Corpus overview


MeSH Disease

Human Phenotype


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    Detection of SARS-CoV-2 in peritoneal fluid from patients with kidney disease MESHD and COVID-19: report of two cases

    Authors: Margarita Ibarra-Hernandez; María de la Luz Alcantar-Vallín; Rodolfo I. Cabrera-Silva; Karina Sánchez-Reyes; Monserrat Alvarez-Zavala; Judith C. De Arcos-Jiménez; Luz A. González-Hernández; Vida V. Ruiz-Herrera; Sara A. Aguirre-Díaz; Roxana García-Salcido; Guillermo García-García; Jaime F. Andrade-Villanueva

    doi:10.21203/ Date: 2020-09-16 Source: ResearchSquare

    Background: Coronavirus disease-2019 (COVID-19) has a broad clinical presentation, involving multiple organs besides the respiratory system. Currently, there is little evidence available on the presence of severe acute respiratory syndrome coronavirus 2 MESHD (SARS-CoV-2) in peritoneal fluid (PF). In this study, we describe the detection of SARS-CoV-2 in the PF of two patients with COVID 19 and kidney disease MESHD.Case presentation: Case 1: A 71-year-old woman with a history of end-stage kidney disease MESHD who presented with a 15-day evolution of progressive dyspnea HP dyspnea MESHD, accompanied by dry cough MESHD cough HP and fever HP fever MESHD; IgM antibodies SERO to SARS-CoV-2 were detected on admission. Real-time SARS-CoV-2 polymerase chain reaction (qRT-PCR) in the PF was positive. Three days after admission the patient's respiratory distress HP improved and she was discharged after 8 days of hospitalization.Case 2: A 78-year-old woman, with type 2 diabetes MESHD, hypertension HP hypertension MESHD, a 15-day history of polypnea, and a 5-day onset of fever HP fever MESHD and dyspnea HP dyspnea MESHD. IgM and IgG antibodies SERO to SARS-CoV-2 were detected on admission, as well as a positive nasopharyngeal qRT-PCR test for SARS-CoV-2. During hospitalization she developed acute kidney injury HP acute kidney injury MESHD, requiring peritoneal dialysis, SARS-CoV-2 was confirmed in PF by qRT-PCRConclusions: These two cases highlights the importance of increasing the level of awareness for the presence and possible SARS-CoV-2 transmission TRANS through non-respiratory routes, like peritoneal fluid.Emphasis should be given to appropriate preventive strategies for minimizing the risk of transmission TRANS of COVID-19 from patients on peritoneal dialysis in both inpatient and outpatient settings.

    Renal Resistive Index is Associated With Acute Kidney Injury HP Acute Kidney Injury MESHD in COVID-19 Patients Treated in the ICU

    Authors: Mårten Renberg; Olof Jonmarker; Naima Kilhamn; Claire Rimes-Stigare; Max Bell; Daniel Hertzberg

    doi:10.21203/ Date: 2020-09-10 Source: ResearchSquare

    Background: Renal resistive index (RRI) is a promising tool for prediction of acute kidney injury HP acute kidney injury MESHD ( AKI MESHD) in critically ill MESHD patients but is not described among patients with Coronavirus disease MESHD 2019 (COVID-19). The aim of this study was to describe the pattern of RRI in relation to AKI MESHD in patients with COVID-19 treated in the intensive care unit.Methods: In this observational cohort study, RRI was measured in COVID-19 patients in six ICUs at two sites of a Swedish University Hospital. AKI MESHD was defined by the creatinine criteria in the Kidney Disease MESHD Improving Global Outcome classification. We investigated the association between RRI and AKI MESHD diagnosis, different AKI MESHD stages and urine output.Results: RRI was measured in 51 patients, of which 23 patients (45%) had AKI MESHD at the time of measurement. Median RRI in patients with AKI MESHD was 0.80 (IQR 0.71-0.85) compared to 0.72 (IQR 0.67-0.78) in patients without AKI MESHD (p=0.004). Compared to patients without AKI MESHD, RRI was higher in patients with AKI MESHD stage 3 (median 0.83, IQR 0.71-0.85, p=0.006) but not in patients with AKI MESHD stage 1 (median 0.76, IQR 0.71-0.83, p=0.347) or AKI MESHD stage 2 (median 0.79, min/max 0.79/0.80, n=2, p=0.134). RRI was higher in patients with an ongoing AKI MESHD episode compared to patients who never developed AKI MESHD (median 0.72, IQR 0.69-0.78, p=0.015) or patients who developed AKI MESHD but had recovered at the time of measurement (median 0.68, IQR 0.67-0.81, p=0.021). Oliguric patients had higher RRI (median 0.84, IQR 0.83-0.85) compared to non-oliguric patients (median 0.74, IQR 0.69-0.81) (p=0.009).Conclusions: Critically ill COVID-19 patients with AKI MESHD have higher RRI compared to those without AKI MESHD, and elevated RRI may have a role in identifying severe and oliguric AKI MESHD in these patients. 

    Clinical Characteristics of Severe Covid Pneumonia HP: Exploring New Trends in ICU

    Authors: Aftab Akhtar; Sheher Bano; Ahtesham Iqbal; Moazma Ramzan; Aayesha Qadeer; Syed Waqar Hussain; Anam Saleem; Omair-ul-Haq Lodhi; Sana Zubair; Abdul Hameed kiani

    doi:10.21203/ Date: 2020-08-31 Source: ResearchSquare

    Background: In late December 2019, Covid-19 emerged as clusters of pneumonia HP pneumonia MESHD of unknown cause in a province of china, Wuhan. Etiological agent was identified as novel coronavirus that resembles severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East Respiratory syndrome coronavirus (MERS-CoV) MESHD and has zoonotic transmission TRANS. Covid pneumonia HP can remain asymptomatic TRANS, present as mild infection, severe HP infection, severe MESHD pneumonia HP pneumonia MESHD or respiratory failure HP respiratory failure MESHD. Diagnosis is based on rRT-PCR carried out on respiratory secretions. Covid related mortality exceeds 50% once patient requires ICU admission. Objective: To study the characteristics of ICU population admitted to ICU of Shifa International hospital.Results: we prospectively analysed 74 patients which included 43.3% females TRANS and 56.7% males TRANS. Commonest symptoms were shortness of breath MESHD (94.5%), fever HP fever MESHD (74.3%) and cough HP (74.3%). Most of our study population consisted of non-smokers (79.7%) and had hypertension HP hypertension MESHD (59.4%) followed by diabetes MESHD (47.2%). Hydroxychloroquine (HCQ) and azithromycin combination is superior to hydroxychloroquine and doxycycline in reducing mortality (p=0.023) whereas Doxycycline alone resulted in increased mortality (p=0.009). Those who did not require antibiotics or required only narrow spectrum antibiotics had increased survival and reduced requirement of invasive mechanical ventilation (p=< 0.0001). in our study population, (44.9%) developed acute kidney injury HP acute kidney injury MESHD, 2.7% needed re-intubations 10.8% developed surgical emphysema HP emphysema MESHD and 2.7 % thromboembolic MESHD events despite full anticoagulation. ICU mortality was 41.8% and was higher in females TRANS (59.4%, p=0.008), those who had SOFA score > 3.5 at time of admission, raised D-Dimers > 931 ng/ml, NLR > 9.2. It was further high in those who required invasive mechanical ventilation and vasopressor support (58.1% mortality p=< 0.001). ICU stay was more prolonged in those requiring invasive mechanical ventilation as compared to those who did not. (23 days vs 6 days, p=0.001). Mean plateau pressure was 19.6 ± 7.6; mean Driving pressures 14.4 ± 4.6; mean PaO2/FiO2 150.7 ± 73.9; mean SPO2/FiO2 173.9 ± 106.9; mean PEEP was 8.2 ±4.33.Conclusion: We concluded that severe covid pneumonia HP pneumonia MESHD is common amongst males TRANS, non-smokers those who had comorbid. HCQ and azithromycin combination is superior to combination of HCQ and doxycycline or doxycycline alone and QT prolongation MESHD is a rare complication. Baseline NLR, APACHI II, SOFA, SAPS II, NUTRIC scores, D-Dimers, invasive ventilation and vasopressor support are important tools to predict ICU mortality. Invasive mechanical ventilation carries higher mortality and associated with more prolonged ICU stay. AKI is most common complication followed by shock HP and surgical emphysema HP emphysema MESHD. CRP, Ferritin levels has no impact on outcome.

    Effect of novel coronavirus disease MESHD 2019 infection on chronic HP infection on chronic MESHD kidney disease G1-G5, G5 Dialysis and G5 Transplantation

    Authors: Fateme Shamekhi Amiri

    doi:10.21203/ Date: 2020-08-26 Source: ResearchSquare

    Background: The pneumonia HP pneumonia MESHD caused by the 2019 novel coronavirus (SARS-CoV-2) is a highly infectious disease MESHD that causes lethal disease and multiorgan failure MESHD. The aim of this research is to investigate association between covid-19 infection MESHD and kidney dysfunction MESHD.Methods and materials: In this retrospective study, sixty-eight patients with kidney dysfunction MESHD and covid-19 infection MESHD were investigated. Clinical features, laboratory data at initial presentation, management and outcomes were collected.The paper has written based on searching PubMed Central and Google Scholar to identify potentially relevant articles. Median, percentage, mean ± standard deviation (SD), two-tailed t and chi-square and Cohen᾽s-d tests were used for statistical analyses. Moreover, relative risk, odds ratio, pearson᾽s correlation for statistical analyses were used. Results: The average age TRANS of patients at time of diagnosis in covid-19 nephropathy HP nephropathy MESHD was 52.04 ± 14.42 years (ranging from 24 years to 88 years). There was not statistical significance correlation between lymphocytopenia MESHD and serum SERO creatinine (SCr) in covid-19 nephropathy HP nephropathy MESHD (R2=0.063; p-value= 0.33).  Effect size of elevated IL-6 on decreased estimated glomerular filtration rate (eGFR) in covid-19 nephropathy HP nephropathy MESHD was assessed 0.656 (medium effect size). Relative risk and odds ratio of acute kidney disease MESHD ( AKD MESHD) in covid-19 nephropathy HP nephropathy MESHD were assessed 0.57 and 0.4, respectively (p-value: 0.422). Correlation between SCr changes and time of emergent AKI MESHD ( acute kidney injury HP acute kidney injury MESHD), AKD MESHD and chronic kidney disease HP chronic kidney disease MESHD ( CKD MESHD) was assessed with R2 of 0.0003 and p-value of 0.94 (not significant).  Conclusion: The present study revealed medium effect size of elevated IL-6 on decreased eGFR. Future clinical research is required for investigating novel unknown findings in covid-19 nephropathy HP nephropathy MESHD

    Neutrophil-to-Lymphocyte Ratio on Admission Predicts In-hospital Mortality in Patients with COVID-19

    Authors: Jin Hu; Jun Zhou; Fang Dong; Jie Tan; Shuntao Wang; Zhi Li; Ximeng Zhang; Huiqiong Zhang; Jie Ming; Tao Huang

    doi:10.21203/ Date: 2020-07-26 Source: ResearchSquare

    Background: A novel coronavirus caused an outbreak of acute infectious pneumonia HP infectious pneumonia MESHD are spreading over the globe. However, studies predicting prognosis are limited. We predicted outcomes of patients with coronavirus disease MESHD 2019 (COVID-19) using the neutrophil-to-lymphocyte ratio (NLR) on admission.Methods: We retrospectively analyzed the characteristics of COVID-19 patients diagnosed from February 6 to March 1. The outcomes, including the occurrence of in-hospital mortality, acute kidney injury HP acute kidney injury MESHD ( AKI MESHD), and endotracheal intubation (ETI), were recorded. The relationships of neutrophils, lymphocytes, C-reactive protein, lactate dehydrogenase, and NLR with outcomes were assessed using multivariate regression model. P-values for trends across quartiles of NLR was examined.Results: A total of 182 patients were included. 37 (20.3%) patients died during the hospitalization, 41 (22.5%) developed AKI MESHD, and 36 (19.8%) received ETI. The NLR had a superior predictive performance SERO than others. Using an NLR cutoff of 11.4, the area under the curves (AUC) were 0.766 for in-hospital mortality, 0.755 for AKI MESHD, and 0.733 for ETI. In multivariate analysis, NLR >11.4 was further identified as an independent prognostic factor. Following stratification with quartiles of NLR, a positive trend between the increasing quartiles of NLR and the three outcomes were observed (p-values for trends across quartiles were 0.043, <0.001, and 0.041, respectively). The multivariate adjusted odds ratio (OR) in the highest quartile vs. the lowest quartile were 5.738 for mortality, 25.307 for AKI MESHD, and 5.136 for ETI.Conclusions: Increasing NLR obtained on admission is a powerful predictor for inpatient mortality, AKI MESHD, and ETI in COVID-19 patients.

    Complex Immuno-metabolic Profiling Reveals Activation of Cellular Immunity and Biliary Lesion MESHD in Patients with Severe COVID-19

    Authors: Adam Klocperk; Marketa Bloomfield; Zuzana Parackova; Irena Zentsova; Petra Vrabcova; Jan Balko; Grigorij Meseznikov; Luis Fernando Casas Mendez; Alzbeta Grandcourtova; Jan Sipek; Martin Tulach; Josef Zamecnik; Tomas Vymazal; Anna Sediva

    id:10.20944/preprints202007.0596.v1 Date: 2020-07-24 Source:

    The aim of this study was to assess the key laboratory features displayed by coronavirus disease MESHD 2019 (COVID-19) inpatients which associated with mild, moderate, severe and fatal course of the disease and, through longitudinal follow-up, to understand the dynamics of COVID-19 pathophysiology. All SARS-CoV-2 positive patients admitted to the University Hospital in Motol between March and June 2020 were included in this study. Severe course of COVID-19 was associated with elevation of proinflammatory markers, efflux of immature granulocytes into peripheral blood SERO, activation of CD8 T cells, which infiltrate lungs, and transient liver disease MESHD. In particular, the elevation of serum SERO gamma-glutamyl transferase (GGT) and histological signs of cholestasis HP cholestasis MESHD were highly specific for patients with severe disease. In contrast, patients with fatal course of COVID-19 failed to upregulate markers of inflammation MESHD, showed dyscoordination MESHD of immune response and progressed towards acute kidney failure MESHD. COVID-19 is a disease with multi-organ affinity characterized by activation of innate and cellular adaptive immunity. Biliary lesion MESHD with elevation of GGT and organ-infiltration of IL-6 producing cells are defining characteristic for patients with fulminant disease.

    Superior anticoagulation strategies for renal replacement therapy in critically ill patients with COVID-19: a cohort study

    Authors: Frederic Arnold; Lukas Westermann; Siegbert Rieg; Elke Neumann-Haefelin; Paul Biever; Gerd Walz; Johannes Kalbhenn; Yakup Tanriver

    doi:10.1101/2020.06.26.20140699 Date: 2020-07-01 Source: medRxiv

    Background Coronavirus disease MESHD 2019 (COVID-19) patients who are admitted to intensive care units (ICU) have a high risk of requiring renal replacement therapy (RRT) due to acute kidney injury HP acute kidney injury MESHD ( AKI MESHD). Concomitantly, COVID-19 patients exhibit a state of hypercoagulability HP hypercoagulability MESHD that can affect circuit lifespan. An optimal anticoagulation strategy is therefore needed in order to maintain circuit patency and therapeutic efficiency of RRT. Methods Retrospective single-centre cohort study on 71 critically ill COVID-19 patients at the University of Freiburg Medical Center. Included were all patients aged TRANS 18 years and older with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection MESHD that were admitted to ICU between February 26 and May 21, 2020. We collected data on the COVID-19 disease course, AKI MESHD, RRT, thromboembolic MESHD events and anticoagulation. Primary outcome of the study was the effect of different anticoagulation strategies during RRT on extracorporeal circuit lifespans. Results Anticoagulation during continuous veno-venous haemodialysis ( CVVHD MESHD) was performed with unfractionated heparin (UFH) or citrate. Mean treatment time in the UFH group was 21.3h (SEM: {+/-}5.6h). Mean treatment time in the citrate group was 45.6h (SEM: {+/-}2.7h). Citrate anticoagulation prolonged treatment duration significantly by 24.4h (p=0.0014). Anticoagulation during sustained low-efficiency daily dialysis ( SLEDD MESHD) was performed with UFH, argatroban or low molecular weight heparin (LMWH). Mean dialysis time with UFH was 8.1h (SEM: {+/-}1.3h), argatroban 8.0h (SEM: {+/-}0.9h) and LMWH 11.8h (SEM: {+/-}0.5h). Compared to UFH and argatroban, LMWH significantly prolonged treatment times by 3.7h (p=0.0082) and 3.8h (p=0.0024), respectively. Conclusions UFH fails to prevent early clotting events in dialysis circuits. For patients, who do not require an effective systemic anticoagulation, regional citrate dialysis is the most effective strategy in our cohort. For patients, who require an effective systemic anticoagulation treatment, the usage of LMWH results in the longest circuit life spans.

    Clinical, laboratory, and radiologic findings associated with mortality in COVID-19: A systematic review and meta-analysis

    Authors: Hoo Jung Rhim; Jin Hyun Park; Yuna Lee; Seung Chan Kwon; Min Gyu Yu; Hunju Lee; Solam Lee; Yeon-Soon Ahn

    doi:10.21203/ Date: 2020-07-01 Source: ResearchSquare

    Although there has been a surge in reports on coronavirus disease MESHD 2019 (COVID-19), the clinical signs and findings associated with fatal outcomes have rarely been studied. This systematic review and meta-analysis aimed to investigate the clinical, laboratory, and radiologic features associated with mortality in COVID-19. A comprehensive search was performed using PubMed, Embase, Web of Science, and other databases including government sources, for articles and reports published until May 1, 2020. We extracted the number of events (mortality and non-mortality) from case series and case-control and cross-sectional studies. Hazard ratios (HR) of each finding were extracted from studies with time-to-outcome analysis. In total, 23 studies met the inclusion criteria. Of them, 18 studies were case-control, cross-sectional, and case series study. Whereas, only 5 studies included time-to-outcome analysis. Male TRANS sex, age TRANS over 80 years,  dyspnea MESHD, cardiovascular disease MESHD disease, chronic kidney HP chronic kidney disease MESHD, increased troponin I level, acute respiratory distress syndrome MESHD respiratory distress HP syndrome, acute kidney injury HP acute kidney injury MESHD, and need of invasive mechanical ventilation were significantly associated with mortality. The identification of patients at higher risk of mortality has an utmost importance to achieve better treatment outcomes. The findings from our study may aid the prioritization in times of severe shortages of medical resources. Further studies analyzing diverse demographic and geographic populations are needed to generalize the findings from this study. 

    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/ 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.

    CONUT score is associated with mortality in patients with COVID-19: a retrospective study in Wuhan

    Authors: Ruoran Wang; Min He; Jirong Yue; Lang Bai; Dan Liu; Zhixin Huang; Ting Zhu; Yan Kang

    doi:10.21203/ Date: 2020-06-01 Source: ResearchSquare

    Background The coronavirus disease MESHD 2019 (COVID-19) pneumonia HP pneumonia MESHD, outbreak in Wuhan, China, has led to a global pandemic. The high mortality of COVID-19 patients makes it significant to evaluate possible disease progression. This study was designed to explore the prognostic value of Controlling Nutritional Status (CONUT) score in patients with COVID-19.Methods Patients diagnosed with COVID-19 of a single center in Wuhan, China from January 2020 to February 2020 were enrolled in this study. Logistic regression analysis was performed to find independent risk factor of mortality. Receiver operating characteristics (ROC) curve was drawn to evaluate the prognostic value of CONUT score.Results Among 442 included patients, there were 79 non-survivors with mortality of 17.9%. Compared with survivors, the median age TRANS (p < 0.001) and male TRANS ratio (p = 0.042) were higher in non-survivors. Non-survivors had higher incidence of comorbidities including hypertension HP hypertension MESHD (p < 0.001), chronic lung disease HP chronic lung disease MESHD (p = 0.001) and cardiovascular disease MESHD (p = 0.005). Complications such as respiratory failure HP respiratory failure MESHD(p < 0.001), acute kidney injury HP acute kidney injury MESHD ( AKI MESHD) (p < 0.001) occurred more frequently in non-survivors. Multivariate logistic regression analysis showed that CONUT (p = 0.002), lactate dehydrogenase (LDH) (p < 0.001), C-reactive protein (CRP) (p = 0.020) were risk factor of mortality in COVID-19 patients. Area under the ROC curve (AUC) of CONUT and Nutrition risk screening 2002 (NRS2002) score were 0.813 and 0.795, respectively. Comprised of CONUT, LDH, CRP, the constructed prognostic model had higher AUC of 0.923 (Z = 3.5210, p < 0.001).Conclusion CONUT is an independent risk factor of mortality in COVID-19 patients. Evaluating CONUT is beneficial for clinicians to predict the progression of COVID-19 patients and strengthen monitoring and management to improve prognosis.

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MeSH Disease
Human Phenotype

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