COVID-19 pandemic,” the authors write.

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Several authors disclosed financial ties to pharmaceutical companies, including Eli Lilly and Company, which manufactures baricitinib and funded the study, under license from Incyte Corporation.

Abstract/Full Text



Hanly J, Robertson J, Kamintsky L, et al. Functional connectivity, enhanced blood-brain barrier leakage and cognitive impairment in systemic lupus erythematosus. Presented at: ACR Convergence 2021; November 3-10, 2021. Abstract 0456.

This article originally appeared on Rheumatology Advisor