Corpus overview


Overview

MeSH Disease

Human Phenotype

Fever (141)

Cough (97)

Pneumonia (49)

Fatigue (37)

Diarrhea (23)


Transmission

Seroprevalence
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    Clinical Course and Management of 73 Hospitalized Moderate Patients with COVID-19 Outside Wuhan

    Authors: Xiaojuan Peng; Qi Liu; Zhaolin Chen; Guiyan Wen; Qing Li; Yanfang Chen; Jie Xiong; Xinzhou Meng; Yuanjin Ding; Ying Shi; Shaohui Tang

    doi:10.21203/rs.3.rs-52239/v1 Date: 2020-08-01 Source: ResearchSquare

    Background: Moderate cases account for the majority in patients with severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) infection MESHD and can also progress to severe/critical condition. Here, we investigated the clinical course and management of hospitalized moderate SARS-CoV-2 patients.Methods: The medical records and follow-up data were analyzed from the SARS-CoV-2 patients outside Wuhan.Results: A total of 73 moderate patients (38 men, 35 women) were included, with median age TRANS of 47.0 (38.5-57.5) years. Among them, only one patient (1.4%) died using active treatment to improve symptoms. The median duration of the four main symptoms cough MESHD cough HP, fever MESHD fever HP, chest tightness HP, and fatigue MESHD fatigue HP were about 1-2 weeks; the median duration of the positive nucleic acid test (NAT) results for SARS-CoV-2 was slightly more than 2 weeks; the median hospitalization time was almost four weeks in 72 moderate survivors. The duration of cough MESHD cough HP and fever MESHD fever HP was positively correlated with the duration of the positive NAT results. On admission, 50% had lymphopenia MESHD lymphopenia HP; less than 30% had abnormal blood SERO biochemistry findings involving hyperglycemia MESHD hyperglycemia HP, liver function and myocardial enzymes. At discharge, the laboratory indexes were substantially improved. Two weeks after discharge, 5.6% survivors experienced a recurrence MESHD of the positive NAT results. Conclusions: Moderate SARS-CoV-2 patients have a good prognosis by the active treatment. After discharge, it is necessary that moderate survivors undergo at least a 2-week collective medical observation in quarantine places, which can identify and treat a proportion of patients with re-positive NAT results and to prevent the spread of the potential sources of infection MESHD.

    Elevated oxygen demand in a case of COVID-19 with severe ARDS: a point for optimal oxygenation therapy including ECMO management

    Authors: Taku Oshima; Takehiko Oami; Mana Yamashiro; Akiko Higashi; Yosuke Hayashi; Natsumi Suga; Shin Takayanagi; Seiichiro Sakao; Taka-aki Nakada

    doi:10.21203/rs.3.rs-51286/v1 Date: 2020-07-30 Source: ResearchSquare

    Background: Coronavirus disease MESHD 2019 (COVID-19) caused by SARS-CoV-2 has become a global pandemic, and those developing critically ill conditions have been reported to have mortality in the range of 39% to 61%. Due to the lack of definitive treatments, mechanical ventilation and supportive oxygenation therapy are key management strategies for the survival of patients with acute respiratory distress HP syndrome MESHD (ARDS). Optimizing oxygenation therapy is mandatory to treat patients with severe respiratory failure HP, to sufficiently compensate for the oxygen (O2) demand. We experienced a case of severe ARDS due to COVID-19 successfully treated with extracorporeal membrane oxygenation (ECMO) after increasing oxygen delivery according to O2 consumption measurement by indirect calorimetryCase Presentation: A 29-year-old obese but otherwise healthy man was hospitalized for treatment of COVID-19 pneumonia MESHD pneumonia HP presenting with a 4-day history of persisting cough MESHD cough HP, high fever MESHD fever HP, and dyspnea MESHD dyspnea HP. Mechanical ventilation, nitric oxide inhalation, and prone positioning were initiated in the ICU against severe respiratory dysfunction. Indirect calorimetry on the 3rd and 6th ICU days revealed persistent elevation of oxygen consumption (VO2) of 380 mL/min. Veno-venous ECMO was initiated on the 7th ICU day after further deterioration of respiratory failure HP. Periodic events of SpO2 decline due to effortful breathing was not resolved by neuromuscular blockade in attempt to reduce O2 consumption. Increasing the ECMO flow induced hemolysis MESHD and hyperkalemia MESHD hyperkalemia HP despite the use of large bore cannulas and ECMO circuit free of clots and defects. The hemoglobin management level was elevated from 10 g/dL to 13 g/dL to increase blood SERO oxygen capacity, enabling the reduction of ECMO flow while attenuating respiratory effort and maintaining SpO2. Lung protective ventilation strategy and prone positioning were continued for successful weaning from ECMO on the 16th ICU day, and the ventilator on the 18th ICU day.Conclusion: The present case of severe ARDS due to COVID-19 was successfully treated with ECMO. Enhancing oxygen delivery was crucial to compensate for the elevated O2 demand. Measuring O2 consumption by indirect calorimetry can elucidate the oxygen demand for optimizing the oxygenation therapy for successful management and survival of critically ill COVID-19 patients. 

    Efficacy and tolerability of bevacizumab in patients with severe Covid -19

    Authors: Jiaojiao Pang; Feng Xu; Gianmarco Aondio; Yu Li; Alberto Fumagalli; Ming Lu; Giuseppe Valmadre; Jie Wei; Yuan Bian; Margherita Canesi; Giovanni Damiani; Yuan Zhang; Dexin Yu; Jun Chen; Xiang Ji; Wenhai Sui; Bailu Wang; Shuo Wu; Attila Kovacs; Miriam Revera; Hao Wang; Ying Zhang; Yuguo Chen; Yihai Cao

    doi:10.1101/2020.07.26.20159756 Date: 2020-07-29 Source: medRxiv

    On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesized that the anti-VEGF drug bevacizumab might be beneficial for treating Covid-19 patients. We recruited 26 patients from 2-centers (China and Italy) with confirmed severe Covid-19, with respiratory rate [≥]30 times/min, oxygen saturation [≤]93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O2 ratio (PaO2/FiO2) >100mmHg and [≤]300 mmHg, and diffuse pneumonia MESHD pneumonia HP confirmed by chest radiological imaging. This trial was conducted from Feb 15 to April 5, 2020, and followed up for 28 days. Relative to comparable control patients with severe Covid-19 admitted in the same centers, bevacizumab showed clinical efficacy by improving oxygenation and shortening oxygen-support duration. Among 26 hospitalized patients with severe Covid-19 (median age TRANS, 62 years, 20 [77%] males TRANS), bevacizumab plus standard care markedly improved the PaO2/FiO2 ratios at days 1 and 7 (elevated values, day 1, 50.5 [4.0,119.0], p<0.001; day 7, 111.0 [85.0,165.0], p<0.001). By day 28, 24 (92%) patients showed improvement in oxygen-support status, 17 (65%) patients were discharged, and none showed worsen oxygen-support status nor died. Significant reduction of lesion areas and ratios were shown in chest CT or X-ray analysis within 7 days. Of 14 patients with fever MESHD fever HP, body temperature normalized within 72 hours in 13 (93%) patients. Lymphocyte counts in peripheral blood SERO were significantly increased and CRP levels were markedly decreased as shown in available data. Our findings suggested bevacizumab plus standard care was highly beneficial for treating patients with severe Covid-19. Clinical efficacy of bevacizumab warrants double blind, randomized, placebo-controlled trials.

    SARS-CoV-2 antibody SERO prevalence SERO in health care workers: Preliminary report of a single center study

    Authors: Michael Brant-Zawadzki; Deborah Fridman; Philip Robinson; Matthew Zahn; Randy German; Marcus Breit; Junko Hara

    doi:10.1101/2020.07.20.20158329 Date: 2020-07-25 Source: medRxiv

    SARS-CoV-2 has driven a pandemic crisis. Serological surveys have been conducted to establish prevalence SERO for covid-19 antibody SERO in various cohorts and communities. However, the prevalence SERO among healthcare workers is still being analyzed. The present study reports on initial sero-surveillance conducted on healthcare workers at a regional hospital system in Orange County, California, during May and June, 2020. Study participants were recruited from the entire hospital employee workforce and the independent medical staff. Data were collected for job title, location, covid-19 symptoms, a PCR test history, travel TRANS record since January 2020, and existence of household contacts TRANS with covid-19. A blood SERO sample was collected from each subject for serum SERO analysis for IgG antibodies SERO to SARS-CoV-2. Of 3,013 tested individuals, a total 2,932 were included in the analysis due to some missing data. Observed prevalence SERO of 1.06% (31 antibody SERO positive cases), adjusted prevalence SERO of 1.13% for test sensitivity SERO and specificity were identified. Significant group differences between positive vs. negative were observed for age TRANS (z = 2.65, p = .008), race (p = .037), presence of fever MESHD fever HP (p < .001) and loss of smell (p < .001). Possible explanation for this low prevalence SERO includes a relatively low local geographic community prevalence SERO (~4.4%) at the time of testing, the hospital's timely procurement of personal protective equipment, rigorous employee education, patient triage and treatment protocol development and implementation. In addition, possible greater presence of cross-reactive adaptive T cell mediated immunity in healthcare workers vs. the general population may have contributed. Determining antibody SERO prevalence SERO in front-line workers, and duration of antibody SERO presence may help stratify the workforce for risk, establish better health place policies and procedures, and potentially better mitigate transmission TRANS.

    Aneurysmal Subarachnoid Haemorrhage After COVID-19 Infection MESHD

    Authors: Sajjad Muhammad; Soheil Naderi; Mostafa Ahmadi; Askar Ghorbani; Daniel Hänggi

    doi:10.21203/rs.3.rs-48374/v1 Date: 2020-07-24 Source: ResearchSquare

    BackgroundSARS-CoV-2 virus infection MESHD leads to a severe and dysbalanced inflammatory response with hypercytokinemia and immunodepression. Systemic inflammation MESHD due to viral infections MESHD can potentially cause vascular damage including disruption of blood SERO-brain barrier (BBB) and alterations in coagulation system that may also lead to cardiovascular and neurovascular events. Here, we report the first case of COVID-19 infection MESHD leading to aneurysmal subarachnoid haemorrhage (aSAH). Case DescriptionA 61-year-old woman presented with dyspnea MESHD dyspnea HP, cough MESHD cough HP and fever MESHD fever HP. She was over weight with Body MESHD mass-index of 34 and history of hypertension MESHD hypertension HP. No history of subarachnoid hemorrhage MESHD subarachnoid hemorrhage HP in the family. She was admitted in ICU due to low oxygen saturation (89%). A chest CT showed typical picture of COVID-19 pneumonia MESHD pneumonia HP. Oropharyngeal swab with a PCR-based testing was COVID-19 positive. She was prescribed with favipiravir and hydroxychloroquine in Addition to oxygen support. On second day she experienced sudden headache MESHD headache HP and losst conciousness. A computer tomography (CT) with CT-angiography revealed subarachnoid haemorrhage in basal cisterns from a ruptured MESHD anterior communicating artery aneurysm MESHD. The aneurysm MESHD was clipped microsurgically through a standard pterional approach and the patient was admitted again to intensive care unit for further intensive medical treatment. Post-operative the patient showed slight motor dysphasia HP. No other neurological deficits.ConclusionAneurysmal subarachnoid haemorrhage secondary to COVID-19 infection MESHD might be triggered by systemic inflammation MESHD. COVID-19 infection MESHD could be one of the risk factors leading to instability and rupture MESHD of intracranial aneurysm MESHD.

    COVID-19 Case Series at UnityPoint Health St. Lukes Hospital in Cedar Rapids, IA

    Authors: Daniel E McGrail; Dianna Edwards

    doi:10.1101/2020.07.17.20156521 Date: 2020-07-19 Source: medRxiv

    A retrospective, descriptive study of all patients tested for SARS-CoV2 on admission for illness to a community hospital in Iowa from 3/21/20 thru 6/14/20 consisted of evaluation as to demographics, presentation and hospital course. Ninety-one patients were SARS-CoV2 PCR+ with 63% being male TRANS and a median age TRANS of 60. Cardiovascular disease MESHD was a significant comorbidity in the PCR+ group. Fever MESHD Fever HP, cough MESHD cough HP, dyspnea MESHD dyspnea HP, nausea MESHD nausea HP, emesis, diarrhea MESHD diarrhea HP, headache MESHD headache HP and myalgias MESHD myalgias HP were significantly more common in that group, as was an elevated CRP, LDH, serum SERO ferritin and transaminases. Overall survival of the COVID-19 patients was 88%, 77% in the critically ill, 59% of those mechanically ventilated and 33% of those requiring new dialysis. Survival was 93% in those not receiving any antivirals. Survival of those treated with hydroxychloroquine-azithromycin was 92%, compared to 86% of those treated with hydroxychloroquine alone. The latter two groups were significantly more ill than the untreated group. A transition from an early intubation strategy to aggressive utilization of high flow nasal cannula and noninvasive ventilation(i.e BiPAP) was successful in freeing up ICU resources.

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

    Authors: Peter Okholm MD; Jan Kampmann MD

    doi:10.21203/rs.3.rs-44654/v1 Date: 2020-07-17 Source: ResearchSquare

    Background: Coronavirus disease MESHD 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 MESHD has a multitude of clinical presentations, and especially the development of acute kidney injury MESHD acute kidney injury HP has been associated with increased mortality.Case Presentation: A 71-year old Caucasian male TRANS was admitted with fever MESHD fever HP and dyspnea MESHD dyspnea HP to the emergency MESHD department. His medical history included type 2 diabetes and hypertension MESHD hypertension HP. 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 and transferred to the intensive care ward where he developed acute anuric kidney failure 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 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.

    Comparison of Clinical Features on Admission Between Coronavirus Disease MESHD 2019 and Influenza A among Children TRANS: A Retrospective Study in China

    Authors: Feng Liang; Xianfeng Wang; Hui Li; Jun Chen; Lei Liu; Jianbo Shao; Yi Xu; Liya He; Huiying Liang; Kuanrong Li; Sitang Gong; Huimin Xia

    doi:10.21203/rs.3.rs-44748/v1 Date: 2020-07-17 Source: ResearchSquare

    Background: Coronavirus disease MESHD 2019 (COVID-19) share similar symptoms with influenza A (IA), but it is more worthwhile to understand the disparities of the two infections MESHD regarding their clinical characteristics on admission. Methods: A total of 71 age TRANS-matched pediatric IA and COVID-19 patient pairs were formed and their clinical data on admission were compared. Results: Fever MESHD Fever HP, cough MESHD cough HP, nasal congestion and nausea MESHD nausea/vomiting HP/ vomiting MESHD were the most common symptoms on admission for both infections MESHD but occurred less often in COVID-19. The IA patients were more likely to have lower-than-normal levels of lymphocyte count and percentage and to have higher-than-normal levels of activated partial thromboplastin time, prothrombin time, serum SERO C-reactive protein, and serum SERO procalcitonin, while the COVID-19 patients had higher odds of having lower-than-normal levels of neutrophil count and percentage.Conclusions: This study suggests that influenza A is more symptomatic than COVID-19 for children TRANS and might be an overall more severe infection HP infection MESHD at the time of admission. 

    Analysis of Clinical Imaging Characteristics of Patients with 2019-nCoV

    Authors: Hao Jiang; WEI GUO; Huijie Jiang; Ruoshui Zheng; Ziao Wang; Ru Yi; Baomin Su; Li Sun

    doi:10.21203/rs.3.rs-44768/v1 Date: 2020-07-17 Source: ResearchSquare

    Background: This article retrospectively analyzed the clinical characteristics and CT characteristics of chest CT of 10 patients with coronavirus disease MESHD 2019 (COVID-19) diagnosed in Heilongjiang Province. Methods: A retrospective analysis of 10 COVID-19 patients confirmed by designated hospitals in Heilongjiang Province. Results: The clinical manifestations were mainly fever MESHD fever HP (80%) and cough MESHD cough HP (50%). Laboratory tests showed elevated C-reactive protein (70%) and serum SERO amyloid A (80%). CT mainly manifests as ground-glass opacity (100%) in the lung, more than two lung lobes (90%), and the lesions are mostly located in the right upper lobe (80%), and lobular septum thickening (60%) is common.Conclusions: In this group of patients with COVID-19, the typical CT manifestations are double lung sheet ground-glass opacity, which are mainly distributed in the subpleural area, and the range of involvement is more than or equal to two lung lobes, “paving stones” changes; pulmonary lesions were absorbed and fibrous cord foci were formed during the transition period. It is worth noting that hilum, mediastinal lymphadenopathy HP lymphadenopathy MESHD, and pleural effusion MESHD pleural effusion HP are less common. During the study period, follow-up imaging performed by some patients showed mild / moderate disease progression MESHD and gradually dissipating.

    Acute Demyelinating Encephalomyelitis MESHD (ADEM) in COVID-19 infection MESHD: A Case Series.

    Authors: Michaela McCuddy; Praful Kelkar; Yu Zhao; David Wicklund

    doi:10.1101/2020.07.15.20126730 Date: 2020-07-17 Source: medRxiv

    Objective: To report three patients infected with COVID-19 with severe respiratory syndrome MESHD requiring intubation, who developed acute demyelinating encephalomyelitis MESHD (ADEM). Method: Patient data were obtained from medical records from the North Memorial Health Hospital, Robbinsdale, MN, USA Results: Three patients (two men and one woman, aged TRANS 38 - 63) presented with fatigue MESHD fatigue HP, cough MESHD cough HP and fever MESHD fever HP leading to development of acute respiratory distress HP syndrome MESHD secondary to COVID-19 infection MESHD requiring intubation and ventilatory support. Two patients were unresponsive, one with strong eye deviation to the left and the third patient had severe diffuse weakness. MRI in all patients showed findings consistent with ADEM. CSF showed elevated protein in all patients with normal cell count and no evidence of infection MESHD, including negative COVID-19 PCR. All three of the patients received Convalescent plasma SERO therapy for COVID-19. All patients were treated with intravenous corticosteroids and improved, although two responded minimally. Two patients treated with IVIG showed no further improvement. Conclusion: Neurological complications from COVID-19 are being rapidly recognized. Our three cases highlight the occurrence of ADEM as a postinfectious/immune mediated complication of COVID-19 infection MESHD, which may be responsive to corticosteroid treatment. Early recognition of this complication and treatment is important to avoid long term complications.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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