Corpus overview


Overview

MeSH Disease

Coronavirus Infections (78)

Fever (67)

Cough (36)

Dyspnea (28)

Fatigue (26)


Human Phenotype

Cough (78)

Fever (72)

Pneumonia (28)

Fatigue (27)

Hypertension (22)


Transmission

Seroprevalence
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    The Effect of Early Hydroxychloroquine-based Therapy in COVID-19 Patients in Ambulatory Care Settings: A Nationwide Prospective Cohort Study

    Authors: Tarek Sulaiman; Abdulrhman Mohana; Laila Alawdah; Nagla Mahmoud; Mustafa Hassanein; Tariq Wani; Amel Alfaifi; Eissa Alenazi; Nashwa Radwan; Nasser AlKhalifah; Ehab Elkady; Manwer AlAnazi; Mohammed Alqahtani; Khalid Abdalla; Yousif Yousif; Fouad AboGazalah; Fuad Awwad; Khaled AlabdulKareem; Fahad AlGhofaili; Ahmed AlJedai; Hani Jokhdar; Fahad Alrabiah

    doi:10.1101/2020.09.09.20184143 Date: 2020-09-13 Source: medRxiv

    ABSTRACT BACKGROUND: Currently, there is no proven effective therapy nor vaccine for the treatment of SARS-CoV-2. Evidence regarding the potential benefit of early administration of hydroxychloroquine (HCQ) therapy in symptomatic patients with Coronavirus Disease MESHD (COVID-19) is not clear. METHODS: This observational prospective cohort study took place in 238 ambulatory fever HP clinics in Saudi Arabia, which followed the Ministry of Health (MOH) COVID-19 treatment guideline. This guideline included multiple treatment options for COVID-19 based on the best available evidence at the time, among which was Hydroxychloroquine (HCQ). Patients with confirmed COVD-19 (by reverse transcriptase polymerase chain reaction (PCR) test) who presented to these clinics with mild to moderate symptoms during the period from 5-26 June 2020 were included in this study. Our study looked at those who received HCQ-based therapy along with supportive care (SC) and compared them to patients who received SC alone. The primary outcome was hospital admission within 28-days of presentation. The secondary outcome was a composite of intensive care admission (ICU) and/or mortality during the follow-up period. Outcome data were assessed through a follow-up telephonic questionnaire at day 28 and were further verified with national hospitalisation and mortality registries. Multiple logistic regression model was used to control for prespecified confounders. RESULTS: Of the 7,892 symptomatic PCR-confirmed COVID-19 patients who visited the ambulatory fever HP clinics during the study period, 5,541 had verified clinical outcomes at day 28 (1,817 patients in the HCQ group vs 3,724 in the SC group). At baseline, patients who received HCQ therapy were more likely to be males TRANS who did not have hypertension HP hypertension MESHD or chronic lung disease HP lung disease MESHD compared to the SC group. No major differences were noted regarding other comorbid conditions. All patients were presenting with active complaints; however, the HCQ groups had higher rates of symptoms compared to the SC group ( fever HP fever MESHD: 84% vs 66.3, headache HP headache MESHD: 49.8 vs 37.4, cough HP: 44.5 vs 35.6, respectively). Early HCQ-based therapy was associated with a lower hospital admission within 28-days compared to SC alone (9.4% compared to 16.6%, RRR 43%, p-value <0.001). The composite outcome of ICU admission and/or mortality at 28-days was also lower in the HCQ group compared to the SC (1.2% compared to 2.6%, RRR 54%, p-value 0.001). Adjusting for age TRANS, gender TRANS, and major comorbid conditions, a multivariate logistic regression model showed a decrease in the odds of hospitalisation in patients who received HCQ compared to SC alone (adjusted OR 0.57 [95% CI 0.47-0.69], p-value <0.001). The composite outcome of ICU admission and/or mortality was also lower for the HCQ group compared to the SC group controlling for potential confounders (adjusted OR 0.55 [95% CI 0.34-0.91], p-value 0.019). CONCLUSION: Early intervention with HCQ-based therapy in patients with mild to moderate symptoms at presentation is associated with lower adverse clinical outcomes among COVID-19 patients, including hospital admissions, ICU admission, and/or death.

    Association factors with severe cases and antiviral drug assessment in patients with COVID-19

    Authors: Xiaowei Gong; Xianfeng Guo; Shiwei Kang; Yan Li; Haixiang Gao; Yadong Yuan

    doi:10.21203/rs.3.rs-70914/v1 Date: 2020-09-02 Source: ResearchSquare

    Background Due to the latent onset of novel coronavirus disease MESHD 2019 (COVID-19), it is important to identify patients with increased probabilities for disease progression early in order to implement timely medical strategies. This study aimed to identify the factors associated with severe COVID-19 and evaluate the current antiviral drugs, especially in severe patients.Methods This was a retrospective observational study performed at the No. 7 Hospital of Wuhan (Wuhan, China) with hospitalized patients confirmed with COVID-19 from January 11 to March 13, 2020. Multivariable logistic regression analysis was used to identify the associated factors of severe COVID. Treatment of antivirus drugs were collected and evaluated.Results Of the 550 patients, 292 (53.1%) were female TRANS and 277 (50.4%) were ≥ 60 years old. The most common symptom was fever HP fever MESHD (n = 372, 67.7%), followed by dry cough MESHD cough HP (n = 257, 46.7%), and dyspnea HP dyspnea MESHD (n = 237, 43.1%), and fatigue HP fatigue MESHD (n = 224, 40.7%). Among the severe patients, 20.2% required invasive ventilator support and 18.0% required non-invasive ventilator. The identified risk factors for severe cases were: age ≥ 60 years (odds ratio (OR) = 3.02, 95% confidence interval (CI): 1.13–8.08, P = 0.028), D-dimer > 0.243 µg/ml (OR = 2.734, 95%CI: 1.012–7.387, P = 0.047), and low oxygenation index (OR = 0.984, 95%CI: 0.980–0.989, P < 0.001). In severe cases, the benefits of arbidol alone was 73.3%, which was better than ribavirin (7/17, 41.2%, P = 0.029).Conclusions Age ≥ 60 years, D-dimer > 0.243 µg/ml, and lower oxygenation index were associated with severe cases. Arbidol might provide more clinical benefits in treating patients with severe COVID-19 compared with other antiviral drugs.

    Gastrointestinal symptoms in coronavirus disease MESHD 2019: a cross-sectional study in Wuhan, China

    Authors: Yong Zhang; Zuneng Lu; Bo Wang; Jinxing Chang; Yonggang Ma

    doi:10.21203/rs.3.rs-69884/v1 Date: 2020-09-01 Source: ResearchSquare

    Background To investigate the clinical symptoms of coronavirus disease MESHD 2019 (COVID-19), particularly the prevalence SERO, time of symptom onset TRANS, and duration of gastrointestinal ( GI MESHD) symptoms.Methods This was a cross-sectional study using paper questionnaires. COVID-19 patients in a temporary hospital in Wuhan voluntarily completed surveys collecting data on COVID-19 symptoms and investigation results.Results A total of 212 adults TRANS were enrolled in this study, of whom 127 (59.9%) were female TRANS, mean age TRANS was 48.50 ± 13.15 years. Concerning symptoms, 78.8% (167/212) had fever HP fever MESHD, and 66% (140/212) had cough HP. Diarrhoea MESHD occurred in 43.8% (93/212) of patients. Nausea and vomiting HP Nausea and vomiting MESHD vomiting MESHD were also common (20.7%). Fever HP Fever MESHD and cough HP cough MESHD were frequently the initial symptoms of COVID-19, and they lasted for 5.00 [interquartile range (IQR): 3.00–10.00] days and 10.00 (IQR: 5.00–24.00) days, respectively. Most patients developed nausea and vomiting HP nausea and vomiting MESHD vomiting MESHD 2.00 (IQR: 0–9.00) days and diarrhoea MESHD 5.00 (IQR: 0.25–11.00) days after the onset of initial symptoms, respectively. There was a median duration of 4.00 (IQR: 2.00–8.75) days with diarrhoea MESHD, and 6.00 (IQR: 4.00–10.00) days with nausea and vomiting HP nausea and vomiting MESHD vomiting MESHD. The patients with diarrhoea MESHD were younger [45.85 ± 13.28 years vs 50.61 ± 12.82 years, P = 0.009] and were more likely to have an abnormal chest CT (95.7% vs 82.4%, P = 0.001) than those without diarrhoea MESHD.Conclusions In our cohort of patients, GI symptoms MESHD were common in COVID-19, occurred mostly during the middle stage of the disease, and lasted for a short duration. GI MESHD symptoms may not be associated with COVID-19 related treatment.

    Clinical Characteristics of Severe Covid Pneumonia HP: Exploring New Trends in ICU

    Authors: Aftab Akhtar; Sheher Bano; Ahtesham Iqbal; Moazma Ramzan; Aayesha Qadeer; Syed Waqar Hussain; Anam Saleem; Omair-ul-Haq Lodhi; Sana Zubair; Abdul Hameed kiani

    doi:10.21203/rs.3.rs-69224/v1 Date: 2020-08-31 Source: ResearchSquare

    Background: In late December 2019, Covid-19 emerged as clusters of pneumonia HP pneumonia MESHD of unknown cause in a province of china, Wuhan. Etiological agent was identified as novel coronavirus that resembles severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East Respiratory syndrome coronavirus (MERS-CoV) MESHD and has zoonotic transmission TRANS. Covid pneumonia HP can remain asymptomatic TRANS, present as mild infection, severe HP infection, severe MESHD pneumonia HP pneumonia MESHD or respiratory failure HP respiratory failure MESHD. Diagnosis is based on rRT-PCR carried out on respiratory secretions. Covid related mortality exceeds 50% once patient requires ICU admission. Objective: To study the characteristics of ICU population admitted to ICU of Shifa International hospital.Results: we prospectively analysed 74 patients which included 43.3% females TRANS and 56.7% males TRANS. Commonest symptoms were shortness of breath MESHD (94.5%), fever HP fever MESHD (74.3%) and cough HP (74.3%). Most of our study population consisted of non-smokers (79.7%) and had hypertension HP hypertension MESHD (59.4%) followed by diabetes MESHD (47.2%). Hydroxychloroquine (HCQ) and azithromycin combination is superior to hydroxychloroquine and doxycycline in reducing mortality (p=0.023) whereas Doxycycline alone resulted in increased mortality (p=0.009). Those who did not require antibiotics or required only narrow spectrum antibiotics had increased survival and reduced requirement of invasive mechanical ventilation (p=< 0.0001). in our study population, (44.9%) developed acute kidney injury HP acute kidney injury MESHD, 2.7% needed re-intubations 10.8% developed surgical emphysema HP emphysema MESHD and 2.7 % thromboembolic MESHD events despite full anticoagulation. ICU mortality was 41.8% and was higher in females TRANS (59.4%, p=0.008), those who had SOFA score > 3.5 at time of admission, raised D-Dimers > 931 ng/ml, NLR > 9.2. It was further high in those who required invasive mechanical ventilation and vasopressor support (58.1% mortality p=< 0.001). ICU stay was more prolonged in those requiring invasive mechanical ventilation as compared to those who did not. (23 days vs 6 days, p=0.001). Mean plateau pressure was 19.6 ± 7.6; mean Driving pressures 14.4 ± 4.6; mean PaO2/FiO2 150.7 ± 73.9; mean SPO2/FiO2 173.9 ± 106.9; mean PEEP was 8.2 ±4.33.Conclusion: We concluded that severe covid pneumonia HP pneumonia MESHD is common amongst males TRANS, non-smokers those who had comorbid. HCQ and azithromycin combination is superior to combination of HCQ and doxycycline or doxycycline alone and QT prolongation MESHD is a rare complication. Baseline NLR, APACHI II, SOFA, SAPS II, NUTRIC scores, D-Dimers, invasive ventilation and vasopressor support are important tools to predict ICU mortality. Invasive mechanical ventilation carries higher mortality and associated with more prolonged ICU stay. AKI is most common complication followed by shock HP and surgical emphysema HP emphysema MESHD. CRP, Ferritin levels has no impact on outcome.

    Clinical characteristics study of elderly TRANS patients aged TRANS 75 or older with COVID-19 pneumonia HP pneumonia MESHD in China

    Authors: Chao Zhang; Hua Fu; Long Zhang; Yuxiong Yin; Jing Lin; Hu Liu; Qing Mao

    doi:10.21203/rs.3.rs-67737/v1 Date: 2020-08-28 Source: ResearchSquare

    Background: Coronavirus disease 2019 (COVID-19), a newly emerged respiratory disease MESHD caused by severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2), has recently become pandemic. Clinical observation indicated that elderly TRANS patients had high incidence of severe pneumonia HP pneumonia MESHD and poor treatment efficacy. Therefore, this study was to clarify the characteristics of elderly TRANS patients aged TRANS 75 or older with COVID-19 pneumonia HP pneumonia MESHD in order to guide rational treatment for elderly TRANS patients. Methods: we enrolled 331 elderly TRANS patients aged TRANS 75 or older with confirmed COVID-19 in Huoshenshan hospital of Wuhan from February 3rd to March 31st. The cases were divided into general, serious and critical groups according to severity after hospitalization, and the difference among groups were compared by R package statistics software. Results: Compared with general group, serious and critical groups had more underlying comorbidities and higher incidence of cough HP cough MESHD, breath shortness MESHD and anorexia HP anorexia MESHD. Moreover, there existed obviously differences in many of laboratory indexes and CT images among them. serious and critical elderly TRANS patients were more likely to receive oxygen, mechanical ventilation, expectorant, corticosteroid, abidor, cephaloprin, imipenem, human serum SERO albumin (HSA), nutrition support, anti SARS-CoV-2 positive plasma SERO and actemra. Multivariate analysis of factors showed that male TRANS sex, hypertension HP hypertension MESHD, diabetes MESHD, renal diseases MESHD, breath shortness MESHD, neutrophil, platelet, creatinine, lactate dehydrogenase were the risk factor for serious and critical illness. While blood SERO cell (WBC) was the protective factor. Conclusion: elderly TRANS patients have high incidence of severe pneumonia HP pneumonia MESHD and poor treatment efficacy. The reasons might be that many of the elderly TRANS patients with COVID-19 pneumonia HP pneumonia MESHD have certain chronic disease MESHD, poor immune function and a meager response to the virus. the pathogenic mechanism of SARS-CoV-2 might be involved in the cell-mediated immunity and cytokine storms by acting on lymphocytes.

    A case report of moderate COVID-19 with an extremely long-term viral shedding period in China

    Authors: yonghong wang; chaoyuan liu; qinghui meng; shuang gui; yu wu; pengjiang cheng; peng wang; xiuyong liao

    doi:10.21203/rs.3.rs-59700/v1 Date: 2020-08-14 Source: ResearchSquare

    BackgroundAn ongoing outbreak of novel coronavirus disease MESHD 2019 (COVID-19) from Wuhan, China, is currently recognized as a global public health emergency, which has subsequently spread to the rest of China and other countries. The WHO raised the COVID-19 alert to the highest level. The virus is a new highly contagious via human-to-human transmission TRANS. The median duration of viral shedding is 20.0 days. We report that the longest duration of viral shedding was 32.0 days from illness onset in a patient with moderate COVID-19 admitted to QianJiang Central Hospital.Case presentationA 37-year-old male TRANS sought medical advice while suffering from fever HP fever MESHD, dry cough MESHD cough HP, fatigue HP fatigue MESHD, dizziness MESHD, runny nose and diarrhoea MESHD. Five days before the visit, he had a history of travel TRANS from affected geographic areas. The patient had a positive RT-PCR test, and chest CT images showed multiple nodules and mixed ground-glass opacification with consolidation in both lungs. Laboratory findings showed that his lymphocyte and CD4+ counts were below the normal range. The patient was given antiviral treatment, including arbidol, lopinavir, IFN-α, and traditional Chinese medicine, and other necessary support care. All clinical symptoms and CT imaging manifestation abnormalities resolved during the course of therapy.ConclusionAlthough the positive RT-PCR tests were verified in consecutive upper respiratory specimens, the clinical symptoms, CT imaging findings, CD4 + lymphocyte counts, and IgG antibody SERO levels had obviously improved. Positive tests may be detecting pieces of inactive viruses, which would not be transmissible in individual cases.

    Clinical and Imaging Characteristics of Two COVID-19 Cluster Infections in Beijing, China: A Retrospective Study

    Authors: Ying Zhao; Jingbo Du; Qi Leng; Zhenwu Li

    doi:10.21203/rs.3.rs-55960/v1 Date: 2020-08-08 Source: ResearchSquare

    Background: As a new infectious disease MESHD, coronavirus disease MESHD 2019 (COVID-19) is not fully understood. During January - July 2020, there were two clusters infections MESHD in Beijing, China. This study was to analyze the features of the two COVID-19 infections in Beijing.Methods: In this retrospective single-center study, 89 cases with the positive novel coronavirus nucleic acid test were collected from January to July 2020 in Beijing. They were divided into January-March group and June-July group. Two groups of data were compared.Results: The eighty-nine cases, 47 males TRANS and 42 females TRANS, mean age TRANS (41±14 years), were used for our study. The most common symptoms were fever HP fever MESHD (46/89, 52%) and cough HP (34/89, 38%). The clinical classification were moderate type (56/89,63%), mild type (24/89, 27%), severe type (4/89, 4%), critical type (0), respectively. Ground glass opacity (GGO) (47%) was the majority CT pattern. The frequency of involvement of lower lobe was higher than that of upper lobe (P<0.01). In January - March group, there were 5 patients (18%) exposure to Wuhan, 15 patients (54%) family clusters, 5 patients (18%) colleague clusters, 3 patients (11%) imported cases. In June-July group, 41 patients (68%) had an exposure to Xinfadi market of Beijing, 6 patients (10%) family clusters, and 14 patients (23%) colleague clusters. The number of patients with fever HP fever MESHD, cough HP cough MESHD, chest CT severity score and the number of lesion lung lobes MESHD in January-March group was higher than that in June-July group (P<0.05).Conclusions: Two COVID-19 clusters were dominated moderate and mild type, but few severe types. Patients in June-July group had less symptoms, imaging and family clusters than that in January-March group. This suggested that closely monitoring, early quarantined, nucleic acid test of COVID-19 and chest CT were important measures to prevent epidemic.

    Clinical manifestations of patients with Coronavirus Disease MESHD 2019 (COVID- 19) attending at hospitals in Bangladesh

    Authors: Md. Shahed Morshed; Abdullah Al Mosabbir; Prodipta Chowdhury; Sheikh Mohammad Ashadullah; Mohammad Sorowar Hossain

    doi:10.1101/2020.07.30.20165100 Date: 2020-08-01 Source: medRxiv

    Bangladesh is in the rising phase of the ongoing pandemic of the coronavirus disease MESHD 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 MESHD (SARS-CoV-2). The scientific literature on clinical manifestations of COVID-19 patients from Bangladesh is scarce. This study aimed to report the sociodemographic and clinical characteristics of patients with COVID-19 in Bangladesh. We conducted a cross-sectional study at three dedicated COVID-19 hospitals. The severity of the COVID-19 cases was assessed based on the WHO interim guidance. Data were collected only from non-critical COVID-19 patients as critical patients required immediate intensive care admission making them unable to respond to the questions. A total of 103 RT-PCR confirmed non-critical COVID-19 patients were enrolled. Most of the patients (71.8%) were male TRANS. Mild, moderate and severe illness were assessed in 74.76%, 9.71% and 15.53% of patients respectively. Nearly 52.4% of patients had a co-morbidity, with hypertension HP hypertension MESHD being the most common (34%), followed by diabetes mellitus HP diabetes mellitus MESHD (21.4%) and ischemic MESHD heart disease MESHD (9.7%). Fever HP Fever MESHD (78.6%), weakness MESHD (68%) and cough HP (44.7%) were the most common clinical manifestations. Other common symptoms included loss of appetite (37.9%), difficulty in breathing (37.9%), altered sensation of taste or smell (35.0%), headache HP headache MESHD (32%) and body ache MESHD (32%). The median time from onset of symptom TRANS to attending hospitals was 7 days (IQR 4-10). This study will help both the clinicians and epidemiologists to understand the magnitude and clinical spectrum of COVID-19 patients in Bangladesh.

    Clinical Characteristics and Predictive Value of low CD4+T Count in Patients with Moderate and Severe COVID-19: A Multicenter Retrospective Study

    Authors: Xue-song Wen; Lei Gao; Dan Jiang; Xiao-cheng Cheng; Bin He; Yue Chen; Peng Lei; Wei-xiao Tan; Shu Qin; Guo-qiang Cai; dongying zhang

    doi:10.21203/rs.3.rs-46009/v1 Date: 2020-07-20 Source: ResearchSquare

    Background In December 2019, coronavirus disease MESHD 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) emerged in Wuhan, Hubei, China. And, it has become a global pandemic. Describe the patient's clinical symptoms in detail, finding markers that predict the prognosis of patients with COVID-19 are of great value.MethodsIn this multicenter, retrospective study, 476 patients with COVID-19 were recruited from a consecutive series. After screening, a total of 395 patients were included in this study. All-cause death MESHD was the primary endpoint. All patients were followed up from admission till discharge or death MESHD.ResultsThe dominant symptoms observed in the study included fever HP fever MESHD on admission, cough HP, fatigue HP fatigue MESHD and shortness of breath MESHD. The most frequent comorbidities were hypertension HP hypertension MESHD and diabetes MESHD. Compared with patients with higher CD4+T cells level, patients with lower CD4+T cells level were older and were more frequently male TRANS. In terms of laboratory findings, lymphocyte count, CD4+T cell count, CD8+T cell count were significantly lower in low group than in higher group. The case in-hospital death rate was significant higher in patients with lower CD4+T level. After adjusting for potential confounding factors, CD4+T count below the lower limit of normal showed independent prognostic value for all-cause in-hospital death MESHD in patients with COVID-19. Conclusions: Reductions in lymphocytes and lymphocyte subsets are common in COVID-19 patients, especially in severe cases. It is the CD8+T count, not the CD4+T count, that reflected the severity of the patient’s disease. Lower CD4+T count is independently associated with an increased rate of in-hospital death. Trial registration: Prognostic Factors of Patients With COVID-19, NCT04292964. Registered 03 March 2020. https://clinicaltrials.gov/ct2/show/NCT04292964.

    Clinical Characteristics of 107 Patients with COVID-19 in Ningbo, China: Single Center Experience Outside Hubei

    Authors: Boming Wu; Junjie Li; Hongping Xuan; Nanhong Zheng; Honghua Ye; Yaoren Hu; Tong’en Chen; Hao Ying; Lingyan Fan; Qing Xie; Zike Sheng; Yin Ying

    doi:10.21203/rs.3.rs-44830/v1 Date: 2020-07-17 Source: ResearchSquare

    Background Since December 2019, there has be an outbreak of coronavirus disease MESHD 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) in Wuhan, China. Nowadays, it rapidly spread across the country and then the worldwide. We aimed to investigate the clinical characteristics of patients with COVID-19.Methods The patients with confirmed COVID-19 admitted between January 25 and February 10, 2020, were enrolled. Epidemiological, demographic, clinical, laboratory, radiological data, and antivirus therapies, were retrospectively collected and analyzed. The 90-day follow-up of these patients was also performed.Results A total of 107 patients were included. The median age TRANS was 55.0 years (range from 18.0 to 85.0 years), and 72 (67.3%) were female TRANS. Ninety-three (86.9%) of the patients had a history of contacting with residents from Wuhan (n=31), or contacting with confirmed COVID-19 patients (n=62) within 2 weeks. Fifty-eight (54.2%) had a family cluster onset. Fever HP Fever MESHD and cough HP cough MESHD were the most common symptoms. Only two patients had diarrhea HP diarrhea MESHD. The most common underlying disease was hypertension HP hypertension MESHD. Lymphopenia HP Lymphopenia MESHD was observed in 26 patients. Fifty-two patients with an elevated level of IL-6. On admission, bilateral patchy shadowing and ground-glass opacity were the typical radiological findings on chest computed tomography. Six patients had an intensive care unit (ICU) stay. Antivirus therapy was performed to all patients. 105 patients discharged with an improved condition, and no death MESHD was occurred during our 90-day follow-up for these patients.Conclusions Patients with COVID-19 in our hospital had relatively mild symptoms, and good prognosis. This study also highlights the importance of human-to-human transmission TRANS in COVID-19.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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