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MeSH Disease

Pneumonia (98)

COVID-19 (97)

Fever (30)

Death (19)

Lymphopenia (18)


HGNC Genes

SARS-CoV-2 proteins

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ProteinS (1)


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    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.

    Clinical Characteristics of 10 Children With a Pediatric Inflammatory Multisystem Syndrome Associated with COVID-19 MESHD In Iran

    Authors: Leila Shahbaznejad; Mohammad Reza Navaifar; Ali Abbaskhanian; Fatemeh Hosseinzadeh; Golnar Rahimzadeh; Mohammad Sadegh Rezai

    doi:10.21203/rs.3.rs-51157/v3 Date: 2020-07-30 Source: ResearchSquare

    Background: Although symptoms and signs of COVID-19 MESHD ( Coronavirus disease 2019 MESHD) in children are milder than adults, there are reports of more severe cases which were defined as pediatric inflammatory multisystem syndrome MESHD ( PIMS MESHD). The purpose of this report was to describe the possible association between COVID-19 MESHD and PIMS in children.  Methods: From 28 March to 24 June 2020, 10 febrile children were admitted with COVID-19 MESHD infection showing characteristics of PIMS in Buali tertiary hospital of Sari, in Mazandaran province, northern Iran. Demographic and clinical characteristics, laboratory and imaging findings, and therapeutic modalities were recorded and analyzed. Results: The mean age of the patients was 5.37±3.9 years (13 months to 12 years). Six of them were boys. Kawasaki disease MESHD, myocarditis MESHD, toxic shock syndrome MESHD, appendicitis MESHD, sepsis MESHD, urosepsis, prolonged febrile seizure MESHD, acute hemorrhagic edema MESHD of infancy, and COVID-19 MESHD-related pneumonia MESHD were their first presentation. All of them had increased C-reactive protein HGNC levels, and most of them had elevated erythrocyte sedimentation rate, lymphopenia, anemia MESHD, and hypoalbuminemia MESHD. Three of them had thrombocytopenia MESHD(PLT<106). Six of them were serologically or polymerase chain reaction positive for COVID-19 MESHD, and 4 of them were diagnosed as COVID-19 MESHD just by chest computed tomography scan. Most of the patients improved without a residual sequel, except one who died with multiorgan failure MESHD and another case was discharged with a giant coronary aneurysm MESHD.Conclusion: Children with COVID-19 MESHD may present symptoms similar to Kawasaki disease MESHD and inflammatory syndromes. PIMS should be considered in children with fever MESHD, rash MESHD, seizure MESHD, cough, tachypnea MESHD, and gastrointestinal symptoms such as vomiting MESHD, diarrhea MESHD, and abdominal pain MESHD.

    Efficacy and tolerability of bevacizumab in patients with severe Covid -19

    Authors: Jiaojiao Pang; Feng Xu; Gianmarco Aondio; Yu Li; Alberto Fumagalli; Ming Lu; Giuseppe Valmadre; Jie Wei; Yuan Bian; Margherita Canesi; Giovanni Damiani; Yuan Zhang; Dexin Yu; Jun Chen; Xiang Ji; Wenhai Sui; Bailu Wang; Shuo Wu; Attila Kovacs; Miriam Revera; Hao Wang; Ying Zhang; Yuguo Chen; Yihai Cao

    doi:10.1101/2020.07.26.20159756 Date: 2020-07-29 Source: medRxiv

    On the basis of Covid-19 MESHD-induced pulmonary pathological and vascular changes, we hypothesized that the anti- VEGF HGNC drug bevacizumab might be beneficial for treating Covid-19 MESHD patients. We recruited 26 patients from 2-centers (China and Italy) with confirmed severe Covid-19 MESHD, with respiratory rate [≥]30 times/min, oxygen saturation [≤]93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O2 ratio (PaO2/FiO2) >100mmHg and [≤]300 mmHg, and diffuse pneumonia MESHD confirmed by chest radiological imaging. This trial was conducted from Feb 15 to April 5, 2020, and followed up for 28 days. Relative to comparable control patients with severe Covid-19 MESHD admitted in the same centers, bevacizumab showed clinical efficacy by improving oxygenation and shortening oxygen-support duration. Among 26 hospitalized patients with severe Covid-19 MESHD (median age, 62 years, 20 [77%] males), bevacizumab plus standard care markedly improved the PaO2/FiO2 ratios at days 1 and 7 (elevated values, day 1, 50.5 [4.0,119.0], p<0.001; day 7, 111.0 [85.0,165.0], p<0.001). By day 28, 24 (92%) patients showed improvement in oxygen-support status, 17 (65%) patients were discharged, and none showed worsen oxygen-support status nor died. Significant reduction of lesion areas and ratios were shown in chest CT or X-ray analysis within 7 days. Of 14 patients with fever MESHD, body temperature normalized within 72 hours in 13 (93%) patients. Lymphocyte counts in peripheral blood were significantly increased and CRP HGNC levels were markedly decreased as shown in available data. Our findings suggested bevacizumab plus standard care was highly beneficial for treating patients with severe Covid-19 MESHD. Clinical efficacy of bevacizumab warrants double blind, randomized, placebo-controlled trials.

    Neutrophil-to-Lymphocyte Ratio on Admission Predicts In-hospital Mortality in Patients with COVID-19 MESHD

    Authors: Jin Hu; Jun Zhou; Fang Dong; Jie Tan; Shuntao Wang; Zhi Li; Ximeng Zhang; Huiqiong Zhang; Jie Ming; Tao Huang

    doi:10.21203/rs.3.rs-49294/v1 Date: 2020-07-26 Source: ResearchSquare

    Background: A novel coronavirus caused an outbreak of acute infectious pneumonia MESHD are spreading over the globe. However, studies predicting prognosis are limited. We predicted outcomes of patients with coronavirus disease 2019 MESHD ( COVID-19 MESHD) using the neutrophil-to-lymphocyte ratio (NLR) on admission.Methods: We retrospectively analyzed the characteristics of COVID-19 MESHD patients diagnosed from February 6 to March 1 HGNC. The outcomes, including the occurrence of in-hospital mortality, acute kidney injury MESHD ( AKI MESHD), and endotracheal intubation (ETI), were recorded. The relationships of neutrophils, lymphocytes, C-reactive protein HGNC, lactate dehydrogenase, and NLR with outcomes were assessed using multivariate regression model. P-values for trends across quartiles of NLR was examined.Results: A total of 182 patients were included. 37 (20.3%) patients died during the hospitalization, 41 (22.5%) developed AKI MESHD, and 36 (19.8%) received ETI. The NLR had a superior predictive performance than others. Using an NLR cutoff of 11.4, the area under the curves (AUC) were 0.766 for in-hospital mortality, 0.755 for AKI MESHD, and 0.733 for ETI. In multivariate analysis, NLR >11.4 was further identified as an independent prognostic factor. Following stratification with quartiles of NLR, a positive trend between the increasing quartiles of NLR and the three outcomes were observed (p-values for trends across quartiles were 0.043, <0.001, and 0.041, respectively). The multivariate adjusted odds ratio (OR) in the highest quartile vs. the lowest quartile were 5.738 for mortality, 25.307 for AKI MESHD, and 5.136 for ETI.Conclusions: Increasing NLR obtained on admission is a powerful predictor for inpatient mortality, AKI MESHD, and ETI in COVID-19 MESHD patients.

    Viral shedding and immunological features of children COVID-19 MESHD patients

    Authors: Yang Yang; Haixia Zheng; Ling Peng; Jinli Wei; Yanrong Wang; Hexiao Li; Bo Peng; Shisong Fang; Mingxia Zhang; Yanjie Li; Hui Liu; Kai Feng; Li Xing; Jun Wang; Mengli Cao; Fuxiang Wang; Lei Liu; Yingxia Liu; Jing Yuan

    doi:10.21203/rs.3.rs-48544/v2 Date: 2020-07-24 Source: ResearchSquare

    Background SARS-CoV-2 could infect people at all ages, and the viral shedding and immunological features of children COVID-19 MESHD patients were analyzed.Methods Epidemiological information and clinical data were collected from 35 children patients. Viral RNAs in respiratory and fecal samples were detected. Plasma of 11 patients were collected and measured for 48 cytokines.Results 40% (14/35) of the children COVID-19 MESHD patients showed asymptomatic infections, while pneumonia MESHD shown by CT scan occurred in most of the cases (32/35, 91.43%). Elevated LDH, AST HGNC, CRP HGNC, neutropenia MESHD, leukopenia MESHD, lymphopenia MESHD and thrombocytopenia MESHD occurred in some cases, and CD4 HGNC and CD8 HGNC counts were normal. A total of 22 cytokines were significantly higher than the healthy control, and IP-10 HGNC, IFN-α2 HGNC of them in children were significantly lower than the adult patients. Meanwhile, MCP-3 HGNC, HGF HGNC, MIP-1α HGNC, and IL-1ra HGNC were similar or lower than healthy control, while significantly lower than adult patients. Viral RNAs were detected as early as the first day after illness onset (d.a.o) in both the respiratory and fecal samples. Viral RNAs decreased as the disease progression and mostly became negative in respiratory samples within 18 d.a.o, while maintained relatively stable during the disease progression and still detectable in some cases during 36~42 d.a.o. Conclusion COVID-19 MESHD in children was mild, and asymptomatic infection was common. Immune responses were relatively normal in children COVID-19 MESHD patients. Cytokine storm also occurred in children patients, while much weaker than adult patients. Positive rate of viral RNAs in fecal samples was high, and profile of viral shedding were different between respiratory and gastrointestinal tract.

    Clinical Severity and CT Features of the COVID-19 MESHD Pneumonia: Focus on CT Score and Laboratory Parameters

    Authors: Jianghui Duan; Kunsong Su; Hongliang Sun; Yanyan Xu; Liangying Liu

    doi:10.21203/rs.3.rs-45453/v1 Date: 2020-07-18 Source: ResearchSquare

    Background: Although CT characteristics of Coronavirus Disease 2019 MESHD ( COVID-19 MESHD) pneumonia MESHD between patients with mild and severe forms of the disease have already been reported in the literature, there was little attention to the correlation of imaging features and laboratory testing. We aimed to compare the laboratory and chest CT imaging features in patients with COVID-19 MESHD pneumonia MESHD between non-severe cases and severe cases, and to analyze the correlation of CT score and laboratory testing.Methods: This study consecutively included 54 patients with COVID-19 MESHD pneumonia MESHD (26 males and 28 females, 26 to 92 years of age, 43 cases with non-severe and 11 cases with severe group). Clinical, laboratory and image data were collected between two subgroups. A CT score system was used to evaluate the extent of disease. Correlation between the CT score and laboratory data were estimated. Receiver operating characteristic (ROC) analysis was used to evaluate the diagnostic performance of CT score and laboratory tests.Results: Compared with non-severe patients, severe patients had showed increased white blood cell count, neutrophil count, neutrophil percentage, the neutrophil-to-lymphocyte ratio (NLR) and decreased lymphocyte percentage (all p < 0.05). Architectural distortion, pleural effusion MESHD, air bronchogram and consolidation-dominant pattern were more common in the severe group (all p < 0.05). CT score of the severe group was higher than the non-severe group (p < 0.001). For distribution characters of the lesions, diffuse pattern in the transverse distribution was more often seen in the severe group (p < 0.001). CT score was positively correlated with the white blood cell counts, neutrophil counts, the percent of neutrophil, NLR, alanine aminotransferase HGNC, lactate dehydrogenase and C-reactive protein HGNC, and was inversely related to the lymphocyte, the percent of lymphocyte. ROC analysis showed that when the optimal threshold of CT score was 13, the area under the curve was the largest, which was 0.855, and the sensitivity and specificity were 100% and 60% respectively for the diagnosis of the severe patients.Conclusion: CT score showed significant correlations with laboratory inflammatory markers, suggesting that chest CT and laboratory examination maybe provide a better reference for clinicians to judge the severity of diseases.

    Clinical Characteristics of SARS-CoV-2 pneumonia diagnosed in a primary care practice in Madrid (Spain)

    Authors: Marina Guisado-Clavero; Ana Herrero Gil; Marta Pérez Álvarez; Marta Castelo Jurado; Ana Herrera Marinas; Vanesa Aguilar Ruiz; Ileana Gefaell Iarrondo; Miguel Menéndez; Sara Ares-Blanco

    doi:10.21203/rs.3.rs-42357/v2 Date: 2020-07-13 Source: ResearchSquare

    Background: Possible cases of SARS-CoV-2 infection MESHD were diagnosed in primary care in Madrid, some of these cases had pneumonia MESHD. Most of the SARS-CoV-2 pneumonia MESHD published data came from hospitalised patients. This study set out to describe clinical characteristics of patients with SARS-CoV-2 pneumonia MESHD diagnosed in primary care across age groups and type of pneumonia MESHD.Methods: Observational retrospective study obtaining clinical data from the electronic health records of patients who were followed-up by SARS-CoV-2 possible infection in a primary care practice in Madrid. All the cases were collected by in-person or remote consultation during the 10th March to the 7th of April. Exposure: Diagnosis of SARS-CoV-2 pneumonia MESHD by chest X-ray ordered by the GP. Main outcomes and measures: Symptoms of SARS-CoV-2 pneumonia MESHD, physical examination and diagnostic tests as a blood test, nasopharyngeal swab results for RT-PCR (Reverse transcriptase-polymerase chain reaction) and chest X-ray results. Results: The overall SARS-CoV-2 pneumonias MESHD collected were 172 (female 87 [50.6%], mean age 60.5 years (standard deviation [SD] 17.0). Comorbidities were body mass index ≥25 kg/m 2 (90 [52.3%]), hypertension MESHD 83 [48.3%]), dyslipidaemia (68 [39.5%]) and diabetes MESHD (33 [19.2%]). The sample was stratified by age groups (<50 years, 50-75 years and ≥75 years). Clinical manifestations at onset were fever MESHD (144 [83.7%]), cough (140 [81.4%]), dyspnoea MESHD (103 [59.9%]) and gastrointestinal disturbances MESHD (72 [41.9%]). Day 7.8 (SD:4.1) from clinical onset was the mean day of pneumonia MESHD diagnosis. Bilateral pneumonia MESHD was more prevalent than unilateral (126 [73.3%]) and 46 [26.7%]). Patients with unilateral pneumonia MESHD were prone to higher pulse oximetry (96% vs 94%, p <0.001). We found differences between unilateral and bilateral cases in C-reactive protein HGNC (29.6 vs 81.5mg/L, p <0.001), and lymphocytes (1400.0 vs 1000.0E3/ml, p<0.001). Complications were registered: 42 (100%) of patients ≥75 years were admitted into hospital; pulmonary embolism MESHD was only present at bilateral pneumonia MESHD (7 patients [5.6%]) and death MESHD occurred in 1 patient with unilateral pneumonia MESHD (2.2%) vs 10 patients (7.9%) with bilateral pneumonia MESHD ( p 0.170).Conclusion: Clinical manifestations of SARS-CoV-2 pneumonia MESHD were fever MESHD, cough and dyspnoea MESHD; this was especially clear in the elderly. We described different characteristics between unilateral and bilateral pneumonia MESHD.

    Complementary Application of the Ozonized Saline Solution in Mild and Severe Patients with Pneumonia Covid-19 MESHD: A Non-randomized Pilot Study

    Authors: Adriana Schwartz; Gregorio Martínez-Sánchez; Alejandra Menassa de Lucía; Sergio Mejía Viana; Constanta Alina Mita

    id:202006.0233/v3 Date: 2020-07-12 Source: Preprints.org

    Currently, there is no effective antiviral therapy recommended for the new coronavirus disease 2019 MESHD pneumonia MESHD ( COVID-19 MESHD). The purpose of this pilot study was to evaluate the safety of Ozonized Saline Solution (O3SS) used as a complementary therapy in adult patients COVID-19 MESHD. Twenty-five adult patients who were hospitalized with mild to severe COVID-19 MESHD symptoms, who met the inclusion criteria and were being treated from April 18rd to April 26th, 2020, at the Viamed Virgen De La Paloma Hospital, Madrid, Spain were included in this study. Patients were allocated to receive standard care (SC) that included 200-400 mg hydroxychloroquine twice daily for 5-7 days plus Tocilizumab 400 mg twice daily for 5 days, low molecular weight heparin (LMWH) and 40 mg-60 mg metil-prednisone plus O3SS, 200 mL, 3-5 µg/mL daily for 10 days. No control group was included, data were compared to clinical trials in this subject. Primary outcomes of treatment with O3SS were an improvement of clinical symptoms and a reduction in mortality. Secondary end points evaluated included participant clinical status, laboratory examinations, and duration of viral shedding. None of the patients treated with SC + O3SS died. Improvements in symptoms such as dyspnea MESHD, weakness MESHD, and reduction in body temperature were observed and corresponded with an improvement of laboratory finding including D-dimer, fibrinogen, LDH, and CRP HGNC. No side effects from the O3SS treatment were observed. Conclusions: COVID-19 MESHD patients with mild to severe symptoms who received intravenous O3SS as a complementary therapy demonstrated no side effects. This preliminary data will be served as base for a future study of the efficacy of this therapy.

    A false alarm of COVID-19 MESHD pneumonia in lung cancer: a case report of anti-PD-1 related pneumonitis and literature review

    Authors: Ying Dai; Ying Dai; Sha Liu; Sha Liu; Zhiyan Zhao; Zhiyan Zhao; Xiaqiu Li; Xiaqiu Li; Yiruo Zhang; Yiruo Zhang; Pingping Liu; Pingping Liu; Yingying Du; Yingying Du

    doi:10.21203/rs.3.rs-41095/v1 Date: 2020-07-11 Source: ResearchSquare

    Background: The fatal toxicity MESHD of anti-PD-1/ PD-L1 HGNC agents is pneumonitis MESHD. The diagnosis consists of the history of immunotherapy, clinical symptoms and presentation of computed tomography (CT) imaging. The typical CT findings include ground-glass opacities. Based on the similar radiographic feature with 2019 Novel Coronavirus ( COVID-19 MESHD) pneumonia MESHD, clinicians are cautious to evaluate diagnosis especially in COVID-19 MESHD epidemic areas. Case presentation: Herein we report a 67-year-old male patient with advanced non-small cell lung cancer MESHD developed pneumonitis MESHD post Sintilimab injection. The dyspnea MESHD appeared at the 15th day of close contact with his son who returned from Wuhan, but not accompanied with fever MESHD. The chest CT indicated peripherally subpleural lattice opacities at the inferior right lung lobe and bilateral thoracic infusion. The real-time reverse-transcription polymerase-chain-reaction (RT-PCR) from double swab samples within 72 hours remained negative. The patient was thereafter treated with prednisolone and antibiotics for over two weeks. Thereafter the chest CT demonstrated the former lesion almost absorbed, in line with prominently falling CRP HGNC level. The anti-PD-1 related pneumonitis MESHD with bacterial infection MESHD was diagnosed finally based on the clinical evidence and good response to the prednisolone and antibiotics. Conclusion: Both ani-PD-1 related pneumonitis MESHD and COVID-19 MESHD pneumonia harbor the common clinical symptom and the varied features of CT imaging. Differential diagnosis was based on the epidemiological and immunotherapy histories, RT-PCR tests. The response to glucocorticoid can indirectly help the diagnosis.

    Recombinant interleukin-2 HGNC stimulates lymphocyte recovery in severe patients with COVID-19 MESHD

    Authors: Meng‘en Zhu; Qian Wang; Shaoqiong Zhou; Bin Wang; Li Ke; Ping He

    doi:10.21203/rs.3.rs-40006/v1 Date: 2020-07-03 Source: ResearchSquare

    Object: A recently developing pneumonia MESHD called COVID-19 MESHD which caused by SARS-CoV-2 has quickly spread across the world. Lymphopenia MESHD and a proinflammatory cytokine storm frequently happened in severe COVID-19 MESHD patients. But no specific immunomodulate therapy on COVID-19 MESHD had been reported. In this retrospect case control study, we observed the potential therapeutic effect of recombinant human i nterleukin-2 HGNC(rIL-2) on severe COVID-19 MESHD patients in a hospital in Wuhan, China. Methods: Fifty nine severe cases with COVID-19 MESHD admitted in hospital from January 29, 2020 to February 29, 2020 were included in this study. Twenty patients received a one-week to 10 days subcutaneous injection of the recombinant human interleulin-2 1 million IU per day other than regular treatment were classified as rIL-2 group. Twenty from thirty nine patients with regular treatment without intervention of rIL-2 were matched as the control group. Clinical characteristic such as age, gender, symptoms, signs, laboratory data and comorbidities were paired in these two groups. Changes of lymphocytes counts, I L-6 HGNCand C - reactive protein HGNC(C RP) HGNC before and after rIL-2 treatment and differences between rIL-2 group and non-rIL-2 group were analyzed.Results: There were a clearly visible increasing in lymphocyte counts and a decreasing in C RP HGNClevel in non rIL-2 group and rIL-2 group. The difference of the change of lymphocyte counts were significant in rIL-2 group and non-rIL-2 group (p<0.01). Though C RP HGNCdecreased more in rIL-2 group, it did not show a significant difference between the two groups (p>0.05).Conclusion: RIL-2 might be a prospective adjuvant therapy for severe COVID-19 MESHD patients by increasing lymphocytes number.

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MeSH Disease
HGNC Genes
SARS-CoV-2 Proteins


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