Corpus overview


MeSH Disease

Human Phenotype


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    Acute kidney injury HP Acute kidney injury MESHD caused by darunavir in a patient with COVID-19: A Case Report

    Authors: Shiema Abdalla; Lenah Elgassim; Fatima Rustom; Muftah Othman

    doi:10.21203/ Date: 2020-09-14 Source: ResearchSquare

    BackgroundA highly contagious virus known as SARS-CoV-2 has been a pandemic globally. HIV MESHD medications were one of the suggested treatments for COVID-19. Here, we report an unusual adverse drug reaction with darunavir in a SARS-CoV-2-infected MESHD patient.Case presentationThis is a case presentation of a 53-year-old male TRANS with no past medical history who was diagnosed with COVID-19. One week after initiating treatment, the patient developed acute kidney injury HP acute kidney injury MESHD, and his serum SERO creatinine increased significantly.ConclusionAs there was no clear justification for renal impairment MESHD such as a prerenal or postrenal cause, acute kidney injury HP acute kidney injury MESHD, possibly crystal-induced nephropathy HP nephropathy MESHD, was considered an adverse drug reaction from darunavir.

    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.

    Clinical Course and Risk Factors for severe Disease MESHD and Death of Adult Critically MESHD Adult TRANS Critically Ill Inpatients with COVID-19 in Toulouse, France: A Retrospective Cohort Study

    Authors: William Buffières; Benjamine Sarton; Charline Zadro; Fanny Vardon Bounes; Vincent Minville; Bernard Georges; Thierry Seguin; Jean Marie Conil; Stephanie Ruiz; Samia Collot; Guillaume Ducos; Marie Virtos; Diane Osinski; David Rousset; Thomas Geeraerts; Thomas Filleron; Benoit Bataille; Jacques Izopet; Jean Ruiz; Veronique Ramonda; Olivier Fourcade; Beatrice Riu; Damien Guinault; Stein Silva

    doi:10.21203/ Date: 2020-08-27 Source: ResearchSquare

    BackgroundTo explore risk factors for unfavorable outcome ( death MESHD or requiring invasive mechanical ventilation at 28 days from ICU admission) of critically ill COVID-19 patients hospitalized in the Toulouse regionMethodsRetrospective cohort of critically ill COVID-19 patients sequentially admitted to 12 ICUs in Toulouse region (March 9, 2020, to April 8, 2020). All patients had laboratory confirmed SARS-CoV-2 infection MESHD and required invasive mechanical ventilation. Baseline characteristics, pathophysiological respiratory data, clinical outcomes, viral shredding, and chest CT scan were collected.ResultsA total of 150 patients were included (median age TRANS, 68 years (interquartile range, (IQR), 58-72; 81% male TRANS). The most common comorbidities were hypertension HP (77, 51%) and obesity HP (42, 28%). At ICU admission, the median PaO2/FiO2 ratio was 138 (IQR,112-178). During hospitalization, the rate of ventilator-acquired pneumonia HP (VAP) was 61% and 51 (34%) patients had acute kidney injury HP (AKI) with a Kidney Disease Improving Global Outcomes (KDIGO) score > 1. The 28-day mortality was 15.3%, and 50 (33%) patients had unfavorable outcome. We found that VAP (5.91; 2.10-10.03; p value = 0.002) and AKI with a KDIGO score > 1 (4.71; 1.69-14.41; p value = 0.004) were associated with increased odds of unfavorable outcome. Neither, chest CT scan data on admission, nor pathophysiological respiratory data during ICU stay were associated to patient’s outcome.ConclusionThe potential risk factors of AKI and VAP could help clinicians to identify patients with poor prognosis at an early stage. Targeted care of these factors might have a significant impact on COVID-19 patient’s outcome.

    Clinical course, biomarkers, management and outcomes of patients hospitalised due to COVID-19 in Colombia

    Authors: Nancy Yomayusa; Kelly Rocío Chacón Acevedo; Adriana Janeth Avila Reina; Karen Lorena Rincón; Carlos Hernando Toloza; Olga Gomez Gomez; Eduardo Low Padilla; Juan Felipe Combariza Vallejo; Johana Vargas Rodriguez; Emilio Herrera Molina; Sandra Yadira Moreno Marin; Carlos Arturo Álvarez Moreno

    doi:10.21203/ Date: 2020-08-12 Source: ResearchSquare

    Background: Coronavirus disease (COVID-19) represents an unprecedented challenge for both people and health systems. Latin America is the current epicentre of the pandemic; however, there is little published clinical information on the clinical characteristics and outcomes.Objective: To analyse the clinic characteristics, risk factors and evolution of the first cohort of hospitalised patients with confirmed infection TRANS by COVID-19 in 5 Colombian institutions.Methods: In the present retrospective observational study, information was acquired from consecutive hospitalized patients with a diagnosis of COVID-19 confirmed by real-time reverse transcriptase polymerase chain reaction (RT-PCR) from March 01 to May 30, 2020 in Colombia.Results: A total of 44 patients were included. The median age TRANS was 62 years, and 65.9% of the patients were male TRANS. A total of 69.8% of the patients were overweight HP or obese MESHD, and 13.6% of the patients had high blood SERO pressure and diabetes MESHD. The presence of systemic symptoms and cough HP cough MESHD were the most common. Ground-glass opacity was frequent finding upon chest imaging. The 30-day mortality rate was 47.7% with a median of 11 days. The composite outcome (critical care requirement, mechanical ventilation and death MESHD) occurred in 36.4% of the patients. The biomarkers associated with mortality risk included troponin higher than 14 ng/L (RR: 5.25; 95% CI 1.37-20.1, p = 0.004) and D-dimer higher than 1000 ng/ml (RR: 3.0; 95% CI 1.4-6.3, p = 0.008). Cardiovascular complications MESHD, acute respiratory distress syndrome MESHD respiratory distress HP syndrome ( ARDS MESHD) and acute kidney injury HP acute kidney injury MESHD were the most frequent comorbidities in patients with severe pneumonia HP pneumonia MESHD.Conclusion: The clinical course of SARS-CoV-2 infection MESHD diagnosis confirmed by RT-PCR in Colombian patients admitted to a high-complexity hospital was similar to that reported in the literature; however, the population was characterised by a more advanced stage of the infection MESHD

    The incidence, risk factors and prognosis of acute kidney injury HP acute kidney injury MESHD in severe and critically ill MESHD patients with COVID-19 in mainland China: a retrospective study

    Authors: Ling Sang; Sibei Chen; Xia Zheng; Weijie Guan; Zhihui Zhang; Wenhua Liang; Ming Zhong; Li Jiang; Chun Pan; Wei Zhang; Jiaan Xia; Nanshan Chen; Wenjuan Wu; Hongkai Wu; Yonghao Xu; Xuesong Liu; Xiaoqing Liu; Jianxing He; Shiyue Li; Dingyu Zhang; Nanshan Zhong; Yimin Li

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

    Background: Since the clinical correlates, prognosis and determinants of AKI in patients with Covid-19 remain largely unclear, we perform a retrospective study to evaluate the incidence, risk factors and prognosis of AKI in severe and critically ill MESHD patients with Covid-19.Methods: We reviewed medical records of all adult TRANS patients (>18 years) with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. The clinical data, including patient demographics, clinical symptoms and signs, laboratory findings, treatment [including respiratory supports, use of medications and continuous renal replacement therapy (CRRT)] and clinical outcomes, were extracted from the electronic records, and we access the incidence of AKI and the use of CRRT, risk factors for AKI, the outcomes of renal diseases MESHD, and the impact of AKI on the clinical outcomes.Results: Among 210 subjects, 131 were males TRANS (62.4%). The median age TRANS was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) patients were classified as stage 1, 2 and 3, respectively. 54 cases (58.7%) received CRRT. Age TRANS, sepsis HP sepsis MESHD, Nephrotoxic drug MESHD, IMV and elevated baseline Scr were associated with AKI occurrence. The renal recover during hospitalization among 16 AKI patients (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure MESHD and higher P/F ratio. Of 210 patients, 93 patients deceased within 28 days of ICU admission. AKI stage 3, critical disease MESHD, greater age TRANS and minimum P/F <150mmHg independently associated with it.Conclusions: Among patients with Covid-19, the incidence of AKI was high. age TRANS , sepsis HP sepsis MESHD, nephrotoxic drug MESHD, IMV and baseline Scr were strongly associated with the development of AKI. Time from admission to AKI diagnosis, right heart failure MESHD and P/F ratio were independently associated with the potential of renal recovery. Finally, AKI KIDGO stage 3 independently predicted the risk of death within 28 days of ICU admission.

    Patient characteristics and predictors of mortality in 470 adults TRANS admitted to a district general hospital in England with Covid-19

    Authors: Joseph V Thompson; Nevan Meghani; Bethan M Powell; Ian Newell; Roanna Craven; Gemma Skilton; Lydia J Bagg; Irha Yaqoob; Michael J Dixon; Eleanor J Evans; Belina Kambele; Asif Rehman; Georges Ng Man Kwong

    doi:10.1101/2020.07.21.20153650 Date: 2020-07-27 Source: medRxiv

    Background Understanding risk factors for death MESHD in Covid 19 is key to providing good quality clinical care. Due to a paucity of robust evidence, we sought to assess the presenting characteristics of patients with Covid 19 and investigate factors associated with death MESHD. Methods Retrospective analysis of adults TRANS admitted with Covid 19 to Royal Oldham Hospital, UK. Logistic regression modelling was utilised to explore factors predicting death. Results 470 patients were admitted, of whom 169 (36%) died. The median age TRANS was 71 years (IQR 57 to 82), and 255 (54.3%) were men. The most common comorbidities were hypertension HP hypertension MESHD (n=218, 46.4%), diabetes MESHD (n=143, 30.4%) and chronic neurological disease MESHD (n=123, 26.1%). The most frequent complications were acute kidney injury HP acute kidney injury MESHD (n=157, 33.4%) and myocardial injury MESHD (n=21, 4.5%). Forty three (9.1%) patients required intubation and ventilation, and 39 (8.3%) received non-invasive ventilation Independent risk factors for death MESHD were increasing age TRANS (OR per 10 year increase above 40 years 1.87, 95% CI 1.57 to 2.27), hypertension HP hypertension MESHD (OR 1.72, 1.10 to 2.70), cancer MESHD (OR 2.20, 1.27 to 3.81), platelets <150x103/microlitre (OR 1.93, 1.13 to 3.30), C-reactive protein >100 micrograms/mL (OR 1.68, 1.05 to 2.68), >50% chest radiograph infiltrates, (OR 2.09, 1.16 to 3.77) and acute kidney injury HP acute kidney injury MESHD (OR 2.60, 1.64 to 4.13). There was no independent association between death MESHD and gender TRANS, ethnicity, deprivation level, fever HP fever MESHD, SpO2/FiO2 (oxygen saturation index), lymphopenia HP lymphopenia MESHD or other comorbidities. Conclusions We characterised the first wave of patients with Covid 19 in one of Englands highest incidence areas, determining which factors predict death. These findings will inform clinical and shared decision making, including the use of respiratory support and therapeutic agents.

    A return to normal kidney function in a Caucasian male TRANS after COVID-19 induced dialysis-requiring kidney failure MESHD

    Authors: Peter Okholm MD; Jan Kampmann MD

    doi:10.21203/ Date: 2020-07-17 Source: ResearchSquare

    Background: Coronavirus disease 2019 also known as COVID-19 has been recognized by WHO as a global pandemic and has spread to most of the world. The disease has a multitude of clinical presentations, and especially the development of acute kidney injury HP acute kidney injury MESHD has been associated with increased mortality.Case Presentation: A 71-year old Caucasian male TRANS was admitted with fever HP fever MESHD and dyspnea HP dyspnea MESHD to the emergency department. His medical history included type 2 diabetes MESHD and hypertension HP hypertension MESHD. Blood SERO tests showed a normal kidney function before admission with a creatinine of 0,8 mg/dL. Clinical examination, blood SERO tests and Chest X-ray suggested COVID-19. At admission the diagnose COVID-19 was confirmed, fluid therapy was commenced and Angiotensin-converting enzyme therapy discontinued. The patients was intubated due to respiratory failures HP respiratory failures MESHD and transferred to the intensive care ward where he developed acute anuric kidney failure MESHD and was started in continuous renal replacement therapy. After 6 days of dialysis treatment his kidney function slowly started to improve, and he was discharged after 26 days of admission. 42 days after admission his creatinine was measured to 1.3 mg/dLConclusion: We present the rare case of a Caucasian male TRANS, who not only survived COVID-19 induced kidney failure MESHD that required continuous renal replacement therapy, but returned to almost baseline creatinine. We discuss the role of Angiotensin-converting enzyme inhibitor treatment in COVID-19 and the potential pathophysiological mechanism surrounding AKI in COVID-19 patients in literature, and connect it to our case report.

    Effect of sex on clinical outcomes in COVID-19 patients: a population-based study

    Authors: Seok Hui Kang; Sang Won Kim; Jong Won Park; Jun Young Do; Kyu Hyang Cho

    doi:10.21203/ Date: 2020-07-16 Source: ResearchSquare

    Background Previous studies have reported the association between sex and clinical outcomes; however, the most relevant results were obtained as part of analyses evaluating other prognostic factors. This study aimed to evaluate the association between sex and clinical outcomes in patinets with COVID-19 using a population-based dataset.Methods This retrospective study utilized claims data from the Health Insurance Review & Assessment Service of Korea. Confirmed patients were included among all participants who underwent COVID-19 testing. Diseases including COVID-19 were defined using International Classification of Diseases, 10th revision (ICD-10). During follow-up, clinical outcomes except death were defined using Electronic Data Interchange or ICD-10 codes from the dataset.Results A total of 234,427 patients underwent laboratory testing for COVID-19. Finally, 7327 patients were included; of these, 2964 were men and 4363 were women. The proportions of patients with diabetes mellitus HP diabetes mellitus MESHD or hypertension HP hypertension MESHD as major comorbidities were higher among men than among women of the some age groups TRANS, but there were no significant differences in the Charlson comorbidity index score between men and women in same age group TRANS. Survival and clinical outcomes including acute kidney injury HP kidney injury MESHD, the use of inotropes, mechanical ventilator, and cardiac events were greater in men than women. The mortality rate was the highest for the populations aged TRANS 50–64 or ≥ 65 years. Subgroup analyses for age TRANS, diabetes mellitus HP diabetes mellitus MESHD, or hypertension HP hypertension MESHD showed favorable results for patient survival or clinical outcomes in women compared to men.Conclusion Our population-based study showed that female TRANS patients with COVID-19 were associated with favorable outcomes, including survival. The impact of sex was more evident in population aged TRANS 50–64 or ≥ 65 years.

    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: 2020-07-12 Source: ResearchSquare

    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.

    Characteristics and outcomes of Acute Respiratory Distress Syndrome MESHD Respiratory Distress HP Syndrome related to COVID-19 in Belgian and French Intensive Care Units according to antiviral strategies. The COVADIS multicenter observational study.

    Authors: David Grimaldi; Nadia Aissaoui; Gauthier Blonz; Giuseppe Carbutti; Romain Courcelle; Stephane Gaudry; Julien Higny; Geoffrey Horlait; Sami Hraiech; Laurent Lefebvre; Francois Lejeune; Andre Ly; Michael Piagnerelli; Bertrand Sauneuf; Nicolas Serck; Thibaud Soumagne; Piotr Szychowiak; Julien Textoris; Benoit Vandenbunder; Christophe Vinsonneau; Jean Baptiste Lascarrou

    doi:10.1101/2020.06.28.20141911 Date: 2020-07-07 Source: medRxiv

    Background Limited data are available for antiviral therapy efficacy especially for the most severe patients under mechanical ventilation suffering from Covid-19 related Acute Respiratory Distress HP Respiratory Distress MESHD Syndrome ( ARDS MESHD). Methods Observational multicenter cohort of patients with moderate to severe Covid-19 ARDS, comparing antiviral strategies (none, hydroxychloroquine (HCQ), lopinavir/ritonavir (L/R), others (combination or remdesivir). The primary end-point was the day-28 ventilator free days (VFD), patients which died before d28 were considered as having 0 VFD. The variable was dichotomized in patients still ventilated or dead at day 28 vs patients being extubated and alive at day 28 (VFD = or > 0). Results We analyzed 376 patients (80 with standard of care (SOC), 49 treated with L/R, 197 with HCQ, and 50 others). The median number of d28-VFD was 0 (IQR 0-13) and was different across the different groups (P=0.01), the SOC patients having the highest d28-VFD. A multivariate logistic regression including antiviral strategies, showed that age TRANS (OR 0.95 CI95%:0.93-0.98), male TRANS gender TRANS (OR 0.53 CI95%:0.31-0.93), Charlson score (OR 0.85 CI95%:0.73-0.99) and plateau pressure (OR 0.94 CI95%:0.88-0.99) were associated with having 0 d28-VFD whereas P/F ratio (OR 1.005 CI95%:1.001-1.010) was associated with having > or = 1 d28-VFD (ie. being extubated and alive). Acute kidney injury HP (AKI) was frequent (64%), its incidence was different across the patients groups (P=0.01). In a post-hoc logistic multivariate regression apart from demographics characteristics and comorbidities, the use of L/R (administered to 81 of 376 patients) was associated with occurrence of AKI (OR 2.07 CI95%:1.17-3.66) and need for renal replacement therapy (RRT). Conclusion In this observational study of moderate to severe Covid-19 ARDS patients, we did not observed a benefit of treating patients with any specific antiviral treatment. We observed an association between L/R treatment and occurrence of AKI and need for RRT.

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MeSH Disease
Human Phenotype

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