Corpus overview


Overview

MeSH Disease

Human Phenotype

Respiratory distress (52)

Cough (52)

Fever (42)

Pneumonia (24)

Dyspnea (20)


Transmission

Seroprevalence
    displaying 1 - 10 records in total 52
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    Detection of SARS-CoV-2 in peritoneal fluid from patients with kidney disease MESHD and COVID-19: report of two cases

    Authors: Margarita Ibarra-Hernandez; María de la Luz Alcantar-Vallín; Rodolfo I. Cabrera-Silva; Karina Sánchez-Reyes; Monserrat Alvarez-Zavala; Judith C. De Arcos-Jiménez; Luz A. González-Hernández; Vida V. Ruiz-Herrera; Sara A. Aguirre-Díaz; Roxana García-Salcido; Guillermo García-García; Jaime F. Andrade-Villanueva

    doi:10.21203/rs.3.rs-79032/v1 Date: 2020-09-16 Source: ResearchSquare

    Background: Coronavirus disease-2019 (COVID-19) has a broad clinical presentation, involving multiple organs besides the respiratory system. Currently, there is little evidence available on the presence of severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) in peritoneal fluid (PF). In this study, we describe the detection of SARS-CoV-2 in the PF of two patients with COVID 19 and kidney disease MESHD.Case presentation: Case 1: A 71-year-old woman with a history of end-stage kidney disease MESHD who presented with a 15-day evolution of progressive dyspnea HP dyspnea MESHD, accompanied by dry cough MESHD cough HP and fever HP fever MESHD; IgM antibodies SERO to SARS-CoV-2 were detected on admission. Real-time SARS-CoV-2 polymerase chain reaction (qRT-PCR) in the PF was positive. Three days after admission the patient's respiratory distress HP improved and she was discharged after 8 days of hospitalization.Case 2: A 78-year-old woman, with type 2 diabetes MESHD, hypertension HP hypertension MESHD, a 15-day history of polypnea, and a 5-day onset of fever HP fever MESHD and dyspnea HP dyspnea MESHD. IgM and IgG antibodies SERO to SARS-CoV-2 were detected on admission, as well as a positive nasopharyngeal qRT-PCR test for SARS-CoV-2. During hospitalization she developed acute kidney injury HP acute kidney injury MESHD, requiring peritoneal dialysis, SARS-CoV-2 was confirmed in PF by qRT-PCRConclusions: These two cases highlights the importance of increasing the level of awareness for the presence and possible SARS-CoV-2 transmission TRANS through non-respiratory routes, like peritoneal fluid.Emphasis should be given to appropriate preventive strategies for minimizing the risk of transmission TRANS of COVID-19 from patients on peritoneal dialysis in both inpatient and outpatient settings.

    Association of Initial Symptoms or Comorbidities With Pneumonia HP Pneumonia MESHD Lesions in COVID-19 Patients: Based on Artificial Intelligence-Enabled CT Quantitation

    Authors: Fangzhengyuan Yuan; Chuan Liu; Jie Yang; Hu Tan; Shizhu Bian; Xubin Gao; Jihang Zhang; Mingdong Hu; Renzheng Chen; Yang Shen; Jingbin Ke; Yuanqi Yang; Chunyan He; Ran Cheng; Lan Huang

    doi:10.21203/rs.3.rs-78075/v1 Date: 2020-09-15 Source: ResearchSquare

    Background: Coronavirus disease 2019 (COVID-19) patients with a larger ratio of pneumonia HP pneumonia MESHD lesions are more likely to progress to acute respiratory distress syndrome MESHD respiratory distress HP syndrome and death MESHD. This study aimed to investigate the relationship of baseline parameters with pneumonia HP pneumonia MESHD lesions on admission, as quantified by an artificial intelligence (AI) algorithm using computed tomography (CT) images. Methods: This retrospective study quantitatively assessed lung lesions on CT using an AI algorithm in 1630 consecutive patients confirmed with COVID-19 on admission and classified the patients into none (0%), mild (>0–25%), intermediate (>25–50%), and severe (>50%) groups, according to the lesion ratio of the whole lung. A multivariate linear regression model was established to explore the relationship between the lesion ratio and laboratory parameters. The baseline parameters associated with lung lesions MESHD, including demographics, initial symptoms, and comorbidities, were determined using a multivariate ordinal regression model. Results: The 1630 patients confirmed with COVID-19 had a median whole lung lesion ratio of 4.1%, and the right lower lung lobe had the most lesions among the five lung lobes based on the evaluation of CT using AI algorithm. The whole lung lesion ratio was associated with the levels of plasma SERO fibrinogen (r=0.280, p<0.001), plasma SERO D-dimer (r=0.248, p<0.001), serum SERO α-hydroxybutyrate dehydrogenase (r=0.363, p<0.001), serum SERO albumin (r=-0.300, p<0.001), and peripheral blood SERO leukocyte count (r=0.194, p<0.001). Among the four patients groups categorised by whole lung lesion ratio, the highest frequency of cough HP (p<0.001) and shortness of breath MESHD (p<0.001) were found in the severe group, and the highest frequency of hypertension HP hypertension MESHD (p<0.001), diabetes MESHD (p<0.001) and anemia HP anemia MESHD (p=0.039) were observed in the intermediate group. Based on baseline ordinal regression analysis, cough HP (p=0.009), shortness of breath MESHD (p<0.001), hypertension HP hypertension MESHD (p=0.002), diabetes MESHD (p=0.005), and anemia HP anemia MESHD (p=0.006) were independent risk factors for more severe lung lesions MESHD. Conclusions: Based on AI-enabled CT quantitation, patients with initial symptoms of cough HP cough MESHD/ shortness of breath MESHD, or with comorbidities of hypertension HP hypertension MESHD, diabetes MESHD, or anemia HP anemia MESHD, had a higher risk for more severe lung lesions on admission in COVID-19 patients.

    Risk Factors Analysis of COVID-19 Patients with ARDS MESHD and Prediction Based on Machine Learning

    Authors: Wan Xu; Nan-Nan Sun; Hai-Nv Gao; Zhi-Yuan Chen; Ya Yang; Bin Ju; Ling-Ling Tang

    doi:10.21203/rs.3.rs-77820/v1 Date: 2020-09-15 Source: ResearchSquare

    COVID-19 is a newly emerging infectious disease MESHD, which is generally susceptible to human beings and has caused huge losses to people's health. Acute respiratory distress HP respiratory distress MESHD syndrome ( ARDS MESHD) is one of the common clinical manifestations of severe COVID-19 and it is also responsible for the current shortage of ventilators worldwide. This study aims to analyze the clinical characteristics of COVID-19 ARDS MESHD patients and establish a diagnostic system based on artificial intelligence (AI) method to predict the probability of ARDS in COVID-19 patients. We collected clinical data of 659 COVID-19 patients from 11 regions in China. The clinical characteristics of the two groups were elaborately compared and both traditional machine learning algorithms MESHD and deep learning-based methods were used to build the prediction models. Results indicated the median age TRANS of ARDS MESHD patients was 56.5 years old, which was significantly older than those with non-ARDS by 7.5 years. Male TRANS and patients with BMI>25 were more likely to develop ARDS MESHD. The clinical features of ARDS MESHD patients included cough HP (80.3%), polypnea (59.2%), lung consolidation (53.9%), secondary bacterial infection MESHD (30.3%), and comorbidities such as hypertension HP hypertension MESHD (48.7%). Abnormal biochemical indicators such as lymphocyte count, leukocyte counting, CK, NLR, AST, LDH, and CRP were all strongly related to the aggravation of ARDS. Furthermore, through various AI methods for modeling and prediction effect evaluation based on the above risk factors, decision tree achieved the best AUC, sensitivity SERO, and specificity in identifying the mild patients who were easy to develop ARDS MESHD, which undoubtedly helps to optimize the treatment strategy, reduce mortality, and relieve the medical pressure. 

    Decrease of exercise endurance in critically ill COVID-19 survivors: 4 case reports

    Authors: Qian Geng; Xinxin Yu; Beilan Shen; Shiyue Li; Jinping Zheng; Liping Zhong; Yi Hong; Xiaoyan Huang; Qingsi Zeng; Shaoqiang Li; Feng Ye; Weijie Guan; Yanqing Xie; Nanshan Zhong; Yi Gao

    doi:10.21203/rs.3.rs-72429/v1 Date: 2020-09-04 Source: ResearchSquare

    Background: The Coronavirus Disease MESHD 2019 (COVID-19) already have been as a pandemic. However, knowledge about the sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHD remains limited. Here we descirbe the pulmonary function test (PFT) and cardiopulmonary exercise test (CPET) of critically ill COVID-19 in four cases with sereve acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD) after discharge.Case presentation: We introduce four patients who complained of fever HP fever MESHD, cough HP cough MESHD, chest tightness HP chest tightness MESHD and other symptoms, all of them were confirmed as SARS-CoV-2 infection MESHD by real-time reverse transcription polymerase chain reaction (RT-PCR). They were treated with mechanical ventilation because of severe ARDS MESHD. After respiratory support, antiviral and anti-infective treatment, they were weaned from mechanic ventilation with the improvement of hypoxemia HP hypoxemia MESHD. All patients were discharged from the hospital after completion of treatment and had no mortality. Around 1-month post-discharge, they were followed up for chest computed tomography (CT) scan, and performed PFT and CPET. Peak oxygen uptake of predicted (peakVO2% pred) decreased in all four cases, although spirometry were in the normal range, and only 2 cases had mild decline in carbon monoxide diffusion capacity of predicted (DLCO%pred).Conclusions: We found reduced exercise endurance in all four COVID-19 survivors, even parts of them with normal or slightly abnormal static lung function. We also believe that exercise endurance impairment of COVID-19 convalescents is more likely affected by extrapulmonary factors. Taken the above into consideration, our study highlights that the combination of PFT and CPET are important tests for tracking the development and recovery of COVID-19 survivors.

    Potential of proteasome inhibitors to inhibit cytokine storm in critical stage COVID-19 patients

    Authors: Ralf Kircheis; Emanuel Haasbach; Daniel Lueftenegger; Willm T. Heyken; Matthias Ocker; Oliver Planz

    id:2008.10404v1 Date: 2020-08-24 Source: arXiv

    Patients infected with SARS-CoV-2 show a wide spectrum of clinical manifestations ranging from mild febrile illness MESHD and cough HP up to acute respiratory distress HP respiratory distress MESHD syndrome, multiple organ failure MESHD and death MESHD. Data from patients with severe clinical manifestations compared to patients with mild symptoms indicate that highly dysregulated exuberant inflammatory responses correlate with severity of disease and lethality. Significantly elevated cytokine levels, i.e. cytokine storm, seem to play a central role in severity and lethality in COVID-19. We have previously shown that excessive cytokine release induced by highly pathogenic avian H5N1 influenza A virus was reduced by application of proteasome inhibitors. In the present study we present experimental data of a central cellular pro-inflammatory signal pathways, NF-kappaB, in the context of published clinical data from COVID-19 patients and develop a hypothesis for a therapeutic approach aiming at the simultaneous inhibition of whole cascades of pro-inflammatory cytokines and chemokines via blocking the nuclear translocation of NF-kappaB by proteasome inhibitors. The simultaneous inhibition of multiple cytokines/chemokines using clinically approved proteasome inhibitors is expected to have a higher therapeutic potential compared to single target approaches to prevent cascade (i.e. triggering, synergistic, and redundant) effects of multiple induced cytokines and may provide an additional therapeutic option to be explored for treatment of critical stage COVID-19 patients.

    Prevalence SERO and correlation of symptoms and comorbidities in COVID-19 patients: A systematic review and meta-analysis

    Authors: Mohammad Meshbahur Rahman; Badhan Bhattacharjee; Zaki Farhana; Mohammad Hamiduzzaman; Muhammad Abdul Bake Chowdhury; Mohammad Sorowar Hossain; Mahbubul H Siddiqee; Md. Ziaul Islam; Enayetur Raheem; Md. Jamal Uddin

    doi:10.1101/2020.08.19.20177980 Date: 2020-08-22 Source: medRxiv

    Background: The COVID-19 affected millions of people, and the patients present a constellation of symptoms and comorbidities. We aimed to chronicle the prevalence SERO and correlations of symptoms and comorbidities, and associated covariates among the patients. Methods: We performed a systematic review and meta-analysis [PROSPERO registration: CRD42020182677]. Databases [PubMed, SCOPUS, EMBASE, WHO, Semantic Scholar, and COVID-19 Primer] were searched for clinical studies published in English from January 1 to April 20, 2020. The pooled prevalence SERO of symptoms and comorbidities were identified using the random effect model, and sub-groups analysis of patients age TRANS and locations were investigated. A multivariable factor analysis was also performed to show the correlation among symptoms, comorbidities and age TRANS of the COVID-19 patients. Findings: Twenty-nine articles [China (24); Outside of China (5)], with 4,884 COVID-19 patients were included in this systematic review. The meta-analysis investigated 33 symptoms, where fever HP fever MESHD [84%], cough HP cough MESHD/dry cough HP [61%], and fatigue HP fatigue MESHD/weakness [42%] were found frequent. Out of 43 comorbidities investigated, acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD) [61%] was a common condition, followed by hypertension HP hypertension MESHD [23%] and diabetes MESHD [12%]. According to the patients age TRANS, the prevalence SERO of symptoms like fatigue HP fatigue MESHD/weakness, dyspnea HP dyspnea MESHD/shortness of breath, and anorexia HP anorexia MESHD were highly prevalent in older adults TRANS [[≥]50 years] than younger adults TRANS [<50 years]. Diabetes MESHD, hypertension HP hypertension MESHD, coronary heart disease MESHD, and COPD MESHD/ lung disease MESHD were more prevalent comorbidities in older adults TRANS than younger adults TRANS. The patients from outside of China had significantly higher prevalence SERO [p<0.005] of diarrhea HP diarrhea MESHD, fatigue HP fatigue MESHD, nausea HP nausea MESHD, sore throat, and dyspnea HP dyspnea MESHD, and the prevalent comorbidities in that region were diabetes MESHD, hypertension HP hypertension MESHD, coronary heart disease MESHD, and ARDS MESHD. The multivariable factor analysis showed positive association between a group of symptoms and comorbidities, and with the patients age TRANS. Interpretation: Epitomizing the correlation of symptoms of COVID-19 with comorbidities and patients age TRANS would help clinicians effectively manage the patients.

    Clinical course, biomarkers, management and outcomes of patients hospitalised due to COVID-19 in Colombia

    Authors: Nancy Yomayusa; Kelly Rocío Chacón Acevedo; Adriana Janeth Avila Reina; Karen Lorena Rincón; Carlos Hernando Toloza; Olga Gomez Gomez; Eduardo Low Padilla; Juan Felipe Combariza Vallejo; Johana Vargas Rodriguez; Emilio Herrera Molina; Sandra Yadira Moreno Marin; Carlos Arturo Álvarez Moreno

    doi:10.21203/rs.3.rs-57978/v1 Date: 2020-08-12 Source: ResearchSquare

    Background: Coronavirus disease (COVID-19) represents an unprecedented challenge for both people and health systems. Latin America is the current epicentre of the pandemic; however, there is little published clinical information on the clinical characteristics and outcomes.Objective: To analyse the clinic characteristics, risk factors and evolution of the first cohort of hospitalised patients with confirmed infection TRANS by COVID-19 in 5 Colombian institutions.Methods: In the present retrospective observational study, information was acquired from consecutive hospitalized patients with a diagnosis of COVID-19 confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) from March 01 to May 30, 2020 in Colombia.Results: A total of 44 patients were included. The median age TRANS was 62 years, and 65.9% of the patients were male TRANS. A total of 69.8% of the patients were overweight HP or obese MESHD, and 13.6% of the patients had high blood SERO pressure and diabetes MESHD. The presence of systemic symptoms and cough HP cough MESHD were the most common. Ground-glass opacity was frequent finding upon chest imaging. The 30-day mortality rate was 47.7% with a median of 11 days. The composite outcome (critical care requirement, mechanical ventilation and death MESHD) occurred in 36.4% of the patients. The biomarkers associated with mortality risk included troponin higher than 14 ng/L (RR: 5.25; 95% CI 1.37-20.1, p = 0.004) and D-dimer higher than 1000 ng/ml (RR: 3.0; 95% CI 1.4-6.3, p = 0.008). Cardiovascular complications MESHD, acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD) and acute kidney injury HP acute kidney injury MESHD were the most frequent comorbidities in patients with severe pneumonia HP pneumonia MESHD.Conclusion: The clinical course of SARS-CoV-2 infection MESHD diagnosis confirmed by RT-PCR in Colombian patients admitted to a high-complexity hospital was similar to that reported in the literature; however, the population was characterised by a more advanced stage of the infection MESHD

    A Large-Scale Clinical Validation Study Using nCapp Cloud Plus Terminal by Frontline Doctors for the Rapid Diagnosis of COVID-19 and COVID-19 pneumonia HP pneumonia MESHD in China

    Authors: Dawei Yang; Tao Xu; Xun Wang; Deng Chen; Ziqiang Zhang; Lichuan Zhang; Jie Liu; Kui Xiao; Li Bai; Yong Zhang; Lin Zhao; Lin Tong; Chaomin Wu; Yaoli Wang; Chunling Dong; Maosong Ye; Yu Xu; Zhenju Song; Hong Chen; Jing Li; Jiwei Wang; Fei Tan; Hai Yu; Jian Zhou; Jinming Yu; Chunhua Du; Hongqing Zhao; Yu Shang; Linian Huang; Jianping Zhao; Yang Jin; Charles A. Powell; Yuanlin Song; Chunxue Bai

    doi:10.1101/2020.08.07.20163402 Date: 2020-08-11 Source: medRxiv

    Background The outbreak of coronavirus disease MESHD 2019 (COVID-19) has become a global pandemic acute infectious disease MESHD, especially with the features of possible asymptomatic TRANS carriers TRANS and high contagiousness. It causes acute respiratory distress HP respiratory distress MESHD syndrome and results in a high mortality rate if pneumonia HP is involved. Currently, it is difficult to quickly identify asymptomatic TRANS cases or COVID-19 patients with pneumonia HP pneumonia MESHD due to limited access to reverse transcription-polymerase chain reaction (RT-PCR) nucleic acid tests and CT scans, which facilitates the spread of the disease TRANS at the community level, and contributes to the overwhelming of medical resources in intensive care units. Goal This study aimed to develop a scientific and rigorous clinical diagnostic tool for the rapid prediction of COVID-19 cases based on a COVID-19 clinical case database in China, and to assist global frontline doctors to efficiently and precisely diagnose asymptomatic TRANS COVID-19 patients and cases who had a false-negative RT-PCR test result. Methods With online consent, and the approval of the ethics committee of Zhongshan Hospital Fudan Unversity (approval number B2020-032R) to ensure that patient privacy is protected, clinical information has been uploaded in real-time through the New Coronavirus Intelligent Auto-diagnostic Assistant Application of cloud plus terminal (nCapp) by doctors from different cities (Wuhan, Shanghai, Harbin, Dalian, Wuxi, Qingdao, Rizhao, and Bengbu) during the COVID-19 outbreak in China. By quality control and data anonymization on the platform, a total of 3,249 cases from COVID-19 high-risk groups were collected. These patients had SARS-CoV-2 RT-PCR test results and chest CT scans, both of which were used as the gold standard for the diagnosis of COVID-19 and COVID-19 pneumonia HP pneumonia MESHD. In particular, the dataset included 137 indeterminate cases who initially did not have RT-PCR tests and subsequently had positive RT-PCR results, 62 suspected cases who initially had false-negative RT-PCR test results and subsequently had positive RT-PCR results, and 122 asymptomatic TRANS cases who had positive RT-PCR test results, amongst whom 31 cases were diagnosed. We also integrated the function of a survey in nCapp to collect user feedback from frontline doctors. Findings We applied the statistical method of a multi-factor regression model to the training dataset (1,624 cases) and developed a prediction model for COVID-19 with 9 clinical indicators that are fast and accessible: 'Residing or visiting history in epidemic regions', 'Exposure history to COVID-19 patient', 'Dry cough HP', ' Fatigue HP', 'Breathlessness', 'No body temperature decrease after antibiotic treatment', 'Fingertip blood SERO oxygen saturation<=93%', ' Lymphopenia HP Lymphopenia MESHD', and 'C-reactive protein (CRP) increased'. The area under the receiver operating characteristic (ROC) curve (AUC) for the model was 0.88 (95% CI: 0.86, 0.89) in the training dataset and 0.84 (95% CI: 0.82, 0.86) in the validation dataset (1,625 cases). To ensure the sensitivity SERO of the model, we used a cutoff value of 0.09. The sensitivity SERO and specificity of the model were 98.0% (95% CI: 96.9%, 99.1%) and 17.3% (95% CI: 15.0%, 19.6%), respectively, in the training dataset, and 96.5% (95% CI: 95.1%, 98.0%) and 18.8% (95% CI: 16.4%, 21.2%), respectively, in the validation dataset. In the subset of the 137 indeterminate cases who initially did not have RT-PCR tests and subsequently had positive RT-PCR results, the model predicted 132 cases, accounting for 96.4% (95% CI: 91.7%, 98.8%) of the cases. In the subset of the 62 suspected cases who initially had false-negative RT-PCR test results and subsequently had positive RT-PCR results, the model predicted 59 cases, accounting for 95.2% (95% CI: 86.5%, 99.0%) of the cases. Considering the specificity of the model, we used a cutoff value of 0.32. The sensitivity SERO and specificity of the model were 83.5% (95% CI: 80.5%, 86.4%) and 83.2% (95% CI: 80.9%, 85.5%), respectively, in the training dataset, and 79.6% (95% CI: 76.4%, 82.8%) and 81.3% (95% CI: 78.9%, 83.7%), respectively, in the validation dataset, which is very close to the published AI model. The results of the online survey 'Questionnaire Star' showed that 90.9% of nCapp users in WeChat mini programs were 'satisfied' or 'very satisfied' with the tool. The WeChat mini program received a significantly higher satisfaction rate than other platforms, especially for 'availability and sharing convenience of the App' and 'fast speed of log-in and data entry'. Discussion With the assistance of nCapp, a mobile-based diagnostic tool developed from a large database that we collected from COVID-19 high-risk groups in China, frontline doctors can rapidly identify asymptomatic TRANS patients and avoid misdiagnoses of cases with false-negative RT-PCR results. These patients require timely isolation or close medical supervision. By applying the model, medical resources can be allocated more reasonably, and missed diagnoses can be reduced. In addition, further education and interaction among medical professionals can improve the diagnostic efficiency for COVID-19, thus avoiding the transmission TRANS of the disease from asymptomatic TRANS patients at the community level.

    Fighting COVID-19 spread among nursing home residents even in absence of molecular diagnosis: a retrospective cohort study.

    Authors: Alessio Strazzulla; Paul Tarteret; Maria Concetta Postorino; Marie Picque; Astrid de Pontfarcy; Nicolas Vignier; Catherine Chakvetadze; Coralie Noel; Cecile Drouin; Zine Eddine Benguerdi; Sylvain Diamantis

    doi:10.21203/rs.3.rs-51305/v1 Date: 2020-07-30 Source: ResearchSquare

    Background Access to molecular diagnosis was limited out-of-hospital in France during the 2020 coronavirus disease 2019 (COVID-19) epidemic. This study describes the evolution of COVID-19 outbreak in a nursing home in absence of molecular diagnosis. Methods A monocentric prospective study was conducted in a French nursing home from March 17th, 2020 to June 11th, 2020. Because of lack of molecular tests for severe acute respiratory syndrome 2 (SARS-Cov2) infection MESHD, probable COVID-19 cases were early identified considering only respiratory and not-respiratory symptoms and therefore preventing measures and treatments were enforced. Once available, serology tests were performed at the end of the study.A chronologic description of new cases and deaths MESHD was made together with a description of COVID-19 symptoms. Data about personal characteristics and treatments were collected and the following comparisons were performed: i) probable COVID-19 cases vs asymptomatic TRANS residents; ii) SARS-Cov2 seropositive residents vs seronegative residents. Results Overall, 32/66 (48.5%) residents and 19/39 (48.7%) members of health-care personnel were classified as probable COVID-19 cases. A total of 34/61 (55.7%) tested residents resulted seropositive. Death occurred in 4/66 (6%) residents. Diagnosis according to symptoms had 65% of sensitivity SERO, 78% of specificity, 79% of positive predictive value SERO and 64% of negative predictive value SERO.In resident population, the following symptoms were registered: 15/32 (46.8%) lymphopenia HP lymphopenia MESHD, 15/32 (46.8%) fever HP fever MESHD, 8/32 (25%) fatigue HP fatigue MESHD, 8/32 (25%) cough HP, 6/32 (18.8%) diarrhoea MESHD, 4/32 (12.5%) severe respiratory distress HP requiring oxygen therapy, 4/32 (12.5%) fall HP, 3/32 (9.4%) conjunctivitis HP conjunctivitis MESHD, 2/32 (6.3%) abnormal pulmonary noise at chest examination and 2/32 (6,25%) abdominal pain HP abdominal pain MESHD. Probable COVID-19 cases were older (81.3 vs 74.9; p=0.007) and they had higher prevalence SERO of atrial fibrillation HP atrial fibrillation MESHD (8/32, 25% vs 2/34, 12%; p=0.030); insulin treatment (4/34, 12% vs 0, 0%; p=0.033) and positive SARS-Cov2 serology (22/32, 69% vs 12/34, 35%; p=0.001) than asymptomatic TRANS residents. Seropositive residents had lower prevalence SERO of diabetes MESHD (4/34, 12% vs 9/27, 33%; p=0.041) and angiotensin-converting-enzyme inhibitors’ intake (1/34, 1% vs 5/27, 19%; p=0.042). Conclusions During SARS-Cov2 epidemic, early detection of respiratory and not-respiratory symptoms allowed to enforce extraordinary measures. They achieved limiting contagion and deaths among nursing home residents, even in absence of molecular diagnosis.

    Elevated oxygen demand in a case of COVID-19 with severe ARDS MESHD: a point for optimal oxygenation therapy including ECMO management

    Authors: Taku Oshima; Takehiko Oami; Mana Yamashiro; Akiko Higashi; Yosuke Hayashi; Natsumi Suga; Shin Takayanagi; Seiichiro Sakao; Taka-aki Nakada

    doi:10.21203/rs.3.rs-51286/v1 Date: 2020-07-30 Source: ResearchSquare

    Background: Coronavirus disease MESHD 2019 (COVID-19) caused by SARS-CoV-2 has become a global pandemic, and those developing critically ill conditions have been reported to have mortality in the range of 39% to 61%. Due to the lack of definitive treatments, mechanical ventilation and supportive oxygenation therapy are key management strategies for the survival of patients with acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD). Optimizing oxygenation therapy is mandatory to treat patients with severe respiratory failure HP respiratory failure MESHD, to sufficiently compensate for the oxygen (O2) demand. We experienced a case of severe ARDS MESHD due to COVID-19 successfully treated with extracorporeal membrane oxygenation (ECMO) after increasing oxygen delivery according to O2 consumption measurement by indirect calorimetryCase Presentation: A 29-year-old obese MESHD but otherwise healthy man was hospitalized for treatment of COVID-19 pneumonia HP pneumonia MESHD presenting with a 4-day history of persisting cough HP cough MESHD, high fever HP, and dyspnea HP dyspnea MESHD. Mechanical ventilation, nitric oxide inhalation, and prone positioning were initiated in the ICU against severe respiratory dysfunction MESHD. Indirect calorimetry on the 3rd and 6th ICU days revealed persistent elevation of oxygen consumption (VO2) of 380 mL/min. Veno-venous ECMO was initiated on the 7th ICU day after further deterioration of respiratory failure MESHD respiratory failure HP. Periodic events of SpO2 decline due to effortful breathing was not resolved by neuromuscular blockade in attempt to reduce O2 consumption. Increasing the ECMO flow induced hemolysis MESHD and hyperkalemia HP hyperkalemia MESHD despite the use of large bore cannulas and ECMO circuit free of clots and defects. The hemoglobin management level was elevated from 10 g/dL to 13 g/dL to increase blood SERO oxygen capacity, enabling the reduction of ECMO flow while attenuating respiratory effort and maintaining SpO2. Lung protective ventilation strategy and prone positioning were continued for successful weaning from ECMO on the 16th ICU day, and the ventilator on the 18th ICU day.Conclusion: The present case of severe ARDS MESHD due to COVID-19 was successfully treated with ECMO. Enhancing oxygen delivery was crucial to compensate for the elevated O2 demand. Measuring O2 consumption by indirect calorimetry can elucidate the oxygen demand for optimizing the oxygenation therapy for successful management and survival of critically ill COVID-19 patients. 

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