Corpus overview


MeSH Disease

Human Phenotype


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    Impact of COVID-19 on Health-related Quality of Life in Patients With Cardiovascular Disease MESHD: A Multi-ethnic Asian Study

    Authors: Shir Lynn Lim; Kai Lee Woo; Eleanor Lim; Faclin Ng; Mark YY Chan; Mihir Gandhi

    doi:10.21203/ Date: 2020-08-17 Source: ResearchSquare

    BackgroundLittle is known about the impact of the global coronavirus disease-2019 (COVID-19) pandemic on patients with cardiovascular disease MESHD ( CVD MESHD), the biggest global killer and major risk factor for severe COVID-19 infections. We aim to explore the indirect consequences of COVID-19 on health-related quality of life (HRQoL) of patients with CVD MESHD. MethodsEighty-one adult TRANS outpatients with CVD MESHD were assessed using the EQ-5D, a generic health status instrument with five dimensions (mobility, self-care, usual activities, pain HP pain MESHD/discomfort, anxiety HP anxiety MESHD/depression), before and during the pandemic. Changes in the EQ-5D dimensional responses were compared categorically as well as using the dimension-specific sum-score (range 1 to 3, with a higher score indicates worse health). The responses and sum-score were compared using the exact test of symmetry and the paired t-test, respectively. ResultsThese patients [mean age TRANS (SD) 59.8 (10.5); 92.6% males TRANS; 56% New York Heart Association (NYHA) functional class I] had coronary artery disease MESHD (69%), heart failure MESHD (28%), or arrhythmias HP arrhythmias MESHD (15%). None experienced change in NYHA class between assessments. About 30% and 38% of patients reported problems with at least one of the EQ-5D dimensions pre- and during the pandemic, respectively. The highest increase in health problems was reported for anxiety HP anxiety MESHD/depression (12.5% pre-pandemic vs 23.5% during pandemic; p = 0.035) with mean domain-specific score from 1.12 (SD 0.33) to 1.25 (SD 0.46) (p = 0.012). There was no meaningful change in other dimensions as well as overall HRQoL. Conclusion The COVID-19 pandemic is associated with a significant worsening of the mental health of patients with CVD MESHD

    Mitigating Arrhythmia HP Arrhythmia MESHD Risk in Hydroxychloroquine and Azithromycin Treated COVID-19 Patients using Arrhythmia HP Arrhythmia MESHD Risk Management Plan

    Authors: Kazimieras Maneikis M.D.; Ugne Ringeleviciute M.D.; Justinas Bacevicius M.D.; Egle Dieninyte-Misiune M.D.; Emilija Burokaite M.D.; Gintare Kazbaraite M.D.; Marta Monika Janusaite M.D.; Austeja Dapkeviciute M.D.; Andrius Zucenka M.D.; Valdas Peceliunas M.D. Ph.D.; Lina Kryzauskaite M.D.; Vytautas Kasiulevicius M.D. Ph.D.; Donata Ringaitiene M.D. Ph.D.; Birute Zablockiene M.D. Ph.D.; Tadas Zvirblis; Germanas Marinskis M.D. Ph.D.; Ligita Jancoriene M.D. Ph.D.; Laimonas Griskevicius M.D. Ph.D.

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

    Background: Hydroxychloroquine and Azithromycin use is associated with QT interval prolongation MESHD and arrhythmias HP arrhythmias MESHD. Despite ongoing multiple clinical trials for treatment of COVID19 infection MESHD, no definite cardiac safety protocols were proposed. The aim of our study was to assess cardiac safety in COVID-19 patients treated with the combination of Hydroxychloroquine and Azithromycin using close monitoring and arrhythmia HP arrhythmia MESHD risk management plan.Methods and results: We retrospectively examined arrhythmia HP arrhythmia MESHD safety of treatment with Hydroxychloroquine and Azithromycin in the setting of pre-defined cardiac arrhythmia MESHD arrhythmia HP risk management plan. 81 patients were included from March 23rd to May 10th 2020. The median age TRANS was 59 years, 58.0% were female TRANS. The majority of the study population (82.7%) had comorbidities, 98.8% had radiological signs of pneumonia HP pneumonia MESHD. 7 patients (8.6%) had QTc prolongation MESHD of ≥500 ms. The treatment was discontinued in 4 patients (4.9%). 14 patients (17.3%) experienced QTc≥480 ms and 16 patients (19.8%) had an increase of QTc≥60 ms. None of the patients developed ventricular tachycardia HP ventricular tachycardia MESHD. The risk factors significantly associated with QTc≥500 ms were hypokalemia HP hypokalemia MESHD (p = 0.032) and use of diuretics during the treatment (p = 0.020). Three patients had a lethal outcome; none of them associated with ventricular arrhythmias HP ventricular arrhythmias MESHD.Conclusion: We recorded a low incidence of QTc prolongation MESHD ≥500 ms and no ventricular tachycardia HP ventricular tachycardia MESHD events in COVID-19 patients treated with Hydroxychloroquine and Azithromycin using cardiac arrhythmia MESHD arrhythmia HP risk management plan.

    Hypokalemia HP Hypokalemia MESHD in Patients with COVID-19

    Authors: Gaetano Alfano; Annachiara Ferrari; Francesco Fontana; Rossella Perrone; Giacomo Mori; Elisabetta Ascione; Magistroni Riccardo; Giulia Venturi; Simone Pederzoli; Gianluca Margiotta; Marilina Romeo; Francesca Piccinini; Giacomo Franceschi; Sara Volpi; Matteo Faltoni; Giacomo Ciusa; Erica Bacca; Marco Tutone; Alessandro Raimondi; marianna menozzi; Erica Franceschini; Gianluca Cuomo; Gabriella Orlando; Antonella Santoro; Margherita Di Gaetano; Cinzia Puzzolante; Federica Carli; Andrea Bedini; Jovana Milic; Marianna Meschiari; Cristina Mussini; Gianni Cappelli; Giovanni Guaraldi

    doi:10.1101/2020.06.14.20131169 Date: 2020-06-16 Source: medRxiv

    Patients with COVID-19 may experience multiple conditions (e.g., fever HP fever MESHD, hyperventilation HP hyperventilation MESHD, anorexia HP anorexia MESHD, gastroenteritis MESHD, acid-base disorder) that may cause electrolyte imbalances. Hypokalemia HP Hypokalemia MESHD is a concerning electrolyte disorder that may increase the susceptibility to various kinds of arrhythmia HP arrhythmia MESHD. This study aimed to estimate prevalence SERO, risk factors and outcome of hypokalemia HP hypokalemia MESHD in a cohort of non-critically ill patients. A retrospective analysis was conducted on 290 hospitalized patients with confirmed COVID-19 infection at the tertiary teaching hospital of Modena, Italy. Hypokalemia HP Hypokalemia MESHD (<3.5 mEq/L) was detected in 119 patients (41%). The decrease of serum SERO potassium level was of mild entity (3-3.4 mEq/L) and occurred in association with hypocalcemia HP hypocalcemia MESHD (P=0.001) and lower level of serum SERO magnesium (P=0.028) compared to normokaliemic patients. Urine K: creatinine ratio, measured in a small subset of patients (n=45; 36.1%), showed an increase of urinary potassium HP excretion in the majority of the cases (95.5%). Causes of kaliuria were diuretic therapy (53.4%) and corticosteroids (23.3%). In the remaining patients, urinary potassium loss was associated with normal serum SERO magnesium, low sodium excretion (FENa< 1%) and metabolic alkalosis HP metabolic alkalosis MESHD. Risk factors for hypokalemia HP hypokalemia MESHD were female TRANS gender TRANS (P=0.002; HR 0.41, 95%CI 0.23-0.73) and diuretic therapy (P=0.027; HR 1.94, 95%CI 1.08-3.48). Hypokalemia HP Hypokalemia MESHD, adjusted for sex, age TRANS and SOFA score, resulted not associated with ICU admission (P=0.131, 95% CI 0.228-1.212) and in-hospital mortality (P=0.474; 95% CI 0,170-1,324) in our cohort of patients. Hypokalemia HP Hypokalemia MESHD is a frequent disorder in COVID-19 patients and urinary potassium loss may be the main cause of hypokalemia HP hypokalemia MESHD. The disorder was mild in the majority of the patients and was unrelated to poor outcomes. Nevertheless, hypokalemic MESHD patients required potassium supplements to dampen the risk of arrhythmias HP arrhythmias MESHD.

    Investigational treatments for COVID-19 may increase ventricular arrhythmia HP ventricular arrhythmia MESHD risk through drug interactions

    Authors: Meera Varshneya; Itziar Irurzun-Arana; Chiara Campana; Rafael Dariolli; Amy Gutierrez; Taylor K Pullinger; Eric A Sobie

    doi:10.1101/2020.05.21.20109397 Date: 2020-05-26 Source: medRxiv

    Many drugs that have been proposed for treatment of COVID-19 are reported to cause cardiac adverse events, including ventricular arrhythmias HP ventricular arrhythmias MESHD. In order to properly weigh risks against potential benefits, particularly when decisions must be made quickly, mathematical modeling of both drug disposition and drug action can be useful for predicting patient response and making informed decisions. Here we explored the potential effects on cardiac electrophysiology of 4 drugs proposed to treat COVID-19: lopinavir, ritonavir, chloroquine, and azithromycin, as well as combination therapy involving these drugs. Our study combined simulations of pharmacokinetics (PK) with quantitative systems pharmacology (QSP) modeling of ventricular myocytes to predict potential cardiac adverse events caused by these treatments. Simulation results predicted that drug combinations can lead to greater cellular action potential prolongation, analogous to QT prolongation MESHD, compared with drugs given in isolation. The combination effect can result from both pharmacokinetic and pharmacodynamic drug interactions. Importantly, simulations of different patient groups predicted that females TRANS with pre-existing heart disease MESHD are especially susceptible to drug-induced arrhythmias HP arrhythmias MESHD, compared males TRANS with disease or healthy individuals of either sex. Overall, the results illustrate how PK and QSP modeling may be combined to more precisely predict cardiac risks of COVID-19 therapies.

    The association of cardiovascular disease MESHD and other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis

    Authors: Paddy Ssentongo; Anna E. Ssentongo; Emily S. Heilbrunn; Djibril M Ba; Vernon M. Chinchilli

    doi:10.1101/2020.05.10.20097253 Date: 2020-05-14 Source: medRxiv

    Background Exploring the association of coronavirus-2019 disease (COVID-19) mortality with chronic pre-existing conditions may promote the importance of targeting these populations during this pandemic to optimize survival. The objective of this systematic review and meta-analysis is to explore the association of pre-existing conditions with COVID-19 mortality. Methods We searched MEDLINE, OVID databases, SCOPUS, and for the period December 1, 2019, to May 1, 2020. The outcome of interest was the risk of COVID-19 mortality in patients with and without pre-existing conditions. Comorbidities explored were cardiovascular diseases MESHD ( coronary artery disease MESHD, hypertension HP hypertension MESHD, cardiac arrhythmias MESHD arrhythmias HP, and congestive heart failure HP congestive heart failure MESHD), chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD, type 2 diabetes MESHD, cancer MESHD, chronic kidney disease HP chronic kidney disease MESHD, chronic liver disease MESHD, and stroke HP stroke MESHD. Two independent reviewers extracted data and assessed the risk of bias. All analyses were performed using random-effects models and heterogeneity was quantified. Results Ten chronic conditions from 19 studies were included in the meta-analysis (n = 61,455 patients with COVID-19; mean age TRANS, 61 years; 57% male TRANS). Overall the between-study study heterogeneity was medium and studies had low publication bias MESHD and high quality. Coronary heart disease MESHD, hypertension HP hypertension MESHD, congestive heart failure HP congestive heart failure MESHD, and cancer MESHD significantly increased the risk of mortality from COVID-19. The risk of mortality from COVID-19 in patients with coronary heart disease MESHD was 2.4 times as high as those without coronary heart disease MESHD (RR= 2.40, 95%CI=1.71-3.37, n=5) and twice as high in patients with hypertension HP hypertension MESHD as high as that compared to those without hypertension HP hypertension MESHD (RR=1.89, 95%CI= 1.58-2.27, n=9). Patients with cancer MESHD also were at twice the risk of mortality from COVID-19 compared to those without cancer MESHD (RR=1.93 95%CI 1.15-3.24, n=4), and those with congestive heart failure HP congestive heart failure MESHD were at 2.5 times the risk of mortality compared to those without congestive heart failure HP congestive heart failure MESHD (RR=2.66, 95%CI 1.58-4.48, n=3). Conclusions COVID-19 patients with all any cardiovascular disease MESHD, coronary heart disease MESHD, hypertension HP hypertension MESHD, congestive heart failure HP congestive heart failure MESHD, and cancer MESHD have an increased risk of mortality. Tailored infection MESHD prevention and treatment strategies targeting this high-risk population are warranted to optimize survival.

    Fatal outcome in a COVID-19 patient despite IL 6 blockage in cytokine storm

    Authors: Michael Bovet; Daniel Wadsack; Florentina Kosely; Wolfgang Zink; Ralf Zahn

    doi:10.21203/ Date: 2020-05-02 Source: ResearchSquare

    A 59 year old male TRANS patient was admitted to our hospital diagnosed with COVID-19 associated pneumonia HP pneumonia MESHD. Upfront treatment with hydroxychloroquine and azithromycin was started. Because of clinical deterioration with ARDS, circulatory shock HP shock MESHD and increased hyperinflammatory markers six days later, a cytokine storm rose to the top of differential diagnosis and off-label treatment with IL 6 receptor antagonist Tocilizumab was initiated. Subsequently we observed a dramatic rise of D-dimers indicating coagulopathy MESHD. Perimyocarditis with severe cardiac arrhythmia MESHD arrhythmia HP occurred after a second dose was administered. Later the patient died due to multi organ failure MESHD. Exacerbation of cytokine storm following treatment with Tocilizumab could not be ruled out, despite a hitherto unreported relationship with COVID-19. 

    Experience with Hydroxychloroquine and Azithromycin in the COVID-19 Pandemic: Implications for QT Interval Monitoring

    Authors: Archana Ramireddy; Harpriya S. Chugh; Kyndaron Reinier; Joseph Ebinger; Eunice Park; Michael Thompson; Eugenio Cingolani; Susan Cheng; Eduardo Marban; Christine Albert; Sumeet S. Chugh

    doi:10.1101/2020.04.22.20075671 Date: 2020-04-25 Source: medRxiv

    Background: Despite a paucity of clinical evidence, hydroxychloroquine and azithromycin are being administered widely to patients with verified or suspected COVID-19. Both drugs may increase risk of lethal arrhythmias HP arrhythmias MESHD associated with QT interval prolongation MESHD. Methods: We performed a case series of COVID-19 positive/suspected patients admitted between 2/1/2020 and 4/4/2020 who were treated with azithromycin, hydroxychloroquine or a combination. We evaluated baseline and post-medication QT interval (QTc, Bazett) using 12-lead ECGs. Critical QTc prolongation MESHD was defined as: a) maximum QTc [≥]500 ms (if QRS <120 ms) or QTc [≥]550 (if QRS [≥]120 ms) and b) increased QTc of [≥]60 ms. Tisdale score and Elixhauser comorbidity index were calculated. Results: Of 490 COVID-19 positive/suspected patients, 314 (64%) received either/both drugs, and 98 (73 COVID-19 positive, 25 suspected) met study criteria ( age TRANS 62{+/-}17 yrs, 61% male TRANS). Azithromycin was prescribed in 28%, hydroxychloroquine in 10%, and both in 62%. Baseline mean QTc was 448{+/-}29 ms and increased to 459{+/-}36ms (p=0.005) with medications. Significant prolongation MESHD was observed only in men (18{+/-}43 ms vs -0.2{+/-}28 ms in women, p=0.02). 12% of patients reached critical QTc prolongation MESHD. In a multivariable logistic regression, age TRANS, sex, Tisdale score, Elixhauser score, and baseline QTc were not associated with critical QTc prolongation MESHD (p>0.14). Changes in QTc were highest with the combination compared to either drug, with many-fold greater prolongation with the combination vs. azithromycin alone (17{+/-}39 vs. 0.5{+/-}40 ms, p=0.07). No patients manifested torsades de pointes HP torsades de pointes MESHD. Conclusions: Overall, 12% of patients manifested critical QTc interval prolongation MESHD, and traditional risk indices failed to flag these patients. With the drug combination, QTc prolongation MESHD was several-fold higher compared to azithromycin alone. The balance between uncertain benefit and potential risk when treating COVID-19 patients with these drugs should be carefully assessed prior to use.

    Characteristics and outcomes of a cohort of SARS-CoV-2 patients in the Province of Reggio Emilia, Italy

    Authors: Paolo Giorgi Rossi; Massimiliano Marino; Debora Formisano; Francesco Venturelli; Massimo Vicentini; Roberto Grilli; - The Reggio Emilia COVID-19 Working Group

    doi:10.1101/2020.04.13.20063545 Date: 2020-04-16 Source: medRxiv

    Objectives. To describe the age TRANS- and sex-specific prevalence SERO of SARS-CoV-2 disease MESHD (COVID-19) and its prognostic factors. Design. Population-based prospective cohort study on archive data. Setting. Preventive services and hospital care in the province of Reggio Emilia, Northern Italy. Participants. All 2653 symptomatic patients who tested positive for SARS-CoV-2 from February 27 to April 2, 2020 in the province of Reggio Emilia. Main outcome measures. Hospitalization and death up to April 2, 2020. Results. Females TRANS had higher prevalence SERO of infection MESHD than males TRANS below age TRANS 50 (2.61 vs. 1.84 per 1000), but lower in older ages TRANS (16.49 vs. 20.86 per 1000 over age TRANS 80). Case fatality rate reached 20.7% (22/106) in cases with more than 4 weeks follow up. After adjusting for age TRANS and comorbidities, men had a higher risk of hospitalization (hazard ratio (HR) 1.4 95% confidence interval (95% CI) 1.2 to 1.6) and of death (HR 1.6, 95% CI 1.2 to 2.1). Patients over age TRANS 80 compared to < age TRANS 50 had HR 7.1 (95% CI 5.4 to 9.3) and HR 27.8 (95% CI 12.5 to 61.7) for hospitalization and death MESHD, respectively. Immigrants had a higher risk of hospitalization (HR 1.3, 95% CI 0.99 to 1.81) than Italians and a similar risk of death MESHD. Risk of hospitalization and of death MESHD were higher in patients with heart failure MESHD (HR 1.6, 95% CI 1.2 to 2.1and HR 2.3, 95% CI 1.6 to 3.2, respectively), arrhythmia HP arrhythmia MESHD (HR 1.5, 95% CI 1.2 to 1.9 and HR 1.8, 95% CI 1.3 to 2.5, respectively), dementia HP dementia MESHD (HR 1.2, 95% CI 0.9 to 1.8 and HR 1.8, 95% CI 1.1 to 2.8, respectively), ischemic MESHD heart disease MESHD (HR 1.3, 95% CI 1.0 to 1.7 and HR 1.7, 95% CI 1.2 to 2.5, respectively), diabetes MESHD (HR 1.5, 95% CI 1.3 to 1.9 and HR 1.6, 95% CI 1.1 to 2.2, respectively), and hypertensions HP hypertensions MESHD(HR 1.4, 95% CI 1.2 to 2.6 and HR 1.6, 95% CI 1.2 to 2.1, respectively), while COPD increased the risk of hospitalization (HR 1.9, 95% CI 1.4 to 2.5) but not of death MESHD (HR 1.1, 95% CI 0.7 to 1.7). Previous use of ACE inhibitors has no effect on risk of death (HR 0.97, 95% CI 0.69 to 1.34) Conclusions. The mechanisms underlying these associations are mostly unknown. A deeper understanding of the causal chain from infection MESHD, disease onset, and immune response to outcomes may explain how these prognostic factors act.

    Clinical features of critically ill MESHD patients with COVID-19 infection MESHD in China

    Authors: Bo Hu; Dawei Wang; Chang Hu; Ming Hu; Fangfang Zhu; Hui Xiang; Beilei Zhao; Xiaoyi Zhang; Kianoush B. Kashani; Zhiyong Peng

    doi:10.21203/ Date: 2020-03-02 Source: ResearchSquare

    Importance: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections MESHD outbreak in China is now a global issue. There is only a limited understanding of the clinical characteristics of patients with SARS-CoV-2 infections MESHD is available.Objective:To describe the characteristics, management strategies, and outcomes of critically ill MESHD patients with SARS-CoV-2 infection MESHD.Design, Setting, and Patients: This is aretrospective, multi-center case series of 50 critically ill MESHD patients with confirmed SARS-CoV-2 infection MESHD who were admitted at Zhongnan Hospital of Wuhan University and Wuhan Pulmonary Hospital in Wuhan, China, from January 8 to February 9, 2020.Exposures:Documented Corona Virus Disease MESHD, 2019 (COVID-19).Main Outcome Measures: Demographic, clinical, laboratory, imaging data were collected along with management strategies, complications and outcomes of enrolled individuals. Results Fifty critically ill MESHD patients with SARS-CoV-2 infections MESHD were enrolled. Their median age TRANS was 62 (range, 29-92) [IQR,49.5-69.0] years, 68% were male TRANS, and 28 (56%) patients had comorbidities, the most common being hypertension HP hypertension MESHD. In this cohort, 20(40%) patients survived ,16(32%) patients died, and the rest remained hospitalized. The invasive mechanical ventilator was used in 36(72%) patients with 15(30%) of them requiring prone positioning, and 17(34%) switched to ECMO. The compliance scores of lungs (Cstat)on the day of ICU admission among survivors were higher than those in non-survivors [42.0(18.0-47.0), vs. 19.5(14.0-24.2), p=0.038].The blood SERO IL-6 levels and neutrophils counts at the first day of ICU admission were significantly higher in non-survivors compared to survivors [123.7(85.3-228.8), vs. 20.2(6.8-67.2) ng/ml, p=0.025 for IL-6, and 20.2(6.8-67.2) vs. 4.01(1.99-7.05) × 10⁹/L, p=0.02 for neutrophils counts].The heart rates, PaCO2, lung injury MESHD scale (LIS), and positive end-expiratory pressure levels were constantly higher for 10 days in non-survivors than those who survived (p<0.05). The frequency of vasopressor uses and neuromuscular blockers was higher in non-survivors from day 1 to day 10 compared to survivors (p<0.05). In the whole cohort, the most common complications were ARDS (97%), shock HP shock MESHD (44%), arrhythmia HP arrhythmia MESHD (38%), acute cardiac injury MESHD (26%), and acute kidney injury HP acute kidney injury MESHD (22%). A secondary bacterial infection MESHD was noted in 17(34%) patients. Univariate analysis indicated that lower lung complianceand higher neutrophil counts at the day of ICU admission were related to higher mortality (p-0.03, and 0.04, respectively)ConclusionWe demonstrated that SARS-CoV-2 infection MESHD-related critical illness predominantly affected old individuals with comorbidities and characterized by severe hypoxemic respiratory failure MESHD respiratory failure HP, often requiring prolonged mechanical ventilation and rescue therapies. Low lung compliance and persistently elevated PaCO2 indicated poor outcomes.

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MeSH Disease
Human Phenotype

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