Corpus overview


MeSH Disease

Human Phenotype


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    COVID-19: Role of the Interferons

    Authors: Claudio G. Gallo; Sirio Fiorino; Giovanni Posabella; Donato Antonacci; Antonio Tropeano; Emanuele Pausini; Carlotta Pausini; Tommaso Guarniero; Marco Zancanaro

    id:202008.0018/v1 Date: 2020-08-02 Source:

    COVID-19 disease MESHD, caused by the SARS-CoV2 virus, is a potentially fatal disease MESHD that represents a serious public health and economic problem worldwide. The SARS-CoV2 virus infects the lower respiratory tract and can cause pneumonia MESHD pneumonia HP in humans. ARDS is the leading cause of death MESHD in COVID-19 disease MESHD. One of the main characteristics of ARDS is the cytokine storm, an uncontrolled systemic inflammatory response resulting from the release of pro-inflammatory cytokines and chemokines and growth factors, by immune cells. The other important aspect of the disease MESHD is represented by the involvement of the vascular organ that undergoes endothelitis. Hyperinflammation and endothelitis contribute in various ways to trigger coagulation disorders with diffuse micro thrombotic and thromboembolic phenomena. Lastly, multiple organ failure MESHD may occur (MOF). Since so far there is no approved treatment, there is an urgent need to reposition known treatments, considered safe, to be included in trials. Naturally produced interferons represent the body's first line of defense against viruses. Pharmacological forms, obtained by means of genetic recombination techniques, have long been approved and used to treat numerous pathologies. Interferons are divided into three families, within which some subfamilies are distinguishable. Only IFN-II comprises a single isoform which has completely different aspects and functions. The IFN I and III, however, each comprise different subfamilies (17 subfamilies the IFN-I and 4 subfamilies the IFN-III), share many aspects, representing the body's first antiviral response, but play different roles. The use of IFNs has been studied in two severe hCoV (Human Coronavirus) diseases MESHD, closely related to COVID-19 disease MESHD, such as SARS and MERS. Numerous in vitro and in vivo studies have been conducted, often in combination with other antivirals. The results have been controversial. The positive results in vitro and in experimental animals were often not replicable in humans. The possible positioning of these molecules in the right window of therapeutic opportunity requires that the complex dialogue between IFN, inflammasome, cytokines, pro-inflammatory chemokines, growth factors and barrier function be shed light.

    Clinical characteristics of neonates with coronavirus disease MESHD 2019 (COVID-19): a systematic review

    Authors: Yuan Hu; Jing Xiong; Yuan Shi

    doi:10.21203/ Date: 2020-07-29 Source: ResearchSquare

    This study aimed to summarize the existing literature on severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) infection in newborns to clarify the clinical features and outcomes of neonates with COVID-19. A systematic search was performed in PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP databases from January 1, 2019 to April 30, 2020. The references of relevant studies were also searched. A descriptive summary was organized by aspects of clinical presentations (symptoms, laboratory examinations, and imaging) and outcomes. We identified 14 studies reporting 18 newborns with COVID-19. The most common clinical manifestations were fever MESHD fever HP (62.5%), shortness of breath (50.0%), diarrhea MESHD diarrhea HP/ vomiting MESHD vomiting HP/feeding intolerance(43.8%), cough MESHD cough HP (37.5%), dyspnea MESHD dyspnea HP (25.0%), and nasal congestion/runny nose/ sneeze MESHD sneeze HP(25.0%). Atypical symptoms included jaundice MESHD jaundice HP and convulsion. Lymphocyte numbers decreased in 5 cases, and radiographic findings were likely to show pneumonia MESHD pneumonia HP. All newborns recovered and discharged from the hospital, and there was no death MESHD.Conclusion: Clinical symptoms of neonatal SARS-CoV-2 infection MESHD are atypical, most of them are mild. Up to now, the prognosis of newborns is good, and there is no death MESHD. Intrauterine vertical transmission TRANS is possible, but confirmed evidence is still lacking. The Long-term follow-up of potential influences of SARS-CoV-2 infection MESHD on neonates need further exploration.


    Authors: Luis Fernando L Paredes Sr.; Ivan I Ilescas Jr.

    doi:10.1101/2020.07.16.20146704 Date: 2020-07-25 Source: medRxiv

    In late December 2019, a new disease MESHD reported at the time by an unknown pathogen was reported, which was later found to be a new variant of coronavirus, now called SARS-CoV2. This new disease MESHD had a very rapid global spread, causing multiple deaths MESHD in a short time, and which led to putting the entire world on health alert. In patients who have this disease MESHD, they present bilateral opacities in frosted multilobar glass with peripheral distribution. Some authors have suggested the use of ultrasound at the point of care for its early recognition. In this study, we evaluated the findings of lung ultrasound in 25 patients admitted to the General Hospital Dr. Enrique Cabrera, Mexico, with a diagnosis confirmed by RT-PCR of SARS CoV2. This small retrospective study suggests that artifacts like glass rockets with or without the Birolleau variant (White lung), confluent B-lines, thick irregular pleural lines, and variable size (subpleural) consolidations are typical findings of lung ultrasound in patients with COVID-19 pneumonia MESHD pneumonia HP. The presence of these findings is useful when evaluating patients with suspected COVID-19. In resource-limited and austere settings where chest radiography, CT, and RT-PCR are not available or the response time is long, lung ultrasound performed by trained personnel can be an aid in the diagnosis of COVID-19.

    Chronic Hemodialysis Patients have better outcomes with COVID-19 - a retrospective cohort study

    Authors: Ashutossh Naaraayan; Abhishek Nimkar; Amrah Hasan; Sushil Pant; Momcilo Durdevic; Henrik Elenius; Corina Nava Suarez; Prasanta Basak; Kameswari Lakshmi; Michael Mandel; Stephen Jesmajian

    doi:10.1101/2020.07.22.20159202 Date: 2020-07-24 Source: medRxiv

    Introduction Several comorbid conditions, have been identified as risk factors in patients with COVID-19. However, there is a dearth of data describing the impact of COVID-19 infection MESHD in patients with end-stage renal disease MESHD on hemodialysis (ESRD-HD). Methods This retrospective case series analyzed 362 adult TRANS patients consecutively hospitalized with confirmed COVID-19 illness between March 12, 2020 and May 13, 2020, at a teaching hospital in the New York City metropolitan area. Primary outcome was severe pneumonia MESHD pneumonia HP as defined by the World Health Organization. Secondary outcomes were: 1) the Combined Outcome of Acute respiratory distress HP syndrome MESHD or in-hospital Death MESHD (COAD), and 2) the need for High-levels of Oxygen supplementation (HiO2). Results Patients with ESRD-HD had lower odds for poor outcomes including severe pneumonia MESHD pneumonia HP [Odds Ratio (OR) 0.4, Confidence Interval (CI) (0.2-0.9) p=.04], HiO2 [OR 0.3, CI (0.1-0.8) p=.02] and COAD [OR 0.4, CI (0.2-1.05) p=.06], when compared to patients without ESRD. In contrast, higher odds for severe pneumonia MESHD pneumonia HP, COAD and HiO2 were seen with advancing age TRANS. African-Americans were over-represented in the hospitalized patient cohort, when compared to their representation in the community (35% vs 18%). Hispanics had higher odds for severe-illness and HiO2 when compared to Caucasians. Conclusions Patients with ESRD-HD had a milder course of illness with a lower likelihood of severe pneumonia MESHD pneumonia HP and a lesser need for aggressive oxygen supplementation when compared to patients not on chronic dialysis. This protective effect, might have a pathophysiologic basis and needs to be further explored.


    Authors: Guillermo Ruiz-Irastorza; Jose-Ignacio Pijoan; Elena Bereciartua; Susanna Dunder; Jokin Dominguez; Paula Garcia-Escudero; Alejandro Rodrigo; Carlota Gomez-Carballo; Jimena Varona; Laura Guio; Marta Ibarrola; Amaia Ugarte; Agustin Martinez-Berriotxoa

    doi:10.1101/2020.07.16.20152868 Date: 2020-07-23 Source: medRxiv

    OBJECTIVE: To analyze the effects of a short course of methyl-prednisolone pulses (MP) during the second week of disease MESHD (week-2) on the clinical course of patients with severe coronavirus disease MESHD 2019 (COVID-19) pneumonia MESHD pneumonia HP. DESIGN: Comparative observational study using data collected from routine care. SETTING: Hospital Universitario Cruces, a tertiary level University hospital at Barakaldo, Bizkaia, Spain. PARTICIPANTS: All patients with COVID-19 pneumonia MESHD pneumonia HP admitted between 1st March and 30th April 2020 to the services of Infectious Diseases MESHD and Internal Medicine. INTERVENTIONS: Treatment with week-2-MP (125-250 mg/d for 3 consecutive days with no subsequent tapering) vs. standard of care. MAIN OUTCOMES MEASURES: Time to death MESHD and time to death MESHD or endotracheal intubation. RESULTS: Two hundred and forty-two patients with confirmed COVID-19 pneumonia MESHD pneumonia HP and elevated inflammatory markers at admission were included in the study. Sixty-one patients (25%) received week-2-MP. Twenty-two patients (9%) died during the study period. Thirty-one patients (12.8%) suffered death MESHD or intubation. The adjusted HR for death MESHD was 0.35 (95%CI 0.11 to 1.06, p= 0.064) for patients in the week-2-MP group. The adjusted HR for death MESHD or intubation week-2-MP was 0.33 (95%CI 0.13 to 0.84, p=0.020) for patients in the week-2-MP group. These differences were seen in the subcohort of patients with a SaO2/FiO2 at day 7 lower than the median of the whole population: HR 0.31, 95% CI 0.08 to 1.12, p=0.073 and HR 0.34, 95%CI 0.12 to 0.94, p=0.038, respectively, but not in patients with higher SaO2/FiO2. Other predictors of the final outcomes were arterial hypertension MESHD hypertension HP, SaO2/FiO2, high-risk CURB65 scores and the use of non-pulse glucocorticoids. Non-pulse glucocorticoids were a predictor of infections MESHD (OR 4.72, 95%CI 1.90 to 11.80, p<0.001), while week-2-MP were not (OR 1.04, 95%CI 0.40 to 2.70, p=0.938). CONCLUSIONS: Week-2-MP are effective in improving the prognosis of patients with COVID-19 pneumonia MESHD pneumonia HP with features of inflammatory activity and respiratory deterioration entering the second week of disease MESHD. The recognition of this high-risk population should prompt early use of MP at this point. REGISTRATION: This study has been registered in the EU PAS Register with the number EUPAS36287.

    Serum SERO cholinesterase on admission as a predictor of COVID-19 pneumonia MESHD pneumonia HP severity and mortality

    Authors: Kento Nakajima; Takeru Abe; Ryo Saji; Fumihiro Ogawa; Hayato Taniguchi; Keishi Yamaguchi; Kazuya Sakai; Tomoki Nakagawa; Reo Matsumura; Yasuhumi Oi; Mototsugu Nishii; Ichiro Takeuchi

    doi:10.21203/ Date: 2020-07-22 Source: ResearchSquare

    Background Although some predictors of COVID-19 pneumonia MESHD pneumonia HP severity and mortality have been identified, much of the pathophysiology of this emerging infectious disease MESHD remains unclear. We hypothesized that a patient’s cholinesterase level on admission could predict COVID-19 pneumonia MESHD pneumonia HP severity and mortality.Methods We retrospectively collected data of 26 COVID-19 pneumonia MESHD pneumonia HP patients from February–May 2020. Outcomes were aggravation of symptoms and in-hospital mortality. We compared receiver operating curves of cholinesterase, C-reactive protein, lymphocytes, albumin, D-dimer, and PaO2/FiO2 ratio and examined prediction accuracy. Regarding the interaction between cholinesterase and other variables, each independent variable was divided into two groups using cutoff values, and interaction terms were created.Results Cholinesterase levels on admission were significantly lower in the severe group than in the mild-to-moderate group (326 vs. 218 IU/L, p = 0.006; area under the curve: 0.81; 95% confidence interval 0.61–0.94). When comparing the area under the curve, cholinesterase was comparable to C-reactive protein, albumin, lymphocytes, and PaO2/FiO2 ratio other than D-dimer in the prediction accuracy of severe cases and mortality. Cholinesterase levels on admission were significantly lower in the death MESHD group than in the survival group (274 vs. 187.5 IU/L, p = 0.028; area under the curve: 0.79; 95% interval 0.58–0.93). Regarding the interaction between cholinesterase and established predictors, the prediction accuracy of both severity and death MESHD was higher when cholinesterase was combined with each predictor than when cholinesterase was used alone.Conclusions Cholinesterase may reflect the disease MESHD state of COVID-19 pneumonia MESHD pneumonia HP, suggesting that a patient’s cholinesterase level on admission may be useful as a predictor of severity and prognosis.

    Adjunctive Corticosteroids for COVID-19: A Retrospective Cohort Study

    Authors: Say Tat Ooi; Purnima Parthasarathy; Yi Lin; Valliammai Nallakaruppan; Shereen Ng; Teck Choon Tan; Serena Low; Terence Tang

    doi:10.1101/2020.07.18.20157008 Date: 2020-07-21 Source: medRxiv

    Background: Coronavirus disease MESHD 2019 (COVID-19) is associated with severe pneumonia MESHD pneumonia HP, respiratory failure HP and death MESHD. We aim to evaluate the efficacy of adjunctive corticosteroids in the management of COVID-19. Methods: This is a retrospective cohort study of hospitalized adults TRANS ([≥]18 years) who were diagnosed with COVID-19 and were given treatment. Treatment included hydroxycholoroquine and lopinavir-ritonavir. Corticosteroids were included as adjunctive therapy in mid-April, 2020. We compared composite outcomes of clinical progression and invasive mechanical ventilation (MV) or death MESHD between group that received treatment only (Group A) versus group that received adjunctive corticosteroids (Group B). Entropy balancing was used to generate stabilized weight for covariates between treatment groups. Unweighted Kaplan-Meir curves, weighted and adjusted Cox regression analysis were used to estimate effect of adjunctive corticosteroids on composite outcomes. Subgroup analysis was performed on those with pneumonia MESHD pneumonia HP. Results: Of 1046 patients with COVID-19, 57 received treatment alone (Group A) and 35 received adjunctive corticosteroids in addition to treatment (Group B). Median day of illness at treatment initiation was 5 day. There were 44 patients with pneumonia MESHD pneumonia HP; 68.9% of them were not requiring supplemental oxygen at treatment initiation. Overall, 17 (18.5%) of 92 patients had clinical progression including 13 (22.8%) of 57 patients in Group A versus 4 (11.4%) of 35 patients in Group B (p=0.172). Unweighted Kaplan-Meier estimates showed no significant difference in the proportion of patients who had clinical progression or invasive MV or death MESHD between the 2 treatment groups. However in those with pneumonia MESHD pneumonia HP, there were lower proportions of patients in Group B with clinical progression (11.1% , 95% CI 0.0 - 22.2 versus 58.8%, 95% CI 27.3 - 76.7, log rank p<0.001 ); and invasive MV or death MESHD (11.3%, 95% CI 0.0 - 22.5 versus 41.2%, 95% CI 12.4. - 60.5, log rank p=0.016). In weighted and adjusted cox regression analysis, patients in Group B were less likely to have clinical progression, (adjusted HR [aHR] 0.08, 95% CI 0.01-0.99, p=0.049) but there was no statistical significant difference in risk of requiring invasive MV or death MESHD (aHR 0.22, 95%CI 0.02 - 2.54, p=0.22). In subgroup with pneumonia MESHD pneumonia HP, patients in Group B were significantly at lower risk of clinical progression (aHR 0.15, 95% CI 0.06 - 0.39, p<0.001) and requiring invasive MV compared to Group A (aHR 0.30, 0.10-0.87, p=0.029). Conclusions: Use of adjunctive corticosteroids is associated with lower risk of clinical progression and invasive MV or death MESHD, especially in those with pneumonia MESHD pneumonia HP. Concurrent use of antivirals and corticosteroids should be considered in the management of COVID-19 related pneumonia MESHD pneumonia HP.

    Clinical characteristics and risk factors for mortality in patients with coronavirus disease MESHD 2019 in intensive care unit: a single-center, retrospective, observational study in China

    Authors: Fangfang Sai; Xiaolei Liu; Lanyu Li; Yan Ye; Changqing Zhu; Ying Hang; Conghua Huang; Lei Tian; Xinhui Xu; Huan Huang

    doi:10.21203/ Date: 2020-07-20 Source: ResearchSquare

    Background: Coronavirus disease MESHD 2019 (COVID-19) is a potentially life-threatening contagious disease MESHD disease which has spread TRANS which has spread all over the world. Risk factors for the clinical outcomes of COVID-19 pneumonia MESHD pneumonia HP in intensive care unit (ICU) have not yet been well determined. Methods: In this retrospective, single-centered, observational study, we consecutively included 47 patients with confirmed COVID-19 who were admitted to the ICU of Leishenshan Hospital in Wuhan, China, from February 24 to April 5, 2020. Clinical characteristics and outcomes were collected and compared between survivors and non-survivors. Multivariable logistic regression was used to explore the risk factors associated with death MESHD in patients of COVID-19.Results: The study cohort included 47 adult TRANS patients with a median age TRANS of 70.55±12.52 years, and 30 (63.8%) patients were men. Totally 15 (31.9%) patients died. Compared with survivors, non-survivors were more likely to develop septic shock MESHD shock HP (6 [40%] patients vs 3 [9.4%] patients ), disseminated intravascular coagulation MESHD disseminated intravascular coagulation HP (3 [21.4%] vs 0), and had higher score of APACHE II (25.07±8.03 vs 15.56±5.95), CURB-65 (3[2-4] vs 2[1-3]), Sequential Organ Failure Assessment (SOFA) (7[5-9] vs 3[1-6]), higher level of D-dimer (5.74 [2.32-18] vs 2.05 [1.09-4.00] ) and neutrophil count (9.4[7.68-14.54] vs 5.32[3.85-9.34] ). SOFA score (OR 1.47, 1.01–2.13; p=0.0042) and lymphocyte count (OR 0.02, 0.00–0.86; p=0.042) on admission were independently risk factors for mortality. Patients with higher lymphocyte count (>0.63×109/L) and lower SOFA score ≤4 on admission had a significantly well prognosis than those with lower lymphocyte count (≤0.63×109/L) and higher SOFA score >4 in overall survival.Conclusions: Higher SOFA score and lower lymphocyte count on admission were associated with poor prognosis of patients with COVID-19 in ICU. Lymphocyte count may serve as a promising prognostic biomarker.

    Lung ultrasound and computed tomography to monitor COVID-19 pneumonia MESHD pneumonia HP in critically ill patients: a two-center prospective cohort study

    Authors: Micah Heldeweg; Jorge A. Lopez Matta; Mark E. Haaksma; Jasper M. Smit; Carlos V. Elzo Kraemer; Harm-Jan S. de Grooth; E. de Jonge; L.J. Meijboom; Leo M.A. Heunks; David J. van Westerloo; Pieter Roel Tuinman

    doi:10.21203/ Date: 2020-07-17 Source: ResearchSquare

    Background: Lung ultrasound can adequately monitor disease MESHD severity in pneumonia MESHD pneumonia HP and acute respiratory distress HP syndrome MESHD. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia MESHD pneumonia HP in critically ill patients. Methods: Adult TRANS patients with COVID-19 pneumonia MESHD pneumonia HP admitted to the intensive care unit of two academic hospitals who underwent a 12-zone lung ultrasound and a chest CT examination were included. Baseline characteristics, and outcomes including composite endpoint death MESHD or ICU stay >30 days were recorded. Lung ultrasound and CT images were quantified as a Lung Ultrasound Score Involvement index (LUSI) and CT Severity Involvement index (CTSI). Primary outcome was the correlation, agreement, and concordance between LUSI and CTSI. Secondary outcome was the association of LUSI and CTSI with the composite endpoints.Results: We included 55 ultrasound examinations in 34 patients, which were 88% were male TRANS, with a mean age TRANS of 63 years and mean P/F ratio of 151. The correlation between LUSI and CTSI was strong (r=0.795), with an overall 15% bias, and limits of agreement ranging -40 to 9.7. Concordance between changes in sequentially measured LUSI and CTSI was 81%. In the univariate model, high involvement on LUSI and CTSI were associated with a composite endpoint. In the multivariate model, LUSI was the only remaining independent predictor.Conclusions: Lung ultrasound can be used as an alternative for chest CT in monitoring COVID-19 pneumonia MESHD pneumonia HP in critically ill patients as it can quantify pulmonary involvement, register changes over the course of the disease MESHD, and predict death MESHD or ICU stay >30 days.Trial registration: NTR, NL8584. registered 01 May 2020 - retrospectively registered,

    Role of intermediate care unit admission and non-invasive respiratory support during the COVID-19 pandemic: a retrospective cohort study

    Authors: Olivier Grosgurin; Antonio Leidi; Pauline Darbellay-Farhoumand; Sebastian Carballo; Jean-luc Reny; Dan Adler; Bernardo Bollen Pinto; Anne Rossel; Jacques Serratrice; Thomas Agoritsas; Jerome Stirnemann; Christophe Marti

    doi:10.1101/2020.07.17.20155929 Date: 2020-07-17 Source: medRxiv

    Background The COVID-19 pandemic has led to shortage of Intensive Care Unit (ICU) capacity. We developed a triage strategy including non-invasive respiratory support and admission to the intermediate care unit (IMCU). ICU admission was restricted to patients requiring invasive ventilation. Objectives The aim of this study is to describe the characteristics and outcomes of patients admitted to the intermediate care unit. Method Retrospective cohort including consecutive patients admitted between March 28th and April 27th 2020. The primary outcome was the proportion of patients with severe hypoxemic respiratory failure HP avoiding ICU admission. Secondary outcomes included the rate of emergency MESHD intubation, 28-days mortality and predictors of ICU admission. Results One hundred fifty seven patients with COVID-19 associated pneumonia MESHD pneumonia HP were admitted to the IMCU. Among the 85 patients admitted for worsening respiratory failure HP, 52/85 (61%) avoided ICU admission. In multivariate analysis, PaO2/FiO2 (OR 0.98; 95% CI 0.96 to 0.99) and Body Mass Index (OR 0.88; 95% CI 0.78 to 0.98) were significantly associated with ICU admission. No death MESHD or emergency MESHD intubation occurred in the intermediate care unit. Among the 72 patients transferred from the ICU, 60/72 (83%) presented neurological complications. Conclusions Non-invasive respiratory support including High-Flow Nasal Oxygen and continuous positive airway pressure prevents ICU admission for a large proportion of patients with COVID-19 hypoxemic respiratory failure HP. In the context of the COVID pandemic, intermediate care units may play an important role in preserving ICU capacity by avoiding ICU admission for patients with worsening respiratory failure HP and allowing early discharge of ICU patients.

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MeSH Disease
Human Phenotype

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