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MeSH Disease

Pneumonia (97)

COVID-19 (96)

Fever (29)

Death (19)

Lymphopenia (18)


HGNC Genes

SARS-CoV-2 proteins

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    LENZILUMAB EFFICACY AND SAFETY IN NEWLY HOSPITALIZED MESHD COVID-19 MESHD SUBJECTS: RESULTS FROM THE LIVE-AIR PHASE 3 RANDOMIZED DOUBLE-BLIND PLACEBO-CONTROLLED TRIAL

    Authors: Zelalem Temesgen; Charles D. Burger; Jason Baker; Christopher Polk; Claudia Libertin; Colleen Kelley; Vincent C Marconi; Robert Orenstein; Cameron Durrant; Dale Chappell; Omar Ahmed; Gabrielle Chappell; Andrew Badley

    doi:10.1101/2021.05.01.21256470 Date: 2021-05-05 Source: medRxiv

    BACKGROUND: Severe COVID19 MESHD pneumonia MESHD results from a hyperinflammatory immune response (cytokine storm, CS), characterized by GM CSF HGNC mediated activation and trafficking of myeloid cells, leading to elevation of downstream inflammatory chemokines ( MCP1 HGNC, IL8 HGNC, IP10 HGNC), cytokines ( IL6 HGNC, IL1 HGNC), and other markers of systemic inflammation MESHD ( CRP HGNC, D dimer, ferritin). CS leads to fever MESHD, hypotension MESHD, coagulopathy MESHD, respiratory failure MESHD, ARDS, and death MESHD. Lenzilumab is a novel Humaneered anti-human GM CSF HGNC monoclonal antibody that directly binds GM CSF HGNC and prevents signaling through its receptor. The LIVE AIR Phase 3 randomized, double blind, placebo controlled trial investigated the efficacy and safety of lenzilumab to assess the potential for lenzilumab to improve the likelihood of ventilator free survival (referred to herein as survival without ventilation, SWOV), beyond standard supportive care, in hospitalized subjects with severe COVID-19 MESHD. METHODS: Subjects with COVID-19 MESHD (n=520), >18 years <94% oxygen saturation on room air and/or requiring supplemental oxygen, but not invasive mechanical ventilation, were randomized to receive lenzilumab (600 mg, n=261) or placebo (n=259) via three intravenous infusions administered 8 hours apart. Subjects were followed through Day 28 following treatment. RESULTS: Baseline demographics were comparable between the two treatment groups: male, 64.7%; mean age, 60.5 years; mean BMI, 32.5 kg/m2; mean CRP HGNC, 98.36 mg/L; CRP HGNC was <150 mg/L in 77.9% of subjects. The most common comorbidities were obesity MESHD (55.1%), diabetes MESHD (53.4%), chronic kidney disease MESHD (14.0%), and coronary artery disease MESHD (13.6%). Subjects received steroids (93.7%), remdesivir (72.4%), or both (69.1%). Lenzilumab improved the likelihood of SWOV by 54% in the mITT population (HR: 1.54; 95% CI: 1.02 to 2.31, p=0.041) and by 90% in the ITT population (HR: 1.90; 1.02 to 3.52, nominal p=0.043) compared to placebo. SWOV also relatively improved by 92% in subjects who received both corticosteroids and remdesivir (1.92; 1.20 to 3.07, nominal p=0.0067); by 2.96-fold in subjects with CRP HGNC<150 mg/L and age <85 years (2.96; 1.63 to 5.37, nominal p=0.0003); and by 88% in subjects hospitalized <2 days prior to randomization (1.88; 1.13 to 3.12, nominal p=0.015). Survival was improved by 2.17-fold in subjects with CRP HGNC<150 mg/L and age <85 years (2.17; 1.04 to 4.54, nominal p=0.040). CONCLUSION: Lenzilumab significantly improved SWOV in hospitalized, hypoxic subjects with COVID-19 MESHD pneumonia MESHD over and above treatment with remdesivir and/or corticosteroids. Subjects with CRP HGNC<150 mg/L and age <85 years demonstrated an improvement in survival and had the greatest benefit from lenzilumab. NCT04351152

    COVID-19 MESHD and pregnancy: An umbrella review of clinical presentation, vertical transmission, and maternal and perinatal outcomes

    Authors: Agustin Ciapponi; Ariel Bardach; Daniel Comande; Mabel Berrueta; Fernando J Argento; Federico Rodriguez Cairoli; Natalia Zamora; Victoria Santa Maria; Xu Xiong; Sabra Zaraa; Agustina Mazzoni; Pierre Buekens

    doi:10.1101/2021.04.29.21256327 Date: 2021-05-02 Source: medRxiv

    Background We conducted an overview of systematic reviews (SRs) summarizing the best evidence regarding the effect of COVID-19 MESHD on maternal and child health following Cochrane methods and PRISMA statement for reporting (PROSPERO-CRD42020208783). Methods We searched literature databases and COVID-19 MESHD research websites from January to October 2020. We selected relevant SRs reporting adequate search strategy, data synthesis, risk of bias assessment, and/or individual description of included studies describing COVID-19 MESHD and pregnancy outcomes. Pair of reviewers independently selected studies through COVIDENCE web-software, performed the data extraction, and assessed its quality through the AMSTAR-2 tool. Discrepancies were resolved by consensus. Each SR's results were synthesized and for the most recent, relevant, comprehensive, and with the highest quality, by predefined criteria, we presented GRADE evidence tables. Results We included 66 SRs of observational studies out of 608 references retrieved and most (61/66) had "critically low" overall quality. We found a relatively low degree of primary study overlap across SRs. The most frequent COVID-19 MESHD clinical findings during pregnancy were fever (28-100%), mild respiratory symptoms (20-79%), raised C-reactive protein HGNC (28-96%), lymphopenia MESHD (34-80%), and pneumonia MESHD signs in diagnostic imaging (7-99%). The most frequent maternal outcomes were C-section (23-96%) and preterm delivery (14-64%). Most of their babies were asymptomatic (16-93%) or presented fever (0-50%), low birth weight MESHD (5-43%) or preterm delivery (2-69%). The odds ratio (OR) of receiving invasive ventilation for COVID-19 MESHD versus non- COVID-19 MESHD pregnant women was 1.88 (95% Confidence Interval [CI] 1.36-2.60) and the OR that their babies were admitted to neonatal intensive care unit was 3.13 (95%CI 2.05-4.78). The risk of congenital transmission or via breast milk was estimated to be low, but close contacts may carry risks. Conclusion This comprehensive overview supports that pregnant women with COVID-19 MESHD may be at increased risk of adverse pregnancy and birth outcomes and low risk of congenital transmission.

    Randomized, Comparative, Clinical Trial to Evaluate Efficacy and Safety of PNB001 in Moderate COVID-19 MESHD Patients

    Authors: Eric Lattman; Pradnya Bhalerao; ShashiBhushan BL; Neeta Nargundkar; Pornthip Lattmann; Sadasivan Pillai K; P.N. Balaram

    doi:10.1101/2021.04.16.21255256 Date: 2021-04-16 Source: medRxiv

    Objective: To evaluate the efficacy and safety of PNB001 a CCK-A HGNC agonist and CCK-B HGNC antagonist, a new chemical entity with anti-inflammatory and immune stimulation properties, along with Standard of Care (SOC) in patients with moderate COVID-19 MESHD infection. Design: Multi-center, randomized, parallel group, comparative, open label study. Setting: Two tertiary-care hospitals in India. Participants: Patients with laboratory-confirmed SARS-CoV-2 infection MESHD as determined by polymerase chain reaction (PCR) within 2 days of randomization, having pneumonia MESHD with no signs of severe disease MESHD (severe disease means SpO2<=94% on room air), and any two of the following signs or symptoms suggestive of COVID-19 MESHD: fever MESHD, cough MESHD, dyspnea MESHD, or hypoxia MESHD. Interventions: Patients were randomized 1:1 to receive PNB001 at an oral dose of 100 mg three times daily for 14 days with Standard of Care (PNB001+SOC) or only SOC. Main outcome measures: The primary endpoints were mean change in the 8-point WHO Ordinal Scale score from baseline by Day 14 and mortality rate by Day 28. The key secondary endpoints were percentage of patients showing change in clinical status using the ordinal scale, improvement in inflammatory segments in X-ray chest, reduction of days of hospitalization, duration of supplemental oxygen use, days to negative PCR for COVID-19 MESHD and change in inflammation MESHD markers Interlukin-6 ( IL6 HGNC) and C-reactive protein HGNC ( CRP HGNC) from baseline by Day 14. Results: A total of 40 (20 in PNB 001+SOC arm and 20 in SOC arm) patients were randomized and received treatment. The primary endpoint showed significant clinical improvement from baseline to Day 14 with PNB001+SOC (0.22 Vs 1.12; P=0.0421). One patient in PNB001+SOC arm and two patients in SOC arm died (1 Vs 2; HR: 2.0 [95%CI=0.18, 22.05]; P=0.5637) by Day 28. At the end of the treatment by Day 14, more patients achieved zero ordinal scale in PNB001+SOC arm (17 Vs 12; P=0.0766). In the PNB001+SOC arm, change in mean chest X-ray score showed significant improvement (2.05 Vs 1.16; P=0.0321), and more patients quickly showed complete improvement (10 Vs 7; HR: 1.48 [95%CI=0.64, 3.44]; P=0.4309). In the PNB001+SOC arm, patients needed shorter duration of hospitalization in days (9.45 Vs 9.80) and more patients attained earlier discharge from the hospital (19 Vs 15; P=0.0486) with respect to days. The mean duration of supplemental oxygen requirement in days was shorter (5.45 Vs 7.10) and complete withdrawal from supplemental oxygen was more frequent with PNB001+SOC compared to SOC by Day 14 (17 Vs 13; P=0.1441). All patients in both the arms had negative PCR by the end of the study (18 Vs 17; P=0.6265) by similar time (7.6 Vs 7.0). Exploratory analysis done for IL-6 HGNC, CRP HGNC, Neutrophil-Lymphocyte-Ratio (NLR), Platelet-Lymphocyte-Ratio (PLR) and Erythrocyte Sedimentation Rate (ESR) showed statistically significant reduction by Day 14 demonstrating PNB001's anti-inflammatory and immunomodulatory properties. Lymphocyte and neutrophil counts also improved by Day 14. 11 adverse events (AE) in 8 patients were observed with PNB001+SOC compared to 13 AEs in 10 patients with SOC; none of the AEs in PNB001+SOC arm were related to PNB001. The most common AE were tachycardia MESHD and acute respiratory distress syndrome MESHD; there were isolated cases of hepatic enzyme elevation and hyperglycemia MESHD. Overall, safety profile was similar between PNB001+SOC and SOC arms. Conclusions: PNB001 with standard of care showed significant clinical improvement in moderate COVID-19 MESHD patients when compared to standard of care and was well tolerated by moderate COVID-19 MESHD patients.

    Clinical characteristics of COVID-19 MESHD in children and adolescents: a systematic review and meta-analysis

    Authors: Lixiang Lou Sr.; Hui Zhang Sr.; Baoming Tang Sr.; Ming Li; Zeqing Li; Haifang Cao; Jian Li; Yuliang Chong; Zhaowei Li

    doi:10.1101/2021.03.12.21253472 Date: 2021-03-13 Source: medRxiv

    Background: Although the number of COVID-19 MESHD ( coronavirus disease 2019 MESHD) cases continues to increase globally, there are few studies on the clinical characteristics of children and adolescents with COVID-19 MESHD. Objective: To conduct a comprehensive systematic evaluation and meta-analysis of the clinical characteristics of COVID-19 MESHD in children and adolescents to better guide the response to the current epidemic. Methods: We searched PubMed, Embase, the Cochrane Library, Web of Science, CNKI (Chinese database), Clinical Trials.gov and chictr.org.cn (China). The methodological quality of the included literature was evaluated using the Quality Assessment Tool for Case Series Studies. Meta-analysis was performed using STATA 14.0. Heterogeneity was assessed by the Q statistic and quantified using I2. We used fixed-effects or random-effects models to pool clinical data in the meta-analysis. Publication bias was evaluated by the Begg's test. Results: We analyzed 49 studies involving 1627 patients. In the pooled data, the most common clinical symptoms were fever MESHD (56% [0.50-0.61]) and cough (45% [0.39-0.51]). The most common laboratory abnormalities were elevated procalcitonin (40% [0.23-0.57]), elevated lactate dehydrogenase (31% [0.19-0.43]), increased lymphocyte count (28% [0.17-0.42]), increased creatine kinase (28% [0.18- 0.40]), and elevated C-reactive protein HGNC (26% [0.17-0.36]). The most common abnormalities determined by computed tomography were lower-lobe involvement (56% [0.42- 0.70]), ground-glass opacities (33% [0.25-0.42]), bilateral pneumonia MESHD (32% [0.24- 0.40]), patchy shadowing (31% [0.18- 0.45]), and upper lobe involvement MESHD (30% [0.20- 0.41]). Conclusion: Disease severity among children and adolescents with COVID-19 MESHD was milder than that among adult patients, with a greater proportion of mild and asymptomatic cases, and thus, the diagnosis of COVID-19 MESHD and control of the infection source are more challenging.

    Clinical course and risk factors for in-hospital mortality of 205 patients with SARS-CoV-2 pneumonia MESHD in Como, Lombardy Region, Italy

    Authors: Mauro Turrini; Angelo Gardellini; Livia Beretta; Lucia Buzzi; Stefano Ferrario; Sabrina Vasile; Raffaella Clerici; Andrea Colzani; Luigi Liparulo; Giovanni Scognamiglio; Gianni Imperiali; Giovanni Corrado; Antonella Strada; Marco Galletti; Nunzio Castiglione; Claudio Zanon

    doi:10.1101/2021.02.25.20134866 Date: 2021-03-05 Source: medRxiv

    Importance: With randomized clinical trials ongoing and vaccine still a long distance away, efforts to repurpose old medications used for other diseases provide hope for treatment of COVID-19 MESHD. Objectives: To examine the risk factors for in-hospital mortality and describe the effectiveness of different treatment strategies in a real-life setting of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia MESHD. Design: Real-life single-center study during the Lombardy COVID-19 MESHD outbreak. Setting: Valduce Hospital in Como, Lombardy Region, Italy. Participants: 205 laboratory-confirmed patients presenting with SARS-Cov-2 pneumonia MESHD requiring hospitalization. Interventions: All patients received best supportive care and, based on their clinical needs and comorbidities, specific interventions that included the main drugs being tested for repurposing to treat COVID-19 MESHD, such as hydroxychloroquine, anticoagulation, antiviral drugs, steroids or interleukin-6 HGNC pathway inhibitors. Main outcomes and measures: Clinical, laboratory and treatment characteristics were analyzed with univariate and multivariate logistic regression methods to explore their impact on in-hospital mortality and compared with current literature data. Results: Univariate analyses for clinical variables showed prognostic significance for age equal or greater than 70 years (estimated 28-days survival: 21.4 vs 67.4%; p<0.0001), presence of 2 or more relevant comorbidities (35.3 vs 61.8%; p=0.0008), ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F) less than 200 at presentation (21-days survival: 14.7 vs 52.4%;p<0.0001), high levels of lactate dehydrogenase (LDH) (26.4 vs 65.3%; p=0.0001), and elevated C-reactive protein HGNC (CRP) values (25.4 vs 74.9%; p=0.0001), while no statistical significance was found for all the other clinical variables tested. At univariate analysis for the different treatment scheduled, prognostic significance for survival was showed for intermediate or therapeutic-dose anticoagulation (estimated 28-days survival: 37.1 vs 23.4%; p=0.0001), hydroxychloroquine (35.7 vs 27.3%; p=0.0029), early antiviral therapy with lopinavir/ritonavir (60.1 vs 22.4%; p<0.0001), late short-course of steroids (47.9 vs 18.2%; p<0.0001) or tocilizumab therapy (69.4 vs 29.4%; p=0.0059). Multivariable regression confirmed increasing odds of in-hospital death associated with age older than 70 years (odds ratio 3.26, 95% CI 1.81 - 5.86; p<0.0001) and showed a reduction in mortality for patients treated with anticoagulant (-0.37, 0.49 - 0.95; p=0.0273), antiviral (-1.22, 0.16 - 0.54; p<0.0001), or steroids (-0.59, 0.35 - 0.87; p=0.0117) therapy.

    Impact of Early Corticosteroids on 60-day Mortality in Critically MESHD Ill Patients with COVID-19 MESHD: A Multicenter Cohort Study of the OUTCOMEREA Network

    Authors: Claire Dupuis; Etienne de Montmollin; Niccolò Buetti; Dany Goldgran-Toledano; Jean Reignier; Carole Schwebel; Julien Domitile; Mathilde Neuville; Moreno Ursino; Shidasp Siami; Stéphane Ruckly; Corinne Alberti; Bruno Mourvillier; Sebastien Bailly; Virginie Laurent; Marc Gainnier; Bertrand Souweine; Jean-François Timsit

    doi:10.21203/rs.3.rs-293856/v1 Date: 2021-03-03 Source: ResearchSquare

    ObjectivesIn severe COVID-19 MESHD pneumonia MESHD, the appropriate timing and dosing of corticosteroids(CS) is not known. Patient subgroups for which CS could be more beneficial also need appraisal. The aim of this study was to assess the effect of early CS in COVID-19 MESHD pneumonia MESHD patients admitted to the ICU on the occurrence of 60-day mortality, ICU-acquired-bloodstream infections(ICU-BSI), and hospital-acquired pneumonia MESHD and ventilator-associated pneumonia MESHD(HAP-VAP).MethodsWe included patients with COVID-19 MESHD pneumonia MESHD admitted to 11 ICUs belonging to the French OutcomeReaTM network from January to May 2020. We used survival models with ponderation with inverse probability of treatment weighting (IPTW). Inflammation MESHD was defined as Ferritin >1000 µg/l or D-Dimers >1000 µg/l or C-Reactive Protein HGNC >100 mg/dL.ResultsThe study population comprised 302 patients having a median age of 61.6(53-70) years of whom 78.8% were male and 58.6% had at least one comorbidity. The median SAPS II MESHD was 33(25-44). Invasive mechanical ventilation was required in 34.8% of the patients. Sixty-six (21.8%) patients were in the Early-CS-subgroup. Most of them (n=55, 83.3%) received high doses of steroids. Overall, 60-day mortality was 29.4%. The risks of 60-day mortality (IPTWHR =0.88;95% CI 0.55 to 1.39, p=0.58), ICU-BSI and HAP-VAP were similar in the two groups. Importantly, early CS treatment was associated with a lower mortality rate in patients aged 60 years or more (IPTWHR, 0.51;95% CI, 0.29 – 0.91; p=0.02). But, CS was associated with an increased risk of death for the patients younger than 60 years without inflammation MESHD on admission (IPTWHR =8.17;95% CI, 1.76, 37.85; p=0.01).ConclusionFor patients with COVID-19 MESHD pneumonia MESHD, early CS treatment was not associated with patient survival. Interestingly, inflammation MESHD and age can significantly influence the effect of CS.

    Compassionate use of rectal Ozone (O3) in severe COVID-19 MESHD pneumonia MESHD: a case-control study.

    Authors: Marcos Edgar Fernández-Cuadros; María Jesús Albaladejo-Florín; Sandra Alava-Rabasa; Juan Gallego-Galiana; Gerardo Fabiel Pérez-Cruz; Isabel Usandizaga-Elio; Enrique Pacios; David Torres-Garcia; Daiana Peña-Lora; Luz Casique-Bocanegra; María Jesús López-Muñoz; Javier Rodríguez-de-Cía; Olga Susana Pérez-Moro

    doi:10.21203/rs.3.rs-231696/v1 Date: 2021-02-11 Source: ResearchSquare

    Objectives: To evaluate effect of rectal Ozone in severe COVID-19 MESHD pneumonia MESHD and to compare to Standard-of-care (SOC). Material and Methods: In a case-control study, 14 patients with severe bilateral COVID-19 MESHD pneumonia MESHD (positive RT-PCR), treated with SOC and rectal Ozone, were evaluated before-and-after treatment and compared with SOC (14 patients) in a 10 day follow-up period. Ozone-protocol consisted of 8 sessions (1 session/day) of intra-rectal Ozone, (150mL volume, 35mg/ml concentration [5.25mg total dose]). The SOC-protocol included O 2- supply, antivirals (Remdesivir), corticosteroids (Dexamethasone/Metilprednisolone), monoclonal antibodies (Anakinra/Tocilizumab), antibiotics (Azytromicine), anticoagulants (Enoxaparine) and hyperimmune serum (if necessary). Primary outcome variables: a) clinical (O 2- saturation and O 2- supply); b) biochemical (Lymphocyte count, Fibrinogen HGNC, D-Dimer, Urea, Ferritin, LDH, IL-6 HGNC and CRP HGNC); c) radiological Taylor Scale. Secondary outcome variables: a) hospitalization length-of-stay, b) mortality-rate. Results: At baseline, Ozone/SOC-groups were not different on age, comorbidities, O 2 -saturation and O 2 -supply. Patients in Ozone-Group improved O 2- saturation and decrease O 2- supply. SOC maintained O 2- saturation and required more O 2- supply. Lymphocyte-count improved only in Ozone-group and with statistical difference (p<0.05). Biomarkers of inflammation MESHD ( Fibrinogen HGNC, D-Dimer, Urea, LDH, CRP HGNC and IL-6 HGNC) decreased in both groups, but only significantly in favor of Ozone-group (p<0.05). Ferritin showed a significant decrease in the Ozone-group but an increase on the SOC-Group. Radiological pneumonitis MESHD decreased on both groups but the decrease was only significant in the Ozone-Group (p<0.0001). Mortality and length-of-stay, although not significant, were inferior in Ozone-Group. Conclusion: Compassionate use of Rectal Ozone improved O 2 -saturation, reduced O 2 -supply, decreased inflammation MESHD biomarkers and improved Taylor’s radiological scale significantly when compared to SOC-Group. Mortality and length-of-stay was inferior in the Ozone-group, but this difference was not significant.

    Evaluation of the Effectiveness and Safety of Adding Ivermectin to Treatment in Severe COVID-19 MESHD Patients

    Authors: Nurullah Okumuş; Nese Demirtürk; Rıza Aytaç ÇETİNKAYA; Rahmet GÜNER; İsmail Yaşar Avcı; Semiha ORHAN; Petek KONYA; Bengü ŞAYLAN; Ayşegül Karalezli; Levent YAMANEL; Bircan Kayaaslan; Gülden Yılmaz; Ümit Savaşçı; Fatma ESER; Gürhan TAŞKIN

    doi:10.21203/rs.3.rs-224203/v1 Date: 2021-02-08 Source: ResearchSquare

    BACKGROUND AND OBJECTIVES:An effective treatment option is not yet available for SARS-CoV2, which causes the COVID-19 pandemic MESHD and whose effects are felt more and more every day. Ivermectin is among the drugs whose effectiveness in treatment has been investigated. In this study; it was aimed to investigate the presence of gene mutations that alter ivermectin metabolism and cause toxic effects in patients with severe COVID-19 MESHD pneumonia MESHD, and to evaluate the effectiveness and safety of ivermectin use in the treatment of patients without mutation.MATERIALS AND METHODS: Patients with severe COVID19 MESHD pneumonia MESHD were included in the study, which was planned as a prospective, randomized, controlled, single-blind phase 3 study. Two groups, the study group and the control group, took part in the study. Ivermectin 200 mcg/kg/day for five days in the form of a solution prepared for enteral use added to the reference treatment protocol -hydroxychloroquine + favipiravir + azithromycin- of patients included in the study group. Patients in the control group were given only reference treatment with 3 other drugs without ivermectin. The presence of mutations was investigated by performing sequence analysis in the mdr1 HGNC/abcab1 gene with the Sanger method in patients included in the study group according to randomization. Patients with mutations were excluded from the study and ivermectin treatment was not continued. Patients were followed for 5 days after treatment. At the end of the treatment and follow-up period, clinical response and changes in laboratory parameters were evaluated.RESULTS: A total of 66 patients, 36 in the study group and 30 in the control group were included in the study. Mutations affecting ivermectin metabolism was detected in genetic tests of six (16.7%) patients in the study group and they were excluded from the study. At the end of the 5-day follow-up period, the clinical improvement rate was higher in the study group [22/30 (73.3%)] compared to the control group [16/30 (53.3%)] (p=0.10). At the end of the study, mortality developed in 6 patients (20%) in the study group and in 9 (30%) patients in the control group (p=0.37). At the end of the follow-up period, the average peripheral capillary oxygen saturation (SpO2)  values of the study and control groups were found to be 93.5% and 93.0%, respectively. Partial pressure of oxygen (PaO2)/FiO2 ratios were determined as 236.3 ± 85.7 and 220.8 ± 127.3 in the study and control groups, respectively. While the blood lymphocyte count was higher in the study group compared to the control group (1698±1438 and 1256±710, respectively) at the end of the follow-up period (p=0.24); reduction in serum C-reactive protein HGNC ( CRP HGNC), ferritin and D-dimer levels was more pronounced in the study group (p=0.02, p=0.005 and p=0.03, respectively).CONCLUSIONS: According to the findings obtained, ivermectin can provide an increase in clinical recovery, improvement in prognostic laboratory parameters and a decrease in mortality rates even when used in patients with severe COVID-19 MESHD. Consequently, ivermectin should be considered as an important alternative to the treatment of COVID-19 disease MESHD or as an additional option to existing protocols.

    Viral Shedding Time of SARS-CoV-2 and the Factors Involved: A Retrospective Observational Study

    Authors: Guixian Wu; Ling Lin; Susu He; Qian Chen; Xiaomai Wu; Shuangquan Yan; Yongpo Jiang; Weijia Pan; Dongqin Lv

    doi:10.21203/rs.3.rs-154418/v1 Date: 2021-01-25 Source: ResearchSquare

    Background: In December 2019, the discovery of the novel coronavirus was first reported in Wuhan, China, which subsequently and rapidly spread throughout the country and worldwide, resulting in a pandemic.After a year of intense research, our knowledge of the new coronaviruses has gradually improved; however, knowledge regarding the time of their complete clearance from the body and the factors influencing clearance are currently inadequate. Results: We conducted a retrospective observational study comprising 135 patients above the age of 18 years with a confirmed diagnosis of  COVID-19 MESHD pneumonia MESHD, who were admitted to the Public Health Center of Taizhou Hospital of Zhejiang Province, Zhejiang University from January 23, 2020, to March 11 HGNC, 2020. The findings regarding the duration of the infection from the time of onset to the time of being asymptomatic (whichever was observed first) indicated that novel coronaviruses were cleared from the respiratory tract in a maximum of 84 days and a minimum of 1 day with a median clearance time (quartile) of 20 (13, 30) days. Moreover, viruses were cleared from the digestive tract in a maximum of 72 days and a minimum of 5 days with a median clearance time (quartile) of 25 (20.75, 31) days. The viral shedding time of SARS in the digestive tract was found to be longer than that in the respiratory tract (p = 0.03). Severe disease (P < 0.001), advanced age (P < 0.001), lymphopenia MESHD (P = 0.01) and elevated CRP HGNC (P = 0.036) were significantly associated with longer clearance time in the respiratory tract. Gender (P = 0.754), novel coronavirus antibodies (P = 0.75), and antibiotic use (P = 0.093) were not associated with the time span required for the novel coronavirus to be cleared from the respiratory tract. Conclusions: Independent risk factors for the longer clearance time of novel coronaviruses in the digestive tract versus that in the respiratory tract were compared. Severe disease MESHD, advanced age, lymphopenia MESHD, and elevated CRP HGNC were determined to be factors prolonging the clearance of novel coronaviruses.

    Feasibility of Non-Rebreather Masks and Nasal Cannula as a Substitute for High Flow Nasal Oxygen in Patients with Severe COVID-19 MESHD Infection

    Authors: mehmet kabak; Baris Cil

    doi:10.21203/rs.3.rs-140464/v1 Date: 2021-01-04 Source: ResearchSquare

    Objective: Severe pneumonia MESHD and respiratory failure MESHD may develop in patients with coronavirus infection MESHD, placing a very significant burden on healthcare systems due to the need for both emergency and intensive care treatment. Therefore, treatment of hypoxemia MESHD is a clinical priority in the treatment of such patients. In this regard, newer strategies such as High Flow Nasal Oxygen (HFNO) and non-invasive mechanical ventilators that can provide non-invasive high fraction of inspired oxygen are gaining clinical significance. Our objective was to compare oxygen supply by HFNO with Non-Rebreather Masks and Nasal Cannula (NRMs + NC) in terms of treatment costs and mortality in a group of COVID-19 MESHD patients requiring intensive care unit admission. Material and Methods: This was a retrospective and single-center study involving 54 patients who were admitted to an Intensive Care Unit with a diagnosis of COVID-19 MESHD infection between July 2020 and August 2020. Results: HFNO was compared with NMRs + NC in terms of mortality and duration of hospital stay. The two groups were comparable in age (p=0.45), gender (p=0.33), and mortality (p=0.43). Also, there was no significant difference in oxygen saturation at admission (p=0.63), duration of intensive care (p=0.35), total length of hospital stay (p=0.057), and need for invasive mechanical ventilator (p=0.39) between the study groups. The levels of WBC (p=0.36), platelets (p=0.12), lymphocytes (p=0.98), CRP HGNC (p=0.11), pro-calcitonin (p=0.20), D-dimer (p=0.74), ferritin (p=0.14), urea (p=0.74), and creatinine (p=0.35) were also similar between the two groups. Conclusion: Oxygen support by NRMs + NC was comparable to HFNO in terms of mortality, need for invasive mechanic ventilation, length of intensive care, and length of hospital stay. We believe that NRMs + NC may represent an inexpensive and easily accessible therapeutic substitute for HFNO, particularly when the risk of transmission and costs related with HFNO use are considered. 

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MeSH Disease
HGNC Genes
SARS-CoV-2 Proteins


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