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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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    CLINICAL COURSE AND OUTCOME OF COVID-19 MESHD ACUTE RESPIRATORY DISTRESS SYNDROME: DATA FROM A NATIONAL REPOSITORY

    Authors: Ali A El Solh; Gianfranco Umberto Meduri; Yolanda Lawson; MIchael Carter; Kari A Mergenhagen

    doi:10.1101/2020.10.16.20214130 Date: 2020-10-20 Source: medRxiv

    Background: Mortality attributable to coronavirus disease-19 MESHD ( COVID-19 MESHD) 2 infection occurs mainly through the development of viral pneumonia MESHD-induced acute respiratory distress syndrome MESHD ( ARDS MESHD). Research Question: The objective of the study is to delineate the clinical profile, predictors of disease progression, and 30-day mortality from ARDS MESHD using the Veterans Affairs Corporate Data Warehouse. Study Design and Methods: Analysis of a historical cohort of 7,816 hospitalized patients with confirmed COVID-19 MESHD infection between January 1, 2020, and August 1, 2020. Main outcomes were progression to ARDS MESHD and 30-day mortality from ARDS MESHD, respectively. Results: The cohort was comprised predominantly of men (94.5%) with a median age of 69 years (interquartile range [IQR] 60-74 years). 2,184 (28%) were admitted to the intensive care unit and 643 (29.4%) were diagnosed with ARDS MESHD. The median Charlson Index was 3 (IQR 1-5). Independent predictors of progression to ARDS MESHD were body mass index (BMI)[≥] 40 kg/m2, diabetes MESHD, lymphocyte counts<700x109/L, LDH>450 U/L, ferritin >862 ng/ml, C-reactive protein HGNC >11 mg/dL, and D-dimer >1.5 ug/ml. In contrast, the use of an anticoagulant lowered the risk of developing ARDS (OR 0.66 [95% CI 0.49-0.89]. Crude 30-day mortality rate from ARDS was 41% (95% CI 38%-45%). Risk of death from ARDS was significantly higher in those who developed acute renal failure and septic shock. Use of an anticoagulant was associated with two-fold reduction in mortality. Survival benefit was observed in patients who received corticosteroids and/or remdesivir but there was no advantage of combination therapy over either agent alone. Conclusions: Among those hospitalized for COVID-19 MESHD, nearly one in ten progressed to ARDS. Septic shock, and acute renal failure are the leading causes of death in these patients. Treatment with either remdesivir and corticosteroids reduced the risk of mortality from ARDS. All hospitalized patients with COVID-19 MESHD should be placed at a minimum on prophylactic doses of anticoagulation.

    Helmet CPAP HGNC to treat hypoxic pneumonia MESHD outside the ICU: an observational study during the COVID-19 MESHD outbreak

    Authors: Andrea Coppadoro; Annalisa Benini; Robert Fruscio; Luisa Verga; Paolo Mazzola; Giuseppe Bellelli; Marco Carbone; Giacomo Mulinacci; Alessandro Soria; Beatrice Noe'; Eduardo Beck; Riccardo Di Sciacca; Davide Ippolito; Giuseppe Citerio; Grazia Valsecchi; Andrea Biondi; Alberto Pesci; Paolo Bonfanti; Davide Gaudesi; Giacomo Bellani; Giuseppe Foti

    doi:10.21203/rs.3.rs-92708/v2 Date: 2020-10-14 Source: ResearchSquare

    Background: Respiratory failure MESHD due to COVID-19 MESHD pneumonia MESHD is associated with high mortality and may overwhelm health care systems, due to the surge patients requiring advanced respiratory support. Shortage of intensive care unit (ICU) beds required many patients to be treated outside the ICU despite severe gas exchange impairment MESHD. Helmet is as effective interface to provide Continuous Positive Airway Pressure ( CPAP HGNC) non-invasively. We report data about the usefulness of helmet CPAP HGNC during pandemic, either as an effective treatment, a bridge to intubation or a rescue therapy for patients with care limitations (DNI).Methods: In this observational study we collected data regarding patients failing standard oxygen therapy (i.e. non-rebreathing mask) due to COVID-19 MESHD pneumonia MESHD treated with a free flow helmet CPAP HGNC system. Patients’ data were recorded before, at initiation of CPAP HGNC treatment and once a day, thereafter. CPAP HGNC failure was defined as a composite outcome of intubation or death MESHD.Results: A total of 306 patients were included; 42% were deemed as DNI. Helmet CPAP HGNC treatment was successful in 69% of the full-treatment and 28% of the DNI patients (P<0.001). With helmet CPAP HGNC, PaO2/FiO2 ratio doubled from about 100 to 200 mmHg (P<0.001); respiratory rate decreased from 28 [22-32] to 24 [20-29] breaths per minute, P<0.001). C-Reactive Protein HGNC, time to oxygen mask failure MESHD, age, PaO2/FiO2 during CPAP HGNC, number of comorbidities were independently associated with CPAP HGNC failure. Helmet CPAP HGNC was maintained for 6 [3-9] days, almost continuously during the first two days. None of the full treatment patients died before intubation in the wards.Conclusions: Helmet CPAP HGNC treatment is feasible for several days outside the ICU, despite persistent impairment in gas exchange. It was used, without escalating to intubation, in the majority of full treatment patients after standard oxygen therapy failed. DNI patients could benefit from helmet CPAP HGNC as rescue therapy to improve survival.Trial Registration: NCT04424992

    Characterization of Confirmed and Suspected COVID-19 MESHD Pneumonia Patients in a Retrospective Cohort Study in Wuhan

    Authors: Maomao Xi; Dan Cui; Qiaomei Liu; Lili Li; Yilin Yin; Fang Dong; Di Xiong; Yuwei Wu; Hongrong Guo; Min Bao; Zhanghua Li; Man Luo; Juan Wu; Weiguo Xie; Qingming Wu; Anlin Peng; Jinhu Wu; Yiqing Tan; Jianbin Sun; Pengcheng Luo; Zan Huang; Xiaodong Huang

    doi:10.21203/rs.3.rs-92239/v1 Date: 2020-10-13 Source: ResearchSquare

    Background: A methodical comparison of confirmed and suspected COVID-19 MESHD patients has not been previously reported. Therefore, we thoroughly analyzed the demographic and clinical characteristics between these groups to identify mortality risk factors.Methods: A retrospective cohort of 1,276 hospitalized COVID-19 MESHD pneumonia MESHD patients at Tongren Hospital (Wuhan, China; January 27 to March 3, 2020) was studied. Cox regression analyses were performed to evaluate multiple mortality risk factors. Results: Both cohorts of confirmed (n=797) and suspected (n=479) patients exhibited typical demographic, clinical, and radiological characteristics. Treatment methods were consistent and both groups shared similarities in many demographic and clinical characteristics: age (≥65, 45.9% vs 41.8%, P=0.378) and lung disease MESHD (12.5% vs 14.6%, P=0.293). However, confirmed patients exhibited more severe disease manifestations than those in suspected patients: a higher incidence of fever MESHD (65.4% vs 58.0%, P<0.01), lower lymphocyte count (1.12×109/L vs 1.22×109/L, P=0.022), higher C-reactive protein HGNC ( CRP HGNC) (11.60 mg/L vs 7.61mg/L, P=0.021), and more severe radiographic manifestations ( lung infection MESHD incidence, 3.8% vs 3.0%, P=0.014; ground-glass opacity lesion incidence, 2.3% vs 2.0%, P=0.033). The dynamic profiles of lymphocytes, monocytes, D-dimer, and CRP HGNC, clearly delineated confirmed patients from suspected patients exhibiting critical illness. Cox regression analysis demonstrated that lung disease MESHD (adjusted hazard ratio 8.972, 95% CI: 3.782-21.283), cardiovascular disease MESHD (3.083, 1.347-7.059), neutrophil count (1.189, 1.081-1.307), age (1.068, 1.027-1.110), and ground-glass opacity lesions MESHD (1.039, 95% 1.013-1.065), were the main risk factors for mortality in confirmed patients; lung disease MESHD (14.725, 2.187-99.147), age (1.076, 1.004-1.153), and CRP HGNC level (1.012, 95% CI 1.004-1.020) were the primary factors in suspected patients.Conclusions: Suspected patients with serious illness should seek medical attention to reduce mortality. Multiple factors must be assessed to determine the mortality risk and the appropriate treatment. 

    Exclusion of bacterial co-infection in COVID-19 MESHD using baseline inflammatory markers and their response to antibiotics

    Authors: Claire Y Mason; Tanmay Kanitkar; Charlotte J Richardson; Marisa Lanzman; Zak Stone; Tabitha Mahungu; Damien Mack; Emmanuel Q Wey; Lucy Lamb; Indran Balakrishnan; Gabriele Pollara

    doi:10.1101/2020.10.09.20199778 Date: 2020-10-11 Source: medRxiv

    Background COVID-19 MESHD is infrequently complicated by secondary bacterial infection MESHD, but nevertheless antibiotic prescriptions are common. We used community-acquired pneumonia MESHD (CAP) as a benchmark to define the processes that occur in a bacterial pulmonary infection MESHD, and tested the hypothesis that baseline inflammatory markers and their response to antibiotic therapy could distinguish CAP from COVID-19 MESHD. Methods In patients admitted to Royal Free Hospital ( RFH MESHD) and Barnet Hospital (BH) we defined CAP by lobar consolidation on chest radiograph, and COVID-19 MESHD by SARS-CoV-2 detection by PCR. Data were derived from routine laboratory investigations. Results On admission all CAP MESHD and >90% COVID-19 MESHD patients received antibiotics. We identified 106 CAP and 619 COVID-19 MESHD patients at RFH MESHD. CAP was characterised by elevated white cell count (WCC) and C-reactive protein HGNC ( CRP HGNC) compared to COVID-19 MESHD (median WCC 12.48 (IQR 8.2-15.3) vs 6.78 (IQR 5.2-9.5) x106 cells/ml and median CRP HGNC CRP HGNC 133.5 (IQR 65-221) vs 86 (IQR 42-160) mg/L). Blood samples collected 48-72 hours into admission revealed decreasing CRP HGNC in CAP but not COVID-19 MESHD ( CRP HGNC difference -33 (IQR -112 to +3.5) vs +15 (IQR -15 to +70) mg/L respectively). In the independent validation cohort (BH) consisting of 169 CAP and 181 COVID-19 MESHD patients, admission WCC >8.2x106 cells/ml or falling CRP MESHD CRP HGNC during admission identified 95% of CAP cases, and predicted the absence of bacterial co-infection MESHD in 45% of COVID-19 MESHD patients. Conclusions We propose that in COVID-19 MESHD the absence of both elevated baseline WCC and antibiotic-related decrease in CRP HGNC can exclude bacterial co-infection MESHD and facilitate antibiotic stewardship efforts.

    Association between corticosteroids and intubation or death among patients with COVID-19 MESHD pneumonia in non-ICU settings: an observational study using of real-world data from 51 hospitals in France and Luxembourg

    Authors: Viet-Thi Tran; Matthieu Mahevas; Firouze Bani Sadr; Olivier Robineau; Thomas Perpoint; Elodie Perrodeau; Laure Gallay; Philippe Ravaud; Francois Goehringer; Xavier Lescure; - COCORICO

    doi:10.1101/2020.09.16.20195750 Date: 2020-09-18 Source: medRxiv

    Objective To assess the effectiveness of corticosteroids on outcomes of patients with mild COVID-19 MESHD pneumonia MESHD. Methods We used routine care data from 51 hospitals in France and Luxembourg to assess the effectiveness of corticosteroids at 0.8 mg/kg/day eq. prednisone (CTC group) vs standard of care (no-CTC group) among patients [≤] 80 years old with COVID-19 MESHD pneumonia MESHD requiring oxygen without mechanical ventilation. The primary outcome was intubation or death at Day 28. Baseline characteristics of patients were balanced using propensity score inverse probability of treatment weighting. Results Among the 891 patients included in the analysis, 203 were assigned to the CTC group. At day 28, corticosteroids did not reduce the rate of the primary outcome (wHR 0.92, 95% CI 0.61 to 1.39) nor the cumulative death rate (wHR 1.03, 95% CI 0.54 to 1.98). Corticosteroids significantly reduced the rate of the primary outcome for patients requiring oxygen [≥] at 3L/min (wHR 0.50, 95% CI 0.30 to 0.85) or C-Reactive Protein HGNC ( CRP HGNC) [≥] 100mg/L (wHR 0.44, 95%CI 0.23 to 0.85). We found a higher number of hyperglycaemia events MESHD among patients who received corticosteroids, but number of infections were similar across the two groups. Conclusions We found no association between the use of corticosteroids and intubation or death MESHD in the broad population of patients [≤]80 years old with COVID-19 MESHD hospitalized in non-ICU settings. However, the treatment was beneficial for patients with [≥] 3L/min oxygen or CRP HGNC [≥] 100mg/L at baseline. These data support the need to confirm the right timing of corticosteroids for patients with mild COVID.

    Cardiomegaly found in the 2019 Novel Coronavirus Disease MESHD ( COVID-19 MESHD): Analysis of 115 Patients

    Authors: Zeinab Shankayi; Farideh Bahrami; Tahereh Mohammadzadeh; Amineh Ghafari Anvar; Hosein Amini; M. Mehdi Asadi; M.Hossein Mirasheh; Mojtaba Sharti

    doi:10.21203/rs.3.rs-69907/v1 Date: 2020-09-01 Source: ResearchSquare

    Objectives There is much evidence showing that most of the mortality and morbidity cases are observed in COVID-19 MESHD patients with cardiovascular diseases MESHD. Thus, the study on COVID 19 patients with cardiovascular diseases MESHD is required for their optimum management. The present study presents a preliminary report on the cardiomegaly MESHD of laboratory and CT findings of COVID-19 MESHD pneumonia MESHD in Iran. A total of 115 Patients with COVID-19 MESHD pneumonia MESHD hospitalized in (confirmed by CT scan and RT-PCR) Baghiyatallah hospital participated in the present study.Results Thirty-three of these patients (26.8%) had cardiomegaly MESHD detected by chest CT scan. Creatinine, Urea and CRP HGNC levels of patients significantly increased based on cardiovascular disease MESHD detection. In contrast, Sodium levels reduced to below the normal in patients with cardiomegaly MESHD. Despite respiratory illness as the first symptom of COVID-19 MESHD, the role of other diseases such as cardiovascular disease MESHD requires further investigation.

    Predictive Risk Factors at Admission and a "Burning Point" During Hospitalization Serve as Sequential Alerts for Critical Illness in COVID-19 MESHD Patients

    Authors: Mei Zhou; Juanjuan Xu; Kai Wang; Zhengrong Yin; Xingjie Hao; Xueyun Tan; Yafei Huang; Hui Li; Fen Wang; Chengguqiu Dai; Guanzhou Ma; Zhihui Wang; Limin Duan; Yang Jin

    doi:10.21203/rs.3.rs-69285/v1 Date: 2020-08-31 Source: ResearchSquare

    Background In critically ill COVID-19 MESHD patients, the crucial turning point before critical illness onset (CIO) remain largely unknown, and the combination of baseline risk factors with the turning point during hospitalization was rarely reported.Methods In this retrospective cohort study, 1150 consecutively admitted patients with confirmed COVID-19 MESHD were enrolled, including 296 critical and 854 non-critical patients. We compared the differences of all the clinically tested indicators and their dynamic changes between critical and non-critical patients. Three prediction models were established and validated based on the risk factors at admission, and an online baseline predictive tool was developed. Linear mixed model (LMM) was applied for longitudinal data analysis in 296 critical patients throughout the hospitalization, to predict the likelihood and possible time of critical illness in COVID-19 MESHD patients. A crucial turning point, where several indicators will experience a greater and significantly continuous change before CIO, was defined as “burning point” in our study. This point indicates the deterioration of patient’s condition before CIO.Results We established a novel two-checkpoint system to predict critical illness for COVID-19 MESHD patients in which the first checkpoint happened at patient admission was assessed by a baseline prediction model to project the likelihood of critical illness based on the variables selected from random forest and LASSO regression analysis, including age, SOFA score, neutrophil-to-lymphocyte ratio (NLR), D-dimer, lactate dehydrogenase (LDH), International Normalized Ratio (INR), and pneumonia MESHD area derived from CT images, which yields an AUC of 0.960 (95% confidence interval, 0.941-0.972) and 0.958 (0.936-0.980) in the training and testing sets, respectively. This model has been translated into a public web-based risk calculator. Furthermore, the second checkpoint (designated as “burning point” in our study) could be identified as early as 5 days preceding the CIO, and 12 (IQR, 7-17) days after illness onset. Seven most significant and representative “burning point” indicators were SOFA score, NLR, C-reactive protein HGNC ( CRP HGNC), glucose, D-dimer, LDH, and blood urea nitrogen (BUN).Conclusions With this two-checkpoint prediction system, the deterioration of COVID-19 MESHD patients could be early identified and more intensive treatments could be started in advance to reduce the incidence of critical illness MESHD.

    A Large-Scale Clinical Validation Study Using nCapp Cloud Plus Terminal by Frontline Doctors for the Rapid Diagnosis of COVID-19 MESHD and COVID-19 MESHD pneumonia 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 2019 MESHD ( COVID-19 MESHD) has become a global pandemic acute infectious disease MESHD, especially with the features of possible asymptomatic carriers and high contagiousness. It causes acute respiratory distress syndrome MESHD and results in a high mortality rate if pneumonia is involved. Currently, it is difficult to quickly identify asymptomatic cases or COVID-19 MESHD patients with 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 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 MESHD cases based on a COVID-19 MESHD clinical case database in China, and to assist global frontline doctors to efficiently and precisely diagnose asymptomatic COVID-19 MESHD 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 MESHD outbreak in China. By quality control and data anonymization on the platform, a total of 3,249 cases from COVID-19 MESHD 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 MESHD and COVID-19 MESHD 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 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 MESHD with 9 clinical indicators that are fast and accessible: 'Residing or visiting history in epidemic regions', 'Exposure history to COVID-19 MESHD patient', 'Dry cough', 'Fatigue', 'Breathlessness', 'No body temperature decrease after antibiotic treatment', 'Fingertip blood oxygen saturation<=93%', ' Lymphopenia' MESHD, and ' C-reactive protein HGNC ( CRP HGNC) 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 of the model, we used a cutoff value of 0.09. The sensitivity 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 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 MESHD high-risk groups in China, frontline doctors can rapidly identify asymptomatic 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 MESHD, thus avoiding the transmission of the disease from asymptomatic patients at the community level.

    Telmisartan for treatment of Covid-19 MESHD patients: an open randomized clinical trial. Preliminary report.

    Authors: Mariano Duarte; Facundo G Pelorosso; Liliana Nicolosi; M. Victoria Salgado; Hector Vetulli; Analia Aquieri; Francisco Azzato; Mauro Basconcel; Marcela Castro; Javier Coyle; Ignacio Davolos; Eduardo Esparza; Ignacio Fernandez Criado; Rosana Gregori; Pedro Mastrodonato; Maria Rubio; Sergio Sarquis; Fernando Wahlmann; Rodolfo Pedro Rothlin

    doi:10.1101/2020.08.04.20167205 Date: 2020-08-11 Source: medRxiv

    Background. Covid-19 MESHD, the disease caused by SARS-CoV-2, is associated with significant respiratory-related morbidity and mortality. Angiotensin receptor blockers (ARBs) have been postulated as tentative pharmacological agents to treat Covid-19 MESHD-induced lung inflammation MESHD. Trial design. This trial is a parallel group, randomized, two arm, open label, multicenter superiority trial with 1:1 allocation ratio. Methods. Participants included patients who were 18 years of age or older and who had been hospitalized with confirmed Covid-19 MESHD with 4 or fewer days since symptom onset. Exclusion criteria included intensive care unit admission prior to randomization and use of angiotensin receptor blocker or angiotensin converting enzyme inhibitors at admission. Participants in the treatment arm received telmisartan 80 mg bid during 14 days plus standard care. Participants in the control arm received standard care alone. Primary outcome was to achieve significant reductions in plasma levels of C-reactive protein HGNC in telmisartan treated Covid-19 MESHD patients at day 5 and 8 after randomization. Key secondary outcomes included time to discharge evaluated at 15 days after randomization and admission to ICU and death MESHD at 15- and 30-days post randomization. We present here a preliminary report. Results. A total of 78 patients were included in the interim analysis, 40 in the telmisartan and 38 in the control groups. CRP HGNC levels at day 5 in the control group were 51.1 +/- 44.8 mg/L (mean +/- SD; n=28) and in the telmisartan group were 24.2 +/- 31.4 mg/L (mean +/- SD; n=32, p<0.05). At day 8, CRP HGNC levels were 41.6 +/- 47.6 mg/L (mean +/- SD; n=16) and 9.0 +/- 10.0 mg/L (mean +/- SD; n=13, p < 0.05) in the control and telmisartan groups, respectively. Also, analysis of time to discharge by Kaplan-Meier method showed that telmisartan treated patients had statistically significant lower time to discharge (median time to discharge control group=15 days; telmisartan group=9 days). No differences were observed for ICU admission or death MESHD. No significant adverse events related to telmisartan were reported. Conclusions. In the present preliminary report, despite the small number of patients studied, ARB telmisartan, a well-known inexpensive safe antihypertensive drug, administered in high doses, demonstrates anti-inflammatory effects and improved morbidity in hospitalized patients infected with SARS -CoV-2, providing support for its use in this serious pandemia (NCT04355936).

    Assessment of Musculoskeletal Pain, Fatigue and Grip Strength in Hospitalized Patients with COVID-19 MESHD

    Authors: Sansin Tuzun; Aslinur Keles; dilara okutan; Tugbay Yildiran; Deniz Palamar

    doi:10.21203/rs.3.rs-56548/v1 Date: 2020-08-10 Source: ResearchSquare

    IMPORTANCE  Coronavirus disease 2019 MESHD ( COVID-19 MESHD) is an emerging disease that was declared as a pandemic by WHO. Although there are many retrospective studies to present clinical aspects of the COVID-19 MESHD, still the involvement of the musculoskeletal system has not been deeply investigated.OBJECTIVE To classify the symptoms of musculoskeletal system in COVID-19 MESHD patients, to evaluate myalgia MESHD, arthralgia MESHD and physical/ mental fatigue MESHD, to assess handgrip muscle strength, and to examine the relationship of these parameters with the severity and laboratory values of the disease. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was performed at the IUC-Cerrahpaşa Pandemic Clinic. Hospitalized 150 adults with laboratory and radiological confirmation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) according to WHO interim guidance were included in the study. Data were recorded from May 15,2020, to June 30, 2020.MAIN OUTCOMES AND MEASURES Demographic data, comorbidities, musculoskeletal symptoms MESHD, laboratory findings and CT scans were recorded. To determine the disease severity 2007 idsa/ats guidelines for community acquired pneumonia MESHD was used. Myalgia MESHD severity was calculated by numerical rating scale (NRS). Visual analog scale and Chalder Fatigue Scale (CFS) were used for fatigue MESHD severity determination. Handgrip strength (HGS) was measured by Jamar hand dynamometer.RESULTS 103 patients (68.7%) were nonsevere and 47 patients (31.3%) were severe. The most common musculoskeletal symptom was fatigue MESHD (133 [85.3%]), followed by myalgia MESHD (102 [68.0%]), arthralgia MESHD (65 [43.3%]) and back pain MESHD (33 [22.0%]). Arthralgia MESHD, which was mostly notable at wrist (25 [16.7%]), ankle (24 [16.0%]) and knee (23 [15.3%]) joints, showed significant correlation with disease severity. There was severe myalgia MESHD according to NRS regardless of disease severity. The physical fatigue severity score was significantly higher in severe cases, whereas no relationship was found with mental fatigue MESHD score. Female patients with severe infection had lower grip strength with a mean value of 18.26 kg (P= .010) in dominant hand, whereas no relationship was found between disease severity and grip strength in male patients, but the mean values in both genders and in decades appears below the specified normative values. Lactate dehydrogenase (LDH) level and lymphocyte count were significantly correlated with lower grip strength. LDH, C-reactive protein (CRP) HGNC and D-dimer levels were above the normal range in patients with myalgia MESHD, arthralgia MESHD and fatigue MESHD. CONCLUSIONS AND RELEVANCE Musculoskeletal symptoms MESHD are quite common aside from other multi-systemic symptoms in patients with COVID-19 MESHD. Arthralgia MESHD, which is related to the disease severity, should be considered apart from myalgia MESHD. COVID-19 MESHD patients have severe ischemic MESHD myalgia MESHD regardless of the disease activity. Although there is a muscle weakness MESHD in all patients, the loss of muscle function is related with the disease activity especially in women. Muscular involvement in coronavirus disease is a triangle of myalgia MESHD, physical fatigue MESHD, and functional impairment.

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MeSH Disease
HGNC Genes
SARS-CoV-2 Proteins


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