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17 PATIENT SAFETY & OUTCOMES 'COVID toes' linked to immune system overreaction, small study suggests By Cailey Gleeson A British Journal of Dermatology study pub- lished Oct. 6 shed more light on "COVID toes," a symptom of some COVID-19 patients who experience toes and fingers that change color, itch and swell. Researchers examined "chilblain-like lesions," which have been extensively reported in COVID-19 cases, in the blood samples and skin biopsies of 50 patients with COVID-like symptoms at Saint-Louis hospital in France in April 2020. Researchers found high levels of Type 1 interferon, a protein that activates the body's immune system to fight viruses, but can also cause damage. The researchers also found high levels of an antibody that can inadvertently attack the body's own cells. The study suggested treating the condition with local or systemic anti-inflammatory agents. n Convalescent plasma offers little benefit to severe COVID-19 patients, study suggests By Erica Carbajal W hile convalescent plasma was among the arsenal of tools to fight COVID-19 in the first few months of the pandemic, it has little effect on improving outcomes among critically ill COVID-19 patients, according to research published Oct. 4 in JAMA. The study involved 2,011 severely ill COVID-19 patients across 129 sites in four countries, including the U.S. About half received two units of high-titer convalescent plasma, while the other half did not. Treatment with convalescent plasma did not significantly reduce the number of days spent on life support, findings showed. "Among critically ill adults with confirmed COVID-19, treatment with convalescent plasma had a low likelihood of providing im- provement in organ support-free days," researchers said. The in-hospital mortality rate for the convalescent plasma group was 37.3 percent and slightly higher at 38.4 percent among those who didn't receive it. For both groups, the median number of days alive and free of organ support was 14. n Substance use disorders tied to higher risk of breakthrough COVID-19, study finds By Erica Carbajal W hile the overall risk is low, people with substance use disorders such as drug and alcohol abuse may be more susceptible to a breakthrough COVID-19 infection than those without the disorders, research published Oct. 5 in World Psychiatry suggests. Researchers from Case Western Reserve University in Cleveland and the National Institute on Drug Abuse evaluated EHRs of nearly 580,000 fully vaccinated people in the U.S. between Dec. 1, 2020, and Aug. 14, 2021, who had not had COVID-19 before. Of those, about 5 percent had a diagnosed substance use disorder. About 7 percent of fully vaccinated people with substance use disorders developed a breakthrough COVID-19 infection, com- pared to 3.6 percent of people without such disorders, the findings showed. e risk differed based on the type of substance abuse disorders, ranging from 6.8 percent for peo- ple with tobacco use disorder to 7.8 percent for cannabis use disorder. Nearly 23 percent of breakthrough COVID-19 patients with these disorders were hospitalized, and 1.7 percent died. e rates were 1.6 percent and 0.5 per- cent, respectively, among people with the disorders but no breakthrough infection. Overall, the risk of severe outcomes related to breakthrough infections was higher among patients with substance use disorders compared to patients without. People with substance use disorders were more likely to have other chronic conditions and adverse socioeconomic characteristics, which is likely why the risk of breakthrough infections among this group was higher, researchers said. e risk was not different for people with substance abuse disorders compared to those without aer researchers controlled for these factors. e exception was for people with cannabis use disorders, who still had a 55 percent higher risk of break- through infections. Researchers hypothe- sized this may be due to the drug's effect on lung and immune function. "We must continue to encourage and facil- itate COVID-19 vaccination among people with substance use disorders, while also acknowledging that even aer vaccination, this group is at an increased risk and should continue to take protective measures against COVID-19," said NIDA Director Nora Vol- kow, MD, one of the study's lead authors. n