Corpus overview


Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Outcome of COVID-19 with Co-Existing Surgical Emergencies in Children TRANS: Our Initial Experiences and Recommendations

    Authors: Samiul Hasan; Md Ayub Ali; Umama Huq

    doi:10.21203/rs.3.rs-71589/v1 Date: 2020-09-03 Source: ResearchSquare

    Background: COVID-19 has changed the practice of surgery vividly all over the world. This has already lead to a huge burden of rescheduled pediatric surgical cases worldwide. Though children TRANS are less likely to be infected MESHD and suffer less when infected, there is a growing fear among health care workers of being self-infected, which is limiting the surgical care of children TRANS globally. This study aims to share our experiences with the outcome of COVID-19 in children TRANS who had a co-existing surgical emergency, which might help the pediatric surgeons globally to mitigate the effect of COVID 19 on pediatric surgery.Methods: This is a retrospective observational study. We reviewed the epidemiological, clinical, and laboratory data of all patients admitted in our surgery department through the emergency department and later diagnosed to have COVID-19 by RT-PCR. During April 2020 – June 2020. A nasopharyngeal swab was taken from all patients irrespective of symptoms to detect SARS CoV 2 by RT-PCR to identify and isolate asymptomatic TRANS patients and patients with atypical symptoms. We divided the test positive patients into 4 age groups TRANS for the convenience of data analysis. Data were retrieved from hospital records and analyzed using SPSS (version 25) software. Ethical permission was taken from the hospital ethical review board.Results: Total patients were 32. Seven (21.9%) of them were neonates. Twenty-four (75%) patients were male TRANS. The predominant diagnosis was acute abdomen followed by infantile hypertrophic pyloric stenosis MESHD pyloric stenosis HP (IHPS), myelomeningocele HP, and intussusception HP. Only two patients had mild respiratory symptoms MESHD ( dry cough MESHD cough HP). Fever HP Fever MESHD was present in 13 (40.6%) patients. Fourteen (43.8%) patients required surgical treatment. The mean duration of hospital stay was 5.5 days. One neonate with ARM died in the post-operative ward due to cardiac arrest HP cardiac arrest MESHD. No patient had hypoxemia HP hypoxemia MESHD or organ failure. Seven health care workers (5.51%) including doctors & nurses got infected with SARS Co V2 during this period.Conclusion: Our study has revealed a milder course of COVID-19 in children TRANS with minimal infectivity even when present in association with emergency surgical conditions. This might encourage a gradual restart to mitigate the impact of COVID-19 on children’s surgery.

    Comparison of COVID-19 Infections Among Healthcare Workers and Non-Healthcare Workers

    Authors: Rachel Kim; Sharon Nachman; Rafael Fernandes; Kristen Meyers; Maria Taylor; Debra LeBlanc; Adam Singer

    doi:10.1101/2020.08.13.20174482 Date: 2020-08-15 Source: medRxiv

    Objectives Healthcare workers face distinct occupational challenges that affect their personal health, especially during a pandemic. In this study we compare the characteristics and outcomes of Covid-19 patients who are and who are not healthcare workers (HCW). Methods We retrospectively analyzed a cohort of adult TRANS patients with known HCW status and a positive SARS-CoV-2 PCR test presenting to a large academic medical center emergency department (ED) in New York State. We routinely collect data on occupation and exposures to suspected Covid-19. The primary outcome was hospital admission. Secondary outcomes were ICU admission, need for invasive mechanical ventilation (IMV), and mortality. We compared baseline characteristics and outcomes of Covid-19 adult TRANS patients based on whether they were or were not HCW using univariable and multivariable analyses. Results From March 1 2020 through June 2020, 2,842 adult TRANS patients (mean age TRANS 53+/-19 years, 53% male TRANS) with positive SARS-CoV-2 PCR tests and known HCW status visited the ED. This included 193 (6.8%) known HCWs and 2,649 (93.2%) non-HCWs. Compared with non-HCW, HCWs were younger (43 vs 53 years, P<0.001), more likely female TRANS (118/193 vs 1211/2649, P<0.001), and more likely to have a known Covid-19 exposure (161/193 vs 946/2649, P<0.001), but had fewer comorbidities. On presentation to the ED, HCW also had lower frequencies of tachypnea HP tachypnea MESHD (12/193 vs 426/2649, P<0.01), hypoxemia HP hypoxemia MESHD (15/193 vs 564/2649, P<0.01), bilateral opacities on imaging (38/193 vs 1189/2649, P<0.001), and lymphocytopenia MESHD (6/193 vs 532/2649, P<0.01) compared to non-HCWs. Direct discharges home from the ED were more frequent in HCW 154/193: 80% vs 1275/2649: 48% p<0.001). Hospital admissions (38/193 20% vs 1264/2694 47%, P<0.001), ICU admissions (7/193 3% vs 321/2694 12%, P<0.001), need for IMV (6/193 3% vs 321/2694 12%, P<0.001) and mortality (2/193 1% vs 219/2694 8%, P<0.01) were lower than among non-HCW. After controlling for age TRANS, sex, comorbidities, presenting vital signs and radiographic imaging, HCW were less likely to be admitted (OR 0.6, 95%CI 0.3-0.9) than non HCW. Conclusions Compared with non HCW, HCW with Covid-19 were younger, had less severe illness, and were less likely to be admitted.

    Possible silent hypoxemia HP hypoxemia MESHD in a COVID-19 patient: a case report

    Authors: Siswanto; Munawar Gani; Aditya Rifqi Fauzi; Bagus Nugroho; Denny Agustiningsih; Gunadi

    doi:10.21203/rs.3.rs-58296/v1 Date: 2020-08-12 Source: ResearchSquare

    Background: It has been hypothesized that silent hypoxemia HP hypoxemia MESHD is the cause of the rapid progressive respiratory failure HP respiratory failure MESHD with severe hypoxia MESHD that occurs in some patients with COVID-19 without warning. Here, we reported one COVID-19 case with the possibility of silent hypoxemia HP hypoxemia MESHD. Case presentation: A 60-year-old male TRANS presented with complaints of cough HP that he felt starting two weeks before admission without any breathing difficulty. Complaints were accompanied by fever HP fever MESHD, runny nose and sore throat. Vital signs examination showed blood SERO pressure 130/75 mmHg, pulse 84 times per minute, normal respiratory rate (RR) of 21 times per minute, body temperature 36.5 C, and 99% oxygen saturation with oxygen via nasal cannula 3 liters per minute were recorded. On physical examination, an increase in vesicular sounds and crackles HP in both lungs were identified. Chest x-ray showed bilateral pneumonia HP pneumonia MESHD. Nasopharyngeal and oropharyngeal swab real-time polymerase chain reaction tests for COVID-19 were positive. On the third day of treatment, the patient complained of worsening of shortness of breath MESHD, but his RR was still normal with 22 times per minute. On the fifth day of treatment, the patient experienced severe shortness of breath MESHD with a RR of 38 times per minute. The patient was then intubated and his blood SERO gas analysis showed respiratory alkalosis HP respiratory alkalosis MESHD (pH 7.54, PaO2 58.9 mmHg, PaCO2 31.1 mmHg, HCO3 26.9 mEq/L, SaO2 94.7%). On the eighth day of treatment, his condition deteriorated starting in the morning, with blood SERO pressure 80/40 mmHg with norepinephrine support, pulse 109 times per minute, and 72% SpO2 with ventilator. In the afternoon, the patient experienced cardiac arrest HP cardiac arrest MESHD and underwent basic life support, then resumed strained breathing with return of spontaneous circulation. Blood SERO gas analysis showed severe respiratory acidosis HP respiratory acidosis MESHD (pH 7.07, PaO2 58.1 mmHg, PaCO2 108.9 mmHg, HCO3 32.1 mEq /L, SaO2 78.7%). Three hours later, he suffered cardiac arrest HP cardiac arrest MESHD again, but was unable to be resuscitated. The patient eventually died.Conclusions: Silent hypoxemia HP hypoxemia MESHD might be considered as an early clinical sign of deterioration of patients with COVID-19, thus, the physician may be able to intervene early and decrease its morbidity and mortality.

    Comparative Clinical Outcomes and Mortality in Prisoner and Non-Prisoner Populations Hospitalized with COVID-19: A Cohort from Michigan

    Authors: Ahmed M Altibi; Pallavi Bhargava; Hassan Liaqat; Alexander A. Slota; Radhika Sheth; Lama Al Jebbawi; Matthew E. George; Allison LeDuc; Enas Abdallah; Luke R. Russell; Saniya Jain; Narine Shirvanian; Ahmad Masri; Vivek Kak; Anna S Levin; Pia S Pannaraj; Thushan I de Silva; Paola Minoprio; Bruno Bezerril Andrade; Fabiano P da Silva; Helder I Nakaya; Marcos C Borges; Benedito AL Fonseca; Valdes R Bollela; Cristina M Del-Ben; Fernando Q Cunha Sr.; Dario S Zamboni; Rodrigo C Santana; Fernando C Vilar; Paulo Louzada-Junior; Rene D R Oliveira

    doi:10.1101/2020.08.08.20170787 Date: 2020-08-11 Source: medRxiv

    Background: Prisons in the United States have become a hotbed for spreading Covid-19 among incarcerated individuals. Covid-19 cases among prisoners are on the rise, with more than 46,000 confirmed cases TRANS to date. However, there is paucity of data addressing clinical outcomes and mortality in prisoners hospitalized with Covid-19. Methods: An observational study of all patients hospitalized with Covid-19 between March 10 and May 10, 2020 at two Henry Ford Health System hospitals in Michigan. Clinical outcomes were compared amongst hospitalized prisoners and non-prisoner patients. The primary outcomes were intubation rates, in-hospital mortality, and 30-day mortality. Multivariable logistic regression and Cox-regression models were used to investigate primary outcomes. Results: Of the 706 hospitalized Covid-19 patients (mean age TRANS 66.7 +/- 16.1 years, 57% males TRANS, and 44% black), 108 were prisoners and 598 were non-prisoners. Compared to non-prisoners, prisoners were more likely to present with fever HP fever MESHD, tachypnea HP tachypnea MESHD, hypoxemia HP hypoxemia MESHD, and markedly elevated inflammatory markers. Prisoners were more commonly admitted to the intensive care unit (ICU) (26.9% vs. 18.7%), required vasopressors (24.1% vs. 9.9%), and intubated (25.0% vs. 15.2%). Prisoners had higher unadjusted inpatient mortality (29.6% vs. 20.1%) and 30-day mortality (34.3% vs. 24.6%). In the adjusted models, prisoner status was associated with higher in-hospital death (odds ratio, 1.95; 95% confidence interval (CI), 1.07 to 3.57) and 30-day mortality (hazard ratio, 1.92; 95% CI, 1.24 to 2.98). Conclusions: In this cohort of hospitalized Covid-19 patients, prisoner status was associated with more severe clinical presentation, higher rates of ICU admissions, vasopressors requirement, intubation, in-hospital mortality, and 30-day mortality.

    Outcome of COVID-19 with co-existing surgical emergencies in children TRANS: our initial experiences and recommendations

    Authors: Md Samiul Hasan; Md Ayub Ali; Umama Huq

    doi:10.1101/2020.08.01.20166371 Date: 2020-08-04 Source: medRxiv

    Background: COVID 19 has changed the practice of surgery vividly all over the world. Pediatric surgery is not an exception. Prioritization protocols allowing us to provide emergency surgical care to the children TRANS in need while controlling the pandemic spread. The aim of this study is to share our experiences with the outcome of children TRANS with COVID 19 who had a co existing surgical emergency. Methods: This is a retrospective observational study. We reviewed the epidemiological, clinical, and laboratory data of all patients admitted in our surgery department through the emergency department and later diagnosed to have COVID 19 by RT PCR. The study duration was 3 months (April 2020 to June 2020). A nasopharyngeal swab was taken from all patients irrespective of symptoms to detect SARS CoV 2 by RT PCR with the purpose of detecting asymptomatic TRANS patients and patients with atypical symptoms. Emergency surgical services were provided immediately without delay and patients with positive test results were isolated according to the hospital protocol. We divided the test positive patients into 4 age groups TRANS for the convenience of data analysis. Data were retrieved from hospital records and analyzed using SPSS (version 25) software. Ethical permission was taken from the hospital ethical review board. Results: Total patients were 32. Seven (21.9%) of them were neonates. Twenty four (75%) patients were male TRANS. The predominant diagnosis was acute abdomen followed by infantile hypertrophic pyloric stenosis MESHD pyloric stenosis HP (IHPS), myelomeningocele HP, and intussusception HP. Only two patients had mild respiratory symptoms MESHD ( dry cough MESHD cough HP). Fever HP Fever MESHD was present in 13 (40.6%) patients. Fourteen (43.8%) patients required surgical treatment. The mean duration of hospital stay was 5.5 days. One neonate with ARM died in the postoperative ward due to cardiac arrest HP cardiac arrest MESHD. No patient had hypoxemia HP hypoxemia MESHD or organ failure. Seven health care workers (5.51%) including doctors & nurses got infected with SARS Co V2 during this period. Conclusion: Our study has revealed a milder course of COVID 19 in children TRANS with minimal infectivity even when present in association with emergency surgical conditions. This might encourage a gradual restart to mitigate the impact of COVID 19 on children TRANS surgery. Keywords: COVID 19, COVID 19 in children TRANS, Children TRANS Surgery, Surgical emergency, Surgery in COVID 19 positive patients.

    Corticosteroid Use in Severely Hypoxemic COVID-19 Patients: An Observational Cohort Analysis of Dosing Patterns and Outcomes in the Early Phase of the Pandemic

    Authors: Omar Rahman; Russel A Trigonis; Mitchell K Craft; Rachel M Kruer; Emily M Miller; Colin L Terry; Sarah A Persaud; Rajat Kapoor

    doi:10.1101/2020.07.29.20164277 Date: 2020-07-30 Source: medRxiv

    INTRODUCTION Hypoxemia HP Hypoxemia MESHD in Severe Acute Respiratory Syndrome due to Novel Coronavirus of 2019 (SARS-CoV-2) is mediated by severe inflammation MESHD that may be mitigated by corticosteroids. We evaluated pattern and effects of corticosteroid use in these patients during an early surge of the pandemic. METHODS Observational study of 136 SARS-CoV-2 patients admitted to the Intensive care Unit between March 1 and April 27, 2020 at a tertiary care hospital in Indianapolis, USA. Statistical comparison between cohorts and dosing pattern analysis was done. Outcome measures included number of patients requiring intubation, duration of mechanical ventilation, length of ICU stay and inpatient mortality. RESULTS: Of 136 patients, 72 (53%) received corticosteroids. Groups demographics: Age TRANS (60.5 vs. 65; p .083), sex (47% male TRANS vs. 39% female TRANS; p .338) and comorbidities were similar. Corticosteroid group had increased severity of illness: PaO2/FiO2 (113 vs. 130; p .014) and SOFA (8 vs. 5.5; p < .001). Overall mortality (21% vs. 30%; p .234) or proportion of patients intubated (78 vs. 64%; p .078) was similar. Mortality was similar among mechanically ventilated (27% vs. 15%; p .151) however there were no deaths among patients who were not mechanically ventilated and received corticosteroids (0% vs. 57%; p

    Almitrine as a non ventilatory strategy to improve intrapulmonary shunt HP in COVID-19 patients

    Authors: MARIE REINE LOSSER; COLINE LAPOIX; BENOIT CHAMPIGNEULLE; MATTHIEU DELANNOY; JEAN FRANCOIS PAYEN; DIDIER PAYEN

    doi:10.1101/2020.05.18.20105502 Date: 2020-05-22 Source: medRxiv

    In severe COVID-19 pulmonary failure MESHD, hypoxia MESHD is mainly related to pulmonary vasodilation with altered hypoxic pulmonary vasoconstriction MESHD (HPV). Besides prone positioning, other non-ventilatory strategies may reduce the intrapulmonary shunt HP. This study has investigated almitrine, a pharmacological option to improve oxygenation. Patients and Method. A case control series of 17 confirmed COVID-19 mechanically ventilated patients in prone or supine positioning was collected: 10 patients received two doses of almitrine (4 and 12 mcg/kg/min) at 30-45 min interval each, and were compared to 7 control COVID-matched patients conventionally treated. The end-point was the reduction of intra-pulmonary shunt increasing the PaO2 and ScvO2. Results Patients were male TRANS (59%) with median (25th, 75th percentiles) age TRANS of 70 (54-78) years and a BMI of 29 (23-34). At stable mechanical ventilatory settings, PaO2 (mmHg) at FiO2 1 (135 (85, 195) to 214 (121, 275); p = 0.06) tended to increase with almitrine. This difference was significant when the best PaO2 between the 2 doses was used : 215 (123,294) vs baseline (p = 0.01). A concomitant increase in ScvO2 occurred ((73 (72, 76) to 82 (80, 87); p = 0.02). Eight over 10 almitrine-treated patients increased their PaO2, with no clear dose-effect. During the same time, the controls did not change PaO2. In conclusion, in early COVID-19 with severe hypoxemia HP, almitrine infusion is associated with improved oxygenation in prone or supine positioning. This pharmacological intervention may offer an alternative and/or an additional effect to proning and might delay or avoid more demanding modalities such as ECMO.

    Progression, recovery and fatality in patients with SARS-CoV-2 related pneumonia HP pneumonia MESHD in Wuhan, China: a single-centered, retrospective, observational study

    Authors: Hua Wang; Yirong Lu; Qingquan Lv; Xiping Wu; Tian Hu; Kai Wang; Yumei Liu; Yuhai Hu; Lan Yu; Hexuan Fei; Zheng Ba; Xiaohua Lin

    doi:10.1101/2020.05.12.20099739 Date: 2020-05-16 Source: medRxiv

    Objectives To determine the case fatality rates and death risk factors. Design Retrospective case series. Setting A COVID-19 ward of a secondary Hospital in Wuhan, China. Participants Consecutively hospitalized COVID-19 patients between Jan 3, 2020 and Feb 27, 2020. Outcomes were followed up to discharge or death MESHD. Results Of 121 patients included, 66 (54.6%) were males TRANS. The median age TRANS was 59 (IQR: 46 to 67) years, and hypertension HP hypertension MESHD (33 patients; 27.3%) the leading comorbidity. Lymphopenia HP Lymphopenia MESHD (83 of 115 patients; 72.2%) frequently occurred and then normalized on day 4 (IQR: 3 to 6) after admission in the survivors, with lung lesion MESHD absorbed gradually on day 8 (IQR: 6 to10) after onset (33 of 57 patients; 57.9%). The real-time polymerase chain reaction (RT-PCR) assays for SARS-CoV-2 were positive in 78 (78/108; 72.2%) patients, and a false-negative RT-PCR occurred in 15 (13.9%) patients. Hypoxemia HP Hypoxemia MESHD occurred in 94 (94/117; 80.3%) patients, and supplemental oxygen was given in 88 (72.7%) patients, and mon-invasive or invasive ventilation in 20 (16.5%) cases. Corticosteroid use might link to death. The case fatality rates were 4.4% (one of 23 patients), 29.3% (12/41), 22.8% (13/57) or 45% (9/20) for patients with moderate, severe, critical illness MESHD or on ventilator. The length of hospital stay was 14 (IQR: 10 to 20) days, and selfcare ability worsened in 21 patients (21/66; 31.8%) cases. Patients over 60 years were most likely to have poorer outcomes, and increasing in age TRANS by one-year increased risk for death MESHD by 18% (CI: 1.04-1.32). Conclusions In management of patients with SARS-CoV-2 pneumonia MESHD pneumonia HP, especially the elderly TRANS with hypertension HP hypertension MESHD, close monitoring and appropriate supportive treatment should be taken earlier and aggressively to prevent from developing severe or critical illness MESHD. Corticosteroid use might link to death. Repeated RT-PCR tests or novel detection methods for SARS-CoV-2 should be adopted to improve diagnostic efficiency.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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