Corpus overview


Overview

MeSH Disease

Cough (195)

Coronavirus Infections (181)

Fever (175)

Disease (107)

Infections (88)


Human Phenotype

Cough (195)

Fever (175)

Fatigue (69)

Pneumonia (55)

Dyspnea (34)


Transmission

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

    Knowledge and attitude of dentists, dental auxiliaries, and students regarding the COVID-19 pandemic in Saudi Arabia: A Cross-Sectional Survey

    Authors: Suliman Yousif Shahin; Amr Said Bugshan; Khalid Salman Almulhim; Mishali Saud AlSharief; Yousif Al Dulaijan; Faisal Dhaifallah Alqarni

    doi:10.21203/rs.3.rs-57059/v1 Date: 2020-08-10 Source: ResearchSquare

    Background: This study aimed to assess the knowledge and attitude of dental professionals in Saudi Arabia regarding severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) and coronavirus disease MESHD 2019 (COVID-19).Methods: A questionnaire was developed to assess various dental professionals from both governmental and private sectors through online and social media outlets. Results: A total of 1,033 responses were collected. Moreover, 63.4% of respondents (63.4%) were working in hospitals. Of all respondents, 44.9%, 33.4%, and 21.7% were in governmental clinics, academia, and private sector, respectively. Overall knowledge on incubation period TRANS and route of transmission TRANS of SARS-CoV-2 was satisfactory across all dental professions. All dental professionals except for dental assistants demonstrated adequate knowledge on the recommended hand-soap cleaning time (p < 0.001). Most dental professionals displayed unsatisfactory knowledge and disagreement on the survival of SARS-CoV-2 outside the host (p < 0.001). Furthermore, 75.1% of respondents were reluctant to treat a suspected COVID-19 patient, and 92% participants believed that the mode of transmission TRANS was droplet inhalation. Fever MESHD Fever HP, coughing MESHD coughing HP, and shortness of breath were identified as the most common symptoms of COVID-19. Most standard methods of prevention in the dental office were selected by at least 50% of participants. Conclusions: An appropriate level of knowledge on SARS-CoV-2 incubation period TRANS and signs and symptoms MESHD of COVID-19 was noted among all dental professionals in Saudi Arabia. Perceived survival outside the host was modest. A certain level of apprehension toward suspected SARS-CoV-2 patients existed among most professionals. Pandemic-awareness campaigns are essential among healthcare providers.

    Prevalence SERO, Pattern and Impact of Self Medication of Anti-infective Agents During COVID-19 Outbreak in Dhaka City

    Authors: Morshed Nasir; Khandaker Abu Talha; ASM Salauddin Chowdhury; Tahmina Zahan; Rawshan Ara Perveen

    doi:10.21203/rs.3.rs-57011/v1 Date: 2020-08-10 Source: ResearchSquare

    Background: The outbreak of coronavirus disease MESHD-2019 is putting a massive strain on vulnerable healthcare system in low and middle-income countries like Bangladesh. Inequitable access to healthcare is further widened by the socio-economic gap and sense of insecurity during this pandemic. Self-medication is a common practice in Bangladesh as it provides a low-cost alternative for people, which involves inappropriate and injudicious use of medicines to treat self-recognized symptoms by the people. During the outbreak of COVID-19 in Dhaka city, the tendency of taking medicines by own decision was thought to be increased alarmingly due to unusual distress, caused by high self-awareness of their health and buying capacity of medication. Objectives: To observe the prevalence SERO, pattern, sources and impact of self-medication practice among the respondents with high socio-economic standings and education. Setting: Citizens living in Dhaka city, Bangladesh during COVID-19 outbreak from April 2020 to May 2020. Method: Cross sectional online survey conducted on 626 citizens without having background of medical knowledge or related to any healthcare services (doctors, nurses, pharmacist, medical students) by structured questionnaires during COVID-19 outbreak. Outcome measures: Frequency of self-medication, commonly used antimicrobial agents, symptoms causing self-medication, sources of inspiration, relation with COVID-19 test results, economic burden involved in self-medication during outbreak. Results: The prevalence SERO of self-medication amid the outbreak of COVID-19 was 88.33% and only 179 (28.59%) took medication with doctors’ advice and remaining 447 (71.40%) respondents took the drugs as “self-medication” by other sources. The most frequently used anti-infective drugs during the outbreak were ivermectine (77.15%), azithromycin (54.15%), doxycycline (40.25%). The common symptoms were fever MESHD fever HP, throat pain MESHD pain HP, dry- cough MESHD cough HP and total 105 (16.77%) respondents took medications without having any symptoms. Almost 355 (85.33%) had taken medication without doing any test for COVID-19. The causes of self-medication as news of spread, effects and remedies in media channels, internet; mental stress of lockdown and isolation, insecurity and panic about scarcity of drug and healthcare support. Conclusion: High risks of developing antibiotic resistance, adverse drug reactions and financial loss was predictable with absence of strict regulatory enforcement to protect people and proper utilization resources during COVID-19 outbreak in Dhaka city.

    Knowledge and attitude of dentists, dental auxiliaries and students regarding the COVID-19 pandemic in Saudi Arabia: A Cross-Sectional Survey

    Authors: Suliman Shahin; Amr Bugshan; Khalid Almulhim; Mishali AlSharief; Yousif Al-Dulaijan; Faisal al-Qarni

    doi:10.21203/rs.3.rs-53964/v1 Date: 2020-08-05 Source: ResearchSquare

    Background: This study aimed to assess the knowledge and attitude of dental professionals in Saudi Arabia regarding severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) and coronavirus disease MESHD 2019 (COVID-19).Methods: A questionnaire was developed to assess various dental professionals from both governmental and private sectors through online and social media outlets. Results: A total of 1,033 responses were collected. Moreover, 63.4% of respondents (63.4%) were working in hospitals. Of all respondents, 44.9%, 33.4%, and 21.7% were in governmental clinics, academia, and private sector, respectively. Overall knowledge on incubation period TRANS and route of transmission TRANS of SARS-CoV-2 was satisfactory across all dental professions. All dental professionals except for dental assistants demonstrated adequate knowledge on the recommended hand-soap cleaning time (p < 0.001). Most dental professionals displayed unsatisfactory knowledge and disagreement on the survival of SARS-CoV-2 outside the host (p < 0.001). Furthermore, 75.1% of respondents were reluctant to treat a suspected COVID-19 patient, and 92% participants believed that the mode of transmission TRANS was droplet inhalation. Fever MESHD Fever HP, coughing MESHD coughing HP, and shortness of breath were identified as the most common symptoms of COVID-19. Most standard methods of prevention in the dental office were selected by at least 50% of participants. Conclusions: An appropriate level of knowledge on SARS-CoV-2 incubation period TRANS and signs and symptoms MESHD of COVID-19 was noted among all dental professionals in Saudi Arabia. Perceived survival outside the host was modest. A certain level of apprehension toward suspected SARS-CoV-2 patients existed among most professionals. Pandemic-awareness campaigns are essential among healthcare providers.

    Early clinical characteristics of Covid-19: scoping review

    Authors: Lakshmi Manoharan; Jonathan W S Cattrall; Carlyn Harris; Katherine Newell; Blake Thomson; Mark G Pritchard; Peter G Bannister; Louise Sigfrid; Tom Solomon; Peter W Horby; Gail Carson; Piero L Olliaro

    doi:10.1101/2020.07.31.20165738 Date: 2020-08-04 Source: medRxiv

    ABSTRACT Background: The Coronavirus disease MESHD 2019 (covid-19) pandemic has spread rapidly across the globe. Accurate clinical characterisation studies are essential to informing research, diagnosis and clinical management efforts, particularly early in a pandemic. In this scoping review we identify the clinical characteristics of patients admitted to hospital in the early months of the pandemic, focusing on symptoms, laboratory and imaging findings, and clinical outcomes. Methods: A scoping review. MEDLINE, EMBASE and Global Health databases were searched studies published from January 1st 2020 to April 28th 2020. Studies which reported on at least 100 hospitalised patients with covid-19 of any age TRANS were included. Results: Of 1,249 studies identified through the search 78 studies were eligible for inclusion; one randomized control trial and 77 observational studies presenting data on 77,443 patients admitted with covid-19. Most studies were conducted in China (82%), 9% in the US and 10% in Europe and two studies were set in more than one country. No studies included patients from low and middle income countries. Coagulopathy was underrecognised as a complication in the early months of the pandemic. Use of corticosteroids varied widely, and the use of anticoagulants was reported in only one study. Fever MESHD Fever HP, cough MESHD cough HP and dyspnoea are less common in older adults TRANS; gastrointestinal symptoms, as the only presenting feature may be underrecognised. The most common laboratory finding was lymphocytopenia. Inflammatory biomarkers were commonly elevated, including C-reactive protein and interleukin-6. Typical computed tomography findings include bilateral infiltrates however imaging may be normal in early disease MESHD. Data on clinical characteristics in children TRANS and vulnerable populations were limited. Conclusions: Clinical characterisation studies from early in the pandemic indicated that covid-19 is a multisystem disease MESHD, with biomarkers indicating inflammation MESHD and coagulopathy. However, early data collection on symptoms and clinical outcomes did not consistently reflect this wide spectrum. Corticosteroid use varied widely, and anticoagulants were rarely used. Clinicians should remain vigilant to the possibility of covid-19 in patients presenting without fever MESHD fever HP, cough MESHD cough HP and dyspnoea, particularly in older adults TRANS. Further characterisation studies in different at-risk populations is needed. Review registration: Available at https://osf.io/r2ch9 Keywords: Covid-19, clinical characteristics, symptoms, biochemical parameters, imaging, outcomes, pandemic research

    COVID-19 Vaccine Candidates by Identification of B and T Cell Multi-Epitopes Against SARS-COV-2

    Authors: Suresh Kumar; Sarmilah Mathavan; Wee Jia Jin; Nur Azznira Bt Azman; Devindren Subramanaiam; Nur Afiqah Binti Zainalabidin; Dhivashini Lingadaran; Zainah Binti Abdul Sattar; Danniya Lakshmi Manickam; Priscilla Sheba Anbananthan; Johan Ahmad Taqiyuddin; Yuvapriya Thevarajan

    id:10.20944/preprints202008.0092.v1 Date: 2020-08-04 Source: Preprints.org

    Coronavirus disease MESHD (COVID-19) is a new discovered strain where WHO officially declares the disease MESHD as COVID-19 while the virus responsible for it called Severe Acute Respiratory Syndrome MESHD Coronavirus 2 or SARS-CoV-2. The incubation period TRANS of this disease MESHD is between 14 days. Ordinary clinical symptoms that reported around the world include fever MESHD fever HP, cough MESHD cough HP, fatigue MESHD fatigue HP, diarrhoea and vomiting MESHD vomiting HP as well as asymptomatic TRANS for certain people. Infection MESHD is spread mainly through broad droplets. In early March 2020, WHO again has announced that COVID-19 is a pandemic with currently no specific treatment. The potential use of SARS-COV-2 proteome as a vaccine candidate by analysing through B-cell and T-cell antigenicity by using a immunoinformatics approach as a vaccine development early stage. In this study, we used consensus sequence for SARS-COV-2 proteome that was retrieved from NCBI database. VaxiJen 2.0 was mainly used to identify the antigenic property of SARS-COV-2 proteins. IEDB then used to analyse the B-cell epitope, the presence of T cell immunogenic epitope in SARS-COV-2 proteins was obtained by using compromise method of MHC class I and II tools that accessible respectively using ProPred-1 server and MHC II Binding Prediction in IEDB database. The best epitopes of B and T-cell epitopes were predicted with high antigencity and the information is disseminated through web-based database resource (https://covid-19.omicstutorials.com/epitopes/). This study will be useful to find a new epitope-based candidate for SARS-COV-2. However, further study needs to be done for the next stages of vaccine development.

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

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

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

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

    Impact of Corticosteroids and Immunosuppressive Therapies on Symptomatic SARS-CoV-2 Infection MESHD in a Large Cohort of Patients with Chronic Inflammatory Arthritis MESHD Arthritis HP

    Authors: Ennio Giulio Favalli; Serena Bugatti; Catherine Klersy; Martina Biggioggero; Silvia Rossi; Orazio De Lucia; Francesca Bobbio-Pallavicini; Antonella Murgo; Silvia Balduzzi; Roberto Caporali; Carlomaurizio Montecucco

    doi:10.21203/rs.3.rs-51667/v1 Date: 2020-07-31 Source: ResearchSquare

    Background: Prevalence SERO and outcomes of Coronavirus Disease MESHD (COVID)-19 in relation to immunomodulatory medications are still unknown. The aim of the study is to investigate the impact of glucocorticoids and immunosuppressive agents on COVID-19 in a large cohort of patients with chronic immune-mediated inflammatory arthritis MESHD arthritis HP.Methods: The study was conducted in the arthritis MESHD arthritis HP outpatient clinic at two large Academic Hospitals in the COVID-19 most endemic area of Northern Italy (Lombardy). We circulated a cross-sectional survey exploring the prevalence SERO of Severe Acute Respiratory Syndrome MESHD-Coronavirus-2 nasopharyngeal swab positivity and the occurrence of acute respiratory illness ( fever MESHD fever HP and/or cough MESHD cough HP and/or dyspnea MESHD dyspnea HP), administered face-to-face or by phone to consecutive patients from 25th February to 20th April 2020. COVID-19 cases were defined as confirmed or highly suspicious according to the World Health Organization criteria. The impact of medications on COVID-19 incidence was evaluated. Results: The study population included 2050 adults TRANS with chronic inflammatory arthritis MESHD arthritis HP receiving glucocorticoids, conventional-synthetic (cs), or targeted-synthetic/biological (ts/b) disease MESHD-modifying drugs (DMARDs). Laboratory-confirmed COVID-19 and highly suspicious infection MESHD were recorded in 1.1% and 1.4% of the population, respectively. Treatment with glucocorticoids was independently associated with increased risk of COVID-19 (adjusted OR [95% CI] ranging from 1.23 [1.04-1.44] to 3.20 [1.97-5.18] depending on the definition used). Conversely, patients treated with ts/bDMARDs were at reduced risk (adjusted OR ranging from 0.46 [0.18-1.21] to 0.47 [0.46-0.48]). No independent effects of csDMARDs were observed.Conclusions: During the COVID-19 outbreak, treatment with immunomodulatory medications appears safe. Conversely, glucocorticoids, even at low-dose, may confer increased risk of infection TRANS risk of infection TRANS infection MESHD.Trial registration:  retrospectively registered

    Fighting COVID-19 spread among nursing home residents even in absence of molecular diagnosis: a retrospective cohort study.

    Authors: Alessio Strazzulla; Paul Tarteret; Maria Concetta Postorino; Marie Picque; Astrid de Pontfarcy; Nicolas Vignier; Catherine Chakvetadze; Coralie Noel; Cecile Drouin; Zine Eddine Benguerdi; Sylvain Diamantis

    doi:10.21203/rs.3.rs-51305/v1 Date: 2020-07-30 Source: ResearchSquare

    Background Access to molecular diagnosis was limited out-of-hospital in France during the 2020 coronavirus disease MESHD 2019 (COVID-19) epidemic. This study describes the evolution of COVID-19 outbreak in a nursing home in absence of molecular diagnosis. Methods A monocentric prospective study was conducted in a French nursing home from March 17th, 2020 to June 11th, 2020. Because of lack of molecular tests for severe acute respiratory syndrome MESHD 2 (SARS-Cov2) infection MESHD, probable COVID-19 cases were early identified considering only respiratory and not-respiratory symptoms and therefore preventing measures and treatments were enforced. Once available, serology tests were performed at the end of the study.A chronologic description of new cases and deaths MESHD was made together with a description of COVID-19 symptoms. Data about personal characteristics and treatments were collected and the following comparisons were performed: i) probable COVID-19 cases vs asymptomatic TRANS residents; ii) SARS-Cov2 seropositive residents vs seronegative residents. Results Overall, 32/66 (48.5%) residents and 19/39 (48.7%) members of health-care personnel were classified as probable COVID-19 cases. A total of 34/61 (55.7%) tested residents resulted seropositive. Death MESHD occurred in 4/66 (6%) residents. Diagnosis according to symptoms had 65% of sensitivity SERO, 78% of specificity, 79% of positive predictive value SERO and 64% of negative predictive value SERO.In resident population, the following symptoms were registered: 15/32 (46.8%) lymphopenia MESHD lymphopenia HP, 15/32 (46.8%) fever MESHD fever HP, 8/32 (25%) fatigue MESHD fatigue HP, 8/32 (25%) cough MESHD cough HP, 6/32 (18.8%) diarrhoea, 4/32 (12.5%) severe respiratory distress HP requiring oxygen therapy, 4/32 (12.5%) fall HP, 3/32 (9.4%) conjunctivitis MESHD conjunctivitis HP, 2/32 (6.3%) abnormal pulmonary noise at chest examination and 2/32 (6,25%) abdominal pain MESHD abdominal pain HP. Probable COVID-19 cases were older (81.3 vs 74.9; p=0.007) and they had higher prevalence SERO of atrial fibrillation MESHD atrial fibrillation HP (8/32, 25% vs 2/34, 12%; p=0.030); insulin treatment (4/34, 12% vs 0, 0%; p=0.033) and positive SARS-Cov2 serology (22/32, 69% vs 12/34, 35%; p=0.001) than asymptomatic TRANS residents. Seropositive residents had lower prevalence SERO of diabetes (4/34, 12% vs 9/27, 33%; p=0.041) and angiotensin-converting-enzyme inhibitors’ intake (1/34, 1% vs 5/27, 19%; p=0.042). Conclusions During SARS-Cov2 epidemic, early detection of respiratory and not-respiratory symptoms allowed to enforce extraordinary measures. They achieved limiting contagion and deaths MESHD among nursing home residents, even in absence of molecular diagnosis.

    Elevated oxygen demand in a case of COVID-19 with severe ARDS: a point for optimal oxygenation therapy including ECMO management

    Authors: Taku Oshima; Takehiko Oami; Mana Yamashiro; Akiko Higashi; Yosuke Hayashi; Natsumi Suga; Shin Takayanagi; Seiichiro Sakao; Taka-aki Nakada

    doi:10.21203/rs.3.rs-51286/v1 Date: 2020-07-30 Source: ResearchSquare

    Background: Coronavirus disease MESHD 2019 (COVID-19) caused by SARS-CoV-2 has become a global pandemic, and those developing critically ill conditions have been reported to have mortality in the range of 39% to 61%. Due to the lack of definitive treatments, mechanical ventilation and supportive oxygenation therapy are key management strategies for the survival of patients with acute respiratory distress HP syndrome MESHD (ARDS). Optimizing oxygenation therapy is mandatory to treat patients with severe respiratory failure HP, to sufficiently compensate for the oxygen (O2) demand. We experienced a case of severe ARDS due to COVID-19 successfully treated with extracorporeal membrane oxygenation (ECMO) after increasing oxygen delivery according to O2 consumption measurement by indirect calorimetryCase Presentation: A 29-year-old obese but otherwise healthy man was hospitalized for treatment of COVID-19 pneumonia MESHD pneumonia HP presenting with a 4-day history of persisting cough MESHD cough HP, high fever MESHD fever HP, and dyspnea MESHD dyspnea HP. Mechanical ventilation, nitric oxide inhalation, and prone positioning were initiated in the ICU against severe respiratory dysfunction. Indirect calorimetry on the 3rd and 6th ICU days revealed persistent elevation of oxygen consumption (VO2) of 380 mL/min. Veno-venous ECMO was initiated on the 7th ICU day after further deterioration of respiratory failure HP. Periodic events of SpO2 decline due to effortful breathing was not resolved by neuromuscular blockade in attempt to reduce O2 consumption. Increasing the ECMO flow induced hemolysis MESHD and hyperkalemia MESHD hyperkalemia HP despite the use of large bore cannulas and ECMO circuit free of clots and defects. The hemoglobin management level was elevated from 10 g/dL to 13 g/dL to increase blood SERO oxygen capacity, enabling the reduction of ECMO flow while attenuating respiratory effort and maintaining SpO2. Lung protective ventilation strategy and prone positioning were continued for successful weaning from ECMO on the 16th ICU day, and the ventilator on the 18th ICU day.Conclusion: The present case of severe ARDS due to COVID-19 was successfully treated with ECMO. Enhancing oxygen delivery was crucial to compensate for the elevated O2 demand. Measuring O2 consumption by indirect calorimetry can elucidate the oxygen demand for optimizing the oxygenation therapy for successful management and survival of critically ill COVID-19 patients. 

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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