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MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Severe Paediatric Multisystem Inflammatory Syndrome MESHD ( PIMS MESHD) in a 23 months old baby post COVID-19 effectively managed with IVIG and pulse Steroid: Case report 

    Authors: Dr Yogesh Kumar Gupta; Dr Sowmya Shenoy; Dr Kuldip G Paike; Dr Mrigendra Nath Tudu

    doi:10.21203/rs.3.rs-68719/v1 Date: 2020-08-30 Source: ResearchSquare

    C oronavirus disease MESHD(COVID-19) in children TRANS largely causes mild disease. Some of these recovered children TRANS may present with delayed manifestations described as H yperinflammatory syndrome MESHDresembling closely with K awasaki disease MESHD(K D) MESHD or T oxic Shock Syndrome MESHD Shock HP Syndrome (T SS) MESHD. Timely identification, supportive treatment and treatment with immunomodulatory drugs make a significant difference in the outcome.

    Therapeutic Prospects for Th-17 Cell Immune Storm Syndrome and Neurological Symptoms MESHD in COVID-19: Thiamine Efficacy and Safety, In-vitro Evidence and Pharmacokinetic Profile

    Authors: Vatsalya Vatsalya; Fengyuan Li; Jane C Frimodig; Khushboo S Gala; Shweta Srivastava; Maiying Kong; Vijay A Ramchandani; Wenke Feng; Xiang Zhang; Craig J McClain

    doi:10.1101/2020.08.23.20177501 Date: 2020-08-25 Source: medRxiv

    Introduction Emerging infectious diseases MESHD, especially the coronavirus disease MESHD identified in 2019 (COVID-19), can be complicated by a severe exacerbation in the Th17 cell-mediated IL-17 proinflammatory immune storm. This enhanced immune response plays a major role in mortality and morbidity, including neurological symptoms MESHD. We hypothesized that countering the cytokine storm with thiamine may have therapeutic efficacy in lowering the Th17 cell proinflammatory response. We used an in vitro study and corroborated those results in disease controls (DC). We developed an effective dose range and model for key pharmacokinetic measures with the potential of targeting the cytokine storm and neurological symptoms of COVID-19. Study Participants and Methods We investigated the effect of a three-week 200 mg dose of thiamine in lowering the Th17 response in sixteen DC (proinflammatory origin due to heavy alcohol drinking) patients; and eight healthy control/volunteers (HV) as a pilot clinical-translational investigation. To further investigate, we performed an in vitro study evaluating the effectiveness of thiamine treatment in lowering the Th17 proinflammatory response in a mouse macrophage cell line (RAW264.7) treated with ethanol. In this in vitro study, 100 mg/day equivalent (0.01 ug/ml) thiamine was used. Based on recent publications, we compared the results of the IL-17 response from our clinical and in vitro study to those found in other proinflammatory disease conditions (metabolic conditions, septic shock MESHD shock HP, viral infections MESHD and COVID-19), including symptoms, and dose ranges of effective and safe administration of thiamine. We developed a dose range and pharmacokinetic profile for thiamine as a novel intervention strategy in COVID-19 to alleviate the effects of the cytokine storm and neurological symptoms MESHD. Results The DC group showed significantly elevated proinflammatory cytokines compared to HV. Three-week of 200 mg daily thiamine treatment significantly lowered the baseline IL-17 levels while increased IL-22 levels (anti-inflammatory response). This was validated by an in vitro macrophage response using a lower thiamine dose equivalent (100 mg), which resulted in attenuation of IL-17 and elevation of IL-22 at the mRNA level compared to the ethanol-only treated group. In humans, a range of 79-474 mg daily of thiamine was estimated to be effective and safe as an intervention for the COVID-19 cytokine storm. A literature review showed that several neurological symptoms of COVID-19 (which exist in 45.5% of the severe cases) occur in other viral infections MESHD and neuroinflammatory states that may also respond to thiamine treatment. Discussion The Th17 mediated IL-17 proinflammatory response can potentially be attenuated by thiamine. Thiamine, a very safe drug even at very high doses, could be repurposed for treating the cytokine/immune storm of COVID-19 and the subsequent neurological symptoms observed in COVID-19 patients. Further studies using thiamine as an interventional/prevention strategy in severe COVID-19 patients could identify its precise anti-inflammatory role.

    Duodenal Perforation Caused Septic Shock MESHD Shock HP: a Rare Case Combined With Coronavirus Disease MESHD 2019

    Authors: Huanhuan Guo; Jing Hu; Yunxiang Li; Wei Xiang; Quan Gan

    doi:10.21203/rs.3.rs-48918/v1 Date: 2020-07-25 Source: ResearchSquare

    Background: Duodenal perforation is one of the rarer causes of acute abdomen in pregnancy, which is especially easy to be overlooked during the outbreak of 2019 novel coronavirus (2019-nCoV) after delivery.Case presentation: Here, we report a case of duodenal perforation-induced septic shock MESHD shock HP with coronavirus disease MESHD 2019 (COVID-19), and the patient underwent emergency laparotomy after reporting to the hospital management department under strict protection. Her recovery in postoperative period in Medical Intensive Care Unit (MICU) was uneventful and she was transferred to a designated hospital for treatment of COVID-19 5 days later.Conclusions: The establishment of emergency green channel for maternal health care, and timely and comprehensive multidisciplinary cooperation during the epidemic period, strengthen the standardized management of high-risk pregnancy, and better guarantee the safety of mothers and infants.

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

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

    doi:10.21203/rs.3.rs-46078/v1 Date: 2020-07-20 Source: ResearchSquare

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

    Unusual Presentation of Kawasaki Disease MESHD with Multisystem Inflammation MESHD and Antibodies SERO Against Severe Acute Respiratory Syndrome MESHD Coronavirus 2: A Case Report

    Authors: Haena Kim; Jung Yeon Shim; Jae-Hoon Ko; Aram Yang; Jae Won Shim; Deok Soo Kim; Hye Lim Jung; Ji Hee Kwak; In Suk Sol

    doi:10.21203/rs.3.rs-41276/v1 Date: 2020-07-12 Source: ResearchSquare

    Background: Since mid-April 2020, cases of multisystem inflammatory syndrome MESHD in children TRANS (MIS-C) associated with coronavirus disease MESHD (COVID-19) that mimic Kawasaki disease MESHD ( KD MESHD) have been reported in Europe and North America. However, no cases have been in East Asia, where KD MESHD is more prevalent.Case presentation: A previously healthy 11-year-old boy was admitted with a 4-day history of fever HP fever MESHD and abdominal pain HP abdominal pain MESHD. He had no contact history to any patient with COVID-19. Blood SERO acute inflammatory markers were highly elevated. He was treated with antibiotics for suspected bacterial enteritis MESHD, but he suddenly developed hypotension HP hypotension MESHD. Inotropics and intravenous immunoglobulin were administered to manage septic shock MESHD shock HP. On hospitalization day 6, he developed signs and symptoms of KD MESHD (conjunctival injection, strawberry tongue HP, cracked lip MESHD, and coronary artery dilatation MESHD dilatation HP) in addition to pleural/pericardial effusion MESHD pericardial effusion HP and mesenteric lymphadenitis HP lymphadenitis MESHD. The results of microbiologic tests, including reverse-transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2), were negative. Fluorescent immunoassay SERO and enzyme-linked immunosorbent assay SERO revealed abundant IgG antibodies SERO against SARS-CoV-2 in his serum SERO, but no IgM antibodies SERO. He was discharged successfully on day 13.Conclusion: MIS-C may occur in children TRANS with a previously asymptomatic TRANS COVID-19 infection MESHD. A high index of suspicion is required for this novel syndrome in unusual cases of KD MESHD or KD shock syndrome MESHD shock HP syndrome with multisystem inflammation MESHD, even when there is no clear history of contact or symptoms of COVID-19.

    Red blood SERO cell distribution width (RDW) in Hospitalized COVID-19 Patients

    Authors: Preethi Ramachandran; Mahesh Gajendran; Abhilash Perisetti; Karim Osama Elkholy; Abhishek Chakraborti; Giuseppe Lippi; Hemant Goyal

    doi:10.1101/2020.06.29.20143081 Date: 2020-07-03 Source: medRxiv

    Introduction: Coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 MESHD (SARS-CoV-2), is causing dramatic morbidity and mortality worldwide. The Red Blood SERO Cell Distribution Width (RDW) has been strongly associated with increased morbidity and mortality in multiple diseases. Objective: To assess if elevated RDW is associated with unfavorable outcomes in hospitalized COVID-19. Methods: We retrospectively studied clinical outcomes of hospitalized COVID-19 patients for their RDW values. In-hospital mortality was defined as primary outcome, while septic shock MESHD shock HP, need for mechanical ventilation, and length of stay (LOS) were secondary outcomes. Results- A total of 294 COVID-19 patients were finally studied. Overall prevalence SERO of increased RDW was 49.7% (146/294). RDW was associated with increased risk of in-hospital mortality (aOR, 4.5; 95%CI, 1.4-14.3) and septic shock MESHD shock HP (aOR, 4.6; 95%CI, 1.4-15.1) after adjusting for anemia HP anemia MESHD, ferritin, and lactate. The association remained unchanged even after adjusting for other clinical confounders such as age TRANS, sex, body mass index, coronary artery disease MESHD, hypertension HP hypertension MESHD, diabetes mellitus HP diabetes mellitus MESHD, and chronic obstructive pulmonary disease HP chronic obstructive pulmonary disease MESHD. No association was found instead with mechanical ventilation and median LOS. Conclusion: Elevated RDW in hospitalized COVID-19 patients is associated with a significantly increased risk of mortality and septic shock MESHD shock HP.

    Risk factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19 in Wuhan, China

    Authors: Xiao-huan Ma; Fang Yin; Jie Zhang; Meng-yun Peng; Hong Guan; Ping Gong

    doi:10.21203/rs.3.rs-37538/v1 Date: 2020-06-22 Source: ResearchSquare

    Background Acute hypoxemic respiratory failure MESHD respiratory failure HP is prevalent in severe Coronavirus Disease MESHD 2019 (COVID-19). High-flow nasal canula (HFNC) is currently the most common ventilation strategy for COVID-19 patients with respiratory failure HP respiratory failure MESHD. This study is to analyze the risk factors associated with high-flow nasal canula (HFNC) oxygen therapy failure MESHD in patients with severe COVID-19.Methods: In this single-center, retrospective, observational study, we enrolled patients with confirmed severe COVID-19 admitted to Renmin Hospital of Wuhan university (Wuhan, China) from 1 February 2020 to 26 March 26 2020. Epidemiological, clinical, and laboratory data, and treatments and outcomes upon hospital admission, were obtained from electronic medical records. Sequential organ failure assessment (SOFA) scores were calculated.Results: Of 54 patients with severe COVID-19, HFNC was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC failure MESHD was seen more commonly in patients aged TRANS ≥60 years and in men. In addition, compared with patients successfully treated with HFNC, patients with HFNC failure MESHD had the following characteristics: higher percentage of fatigue HP fatigue MESHD and anorexia HP anorexia MESHD as well as cardiovascular disease MESHD; increased time from onset to diagnosis and SOFA scores; elevated body temperature, respiratory rate, and heart rate; more complications including ARDS, septic shock MESHD shock HP, myocardial damage MESHD, and acute kidney injury HP acute kidney injury MESHD; increased neutrophil counts and prothrombin time; and decreased HP arterial partial pressure of oxygen/fraction of inspired oxygen (PaO2/FiO2) (all P < 0.05). However, binary logistic regression analysis showed that only male TRANS gender TRANS and PaO2/FiO2 were independent risk factors significantly associated with HFNC failure MESHD (both, P < 0.05). Conclusion: Patients with severe COVID-19 had a high HFNC treatment failure rate. Male TRANS gender TRANS and decreased PaO2/FiO2 were independent risk factors associated with HFNC failure MESHD in severe COVID-19 patients.

    An insertion unique to SARS-CoV-2 exhibits superantigenic character strengthened by recent mutations

    Authors: Mary Hongying Cheng; She Zhang; Rebecca A. Porritt; Moshe Arditi; Ivet Bahar

    doi:10.1101/2020.05.21.109272 Date: 2020-05-21 Source: bioRxiv

    Multisystem Inflammatory Syndrome in Children TRANS (MIS-C) associated with Coronavirus Disease MESHD 2019 (COVID-19) is a newly recognized condition in which children TRANS with recent SARS-CoV-2 infection MESHD present with a constellation of symptoms including hypotension HP hypotension MESHD, multiorgan involvement, and elevated inflammatory markers. These symptoms and the associated laboratory values strongly resemble toxic shock syndrome MESHD shock HP syndrome, an escalation of the cytotoxic adaptive immune response triggered upon the binding of pathogenic superantigens to MHCII molecules and T cell receptors (TCRs). Here, we used structure-based computational models to demonstrate that the SARS-CoV-2 spike (S) exhibits a high-affinity motif for binding TCR, interacting closely with both the - and {beta}-chains variable domains complementarity-determining regions. The binding epitope on S harbors a sequence motif unique to SARS-CoV-2 (not present in any other SARS coronavirus), which is highly similar in both sequence and structure to bacterial superantigens. Further examination revealed that this interaction between the virus and human T cells is strengthened in the context of a recently reported rare mutation (D839Y/N/E) from a European strain of SARS-CoV-2. Furthermore, the interfacial region includes selected residues from a motif shared between the SARS viruses from the 2003 and 2019 pandemics, which has intracellular adhesion molecule (ICAM)-like character. These data suggest that the SARS-CoV-2 S may act as a superantigen to drive the development of MIS-C as well as cytokine storm in adult TRANS COVID-19 patients, with important implications for the development of therapeutic approaches. SignificanceAlthough children TRANS have been largely spared from severe COVID-19 disease, a rare hyperinflammatory syndrome has been described in Europe and the East Coast of the United States, termed Multisystem Inflammatory Syndrome in Children TRANS (MISC). The symptoms and diagnostic lab values of MIS-C resemble those of toxic shock HP, typically caused by pathogenic superantigens stimulating excessive activation of the adaptive immune system. We show that SARS-CoV-2 spike has a sequence and structure motif highly similar to those of bacterial superantigens, and may directly bind to the T cell receptors. This sequence motif, not present in other coronaviruses, may explain the unique potential for SARS-CoV-2 to cause both MIS-C and the cytokine storm observed in adult TRANS COVID-19 patients.

    Traces TRANS of SARS-CoV-2 RNA in the Blood SERO of COVID-19 Patients

    Authors: Ahmed Moustafa; Ramy K Aziz

    doi:10.1101/2020.05.10.20097055 Date: 2020-05-18 Source: medRxiv

    The severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) is the third virus that caused coronavirus-related outbreaks over the past 20 years. The outbreak was first reported in December 2019 in Wuhan, China, but rapidly progressed into a pandemic of an unprecedented scale since the 1918 flu pandemic. Besides respiratory complications in COVID-19 patients, clinical characterizations of severe infection HP infection MESHD cases showed several other comorbidities, including multiple organ failure MESHD (liver, kidney, and heart) and septic shock MESHD shock HP. To better understand COVID-19 pathogenesis in different human organs, we interrogated the presence of the virus in the blood SERO, or any of its components, which might provide a form of trafficking or hiding to the virus. By computationally analyzing high-throughput sequence data from patients with active COVID-19 infection, we found evidence of only traces TRANS of SARS-CoV-2 RNA in peripheral blood SERO mononuclear cells (PBMC), while the virus RNA was abundant in bronchoalveolar lavage specimens from the same patients. We also devised a "viral spike-to-actin" RNA normalization, as a metric to compare across various samples and minimize errors caused by intersample variability in human RNA. To the best of our knowledge, the presence of SARS-CoV-2 RNA in the PBMC of COVID-19 patients has not been reported before, and this observation could suggest immune presentation, but discounts the possibility of extensive viral infection of lymphocytes or monocytes.

    Coronavirus Disease MESHD 19 in Minority Populations of Newark, New Jersey

    Authors: Alexis K Okoh; Christoph Sossou; Neha S Dangayach; Sherin Meledathu; Oluwakemi Phillips; Corrine Raczek; Michael Patti; Nathan Kang; Sameer Hirji; Charles Cathcart; Christian Engell; Marc Cohen; Eliahu Bishburg; Sandhya Nagarakanti; Harpreet Grewal

    doi:10.21203/rs.3.rs-28520/v1 Date: 2020-05-11 Source: ResearchSquare

    BACKGROUND:The purpose of this study is to report the clinical features and outcomes of Black/African American (AA) and Latino Hispanic patients with Coronavirus disease MESHD 2019 (COVID-19) hospitalized in an inter-city hospital in the state of New Jersey. METHODS: This is a retrospective cohort study of AA and Latino Hispanic patients with COVID-19 admitted to a 665-bed quaternary care, teaching hospital located in Newark, New Jersey. The study included patients who had completed hospitalization between March 10, 2020, and April 10, 2020. We reviewed demographics, socioeconomic variables and incidence of in-hospital mortality and morbidity. Logistic regression was used to identify predictor of in-hospital death MESHD.RESULTS: Out of 416 patients, 251 (60%) had completed hospitalization as of April 10, 2020. The incidence of In-hospital mortality was 38.6% (n=97). Most common symptoms at initial presentation were dyspnea HP dyspnea MESHD 39% (n=162) followed by cough HP 38%(n=156) and fever HP fever MESHD 38% (n=143). Patients were in the highest quartile for population’s density, number of housing units and disproportionately fell HP into the lowest median income quartile for the state of New Jersey. The incidence septic shock MESHD shock HP, acute kidney injury HP acute kidney injury MESHD ( AKI MESHD) requiring hemodialysis and admission to an intensive care unit (ICU) was 24% (n=59), 21% (n=52), 33% (n=82) respectively. Independent predictors of in-hospital mortality were older age TRANS, lower serum SERO Hemoglobin <10mg/dl, elevated serum SERO Ferritin and Creatinine phosphokinase levels >1200U/L and >1000 U/L.CONCLUSIONS: Findings from an inter-city hospital’s experience with COVID-19 among underserved minority populations showed that, more than one of every three patients were at risk for in-hospital death MESHD or morbidity. Older age TRANS and elevated inflammatory markers at presentation were associated with in-hospital death. 

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