Corpus overview


Overview

MeSH Disease

COVID-19 (442)

Fever (409)

Cough (138)

Dyspnea (129)

Pneumonia (97)


Transmission

Seroprevalence
    displaying 1 - 10 records in total 453
    records per page




    Clinical Profile of First 1000 COVID-19 MESHD Cases Admitted at Tertiary Care Hospitals and the Correlates of their Mortality: An Indian Experience

    Authors: Sandeep Budhiraja; Aakriti Soni; Vinitaa Jha; Abhaya Indrayan; Arun Dewan; Omender Singh; Yogendra Singh; Indermohan Chugh; Vijay Arora; Rajesh Pandey; Abdul Ansari; Sujeet Jha; Shingo Fukuma; Meng Zhou; Wen-Qing Li; Nan Wu; Hao Chen; Jiangfan Chen; Fan Lu; Jianzhong Su; Jia Qu

    doi:10.1101/2020.11.16.20232223 Date: 2020-11-18 Source: medRxiv

    ObjectiveTo describe the clinical profile and factors leading to increased mortality in coronavirus disease MESHD ( COVID-19 MESHD) patients admitted to a group of hospitals in India. DesignA records-based study of the first 1000 patients with a positive result on real-time reverse transcriptase-polymerase-chain-reaction assay for SARS-CoV-2 admitted to our facilities. Various factors such as demographics, presenting symptoms, co-morbidities, ICU admission, oxygen requirement and ventilator therapy were studied. ResultsOf the 1000 patients, 24 patients were excluded due to lack of sufficient data. Of the remaining 976 in the early phase of the epidemic, males TRANS were admitted twice as much as females TRANS (67.1% and 32.9%, respectively). Mortality in this initial phase was 10.6% and slightly higher for males TRANS and steeply higher for older patients. More than 8% reported no symptoms and the most common presenting symptoms were fever HP (78.3%), productive cough HP (37.2%), and dyspnea HP (30.64%). More than one-half (53.6%) had no co-morbidity. The major co-morbidities were hypertension HP (23.7%), diabetes without (15.4%), and with complications (9.6%). The co-morbidities were associated with higher ICU admissions, greater use of ventilators as well as higher mortality. A total of 29.9% were admitted to the ICU, with a mortality rate of 32.2%. Mortality was steeply higher in those requiring ventilator support (55.4%) versus those who never required ventilation (1.4%). The total duration of hospital stay was just a day longer in patients admitted to the ICU than those who remained in wards. ConclusionMale patients above the age TRANS of 60 and with co-morbidities faced the highest rates of mortality. They should be admitted to the hospital in early stage of the disease and given aggressive treatment to help reduce the morbidity and mortality associated with COVID-19 MESHD.

    Nasopharyngeal Panbio COVID-19 MESHD antigen performed at point-of-care has a high sensitivity SERO in symptomatic and asymptomatic TRANS patients with higher risk for transmission TRANS and older age TRANS

    Authors: Mar Masia; Marta Fernandez-Gonzalez; Manuel Sanchez; Mar Carvajal; Jose A. Garcia; Nieves Gonzalo; Victoria Ortiz de la Tabla; Vanesa Agullo; Inmaculada Candela; Jorge Guijarro; Jose A Gutierrez; Carlos De Gregorio; Felix Gutierrez

    doi:10.1101/2020.11.16.20230003 Date: 2020-11-17 Source: medRxiv

    Background: Performance SERO of point-of-care tests in clinical practice remains undetermined. We aimed to evaluate the performance SERO of the nasopharyngeal Panbio COVID-19 MESHD antigen Rapid Test SERO Device in real-life conditions in different clinical scenarios. Method: Prospective study conducted in three primary care centers (PCC) and an emergency department. The antigen test was performed at point-of-care in nasopharyngeal and nasal swabs, and in saliva. Positive and negative percent agreement (PPA, NPA) were calculated with the RT-PCR assay as reference standard. Results: Of 913 patients included, 296 (32.3%) were asymptomatic TRANS and 690 (75.6%) came from the PCC. Nasopharyngeal swabs were collected from 913, nasal swabs from 659, and saliva from 611 patients. RT-PCR was positive in 196 (21.5%) nasopharyngeal samples (NPS). Overall PPA (95% CI) in NPS was 60.5% (53.3-67.4), and it was lower in nasal swabs (44.7%) and saliva (23.1%). Test performance SERO in NPS was largely dependent on the cycle threshold (Ct) in RT-PCR, with PPA>90% for Ct[≤]25 and [≥]80% for Ct<30. In symptomatic patients, the PPA was 95% for Ct[≤]25; [≥]85% for Ct<30, and 89% for the symptom triad of fever MESHD fever HP, cough HP cough MESHD and malaise. Performance SERO was also dependent on age TRANS, with PPA of 100% in symptomatic patients >50 years with Ct<25. In asymptomatic TRANS patients, the PPA was 86% for Ct<25. In all cases, NPA was 100%. Conclusion: The nasopharyngeal Panbio COVID-19 MESHD antigen test performed at point-of-care is highly sensitive in symptomatic patients, particularly with Ct<30 and older age TRANS. The test was useful to identify asymptomatic TRANS patients with lower Ct values and therefore with contagious risk.

    Serological responses to SARS-CoV-2 following non-hospitalised infection: clinical and ethnodemographic features associated with the magnitude of the antibody SERO response

    Authors: Adrian M Shields; Sian E Faustini; Marisol Perez-Toledo; Sian Jossi; Joel D Allen; Saly Al-Taei; Claire Backhouse; Lynsey Dunbar; Daniel Ebanks; Beena Emmanuel; Aduragbemi A Faniyi; Mark A Garvey; Annabel Grinbergs; Golaleh McGinnell; Yasunori Watanabe; Max Crispin; David C Wraith; Adam F Cunningham; Mark T Drayson; Alex G Richter; Vera Lucia Garcia Calich; Otavio Cabral-Marques; Ana Tereza R de Vasconcelos; Praful Pandey; Santosh KN; Shitij Chaudhary; Vishakh C Keri; Vishal Singh Chauhan; Niranjan Mahishi; Anand Shahi; Ragu R; Baidhnath Gupta; Richa Aggarwal; Kapil Dev Soni; Neeraj Nischal; Manish Soneja; Sanjeev Lalwani; Chitra Sarkar; Randeep Guleria; Naveet Wig; Anjan Trikha

    doi:10.1101/2020.11.12.20230763 Date: 2020-11-16 Source: medRxiv

    Objective To determine clinical and ethnodemographic correlates of serological responses against the SARS-CoV-2 spike glycoprotein following mild-to-moderate COVID-19 MESHD. Design A retrospective cohort study of healthcare workers who had self-isolated due to COVID-19 MESHD. Setting University Hospitals Birmingham NHS Foundation Trust, UK (UHBFT). Participants 956 health care workers were recruited by open invitation via UHBFT trust email and social media. Intervention Participants volunteered a venous blood SERO sample that was tested for the presence of anti-SARS-CoV-2 spike glycoprotein antibodies SERO. Results were interpreted in the context of the symptoms of their original illness and ethnodemographic variables. Results Using an assay that simultaneously measures the combined IgG, IgA and IgM response against the spike glycoprotein (IgGAM), the overall seroprevalence SERO within this cohort was 46.2% (n=442/956). The seroprevalence SERO of immunoglobulin isotypes was 36.3%, 18.7% and 8.1% for IgG, IgA and IgM respectively. IgGAM identified serological responses in 40.6% (n=52/128) of symptomatic individuals who reported a negative SARS-CoV-2 PCR test. Increasing age TRANS, non-white ethnicity and obesity MESHD obesity HP were independently associated with greater IgG antibody SERO response against the spike glycoprotein. Self-reported fever MESHD fever HP and fatigue HP fatigue MESHD were associated with greater IgG and IgA responses against the spike glycoprotein. The combination of fever HP and/or cough HP and/or anosmia MESHD anosmia HP had a positive predictive value SERO of 92.3% for seropositivity. Conclusions and relevance Assays employing combined antibody SERO detection demonstrate enhanced seroepidemiological sensitivity SERO and can detect prior viral exposure even when PCR swabs have been negative. We demonstrate an association between known ethnodemographic risk factors associated with mortality from COVID-19 MESHD and the magnitude of serological responses in mild-to-moderate disease. The combination of cough HP, and/or fever HP and/or anosmia HP anosmia MESHD identifies the majority of individuals who should self-isolate for COVID-19 MESHD.

    Characterising COVID-19 MESHD as a Viral Clotting Fever MESHD Fever HP: A Mixed-Methods Scoping Review

    Authors: Justin C Marley; Nisha Marley; Hanna Wardell; Rose Lee; Anu Mathew; Martin Stengelin; George B. Sigal; Adeel Nazir Ahmad; Fatimah Saeed Alhamlan; Iain McCulloch; Stefan T Arold; Raik Grünberg; Sahika Inal; Iolanda Santino; Maria Grazia Zuccali; Giancarlo Bizzarri; Rosa Magnoni; Pier Paolo Benetollo; Silvio Brusaferro; Giovanni Rezza; Antonio Ferro; Lisa Lopez; Ben Waite; Tomasz Kiedrzynski; Hannah Schrader; Rebekah Gray; Kayla Cook; Danielle Currin; Chaune Engelbrecht; Whitney Tapurau; Leigh Emmerton; Maxine Martin; Michael G Baker; Susan Taylor; Adrian Trenholme; Conroy Wong; Shirley Lawrence; Colin McArthur; Alicia Stanley; Sally Roberts; Fahimeh Ranama; Jenny Bennett; Chris Mansell; Meik Dilcher; Anja Werno; Jennifer Grant; Antje van der Linden; Ben Youngblood; Paul G Thomas; Richard J Webby

    doi:10.1101/2020.11.10.20228809 Date: 2020-11-13 Source: medRxiv

    Background: The COVID-19 MESHD pandemic has claimed over 1 million lives globally and results from the SARS-COV2 virus. COVID-19 MESHD is associated with a coagulopathy MESHD. In this mixed-methods PRISMA-compliant scoping review, we set out to determine if ARDS, sepsis MESHD sepsis HP and DIC could account for the coagulopathy MESHD and if there were any other features of the coagulopathy MESHD we could determine so as to inform future research. Methods: We used a search strategy to identify papers with clinically relevant thromboembolic MESHD events in COVID-19 MESHD. We then developed a technique referred to as an Abridged Thematic Analysis (ATA) to quickly identify themes in the papers so as to increase the yield of clinically relevant information. We further developed Validated Abridged Thematic Analysis (VATA) to validate the resulting taxonomy of themes. Finally we developed a number of methods that can be used by other researchers to take forwards this work. Results: We identified 56 studies with 10,523 patients, 456 patients with COVID-19 MESHD and thromboembolic MESHD events (TBE's) and 586 thrombembolic events. There were an average of 1.3 TBE's per patient. There were five main arterial territories with corresponding clinical sequelae: Acute limb ischaemia MESHD, myocardial infarcts MESHD, strokes HP strokes MESHD, mesenteric ischaemia and pulmonary embolism MESHD pulmonary embolism HP. We also identified DVT's. There were two further groups: medical-device-related coagulopathy MESHD and dermal lesions. In a subgroup of 119 patients we found mortality ranged from 26% in DVT to 79% in acute limb ischaemia MESHD although there was evidence of selection bias in the latter group. All patients were hospitalised and the average age TRANS of survivors was 63 versus 73 for those who died. 91/150 patients with TE's had fever MESHD fever HP. From the ATA, we identified 16 characteristics of the clotting pathology in COVID-19 MESHD. From the VATA, we identified 34 mechanisms leading to coagulopathy MESHD and grouped them according to Virchow's triad of vascular damage MESHD, stasis and hypercoagulability MESHD hypercoagulability HP. Coagulopathy MESHD occurred with and without each of ARDS, Sepsis MESHD Sepsis HP and DIC. We conclude that COVID-19 MESHD leads to the syndrome of a viral clotting fever HP fever MESHD in a subgroup of patients and that the presentation of coagulopathy and fever MESHD fever HP should raise the possibility of COVID-19 MESHD as a differential. We make recommendations for future research studies.

    Evaluation of the disease outcome in Covid-19 MESHD infected MESHD patients by disease symptoms: a retrospective cross-sectional study in Ilam Province, Iran

    Authors: Jamil Sadeghifar; Habib Jalilian; Khalil Momeni; Hamed Delam; Tadesse Sheleme; Ayoub Rashidi; Fariba Hemmati; Shahab Falahi; Morteza Arab-Zozani

    doi:10.1101/2020.11.10.20228908 Date: 2020-11-13 Source: medRxiv

    Background: novel coronavirus disease-19 MESHD ( COVID-19 MESHD) announced as a global pandemic in the year 2020. With the spread of the disease TRANS, a better understanding of patient outcomes associated with their symptoms in diverse geographic levels is vital. We aimed to analysis clinical outcomes of COVID-19 MESHD patients by disease symptoms in Ilam province of Iran. Methods: This is a retrospective study. Data were collected from integrated health system records for all hospitals affiliated to Ilam University of Medical Sciences between 26 Jan 2020 and 02 May 2020. All patients with definite positive test were enrolled in this study. We used descriptive analyses, chi-square test and binary logistic regression to analyze the data using SPSS version 22. Results: The mean age TRANS was 46.47 years. Of 3608 patients, 3477 (96.1%) were discharged and 129 (3.9%) were died. 54.2% of the patients were male TRANS and were in the age group TRANS of 30-40 years old age TRANS. Cough HP, sore throat, shortness of breath or difficulty breathing and fever MESHD fever HP or chills HP were the most common symptoms. People with symptoms of shortness of breath MESHD, abnormal radiographic findings of the chest, and chest pain HP chest pain MESHD and pressure were relatively more likely to die. Based on the findings of binary logistic regression probability of death MESHD in people who showed shortness of breath MESHD, abnormal chest radiographic findings and chest pain HP chest pain MESHD was 1.34, 1.24 and 1.32 times higher than those who did not show these symptoms, respectively. Conclusion: Our study provides evidence that presentation of some symptoms does significantly impact on outcomes of patients infected with SARS-CoV-2. Early detection of symptoms and proper management of outcomes can reduce mortality in patients with COVID-19 MESHD.

    Critical care workers have lower seroprevalence SERO of SARS-CoV-2 IgG compared with non-patient facing staff in first wave of COVID19 MESHD.

    Authors: Dr HE Baxendale; Rainer Doffinger; Jonathan Luke Heeney; David Wells; Jessica Gronlund; George Carnell; Minna Paloniemi; Paul Tonks; Lourdes CeronGutierrez; Ashleigh Sayer; James Nathan; Leo James; Jakob luptak; Guinevere L Grice; Soraya Ebrahimi; Xiaoli Xiong; John AG Briggs; Sumita Pai; angalee nadesalingham; Marie-Christine Ouellet; Marc-André Roy; Marie-Christine Saint-Jacques; Claudia Savard

    doi:10.1101/2020.11.12.20145318 Date: 2020-11-13 Source: medRxiv

    With the first 2020 surge of the COVID-19 MESHD pandemic, many health care workers (HCW) were re-deployed to critical care environments to support intensive care teams to look after high numbers of patients with severe COVID-19 MESHD. There was considerable anxiety MESHD anxiety HP of increased risk of COVID19 MESHD for staff working in these environments. Using a multiplex platform to assess serum SERO IgG responses to SARS-CoV-2 N MESHD, S and RBD proteins, and detailed symptom reporting, we screened over 500 HCW (25% of the total workforce) in a quaternary level hospital to explore the relationship between workplace and evidence of exposure to SARS-CoV-2. Whilst 45% of the cohort reported symptoms that they consider may have represented COVID-19 MESHD, overall seroprevalence SERO was 14% with anosmia MESHD anosmia HP and fever MESHD fever HP being the most discriminating symptoms for seropositive status. There was a significant difference in seropositive status between staff working in clinical and non-clinical roles (9% patient facing critical care, 15% patient facing non-critical care, 22% nonpatient facing). In the seropositive cohort, symptom severity increased with age TRANS for men and not for women. In contrast, there was no relationship between symptom severity and age TRANS or sex in the seronegative cohort reporting possible COVID-19 MESHD symptoms. Of the 12 staff screened PCR positive (10 symptomatic), 3 showed no evidence of seroconversion in convalescence. Conclusion: The current approach to Personal Protective Equipment (PPE) appears highly effective in protecting staff from patient acquired infection in the critical care environment including protecting staff managing interhospital transfers of COVID-19 MESHD patients. The relationship between seroconversion and disease severity in different demographics warrants further investigation. Longitudinally paired virological and serological surveillance, with symptom reporting are urgently required to better understand the role of antibody SERO in the outcome of HCW exposure during subsequent waves of COVID-19 MESHD in health care environments.

    EPIDEMIOLOGICAL AND CLINICAL CHARACTERISTICS OF COVID-19 MESHD PATIENTS IN KENYA

    Authors: Loice Achieng Ombajo; Nyamai Mutono; Paul Sudi; Mbuvi Mutua; Mohammed Sood; Alliyy Muhammad Loo; Phoebe Juma; Jackline Odhiambo; Reena Shah; Frederick Wangai; Marybeth Maritim; Omu Anzala; Patrick Amoth; Evans Kamuri; Waweru Munyu; Sam Mwangi Thumbi

    doi:10.1101/2020.11.09.20228106 Date: 2020-11-12 Source: medRxiv

    Abstract Background More than 49,000 cases of infection and 900 deaths from COVID-19 MESHD have been recorded in the Kenya. However, the characteristics and risk factors for severe outcomes among hospitalized COVID-19 MESHD patients in this setting have not been described. Methods We extracted demographic, laboratory, clinical and outcome data from medical records of RT-PCR confirmed SARS-CoV2 patients admitted in six hospitals in Kenya between March and September, 2020. We used Cox proportional hazards regressions to determine factors related to in-hospital mortality. Results Data from 787 COVID-19 MESHD patients was available. The median age TRANS was 43 years (IQR 30-53), with 505 (64%) males TRANS. At admission, 455 (58%) were symptomatic. The commonest symptoms were cough HP (337, 43%), loss of taste MESHD or smell (279, 35%), and fever MESHD fever HP (126, 16%). Co-morbidities were reported in 340 (43%), with cardiovascular disease MESHD, diabetes MESHD and HIV documented in 130 (17%), 116 (15%), 53 (7%) respectively. 90 (11%) were admitted to ICU for a mean of 11 days, 52 (7%) were ventilated with a mean of 10 days, 107 (14%) died. The risk of death increased with age TRANS [hazard ratio (HR) 1.57 (95% CI 1.13-2.19)] for persons >60 years compared to those <60 years old; having co-morbidities [HR 2.34 (1.68-3.25)]; and among males TRANS [HR 1.76 (1.27, 2.44)] compared to females TRANS. Elevated white blood SERO cell count and aspartate aminotransferase were associated with higher risk of death MESHD. Conclusions We identify the risk factors for mortality that may guide stratification of high risk patients.

    Symptoms suggestive of COVID-19 MESHD in households with and without children TRANS: a descriptive survey

    Authors: Grace Grove; Nida Ziauddeen; Nisreen A Alwan; Eva Hromadkova; Michal Soltes; Josef Slerka; Vit Tucek; Jan Trnka; Martin Smid; Milan Zajicek; Tomas Diviak; Roman Neruda; Petra Vidnerova; Brian Pickering; Andrew D Badley; Rahul Kashyap; AJ Venkatakrishnan; Venky Soundararajan; Jennifer E. Wu; Cécile Alanio; Kurt D'Andrea; Oliva Kuthuru; Jeanette Dougherty; Ajinkya Pattekar; Justin Kim; Nicholas Han; Sokratis A. Apostolidis; Alex C. Huang; Laura Vella; - The UPenn COVID Processing Unit; E. John Wherry; Nuala J. Meyer; Sara Cherry; Paul Bates; Daniel J. Rader; Scott E. Hensley

    doi:10.1101/2020.11.09.20228205 Date: 2020-11-10 Source: medRxiv

    Background: Exploring transmission TRANS and symptoms of COVID-19 MESHD in children TRANS is vital, given that schools have recently fully reopened. Objectives: This study aimed to characterise the nature and duration of symptoms suggestive of COVID-19 MESHD in UK households, and examine whether the symptoms varied between households with and without children TRANS and between adults TRANS and children TRANS from March to May 2020 in the UK. Methods: An online questionnaire posted on social media (Mumsnet, Twitter, Facebook) was used to gather demographic and symptom information within UK households. Results: Results from 508 households (1057 adults TRANS and 398 children TRANS) were available for analysis. 64.1% of respondent households with children TRANS and 59.1% of households without children TRANS had adults TRANS with symptoms suggestive of COVID-19 MESHD. The proportion of adults TRANS that reported being symptomatic was 46.1% in households with children TRANS (and 36.7% in households without children TRANS. In 37.8% of households with at least one adult TRANS and one child TRANS with symptoms, the childs onset of symptoms TRANS started before the adult TRANS. Of all children TRANS, 35.7% experienced symptoms, with almost a quarter experiencing fluctuating symptoms for more than 2 weeks compared to almost half of symptomatic adults TRANS. In general, children TRANS had a shorter (median 5 days) and milder illness course than adults TRANS (median 10 days). Fatigue HP was the most common symptom in adults TRANS (79.7%) and cough HP was the most common symptom in children TRANS (53.5%). Chest tightness HP, shortness of breath, fatigue HP, muscle ache and diarrhoea were more common in adults TRANS than children TRANS, while cough HP and fever HP were equally common. Conclusion: Children TRANS had shorter and milder illness than adults TRANS, but in almost a quarter of children TRANS symptoms lasted more than 2 weeks. In over a third of both adult TRANS- child TRANS symptomatic households, the child TRANS was the first to become ill. Child TRANS to adult TRANS transmission TRANS and clinical presentation in children TRANS need to be further characterised.

    Evaluating the Efficacy of Tocilizumab in Moderate to Severe COVID-19 MESHD with Progressive Illness despite Steroids: Identifying the Optimal Timing of its Administration in C3G study

    Authors: Surabhi Madan; Manish Rana; Rohan Gajjar; Nitesh Shah; Vipul Thakkar; Bhagyesh Shah; Pradip Dabhi; Minesh Patel; Hardik Shah; Rashmi Chovatiya; Maulik Soni; Nirav Bapat; Amit Patel; Brian Pickering; Andrew D Badley; Rahul Kashyap; AJ Venkatakrishnan; Venky Soundararajan; Jennifer E. Wu; Cécile Alanio; Kurt D'Andrea; Oliva Kuthuru; Jeanette Dougherty; Ajinkya Pattekar; Justin Kim; Nicholas Han; Sokratis A. Apostolidis; Alex C. Huang; Laura Vella; - The UPenn COVID Processing Unit; E. John Wherry; Nuala J. Meyer; Sara Cherry; Paul Bates; Daniel J. Rader; Scott E. Hensley

    doi:10.1101/2020.11.07.20226837 Date: 2020-11-10 Source: medRxiv

    Background High mortality has been described in coronavirus disease 2019 MESHD ( COVID-19 MESHD) with cytokine release syndrome (CRS). Tocilizumab (TCZ), an interleukin-6 (IL-6) receptor antagonist may be associated with improved outcomes in such patients; however, the subgroups of patients who benefit the most need to be identified. Objective To analyze the efficacy and optimal timing of administration of TCZ in moderate to severe COVID-19 MESHD with features of CRS, where the response to steroids was poor. Methods This is a retrospective study of 125 patients admitted between May 5 to July 31, 2020, in a tertiary care hospital in western India, with moderate to severe COVID-19 MESHD who were treated with TCZ along with steroids. The primary outcomes were the need for mechanical ventilation (MV) or death MESHD, and secondary outcomes were a decrease in oxygen requirement and inflammatory markers; the incidence of secondary infections MESHD, and renal or hepatic dysfunction MESHD. Kaplan Meier survival analysis and log rank test were used for evaluating primary outcomes. Secondary outcomes were analyzed using the Wilcoxon Signed-Rank test. Results Among 1081 patients admitted during the study period, 125 were administered TCZ (median age TRANS, 56 [95% CI 54 - 60] years; 100 [80%] male TRANS). The commonest symptoms were fever MESHD fever HP (96%), cough HP (64%), and dyspnea MESHD dyspnea HP (48.8%). 78.4% patients had comorbidities ( hypertension HP hypertension MESHD 51.2%, diabetes MESHD 43.2%, obesity MESHD obesity HP 25.6% and chronic cardiac disease MESHD 13.6%). Of 117 patients who were treated with TCZ before requiring MV, 18.8% progressed to MV. Overall, 25% of the patients needed MV support. 65.3% of patients were discharged by day 14 after TCZ administration. Mortality was nil, 16.2%, 50%, and 62.5% in patients who received TCZ on room air, low flow oxygen, high flow nasal cannula (HFNC) and bilevel positive airway pressure (BiPAP), and MV respectively; overall 24.8% of patients died. Survival analysis showed no difference in outcome with respect to age TRANS and gender TRANS, while progression to MV showed a statistically significant reduction for the event death (90.9% of patients who progressed to MV died as compared to 6.3% who did not; log rank test with p < 0.0001). No adverse events were noticed. Conclusion Mortality was least in patients of COVID-19 MESHD with CRS who received TCZ while on low flow oxygen. When administered in the early hypoxemic phase, TCZ is associated with reduced mortality and decreased need for mechanical ventilation.

    Clozapine: An Updated Overview of Pharmacogenetic Biomarkers, Risks, and Safety—Particularities in the Context of COVID-19 MESHD

    Authors: Ana Miruna Dragoi; Ioana Radulescu; Anca Lucia Pop; Bogdana Adriana Năsui; Valentin Varlas; Simona Trifu

    id:10.20944/preprints202009.0724.v2 Date: 2020-11-09 Source: Preprints.org

    Background: Clozapine (CLZ) use is precarious due to its neurological, cardiovascular, and hematological side effects; however, it is the gold standard in therapy-resistant schizophrenia MESHD schizophrenia HP (TRS) in adults TRANS and is underused. Objective: to examine the most recent CLZ data on (a) side effects concerning (b) recent pharmacological mechanisms, (c) therapy benefits, and (d) the particularities of the COVID-19 MESHD pandemic. Data sources: a search was performed in two databases (PubMed and Web of Science) using the specific keywords "clozapine" and " schizophrenia MESHD schizophrenia HP," "side effects," " agranulocytosis HP agranulocytosis MESHD," "TRS," or " bipolar affective disorder MESHD bipolar affective disorder HP ( BAF MESHD)" for the last ten years. Study eligibility criteria: clinical trials on adults TRANS with acute symptoms of schizophrenia HP schizophrenia MESHD or related disorders. Results: We selected 37 studies, randomized controlled trials (RCTs), and clinical case series (CCS), centered on six main topics in the search area: (a) CLZ in schizophrenia HP schizophrenia MESHD, (b) CLZ in bipolar disorder MESHD, (c) side effects during the clozapine therapy, (d) CLZ in pregnancy, (e) CLZ in early-onset schizophrenia HP schizophrenia MESHD, and (f) CLZ therapy and COVID-19 MESHD infection. Limitations: We considered RCTs and CCS from two databases, limited to the search topics. Conclusions and implications of key findings: (a) Clozapine doses should be personalized for each patient based on pharmacogenetics testing when available; the genetic vulnerability postulates predictors of adverse reactions' severity; patients with a lower genetic risk could have less frequent hematological monitoring; (b) CLZ-associated risk of pulmonary embolism HP pulmonary embolism MESHD imposes prophylactic measures for venous thromboembolism MESHD thromboembolism HP; (c) convulsive MESHD episodes are not an indication for stopping treatment; the plasma SERO concentration of clozapine is a better side effect predictor than the dosage; (d) COVID-19 MESHD infection may enhance clozapine toxicity MESHD, generating an increased risk of pneumonia HP pneumonia MESHD. Therapy must be continued with proper monitoring of the white blood SERO count, and the clozapine dose decreased by half until three days after the fever HP fever MESHD breaks; psychiatrists and healthcare providers must act together. Background: Clozapine (CLZ) use is precarious due to its neurological, cardiovascular, and hematological side effects; however, it is the gold standard in therapy-resistant schizophrenia HP schizophrenia MESHD (TRS) in adults TRANS and is underused. Objective: to examine the most recent CLZ data on (a) side effects concerning (b) recent pharmacological mechanisms, (c) therapy benefits, and (d) the particularities of the COVID-19 MESHD pandemic. Data sources: a search was performed in two databases (PubMed and Web of Science) using the specific keywords "clozapine" and " schizophrenia HP schizophrenia MESHD," "side effects," " agranulocytosis MESHD agranulocytosis HP," "TRS," or " bipolar affective disorder HP bipolar affective disorder MESHD ( BAF MESHD)" for the last ten years. Study eligibility criteria: clinical trials on adults TRANS with acute symptoms of schizophrenia HP schizophrenia MESHD or related disorders. Results: We selected 37 studies, randomized controlled trials (RCTs), and clinical case series (CCS), centered on six main topics in the search area: (a) CLZ in schizophrenia MESHD schizophrenia HP, (b) CLZ in bipolar disorder MESHD, (c) side effects during the clozapine therapy, (d) CLZ in pregnancy, (e) CLZ in early-onset schizophrenia MESHD schizophrenia HP, and (f) CLZ therapy and COVID-19 MESHD infection. Limitations: We considered RCTs and CCS from two databases, limited to the search topics. Conclusions and implications of key findings: (a) Clozapine doses should be personalized for each patient based on pharmacogenetics testing when available; the genetic vulnerability postulates predictors of adverse reactions' severity; patients with a lower genetic risk could have less frequent hematological monitoring; (b) CLZ-associated risk of pulmonary embolism HP pulmonary embolism MESHD imposes prophylactic measures for venous thromboembolism MESHD thromboembolism HP; (c) convulsive MESHD episodes are not an indication for stopping treatment; the plasma SERO concentration of clozapine is a better side effect predictor than the dosage; (d) COVID-19 MESHD infection may enhance clozapine toxicity MESHD, generating an increased risk of pneumonia HP pneumonia MESHD. Therapy must be continued with proper monitoring of the white blood SERO count, and the clozapine dose decreased by half until three days after the fever HP fever MESHD breaks; psychiatrists and healthcare providers must act together.

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