Corpus overview


Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Intracerebral hemorrhage MESHD in COVID-19 patients with pulmonary failure – a propensity score matched registry study

    Authors: Corinna N. Lang; Johanna S. Dettinger; Michael Berchtold-Herz; Stefan Utzolino; Xavier Bemtgen; Viviane Zotzmann; Bonaventura Schmid; Paul M. Biever; Christoph Bode; Katharina Müller-Peltzer; Daniel Duerschmied; Tobias Wengenmayer; Wolf-Dirk Niesen; Dawid L. Staudacher

    doi:10.21203/rs.3.rs-56258/v1 Date: 2020-08-09 Source: ResearchSquare

    Background: Hypercoagulopathy in coronavirus disease MESHD 2019 (COVID-19) causing deep vein thrombosis MESHD and pulmonary artery embolism MESHD necessitate systemic anticoagulation. Case reports of intracerebral hemorrhages MESHD in ventilated COVID-19 patients warrant precaution. It is unclear however, if COVID-19 patients with acute respiratory distress HP syndrome MESHD (ARDS) with and without extracorporeal membrane oxygenation therapy (ECMO) have more intracerebral hemorrhages MESHD (ICH) compared to other ARDS patients.Methods: We conducted a retrospective observational single center study enrolling all patients with ARDS from 01/2018-05/2020. Patients with ARDS positive for SARS-CoV2 PCR were allocated to the COVID-19 group. Propensity score matching was performed for age TRANS, ECMO and risk of bleeding according to HAS-BLED score.Results: A total of 163, mostly severe ARDS patients were identified, 116 (71.2%) without COVID-19 and 47 (28.8%) positive for SARS-CoV-2. The two groups were comparable concerning the main confounders of ICH including age TRANS, HAS-BLED score, need for ECMO-therapy as well as anticoagulation levels reported. In 63/163 cases (38.7%), veno-venous ECMO therapy was required and ICU survival was 52.8%. Although HAS-BLED-score on admission was generally low (1.6±1.3), intracerebral hemorrhage MESHD was detected in 22 patients (13.5%) with no statistical difference between the groups (11.2 vs. 19.1% with and without SARS-CoV-2, respectively, p=0.21). Propensity score matching confirmed similar intracerebral bleeding rates in both groups (12.8 vs. 19.1% with and without SARS-CoV-2, respectively, p=0.57). Conclusions: Intracerebral hemorrhage MESHD was detectable in every tenth patient with ARDS. We found no statistically significant increased bleeding rate in patients with ARDS due to COVID-19 compared to other causes of ARDS.

    Characteristics and outcomes of patients admitted to Swedish intensive care units for COVID-19 during the first 60 days of the 2020 pandemic: a registry-based, multicenter, observational study.

    Authors: Michelle S Chew; Patrik Blixt; Rasmus Ahman; Lars Engerstrom; Henrik Andersson; Ritva Kiiski Berggren; Anders Tegnell; Sarah McIntyre

    doi:10.1101/2020.08.06.20169599 Date: 2020-08-07 Source: medRxiv

    Background The mortality of patients admitted to the intensive care unit (ICU) with COVID-19 is unclear due to variable censoring and substantial proportions of undischarged patients at follow-up. Nationwide data have not been previously reported. We studied the outcomes of Swedish patients at 30 days after ICU admission. Methods We conducted a registry-based cohort study of all adult TRANS patients admitted to Swedish ICUs from 6 March-6 May, 2020 with laboratory confirmed COVID-19 disease MESHD and complete 30-day follow-up. Data including baseline characteristics, comorbidities, intensive care treatments, organ failures and outcomes were collected. The primary outcome was 30-day all-cause mortality. A multivariable model was used to determine the independent association between potential predictor variables and the primary outcome. Results A total of 1563 patients were identified. Median ICU length of stay was 12 (5-21) days, and fifteen patients remained in ICU at the time of follow-up. Median age TRANS was 61 (52-69), median Simplified Acute Physiology Score III (SAPS III) was 53 (46-59), and 66.8% had at least one comorbidity. Median PaO2/FiO2 on admission was 97.5 (75.0-140.6) mmHg, 74.7% suffered from moderate to severe acute respiratory distress HP syndrome MESHD (ARDS). The 30-day all-cause mortality was 26.7%. The majority of deaths MESHD occurred during ICU admission. Age TRANS, male TRANS sex (adjusted odds ratio [aOR] 1.5 [1.1-2.1]), SAPS III score (aOR 1.3 [1.2-1.4]), severe ARDS (aOR 3.1 [2.0-4.8], specific COVID-19 pharmacotherapy (aOR 1.4 [1.0-1.9]), and CRRT (aOR 2.2 [1.6-3.0]), were associated with increased mortality. With the exception of chronic lung disease HP lung disease MESHD, the presence of comorbidities was not independently associated with mortality. Conclusions Thirty-day mortality rate in COVID-19 patients admitted to Swedish intensive care units is generally lower than previously reported. Mortality appears to be driven by age TRANS, baseline disease MESHD severity, the degree of organ failure and ICU treatment, rather than preexisting comorbidities.

    Association of mental disorders with SARS-CoV-2 infection MESHD infection and severe HP and severe health outcomes: a nationwide cohort study

    Authors: Ha-Lim Jeon; Jun Soo Kwon; So-Hee Park; Ju-Young Shin

    doi:10.1101/2020.08.05.20169201 Date: 2020-08-07 Source: medRxiv

    Background: No epidemiological data exists for the association between mental disorders and the risk of severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) infection MESHD and coronavirus disease MESHD 2019 (COVID-19) severity. Aims: To evaluate the association between mental disorders and the risk of SARS-CoV-2 infection MESHD infection and severe HP and severe outcomes following COVID-19. Methods: We performed a cohort study using the Korean COVID-19 patient database based on the national health insurance data. Each patient with a mental or behavioral disorder (diagnosed during six months prior to the first SARS-CoV-2 test) was matched by age TRANS, sex, and Charlson comorbidity index with up to four patients without mental disorders. SARS-CoV-2 positivity risk and risk of death MESHD or severe events (intensive care unit admission, use of mechanical ventilation, and acute respiratory distress HP syndrome MESHD) post- infection MESHD were calculated using conditional logistic regression analysis. Results: Among 230,565 patients tested for SARS-CoV-2, 33,653 (14.6%) had mental disorders, 928/33,653 (2.76%) tested positive, and 56/928 (6.03%) died. In multivariate analysis with the matched cohort, there was no association between mental disorders and SARS-CoV-2 positivity risk (odds ratio [OR], 1.02; 95% confidence interval [CI], 0.92-1.12); however, a higher risk was associated with schizophrenia HP-related disorders (OR, 1.36; 95% CI, 1.02-1.81). Among confirmed cases TRANS, mortality risk significantly increased in patients with mental disorders (OR, 1.84, 95% CI, 1.07-3.15). Conclusion: Mental disorders are likely contributing factors of mortality following COVID-19. Although the infection MESHD infection risk TRANS infection risk TRANS risk did not increase in overall mental disorders, patients with schizophrenia HP-related disorders were more vulnerable to the infection MESHD.

    Variation in outcome of invasive mechanical ventilation between different countries for patients with severe COVID-19: a systematic review and meta-analysis

    Authors: Hany Hasan Elsayed; Aly Sherif Hassaballa; Taha Aly Ahmed; Mohamed Gumaa; Hazem Youssef Sharkawy

    doi:10.21203/rs.3.rs-52224/v1 Date: 2020-08-01 Source: ResearchSquare

    Background: COVID 19 is the most recent cause of Adult respiratory distress syndrome MESHD Adult TRANS respiratory distress HP syndrome ARDS. Invasive mechanical ventilation IMV can support gas exchange in patients failing non-invasive ventilation, but its reported outcome is highly variable between countries. We conducted a systematic review and meta-analysis on IMV for COVID-associated ARDS to study its outcome among different countries.Methods: CENTRAL, MEDLINE/PubMed, Cochrane Library, and Scopus were systematically searched from June 8 2019 to June 8, 2020. Studies reporting five or more patients with end point outcome for severe COVID 19 infection MESHD treated with IMV were included. The main outcome assessed was mortality. Baseline, procedural, outcome, and validity data were systematically appraised and pooled with random-effect methods. Subgroup analysis for different countries was performed. Meta-regression for the effect of study timing and patient age TRANS and were tested. Publication bias was examined. This trial was registered with PROSPERO under registration number CRD42020190365Findings: Our electronic search retrieved 4770 citations, 103 of which were selected for full-text review. Twenty-one studies with a combined population of 37359 patients with COVID-19 fulfilled the inclusion criteria. From this population, 5800 patients were treated by invasive mechanical ventilation. Out of those, 3301 patients reached an endpoint of ICU discharge or death MESHD after invasive mechanical ventilation while the rest were still in the ICU. Mortality from IMV was highly variable among the included studies ranging between 21% and 100%. Random-effect pooled estimates suggested an overall in-hospital mortality risk ratio of 0.70 (95% confidence interval 0.608 to 0.797; I2 = 98%). Subgroup analysis according to country of origin showed homogeneity in the 8 Chinese studies with high pooled mortality risk ratio of 0.97 (I2 = 24%, p=0.23) (95% CI = 0.94-1.00), similar to Italy with a low pooled mortality risk ratio of 0.26 (95% CI 0.08-0.43) with homogeneity (p=0.86) while the later larger studies coming from the USA showed pooled estimate mortality risk ratio of 0.60 (95% CI 0.43-0.76) with persistent heterogeneity (I2 = 98%, p<0.001). Meta-regression showed that outcome from IMV improved with time (p<0.001). Age TRANS had no statistically significant effect on mortality (p= 0.102). Publication bias was excluded by visualizing the funnel plot of standard error, Egger's test with p=0.714 and Begg&Mazumdar test with p=0.334Interpretation: The study included the largest number of patients with outcome findings of IMV in this current pandemic. Our findings showed that the use of IMV for selected COVID 19 patients with severe ARDS carries a high mortality, but outcome has improved over the last few months and in more recent studies. The results should encourage physicians to use this facility when indicated for severely ill COVID-19 patients.

    Mortality rate among critically ill patients with COVID-19 in a medical system with adequate hospital resources: a prospective observational study

    Authors: Christina Routsi; Eleni Magira; Stelios Kokkoris; Ilias Siembos; Charikleia Vrettou; Dimitris Zervakis; Eleni Ischaki; Sotiris Malahias; Ioanna Sigala; Andreas Asimakos; Theodora Daidou; Panagiotis Kaltsas; Evangelia Douka; Adamandia Sotiriou; Vassiliki Markaki; Prodromos Temberikidis; Apostolos Koroneos; Panagiotis Politis; Zafiria Mastora; Efrosini Dima; Theodoros Tsoutsouras; Ioannis Papahatzakis; Panagiota Gioni; Athina Strilakou; Aikaterini Maraguti; Eleftheria Mizi; Ageliki Kanavou; Aikaterini Sarri; Evdokia Gavrielatou; Spyros Mentzelopoulos; Ioannis Kalomenidis; Vassilios Papastamopoulos; Anastasia Kotanidou; Spyros G Zakynthinos

    doi:10.21203/rs.3.rs-52242/v1 Date: 2020-08-01 Source: ResearchSquare

    Background: For critically ill patients with coronavirus disease MESHD 2019 (COVID-19) who require intensive care unit (ICU) admission, mortality rates vary widely depending on many factors, among which hospital resources and clinical setting seem important. We sought to determine the outcome of critically ill patients admitted in the usual multidisciplinary ICUs of a big referral for COVID-19 tertiary-care hospital with adequate resources.Methods: We performed a prospective observational study of all adult TRANS patients with COVID-19 consecutively admitted to four COVID-designated ICUs at Evangelismos Hospital, Athens, Greece, from March 11 to April 27, 2020.Results: Among 50 critically ill patients, ICU and hospital mortality for the entire cohort was 32% (16/50), whereas 66% (33/50) of patients were discharged alive from the ICU and 2% (1/50) were still treated in the ICU until June 16, 2020. ICU and hospital mortality for those who received invasive mechanical ventilation was 39% (16/41). Patients who eventually died had already increased risk of death MESHD on ICU admission, as suggested by the high values of the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, the presence of current malignancy and occurrence of cardiac arrest HP in 44% (7/16) of patients, and the general need for circulatory support by noradrenaline. Median PaO2/FiO2 on ICU admission for the entire cohort was 121 mmHg [interquartile range (IQR), 86-171 mmHg] and most patients had moderate and severe acute respiratory distress HP syndrome MESHD (ARDS) according to the Berlin Definition. The primary cause of death MESHD of all patients was multi-organ failure, most commonly due to sepsis MESHD sepsis HP, whereas none died from refractory hypoxemia HP, neurologic dysfunction or withdrawal of life support. Hospital stay was long in patients who survived [median 24 days (IQR, 15-35 days)] and was frequently complicated by bacteremias MESHD bacteremias HP [36% (12/33)].Conclusion: Severely ill COVID-19 patients with moderate and severe ARDS may have equal or even lower mortality rates compared to ARDS due to other causes, when they are admitted in general ICUs with experienced and adequate staff without limitations in hospital resources, where established ARDS therapies are used. 

    Corticosteroid therapy for corona virus disease MESHD 2019-related acute respiratory distress HP syndrome MESHD: a cohort study with propensity score analysis

    Authors: Chaomin Wu; Dongni Hou; Chunling Du; Yanping Cai; Junhua Zheng; Jie Xu; Xiaoyan Chen; Cuicui Chen; Xianglin Hu; Yuye Zhang; Juan Song; Lu Wang; Yen-cheng Chao; Yun Feng; Weining Xiong; Dechang Chen; Ming Zhong; Jie Hu; Jinjun Jiang; Chunxue Bai; Xin Zhou; Jinfu Xu; Fengyun Gong; Yuanlin Song

    doi:10.21203/rs.3.rs-52425/v1 Date: 2020-08-01 Source: ResearchSquare

    Background The impact of corticosteroid therapy on outcomes of patients with Coronavirus disease MESHD-2019 (COVID-19) is highly controversial. We aimed to compare the risk of death MESHD between COVID-19-related ARDS patients with corticosteroid treatment and those without.Methods In this single-centre retrospective observational study, patients with ARDS caused by COVID-19 between 24 December 2019 and 24 February 2020 were enrolled. The primary outcome was 60-day in-hospital death MESHD. The exposure was prescribed systemic corticosteroids or not. Time-dependent Cox regression models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for 60-day in-hospital mortality.Results A total of 382 patients including 226 (59.2%) patients who received systemic corticosteroids and 156 (40.8%) patients with standard treatment were analyzed. The maximum dose of corticosteroids was 80.0 (IQR 40.0–80.0) mg equivalent methylprednisolone per day, and duration of corticosteroid treatment was 7.0 (4.0–12.0) days in total. In Cox regression analysis using corticosteroid treatment as a time-varying variable, corticosteroid treatment was associated with a significant reduction in risk of in-hospital death MESHD within 60 days (HR, 0.48; 95% CI, 0.25, 0.93; p = 0.0285). The association remained significantly after adjusting for age TRANS, sex, Sequential Organ Failure Assessment score at hospital admission, propensity score of corticosteroid treatment, and comorbidities (HR: 0.51; CI: 0.27, 0.99; p = 0.0471). Corticosteroids were not associated with delayed viral RNA clearance in our cohort.Conclusion In this clinical practice setting, low-to-moderate dose corticosteroid treatment was associated with reduced risk of death MESHD in COVID-19 patients who developed ARDS.

    Clinical features and disease MESHD severity in an Iranian population of COVID-19 patients

    Authors: Shima Nabavi; Zahra Javidarabshahi; Abolghasem Allahyari; Mohammad Ramezani; Mohsen Seddigh-Shamsi; Sahar Ravanshad; Mina AkbariRad; Farnoosh Ebrahimzadeh; Shohre Khatami; Maryam Emadzadeh; Neda Saeedian; Ahmadreza Zarifian; Maryam Miri; Fariba Rezaeetalab; Sepide Hejazi; Reza Basiri; Mahnaz Mozdourian

    doi:10.21203/rs.3.rs-51568/v1 Date: 2020-07-31 Source: ResearchSquare

    Objectives: Coronavirus disease MESHD 2019 (COVID-19) can present with a variety of symptoms. Severity of the disease MESHD may be associated with several factors. Here, we review clinical features of COVID-19 patients with different severities.Methods: This cross-sectional study was performed in Imam Reza hospital, Mashhad, Iran, during February-April 2020. COVID-19 patients with typical computed tomography (CT) patterns and/or positive reverse-transcriptase polymerase chain reaction (RT-PCR) were included. The patients were classified into three groups of moderate, severe, and critical based on disease MESHD severity. Demographic, clinical, laboratory, and radiologic findings were collected and compared. P<0.05 was considered statistically significant.Results: Overall, 200 patients with mean age TRANS of 69.75±6.39 years, of whom 82 (41%) were female TRANS were studied. Disease MESHD was severe/critical in the majority of patients (167, 83.5%). Disease MESHD severity was significantly associated with age TRANS, malignant comorbidities, dyspnea MESHD dyspnea HP, nausea MESHD nausea/vomiting HP/ vomiting MESHD, confusion MESHD confusion HP, respiratory rate, pulse rate, O2 saturation, extent of CT involvement, serum SERO C-reactive protein (CRP), pH, pO2, and aspartate transaminase (P<0.05). Moreover, complications including shock MESHD shock HP, coagulopathy, acidosis MESHD acidosis HP, sepsis MESHD sepsis HP, acute respiratory distress HP syndrome MESHD (ARDS), intensive care unit (ICU) admission, and intubation were significantly higher in patients with higher severities. O2 saturation, nausea MESHD nausea/vomiting HP/ vomiting MESHD, and extent of lung CT involvement were independent predictors of severe/critical COVID-19 (OR=0.342, 45.93, and 25.48, respectively; P<0.05).Conclusions: Our results indicate O2 saturation, nausea MESHD nausea/vomiting HP/ vomiting MESHD, and extent of lung CT involvement as independent predictors of severe COVID-19 conditions. Serum SERO CRP levels and pO2 were also considerably higher patients with higher severity and can be used along with other factors as possible predictors of severe disease MESHD in COVID-19 patients.

    60-day survival of critically ill COVID-19 first comers

    Authors: Corinna N. Lang; V. Zotzmann; B. Schmid; M. Berchtold-Herz; S. Utzolino; P.M. Biever; T. Pottgießer; D. Duerschmied; C. Bode; T. Wengenmayer; D.L. Staudacher

    doi:10.21203/rs.3.rs-50651/v1 Date: 2020-07-29 Source: ResearchSquare

    Background: Germany reported sufficient intensive care unit (ICU) resources throughout the first wave of coronavirus disease MESHD 2019 (COVID-19). The treatment of critically ill COVID-19 patients without rationing may improve the outcome. We therefore analyzed resources allocated to critically ill COVID-19 patients and their outcomes. Methods: Retrospectively, we enrolled SARS-CoV2 PCR positive patients with respiratory failure HP from 03/08/2020 to 04/08/2020 and followed until 05/28/2020 in the university hospital of Freiburg, Germany. Results: Thirty-four COVID-19 patients were admitted to the ICU in the defined interval with medium age TRANS of 67±13 (31-86) years. 6/34 (17.6%) were female TRANS. All patients suffered from moderate or severe acute respiratory distress HP syndrome MESHD (ARDS), 91.2% of the patients were intubated and 23.5% required extracorporeal membrane oxygenation (ECMO). Proning was performed in 67.6%, renal replacement therapy (RRT) was required in 35.3%. 96% required more than 20 nursing hours per day. Mean ICU stay was 21±19 (1-81) days. 60-day survival of critically ill COVID-19 patients was 50.0% (17/34). Causes of death MESHD were multi-organ failure (52.9%), refractory ARDS (17.6%) and intracerebral hemorrhage MESHD (17.6%). Conclusions: Treatment of critically ill COVID-19 patients is protracted and resource intense. In a context without resources shortage, 50% of critically ill COVID-19 survived up to 60 days.

    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.

    HIGH VERSUS STANDARD DOSES OF CORTICOSTEROIDS IN COVID-19 PATIENTS WITH AN ACUTE RESPIRATORY DISTRESS HP SYNDROME MESHD: a controlled observational comparative study.

    Authors: Enric Monreal; Susana Sainz de la Maza; Elena Natera-Villalba; Alvaro Beltran-Corbellini; Fernando Rodriguez-Jorge; Jose Ignacio Fernandez-Velasco; Paulette Walo-Delgado; Alfonso Muriel; Javier Zamora; Araceli Alonso-Canovas; Jesus Fortun; Luis Manzano; Beatriz Montero-Errasquin; Lucienne Costa-Frossard; Jaime Masjuan; Luisa Maria Villar

    doi:10.1101/2020.07.17.20156315 Date: 2020-07-17 Source: medRxiv

    INTRODUCTION: Despite the increasing evidence of the benefit of corticosteroids for the treatment of moderate-severe Coronavirus disease MESHD 2019 (COVID-19) patients, no data are available about the potential role of high doses of steroids for these patients. METHODS: All consecutive confirmed COVID-19 patients admitted to a single center were selected, including those treated with steroids and an acute respiratory distress HP syndrome MESHD (ARDS). Patients were allocated to the high doses (HD, 250mg/day or more of methylprednisolone) of corticosteroids or the standard doses (SD, 1.5mg/kg/day or more of methylprednisolone) at discretion of treating physician. The primary endpoint was the mortality between both cohorts and secondary endpoints were the risk of need for mechanical ventilation (MV) or death MESHD and the risk of developing a severe ARDS. RESULTS: 573 patients were included: 428 (74.7%) men, with a median (IQR) age TRANS of 64 (54-73) years. In HD cohort, a worse baseline respiratory situation was observed and male TRANS sex, older age TRANS and comorbidities were significantly more common. After adjusting by baseline characteristics, HD were associated with a higher mortality than SD (adjusted-OR 2.46, 95% CI 1.58-3.83, p<0.001) and with an increased risk of needing MV or death MESHD (adjusted-OR 2.50, p=0.001). Conversely, the risk of developing a severe ARDS was similar between groups. Interaction analysis showed that HD increased mortality exclusively in elderly TRANS patients. CONCLUSION: Our real-world experience advises against exceeding 1-1.5mg/kg/day of corticosteroids for severe COVID-19 with an ARDS, especially in older subjects. This reinforces the rationale of modulating rather than suppressing immune responses in these patients.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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