Corpus overview


Overview

MeSH Disease

Fever (6)

Myalgia (5)

Arthralgia (5)

Diarrhea (4)

Dyspnea (3)


Human Phenotype

Cough (7)

Myalgia (7)

Arthralgia (7)

Anosmia (6)

Fever (6)


Transmission

Seroprevalence
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    Azithromycin with nitazoxanide, hydroxychloroquine or ivermectin, with or without dutasteride, for early stage COVID-19: an open-label prospective observational study in males TRANS with mild-to-moderate COVID-19 (The Pre-AndroCoV Male TRANS Trial).

    Authors: Flavio A Cadegiani; Andy Goren; Carlos G Wambier; John McCoy

    doi:10.21203/rs.3.rs-88952/v1 Date: 2020-10-07 Source: ResearchSquare

    Background: COVID-19 is a multisystemic disorder MESHD caused by SARS-CoV-2 that has led to more than 1,000,000 deaths until the end of September 2020. Besides aging, obesity HP obesity MESHD, and metabolic diseases MESHD, males TRANS, in particular those affected by androgenetic alopecia HP (AGA), are at higher risk to develop complications. While policies for diagnosis of COVID-19 still focus on the presence of fever HP fever MESHD or shortness of breath MESHD, these symptoms tend to appear only in later and more severe stages of the disease, when viral infectivity is already, hampering potential antiviral approaches. In addition, clinical characterization of early COVID-19 stages still lacks. The objective of the present observational study was to characterize prospectively clinical features and predictors in males TRANS during early COVID-19, and to evaluate whether the combination of more sensitive case-detection, early diagnosis and early pharmacological approaches would lead to improved clinical outcomes. Material and methods: Males confirmed for COVID-19 through positive real-time polymerase chain reaction (rtPCR) for SARS-CoV-2 with less than seven days of symptoms and three days of COVID-19 confirmation were divided into non-AGA, AGA not using dutasteride (AGA no-5ARi), and AGA using dutasteride (AGA-5ARi) groups. Patients were actively characterized for baseline and lifestyle characteristics, 22 different diseases, 42 drug classes and vaccines, 26 different symptoms, and 10 different parameters to measure COVID-19 related clinical outcomes. Azithromycin plus hydroxychloroquine, nitazoxanide 500mg or ivermectin, with or without dutasteride or spironolactone were used. Patients were then evaluated for COVID-19 clinical course, duration and progression.Results:  A total of 305 males TRANS were enrolled, including 192 non-AGA, 71 AGA non-ARi and 52 AGA-5ARi. The prevailing symptoms were anosmia HP (68.9%), ageusia (61.2%), headache  (37.5%), hyporexia  (37.5%), fatigue HP (35.2%), dry cough  (35.2%), fever HP or “feverish” (33.9%), thoracic pain HP (32.4%), conjunctival hyperemia  (29.5%), weakness (29.5%), nasal congestion or rhinorrhea (28.6% and myalgia HP (26.3%). ARi users remained asymptomatic TRANS throughout COVID-19 treatment in 82.7% (43 of 52 males TRANS), and the only symptoms present in more than two patients were anosmia HP and ageusia. Thoracic, upper back, lower back pain HP, arthralgia HP affected a higher percentage of AGA no-5ARi than non-AGA males TRANS (all p < 0.01), but had similar durations (p = n/s). Anosmia HP, ageusia, headache HP, fatigue HP, myalgia HP and conjunctival hyperemia HP were more commonly present and lasted for longer periods in AGA no 5ARi patients (all p < 0.01). Self-reported perception of “sinusitis” and “sore throat”, dry cough HP and weakness were equally present (p = n/s) but had longer duration in AGA no-5ARi males TRANS (all p < 0.01).The different drug were equally distributed. AGA males TRANS were more severely affected than non-AGA in terms of duration of clinical manifestations (9.4 ± 6.0 vs 14.2 ± 7.3 days, p < 0.0001) and viral shedding (14.0 ± 5.2 vs 17.8 ± 6.2 days; p < 0.0001), which has been fully mitigated by the chronic use of dutasteride (p < 0.0001 and < 0.0001 vs non-AGA and AGA no-5ARi, respectively, for both clinical manifestations and viral shedding duration. Non-AGA, AGA no-5ARi and AGA-5ARi achieved 95% clinical recovery in seven, 14, and two days, respectively. In regards functional capacity, AGA no -5ARi males TRANS at Days 30, 14, 7, and 3 after treatment initiation were similar than non-AGA at Days 14, 7, 3, and 0, respectively (all p > 0.9). None of the patients required hospitalization and mechanical ventilation, or progressed to more severe states. Conclusion: The combination of more sensitive and earlier diagnosis of COVID-19 with  a variety of drug combinations with preliminary demonstration of direct or indirect antiviral activity against SARS-CoV-2 demonstrated indisputable improved COVID-19 related clinical outcomes compared to the extensively described COVID-19 clinical course, and avoided the progression to more severe state in all patients included in the present analysis, independently of risk factors, demonstrating that any additional risk factor can be completely mitigated by the combination of more sensitive clinical suspect with early pharmacological approaches.The overwhelming differences indicate that full placebo control RCTs for early COVID-19 may be ethically questionable. Instead, double blind therapies with different options, or mixed open label placebo control for COVID-19 should be considered.

    Symptomatology of Coronavirus Disease MESHD 2019 (COVID-19) - Lessons from A Meta-Analysis Across 13 Countries

    Authors: Champika Saman Kumara Gamakaranage; Dineshani Hettiarachchi; Dileepa Ediriweera; Saroj Jayasinghe

    doi:10.21203/rs.3.rs-39412/v1 Date: 2020-07-01 Source: ResearchSquare

    Background: COVID-19 pandemic has resulted in varying clinical manifestations and mortality rates. There is no consensus on the symptomatology that would guide researchers and clinicians.Objective: The objective of the study was to identify symptoms and their frequencies of coronavirus disease MESHD 2019 with a meta-analysis of studies from several countries. Data sources: A systematic review using PubMed and Google Scholar data sources and reference tracing TRANS were used to identify 7176 relevant articles. Eligibility criteria: Suitable articles were selected manually with selection criteria and 14 original articles included for meta-analysis. Data abstraction analysis: PRISMA guideline was used for abstracting data. Then a table was generated by feeding it with numbers and proportions of each symptom described in original studies. A meta-analysis was carried out using random effect models on each symptom separately across the studies and their prevalence SERO rates and 95% confident intervals calculated.Results: We identified 14 relevant scientific papers, either cross-sectional or cohort studies and analyzed. There were 2,660 cases of COVID-19. he majority were from China (n=2,439, 91.7%) and remainder from the Netherlands, Italy, Korea and India and one article from Europe. There was a total of 32 symptoms (i.e. present in >50% of patients):  fever MESHD (79.56%, 95% CI: 72.17-86.09%), malaise (63.3%, 95% CI: 53.1 – 73.0%), cough HP (56.7. %, 95% CI: 48.6 - 64.6 %) and cold (55.6%, 95% CI: 45.2 – 65.7%). Symptoms of intermediate incidence (5-49%) were; anosmia HP anosmia MESHD, sneezing HP, ocular pain HP ocular pain MESHD, fatigue HP fatigue MESHD, sputum production, arthralgia HP arthralgia MESHD, tachypnea HP tachypnea MESHD, palpitation HP, headache HP headache MESHD, chest tightness HP chest tightness MESHD, shortness of breath MESHD, chills HP, myalgia HP myalgia MESHD, sore throat, anorexia HP anorexia MESHD, weakness MESHD, diarrhea HP diarrhea MESHD, rhinorrhea HP rhinorrhea MESHD, dizziness MESHD, nausea HP nausea MESHD, altered level of consciousness, vomiting HP vomiting MESHD and abdominal pain HP abdominal pain MESHD. Rare symptoms (<5% of patients) were: tonsil swelling, haemoptysis, conjunctival injection, lymphadenopathy HP lymphadenopathy MESHD and rash MESHD were uncommon symptoms of coronavirus disease MESHD (<5%).Conclusion and implications of key findings: We found (25/32) symptoms to be present in =>5% of cases which could be considered as “typical” symptoms of COVID-19. The list of symptoms we identified are different from those documents released by the WHO, CDC, NHS, Chinese CDC, Institute Pasteur and Mayo Clinic. The compiled list would be useful for future researchers to document a comprehensive picture of the illness.

    Symptomatology of Coronavirus Disease MESHD 2019 (COVID-19) - Lessons from a meta-analysis across 13 countries

    Authors: Champika Saman Kumara Gamakaranage; Dineshani Hettiarachchi; Dileepa Ediriweera; Saroj Jayasinghe

    doi:10.21203/rs.3.rs-39412/v2 Date: 2020-07-01 Source: ResearchSquare

    Background: COVID-19 pandemic has resulted in varying clinical manifestations and mortality rates. There is no consensus on the symptomatology that would guide researchers and clinicians. Objective: The objective was to identify symptoms and their frequencies of COVID-19 with a meta-analysis of studies from several countries. Data sources: A systematic review using PubMed and Google Scholar data sources and reference tracing TRANS were used to identify 7176 articles. Eligibility criteria: Suitable articles were selected manually with selection criteria and 14 original articles included in meta-analysis. Data abstraction and analysis: PRISMA guidelines, used for data abstraction and a table was generated by feeding it with numbers and proportions of each symptom described. A meta-analysis was carried out using random effect models on each symptom separately across the studies and their prevalence SERO rates and 95% confident intervals were calculated.Results: Selected 14 studies, either cross-sectional or cohort studies are analyzed. There were 2,660 confirmed cases TRANS of COVID-19. The majority were from China (n=2,439, 91.7%) and remainder from the Netherlands, Italy, Korea and India and one article from Europe. There was a total of 32 symptoms identified from the meta-analysis and additional 7 symptoms were identified from reference searching. The most common symptoms were ( prevalence SERO >50%): fever HP fever MESHD (79.56%, 95% CI: 72.17-86.09%), malaise (63.3%, 95% CI: 53.1 – 73.0%), cough HP (56.7. %, 95% CI: 48.6 - 64.6 %) and cold (55.6%, 95% CI: 45.2 – 65.7%). Symptoms of intermediate incidence (5-49%) were; anosmia HP anosmia MESHD, sneezing HP, ocular pain HP ocular pain MESHD, fatigue HP fatigue MESHD, sputum production, arthralgia HP arthralgia MESHD, tachypnea HP tachypnea MESHD, palpitation HP, headache HP headache MESHD, chest tightness HP chest tightness MESHD, shortness of breath MESHD, chills HP, myalgia HP myalgia MESHD, sore throat, anorexia HP anorexia MESHD, weakness MESHD, diarrhea HP diarrhea MESHD, rhinorrhea HP rhinorrhea MESHD, dizziness MESHD, nausea HP nausea MESHD, altered level of consciousness, vomiting HP vomiting MESHD and abdominal pain HP abdominal pain MESHD. Rare symptoms (<5%): tonsil swelling MESHD, haemoptysis, conjunctival injection, lymphadenopathy HP lymphadenopathy MESHD and rash MESHD. Conclusion and implications of key findings: We found (25/32, from meta-analysis) symptoms to be present in =>5% of cases which could be considered as “typical” symptoms of COVID-19. The list of symptoms we identified is different from those documents released by the WHO, CDC, NHS, Chinese CDC, Institute Pasteur and Mayo Clinic. The compiled list would be useful for future researchers to document a comprehensive picture of the illness.  

    A primary care approach to the COVID-19 pandemic: clinical features and natural history of 2,073 suspected cases in the Corona Sao Caetano programme, Sao Paulo, Brazil

    Authors: Fabio E Leal; Maria C Mendes-Correa; Lewis F Buss; Silvia F Costa; Joao CS Bizario; Sonia RP Souza; Osorio Thomaz; Tania R Tozetto-Mendoza; Lucy S Villas-Boas; Lea CO Silva; Regina MZ Grespan; Ligia Capuani; Renata Buccheri; Helves Domingues; Neal DE Alexander; Philippe Mayaud; Ester C Sabino

    doi:10.1101/2020.06.23.20138081 Date: 2020-06-23 Source: medRxiv

    Background: Despite most cases not requiring hospital care, there are limited community-based clinical data on COVID-19. Methods and findings: The Corona Sao Caetano program is a primary care initiative offering COVID-19 care to all residents of Sao Caetano do Sul, Brazil. After triage of potentially severe cases, consecutive patients presenting between 13th April and 13th May 2020 were tested at home with SARS-CoV-2 reverse transcriptase (RT) PCR; positive patients were followed up for 14 days. RT-PCR-negative patients were offered SARS-CoV-2 serology. We describe the clinical features, virology and natural history of this prospective population-based cohort. Of 2,073 suspected COVID-19 cases, 1,583 (76.4%) were tested by RT-PCR, of whom 444 (28.0%, 95%CI: 25.9% - 30.3%) were positive; 604/1,136 (53%) RT-PCR-negative patients underwent serology, of whom 52 (8.6%) tested SARS-CoV-2 seropositive. The most common symptoms of COVID-19 were cough HP, fatigue HP fatigue MESHD, myalgia HP myalgia MESHD and headache HP headache MESHD; whereas self-reported fever HP fever MESHD, anosmia HP anosmia MESHD, and ageusia MESHD were most associated with a positive COVID-19 diagnosis. RT-PCR cycle thresholds were lower in men, older patients, those with fever HP fever MESHD and arthralgia HP arthralgia MESHD, and around symptom onset TRANS. The rates of hospitalization and death MESHD among 444 RT-PCR-positive cases were 6.7% and 0.7%, respectively, with older age TRANS and obesity HP obesity MESHD more frequent in the hospitalized group. Conclusions: COVID-19 presents similarly to other mild respiratory disease MESHD in primary care. Some symptoms assist the differential diagnosis. Most patients can be managed at home.

    Augmented Curation of Unstructured Clinical Notes from a Massive EHR System Reveals Specific Phenotypic Signature of Impending COVID-19 Diagnosis

    Authors: Tyler Wagner; FNU Shweta; Karthik Murugadoss; Samir Awasthi; AJ Venkatakrishnan; Sairam Bade; Arjun Puranik; Martin Kang; Brian W Pickering; John C O'Horo; Philippe R Bauer; Raymund R Razonable; Paschalis Vergidis; Zelalem Temesgen; Stacey Rizza; Maryam Mahmood; Walter R Wilson; Douglas Challener; Praveen Anand; Matt Liebers; Zainab Doctor; Eli Silvert; Hugo Solomon; Akash Anand; Rakesh Barve; Gregory J Gores; Amy W Williams; William G Morice; John Halamka; Andrew D Badley; Venky Soundararajan

    doi:10.1101/2020.04.19.20067660 Date: 2020-04-23 Source: medRxiv

    Understanding temporal dynamics of COVID-19 patient symptoms could provide fine-grained resolution to guide clinical decision-making. Here, we use deep neural networks over an institution-wide platform for the augmented curation of clinical notes from 77,167 patients subjected to COVID-19 PCR testing. By contrasting Electronic Health Record (EHR)-derived symptoms of COVID-19-positive (COVIDpos; n=2,317) versus COVID-19-negative (COVIDneg; n=74,850) patients for the week preceding the PCR testing date, we identify anosmia HP anosmia MESHD/dysgeusia (27.1-fold), fever HP fever MESHD/ chills HP (2.6-fold), respiratory difficulty (2.2-fold), cough HP (2.2-fold), myalgia HP myalgia MESHD/ arthralgia HP arthralgia MESHD (2-fold), and diarrhea HP diarrhea MESHD (1.4-fold) as significantly amplified in COVIDpos over COVIDneg patients. The combination of cough HP and fever HP fever MESHD/ chills HP has 4.2-fold amplification in COVIDpos patients during the week prior to PCR testing, and along with anosmia HP anosmia MESHD/dysgeusia, constitutes the earliest EHR-derived signature of COVID-19. This study introduces an Augmented Intelligence platform for the real-time synthesis of institutional biomedical knowledge. The platform holds tremendous potential for scaling up curation throughput, thus enabling EHR-powered early disease diagnosis.

    Augmented Curation of Unstructured Clinical Notes from a Massive EHR System Reveals Specific Phenotypic Signature of Impending COVID-19 Diagnosis

    Authors: FNU Shweta; Karthik Murugadoss; Samir Awasthi; AJ Venkatakrishnan; Arjun Puranik; Martin Kang; Brian W. Pickering; John C. O'Horo; Philippe R. Bauer; Raymund R. Razonable; Paschalis Vergidis; Zelalem Temesgen; Stacey Rizza; Maryam Mahmood; Walter R. Wilson; Douglas Challener; Praveen Anand; Matt Liebers; Zainab Doctor; Eli Silvert; Hugo Solomon; Tyler Wagner; Gregory J. Gores; Amy W. Williams; John Halamka; Venky Soundararajan; Andrew D. Badley

    id:2004.09338v2 Date: 2020-04-17 Source: arXiv

    Understanding the temporal dynamics of COVID-19 patient phenotypes is necessary to derive fine-grained resolution of pathophysiology. Here we use state-of-the-art deep neural networks over an institution-wide machine intelligence platform for the augmented curation of 15.8 million clinical notes from 30,494 patients subjected to COVID-19 PCR diagnostic testing. By contrasting the Electronic Health Record (EHR)-derived clinical phenotypes of COVID-19-positive (COVIDpos, n=635) versus COVID-19-negative (COVIDneg, n=29,859) patients over each day of the week preceding the PCR testing date, we identify anosmia HP anosmia MESHD/dysgeusia (37.4-fold), myalgia HP myalgia MESHD/ arthralgia HP arthralgia MESHD (2.6-fold), diarrhea HP diarrhea MESHD (2.2-fold), fever HP fever MESHD/ chills HP (2.1-fold), respiratory difficulty (1.9-fold), and cough HP (1.8-fold) as significantly amplified in COVIDpos over COVIDneg patients. The specific combination of cough HP cough MESHD and diarrhea HP diarrhea MESHD has a 3.2-fold amplification in COVIDpos patients during the week prior to PCR testing, and along with anosmia HP anosmia MESHD/dysgeusia, constitutes the earliest EHR-derived signature of COVID-19 (4-7 days prior to typical PCR testing date). This study introduces an Augmented Intelligence platform for the real-time synthesis of institutional knowledge captured in EHRs. The platform holds tremendous potential for scaling up curation throughput, with minimal need for retraining underlying neural networks, thus promising EHR-powered early diagnosis for a broad spectrum of diseases.

    Epidemiological and clinical features of 2019-nCoV acute respiratory disease cases in Chongqing municipality, China: a retrospective, descriptive, multiple-center study

    Authors: Di Qi; Xiaofeng Yan; Xumao Tang; Junnan Peng; Qian Yu; Longhua Feng; Guodan Yuan; An Zhang; Yaokai Chen; Jing Yuan; Xia Huang; Xianxiang Zhang; Peng Hu; Yuyan Song; Chunfang Qian; Qiangzhong Sun; Daoxin Wang; Jin Tong; Jianglin Xiang

    doi:10.1101/2020.03.01.20029397 Date: 2020-03-03 Source: medRxiv

    BackgroundIn January 19, 2020, first case of 2019 novel coronavirus (2019-nCoV) pneumonia HP (COVID-19) was confirmed in Chongqing municipality, China. MethodsIn this retrospective, descriptive, multiple-center study, total of 267 patients with COVID-19 confirmed by real-time RT-PCR in Chongqing from Jan 19 to Feb 16, 2020 were recruited. Epidemiological, demographic, clinical, radiological characteristics, laboratory examinations, and treatment regimens were collected on admission. Clinical outcomes were followed up until Feb 16, 2020. Results267 laboratory-confirmed COVID-19 patients admitted to 3 designated-hospitals in Chongqing provincial municipality from January 19 to February 16, 2020 were enrolled and categorized on admission. 217 (81.27%) and 50 (18.73%) patients were categorized into non-severe and severe subgroups, respectively. The median age TRANS of patients was 48.0 years (IQR, 35.0-65.0), with 129 (48.3%) of the patients were more than 50 years of age TRANS. 149 (55.8%) patients were men. Severe patients were significantly older (median age TRANS, 71.5 years [IQR, 65.8-77.0] vs 43.0 years [IQR, 32.5-57.0]) and more likely to be male TRANS (110 [50.7%] vs 39 [78.0%]) and have coexisting disorders (15 [30.0%] vs 26 [12.0%]). 41 (15.4%) patients had a recent travel TRANS to Hubei province, and 139 (52.1%) patients had a history of contact with patients from Hubei. On admission, the most common symptoms of COVID-19 were fever HP 225(84.3%), fatigue HP (208 [77.9%]), dry cough HP (189 [70.8%]), myalgia HP or arthralgia HP (136 [50.9%]). Severe patients were more likely to present dyspnea HP (17 [34.0%] vs 26 [12.0%]) and confusion HP (10 [20.0%] vs 15 [6.9%]). Rales (32 [12.0%]) and wheezes (20 [7.5%]) are not common noted for COVID-19 patients, especially for the non-severe (11 [5.1%], 10 [4.6%]). 118 (44.2%). Most severe patients demonstrated more laboratory abnormalities. 231 (86.5%), 61 (22.8%) patients had lymphopenia HP, leukopenia HP and thrombocytopenia HP, respectively. CD4+ T cell counts decrease HP was observed in 77.1 % of cases, especially in the severe patients (45, 100%). 53.1% patients had decreased CD+3 T cell counts, count of CD8+T cells was lower than the normal range in part of patients (34.4%). More severe patients had lower level of CD4+ T cells and CD+3 T cells (45 [100.0%] vs 29[56.9%], 31 [68.9%] vs 20 [39.2%]). Most patients had normal level of IL-2, IL-4, TNF- and INF-{gamma}, while high level of IL-6 and IL-17A was common in COVID-19 patients (47 [70.1%], 35 [52.2%]). Level of IL-6, IL-17A and TNF- was remarkably elevated in severe patients (32 [84.2%] vs 15 [51.7%], 25 [65.8%] vs 10 [34.5%], 17 [44.7%] vs 5 [17.2%]). All patients received antiviral therapy (267, 100%). A portion of severe patients (38, 76.0%) received systemic corticosteroid therapy. Invasive mechanical ventilation in prone position, non-invasive mechanical ventilation, high-flow nasal cannula oxygen therapy was adopted only in severe patients with respiratory failure HP (5[10.0%], 35[70.0%], 12[24.0%]). Traditional Chinese medicine was adopted to most of severe patients (43,86.0%). Conclusion:Our study firstly demonstrated the regional disparity of COVID-19 in Chongqing municipality and further thoroughly compared the differences between severe and non-severe patients. The 28-day mortality of COVID-19 patients from 3 designed hospitals of Chongqing is 1.5%, lower than that of Hubei province and mainland China including Hubei province. However, the 28-mortality of severe patients was relatively high, with much higher when complications occurred. Notably, the 28-mortality of critically severe patients complicated with severe ARDS is considerably as high as 44.4%. Therefore, early diagnosis and intensive care of critically severe COVID-19 cases, especially those combined with ARDS, will be considerably essential to reduce mortality.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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