Corpus overview


MeSH Disease

Human Phenotype


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    Genetic testing and serological SERO screening for SARS-CoV-2 infection MESHD in a COVID-19 outbreak in a nursing facility in Japan

    Authors: Yong Chong; Naoki Tani; Hideyuki Ikematsu; Nobuto Terazawa; Hitoshi Nakashima; Nobuyuki Shimono; Koichi Akashi; Yosuke Tanaka

    doi:10.21203/ Date: 2020-08-23 Source: ResearchSquare

    Background: The Pandemic of coronavirus disease MESHD (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2), has critically impacted the spread of infection within nursing facilities. We evaluated the usefulness of genetic and serological tests SERO conducted during a COVID-19 outbreak in a nursing facility in Japan.Methods: After the first identification of SARS-CoV-2 infection MESHD, a comprehensive, facility- and/or unit-wide PCR testing from nasopharyngeal swabs was repeatedly performed in a three-unit facility including 99 residents with dementia HP dementia MESHD and 53 healthcare personnel. Additionally, PCR testing was conducted separately for residents and staff with fever HP fever MESHD of ≥37.5 oC. Facility-wide serological testing SERO, including rapid kit testing and quantitative assay, was conducted twice over 1 month apart.Results: A total of 322 PCR and 257 antibody tests SERO were performed. 37 (24.3%) of the 152 individuals (25/99 residents, 25.3%; 12/53 staff, 22.6%) were identified as PCR-positive. Seven residents died with a mortality of 7.1% (7/99). Among the 37 individuals, 10 (27.0%) were asymptomatic TRANS at the time of testing. PCR positivity was concentrated on one unit (Unit 1) (20/30 residents, 66.7%; 9/14 staff, 64.3%). The other units showed a limited spread of infection MESHD. In unit-wide and separate tests, PCR positivity detection was highly prevalent (22.9% and 44.4%, respectively) in Unit 1, compared with that in the other units. Serological testing SERO identified two additional infected residents with a negative PCR result and showed that no staff was newly identified as infected.Conclusions: Thorough PCR testing, in combination with comprehensive and separate tests, is critical for managing COVID-19 outbreaks in nursing facilities, particularly, in units considered an epicenter. Serological testing SERO is also beneficial for tracing contacts TRANS, confirming the number of infected individuals, and authorizing the termination of the outbreak.

    Impact of tocilizumab administration on mortality in severe COVID-19

    Authors: Andrew Tsai; Oumou Diawara; Ronald G Nahass; Luigi Brunetti

    doi:10.1101/2020.07.30.20114959 Date: 2020-08-02 Source: medRxiv

    Background The novel coronavirus disease MESHD 2019 (COVID-19) worldwide pandemic has placed a significant burden on hospitals and healthcare providers. The immune response to this disease is thought to lead to a cytokine storm, which contributes to the severity of illness. There is an urgent need to confirm whether the use of tocilizumab provides a benefit in individuals with COVID-19. Methods A single-center propensity-score matched cohort study, including all consecutive COVID-19 patients, admitted to the medical center who were either discharged from the medical center or expired between March 1, 2020, and May 5, 2020, was performed. Patients were stratified according to the receipt of tocilizumab for cytokine storm and matched to controls using propensity scores. The primary outcome was in-hospital mortality. Results A total of 132 patients were included in the matched dataset (tocilizumab=66; standard of care=66). Approximately 73% of the patients were male TRANS. Hypertension HP Hypertension MESHD (55%), diabetes mellitus HP diabetes mellitus MESHD (31%), and chronic pulmonary disease MESHD (15%) were the most common comorbidities present. There were 18 deaths (27.3%) in the tocilizumab group and 18 deaths (27.3%) in the standard of care group (odds ratio, 1.0; 95% confidence interval, 0.465 - 2.151; p=1.00). Advanced age TRANS, history of myocardial infarction HP myocardial infarction MESHD, dementia HP dementia MESHD, chronic pulmonary disease MESHD, heart failure MESHD, and malignancy MESHD were significantly more common in patients who died. Interpretation The current analysis does not support the use of tocilizumab for the management of cytokine storm in patients with COVID-19. Use of this therapeutic agent should be limited to the context of a clinical trial until more evidence is available.

    The natural history of symptomatic COVID-19 in Catalonia, Spain: a multi-state model including 109,367 outpatient diagnoses, 18,019 hospitalisations, and 5,585 COVID-19 deaths among 5,627,520 people

    Authors: Edward Burn; Cristian Tebe; Sergio Fernandez-Bertolin; Maria Aragon; Martina Recalde; Elena Roel; Albert Prats-Uribe; Daniel Prieto-Alhambra; Talita Duarte-Salles

    doi:10.1101/2020.07.13.20152454 Date: 2020-07-14 Source: medRxiv

    Background The natural history of Coronavirus Disease MESHD 2019 (COVID-19) has yet to be fully described, with most previous reports focusing on hospitalised patients. Using linked patient-level data, we set out to describe the associations between age TRANS, gender TRANS, and comorbidities and the risk of outpatient COVID-19 diagnosis, hospitalisation, and/or related mortality. Methods A population-based cohort study including all individuals registered in Information System for Research in Primary Care (SIDIAP). SIDIAP includes primary care records covering > 80% of the population of Catalonia, Spain, and was linked to region-wide testing, hospital and mortality records. Outpatient diagnoses of COVID-19, hospitalisations with COVID-19, and deaths with COVID-19 were identified between 1st March and 6th May 2020. A multi-state model was used, with cause-specific Cox survival models estimated for each transition. Findings A total of 5,664,652 individuals were included. Of these, 109,367 had an outpatient diagnosis of COVID-19, 18,019 were hospitalised with COVID-19, and 5,585 died after either being diagnosed or hospitalised with COVID-19. Half of those who died were not admitted to hospital prior to their death. Risk of a diagnosis with COVID-19 peaked first in middle- age TRANS and then again for oldest ages TRANS, risk for hospitalisation after diagnosis peaked around 70 years old, with all other risks highest at oldest ages TRANS. Male TRANS gender TRANS was associated with an increased risk for all outcomes other than outpatient diagnosis. The comorbidities studied (autoimmune condition, chronic kidney disease HP chronic kidney disease MESHD, chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD, dementia HP dementia MESHD, heart disease MESHD, hyperlipidemia HP hyperlipidemia MESHD, hypertension HP hypertension MESHD, malignant neoplasm HP neoplasm MESHD, obesity HP obesity MESHD, and type 2 diabetes MESHD) were all associated with worse outcomes. Interpretation There is a continued need to protect those at high risk of poor outcomes, particularly the elderly TRANS, from COVID-19 and provide appropriate care for those who develop symptomatic disease. While risks of hospitalisation and death MESHD are lower for younger populations, there is a need to limit their role in community transmission TRANS. These findings should inform public health strategies, including future vaccination campaigns.

    Prior diagnoses and medications as risk factors for COVID-19 in a Los Angeles Health System

    Authors: Timothy S Chang; Yi Ding; Malika K Freund; Ruth Johnson; Tommer Schwarz; Julie M Yabu; Chad Hazlett; Jeffrey N Chiang; Ami Wulf; - UCLA Health Data Mart Working Group; Daniel H Geschwind; Manish J Butte; Bogdan Pasaniuc

    doi:10.1101/2020.07.03.20145581 Date: 2020-07-04 Source: medRxiv

    With the continuing coronavirus disease MESHD 2019 (COVID-19) pandemic coupled with phased reopening, it is critical to identify risk factors associated with susceptibility and severity of disease in a diverse population to help shape government policies, guide clinical decision making, and prioritize future COVID-19 research. In this retrospective case-control study, we used de-identified electronic health records (EHR) from the University of California Los Angeles (UCLA) Health System between March 9th, 2020 and June 14th, 2020 to identify risk factors for COVID-19 susceptibility (severe acute respiratory distress syndrome coronavirus 2 MESHD respiratory distress HP syndrome coronavirus 2 (SARS-CoV-2) PCR test positive), inpatient admission, and severe outcomes (treatment in an intensive care unit or intubation). Of the 26,602 individuals tested by PCR for SARS-CoV-2, 992 were COVID-19 positive (3.7% of Tested), 220 were admitted in the hospital (22% of COVID-19 positive), and 77 had a severe outcome (35% of Inpatient). Consistent with previous studies, males TRANS and individuals older than 65 years old had increased risk of inpatient admission. Notably, individuals self-identifying as Hispanic or Latino constituted an increasing percentage of COVID-19 patients as disease severity escalated, comprising 24% of those testing positive, but 40% of those with a severe outcome, a disparity that remained after correcting for medical co-morbidities. Cardiovascular disease MESHD, hypertension HP hypertension MESHD, and renal disease MESHD were premorbid risk factors present before SARS-CoV-2 PCR testing associated with COVID-19 susceptibility. Less well-established risk factors for COVID-19 susceptibility included pre-existing dementia HP dementia MESHD (odds ratio (OR) 5.2 [3.2-8.3], p=2.6 x 10-10), mental health conditions ( depression MESHD OR 2.1 [1.6-2.8], p=1.1 x 10-6) and vitamin D deficiency MESHD (OR 1.8 [1.4-2.2], p=5.7 x 10-6). Renal diseases MESHD including end-stage renal disease MESHD and anemia HP anemia MESHD due to chronic renal disease MESHD were the predominant premorbid risk factors for COVID-19 inpatient admission. Other less established risk factors for COVID-19 inpatient admission included previous renal transplant (OR 9.7 [2.8-39], p=3.2x10-4) and disorders of the immune system (OR 6.0 [2.3, 16], p=2.7x10-4). Prior use of oral steroid medications was associated with decreased COVID-19 positive testing risk (OR 0.61 [0.45, 0.81], p=4.3x10-4), but increased inpatient admission risk (OR 4.5 [2.3, 8.9], p=1.8x10-5). We did not observe that prior use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers increased the risk of testing positive for SARS-CoV-2, being admitted to the hospital, or having a severe outcome. This study involving direct EHR extraction identified known and less well-established demographics, and prior diagnoses and medications as risk factors for COVID-19 susceptibility and inpatient admission. Knowledge of these risk factors including marked ethnic disparities observed in disease severity should guide government policies, identify at-risk populations, inform clinical decision making, and prioritize future COVID-19 research.

    Frailty and mortality in hospitalized older adults TRANS with COVID-19: retrospective observational study

    Authors: Robert De Smet; Bea Mellaerts; Hannelore Vandewinckele; Peter Lybeert; Eric Frans; Sara Ombelet; Wim Lemahieu; Rolf Symons; Erwin Ho; Johan Frans; Annick Smismans; Michael R Laurent

    doi:10.1101/2020.05.26.20113480 Date: 2020-05-27 Source: medRxiv

    Background: Older adults TRANS with coronavirus disease MESHD 2019 (COVID-19) face an increased risk of adverse health outcomes including mortality. Ethical guidelines consider allocation of limited resources based on likelihood of survival, frailty, co-morbidities and age TRANS. However, the association of frailty with clinical outcomes in older COVID-19 patients remains unclear. Objectives: To determine the association between frailty and short-term mortality in older adults TRANS hospitalized for COVID-19. Design: Retrospective single-center observational study. Setting and participants: N = 81 patients with COVID-19 confirmed by reverse-transcriptase polymerase chain reaction (RT-PCR), at the Geriatrics department of Imelda general hospital, Belgium. Measurements: Frailty was graded according to the Rockwood Clinical Frailty Scale (CFS). Demographic, biochemical and radiological variables, co-morbidities, symptoms and treatment were extracted from electronic medical records. Results: Participants (N = 48 women, 59%) had a median age TRANS of 85 years (range 65 - 97 years), median CFS score of 7 (range 2 - 9), and 42 (52%) were long-term care residents. Within six weeks, eighteen patients died. Mortality was significantly but weakly associated with age TRANS (Spearman r = 0.241, P = 0.03) and CFS score (r = 0.282, P = 0.011), baseline lactate dehydrogenase (LDH) (r = 0.301, P = 0.009), lymphocyte count (r = -0.262, P = 0.02) and RT-PCR Ct value (r TRANS = -0.285, P = 0.015). Mortality was not associated with long-term care residence, dementia HP dementia MESHD, delirium HP delirium MESHD or polypharmacy. In multivariable logistic regression analyses, CFS, LDH and RT-PCR Ct values (but not age TRANS) remained independently associated with mortality. Both age TRANS and frailty had poor specificity to predict survival. A multivariable model combining age TRANS, CFS, LDH and viral load significantly predicted survival. Conclusions and implications: Although their prognosis is worse, even the oldest and most severely frail patients may benefit from hospitalization for COVID-19, if sufficient resources are available.

    Clinical characteristics of 106 patients with neurological diseases MESHD and co-morbid coronavirus disease MESHD 2019: a retrospective study

    Authors: Rong Yin; Zhiqi Yang; Yaxuan Wei; Yuanming Li; Hui Chen; Zhao Liu; Bo Zhao; Dandan Ma; Meiling Dan; Yingjie Zhang; Xuan Liu; Huiceng Leng; Dawei Xiang

    doi:10.1101/2020.04.29.20085415 Date: 2020-05-05 Source: medRxiv

    Objectives:To describe the clinical characteristics of patients with coronavirus disease MESHD 2019 (COVID-19) with co-morbid neurological symptoms. Design:Retrospective case series. Setting:Huoshenshan Hospital in Wuhan, China. Participants:From 4 February to 14 April 2020, 106 patients with neurological diseases MESHD were enrolled from all patients in the hospital with confirmed COVID-19 and divided into a severe group and a nonsevere group according to their COVID-19 diagnosis. Main outcome measures:Clinical characteristics, laboratory results, imaging findings, and treatment methods were all retrieved through an electronic medical records system and recorded in spreadsheets. Results:The mean (standard deviation, SD MESHD) age TRANS of patients was 72.7 (11.8) years, and 64 patients were male TRANS (60.4%). Among patients with co-morbid neurological diseases MESHD, 81 had a previous cerebral infarction MESHD (76.4%), 20 had dementia HP dementia MESHD (18.9%), 10 had acute cerebral infarction MESHD (9.4%), 5 had sequelae of cerebral haemorrhage MESHD (4.7%), 4 had intracranial mass lesions (3.8%), 3 had epilepsy MESHD (2.8%), 2 had Parkinsons disease MESHD (1.9%), and 1 had myelopathy HP myelopathy MESHD (0.9%). Fever HP Fever MESHD (n = 62, 58.5%) was the most common symptom. The most common neurological symptoms were myalgia HP myalgia MESHD (n = 26, 24.5%), followed by extremity paralysis MESHD paralysis HP (n = 20, 18.9%), impaired consciousness MESHD (n = 17, 16%), and positive focal neurological signs (n = 42, 39.6%). Eight patients (7.5%) died. There were more patients with altered mental status in the severe group than in the non-severe group (6 [10.2%] vs. 0, P = 0.033). The inflammatory response in the severe group was more significant than that in the non-severe group. There were more patients taking anticoagulant drugs (25 [42.4%] vs. 4 [8.5%], P < 0.001) and sedative drugs (22 [37.3%] vs. 9 [19.1%], P = 0.041) in the severe group than in the non-severe group. Amid all 93 patients with cerebrovascular diseases MESHD, only 32 (34.4%) were taking aspirin, 13 (14%) taking clopidogrel, and 33 (35.5%) taking statins. Conclusions:Patients with COVID-19 with co-morbid neurological diseases had an advanced age TRANS, a high rate of severe illness MESHD, and a high mortality rate. Among the neurological symptoms, altered mental status was more common in patients with severe COVID-19 with co-morbid neurological diseases MESHD.

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MeSH Disease
Human Phenotype

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