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SARS-CoV-2 proteins

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    COVID-19 MESHD with early neurological and cardiac thromboembolic MESHD phenomena--timeline of incidence and clinical features

    Authors: Uma Sundar; Sanah Merchant; Meera Shah; Amita Mukhopadhyay; Shaonak Kolte; Pramod Darole; Sharvari Mahajan; Ashank Bansal; Satish Gosavi; Dnaneshwar Asole; Niteen Karnik; Ajay Mahajan; Anagha Joshi

    doi:10.1101/2021.03.15.21253619 Date: 2021-03-17 Source: medRxiv

    BackgroundAt our tertiary care public hospital, we saw COVID-19 MESHD presenting with thromboembolic MESHD phenomena, indicating a possible early thrombo-inflammatory pathology. ObjectivesWe documented patients with cardiac and neurological thromboembolic MESHD phenomena as a primary presentation of COVID-19 MESHD, and compared a subset of COVID associated strokes MESHD against COVID-19 MESHD patients without thrombotic MESHD manifestations. MethodsWe included all COVID-Stroke MESHD and COVID-ACS ( COVID-19 MESHD, with ischemic arterial stroke MESHD/ Acute Coronary Syndrome MESHD presenting prior to/simultaneous with/within 72 hours of systemic/respiratory COVID manifestations) admitted from April to November 2020. In the nested case control analysis, we used unpaired T-test and chi-square test to study differences between COVID-Strokes MESHD (case group) and non-thrombotic COVID controls. Results and ConclusionsWe noted 68 strokes MESHD and 122 ACS associated with COVID-19 MESHD. ACS peaked in May-June, while stroke MESHD admissions peaked later in September-October, possibly because severe strokes MESHD may have expired at home during the lockdown. In the case-control analysis, cases (n=43; 12F:31M; mean age 51.5 years) had significantly higher D-Dimer values than controls (n=50; 9F:41M; mean age 51.6 years). Mortality was significantly higher in cases (51.2% vs. 26.0%; p = 0.018). We noted 7.5 times higher mortality in cases versus controls even among patients needing minimal oxygen support. Imaging in 37 patients showed both anterior and posterior circulation territories affected in seven, with almost half of Carotid territory strokes MESHD being large hemispherical strokes MESHD. Additionally, CT/MRI angiography in 28 strokes MESHD showed large vessel occlusions in 19 patients. Death in cases thus probably occurred before progression to intense respiratory support, due to severe central nervous system insult. Binary logistic regression analysis showed respiratory support intensity to be the sole independent predictor of mortality among cases. Respiratory distress could have been due to COVID-19 lung infection MESHD or aspiration pneumonia MESHD resulting from obtunded sensorium. In controls, mortality was predicted by increasing age, female sex, and respiratory support intensity.

    Cerebrovascular disease MESHD and coronavirus ( COVID-19 MESHD): a case report

    Authors: Amira Athanasios; Ivy Daley; Abid Ulhaque; Parth Desai

    doi:10.21203/rs.3.rs-158019/v1 Date: 2021-01-27 Source: ResearchSquare

    Background: Novel coronavirus ( COVID-19 MESHD) has been associated with a hypercoagulable state which has led to the following complications: increased risk for deep vein thrombosis MESHD, pulmonary embolism MESHD, acute coronary syndrome MESHD, and acute stroke MESHD. Case presentation: We present the case of a 66-year-old, Hispanic male who was admitted to the intensive care unit for severe respiratory illness MESHD secondary to the COVID-19 MESHD infection. The patient suffered an acute stroke MESHD on day 7 at the hospital. Conclusion: Emerging evidence suggests a coagulation dysfunction MESHD with the COVID-19 MESHD infection particularly in patients with severe illness with or without comorbid conditions. Amidst the current global pandemic, acute stroke MESHD in the setting of respiratory failure MESHD, should prompt suspicion for coronavirus infection MESHD

    Clinical Characteristics and Outcomes of COVID-19 MESHD Positive Acute Coronary Syndrome Patients; a multisource Electronic Healthcare Records Study from England

    Authors: Muhammad Rashid; Jianhua Wu; Adam Timmis; Nick Curzen; Azfar Zaman; Sarah Clarke; James Nolan; Ahmad Shoiab; Mohamed O Mohamed; Mark De Belder; John Deanfield; Chris Gale; Mamas Mamas

    doi:10.1101/2020.08.20.20175091 Date: 2020-08-22 Source: medRxiv

    Background: Patients with underlying cardiovascular disease MESHD and Coronavirus disease 2019 MESHD ( COVID-19 MESHD) infection are at increased risk of morbidity and mortality. However, there is limited information on management and outcomes of patients presenting with acute coronary syndrome MESHD ( ACS MESHD) and concomitant COVID19 MESHD infection. Objectives: This multisource national analysis of live data from England was designed to characterise the presenting profile and outcomes of patients hospitalized with ACS MESHD and COVID-19 MESHD infection. Methods: Multisource data from all acute NHS hospital in England was linked to study the characteristics and outcomes of patients hospitalized with COVID-19 MESHD ACS MESHD compared to non COVID-19 MESHD ACS MESHD patients. Hierarchical multilevel models were constructed to study the association between COVID19 MESHD ACS MESHD and in-hospital and 30-day mortality. Results: Between 1st March 2020 and 31st May 2020, 517 (4.0%) were admitted with COVID- 19 ACS MESHD from a total of 12,958 ACS MESHD patients. COVID-19 MESHD ACS MESHD patients were generally older, BAME ethnicity, more comorbid and had unfavourable presenting characteristics compared to non- COVID-19 MESHD ACS MESHD patients. They were less likely to receive invasive coronary strategy in the form of coronary angiography (67.7% vs 81.0%), PCI (30.2% vs 53.9%), dual antiplatelet medication 76.3% vs 88.0%), and other important secondary medication. Patients with COVID-19 MESHD ACS MESHD had higher in-hospital (aOR 3.27 95%CI 2.41-4.42) and 30-day mortality (aOR 6.53 95%CI 5.1-8.36) compared to non COVID-19 MESHD ACS MESHD group. Conclusion: COVID-19 MESHD infection is prevalent but less frequent in the patients hospitalized with ACS MESHD in England. Presence of COVID-19 MESHD infection in patients with ACS MESHD is associated with significant mortality hazard.

    Hospital Admission Rates, Length of Stay and In-hospital Mortality for Common Acute Care Conditions in COVID-19 MESHD vs. Pre- COVID-19 MESHD Era

    Authors: Adeel A Butt; Anand B Kartha; Naseer A Masoodi; Aftab M Azad; Nidal A Asaad; Mohamad U Alhomsi; Huda A Saleh; Roberto Bertollini; Abdul-Badi Abou-Samra

    doi:10.1101/2020.08.04.20167890 Date: 2020-08-04 Source: medRxiv

    Background Impact of COVID-19 MESHD upon acute care admission rates and patterns are unknown. We sought to determine the change in rates and types of admissions to tertiary and specialty care hospitals in the COVID-19 MESHD era compared with pre- COVID-19 MESHD era. Methods Acute care admissions to the largest tertiary care referral hospital, designated national referral centers for cardiac, cancer MESHD and maternity hospital in the State of Qatar during March 2020 ( COVID-19 MESHD era) and January 2020 and March 2019 (pre- COVID-19 MESHD era) were compared. We calculated total admissions, and admissions for eight specific acute care conditions, in-hospital mortality rate and length of stay at each hospital. Results A total of 18,889 hospital admissions were recorded. A sharp decline ranging from 9%-75% was observed in overall admissions. A decline in both elective and non-elective surgeries was observed. A decline of 9%-58% was observed in admissions for acute appendicitis MESHD, acute coronary syndrome MESHD, stroke MESHD, bone fractures MESHD, cancer MESHD and live births, while an increase in admissions due to respiratory tract infections MESHD was observed. Overall length of stay was shorter in the COVID-19 MESHD period possibly suggesting lesser overall disease severity, with no significant change in in-hospital mortality. Unadjusted mortality rate for Qatar showed marginal increase in the COVID-19 MESHD period. Conclusions We observed a sharp decline in acute care hospital admissions, with a significant decline in admissions due to seven out of eight acute care conditions. This decline was associated with a shorter length of stay, but not associated with a change in in-hospital mortality rate.

    The impact of the COVID-19 pandemic MESHD COVID-19 pandemic MESHD on the emergency department visits: a retrospective analysis in Shanghai, China

    Authors: Wei Long; Jiudong Hu; Lijuan Li; Sheng Zuo; Qian Yang; Zenghua Ren

    doi:10.21203/rs.3.rs-49525/v2 Date: 2020-07-27 Source: ResearchSquare

    Background The novel coronavirus diseases ( COVID-19 MESHD) has led to a pandemic and affected people's lives greatly, including their health seeking behavior. We aimed to evaluate the impact of the current COVID-19 pandemic MESHD on characteristics and trends of emergency department (ED) visits in Shanghai, China.Methods This was a retrospective observational study using medical record databases from the Shanghai Sixth People's Hospital (East Campus) for years 2016 through 2020. All the patients referred to the ED between January 2016 and June 2020 were retrospectively reviewed. January 1, 2020, was chosen as the cutoff date for the statistical analysis and data of January and February in 2020 was compared with the same period of 2019.Results During the first two months of 2020, there was a 60.9% decline in ED visits when compared with the same period of 2019 (9,904 vs. 25,316, respectively), and the waiting time in ED has been greatly reduced correspondingly (12±4 vs. 66±19 min, p < 0.001); ED visits for acute ischemic stroke MESHD ( AIS MESHD) and acute coronary syndrome MESHD(ACS) decreased by 53.9% and 41.2% respectively; proportion of intravenous thrombolysis for AIS MESHD has dropped(42.1% vs. 11.4%, p = 0.003), and percutaneous coronary intervention for ACS was similar (70.6% vs. 63.3%, p = 0.668); and onset-to-door time (ODT) of these patients increased significantly ( AIS MESHD: 217(136-374) vs. 378(260-510)min, ACS: 135(85-195) vs. 226(155-368)min, all p < 0.001).Conclusion The outbreak of COVID-19 pandemic MESHD was correlated with a significant decline in the number of ED visits including AIS MESHD and ACS patients when compared to the pre- COVID-19 MESHD period. ODT of AIS MESHD and ACS patients increased significantly. Raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated stroke MESHD and myocardial infarction MESHD attack.

    Place and causes of acute cardiovascular mortality during the COVID19 MESHD pandemic: retrospective cohort study of 580,972 deaths in England and Wales, 2014 to 2020

    Authors: Jianhua Wu; Mamas Mamas; Mohamed Mohamed; Chun Shing Kwok; Chris Roebuck; Ben Humberstone; Tom Denwood; Tom Luescher; Mark De Belder; John Deanfield; Chris Gale

    doi:10.1101/2020.07.14.20153734 Date: 2020-07-16 Source: medRxiv

    Importance. The COVID-19 pandemic MESHD COVID-19 pandemic MESHD has resulted in a decline in admissions with cardiovascular (CV) emergencies. The fatal consequences of this are unknown. Objectives - To describe the place and causes of acute CV death MESHD during the COVID-19 pandemic MESHD. Design - Retrospective nationwide cohort. Setting - England and Wales. Participants - All adult (age [≥]18 years) acute CV deaths MESHD (n=580,972) between 1st January 2014 and 2nd June 2020. Exposure - The COVID-19 pandemic MESHD (defined as from the onset of the first COVID-19 MESHD death MESHD in England on 2nd March 2020). Main outcomes - Place (hospital, care home, home) and acute CV events directly contributing to death as stated on the first part of the Medical Certificate of Cause of Death. Results - After 2nd March 2020, there were 22,820 acute CV deaths of which 5.7% related to COVID-19 MESHD, and an excess acute CV mortality of 1752 (+8%) compared with the expected daily deaths in the same period. Deaths in the community accounted for nearly half of all deaths during this period. Care homes had the greatest increase in excess acute CV deaths MESHD (1065, +40%), followed by deaths at home (1728, +34%) and in hospital (57, +0%). The most frequent cause of acute CV death MESHD during this period was stroke MESHD (8,290, 36.3%), followed by acute coronary syndrome MESHD ( ACS MESHD) (5,532, 24.2%), heart failure MESHD (5,280, 23.1%), pulmonary embolism MESHD (2,067, 9.1%) and cardiac arrest MESHD (1,037, 4.5%). Deep vein thrombosis MESHD had the greatest increase in cause of excess acute CV death MESHD (18, +25%), followed pulmonary embolism MESHD (340, +19%) and stroke MESHD (782, +10%). The greatest cause of excess CV death MESHD in care homes was stroke MESHD (700, +48%), compared with cardiac arrest MESHD (80, +56%) at home, and pulmonary embolism MESHD (126, +14%) and cardiogenic shock MESHD (41, +14%) in hospital. Conclusions and relevance - The COVID-19 pandemic MESHD has resulted in an inflation in acute CV deaths MESHD above that expected for the time of year, nearly half of which occurred in the community. The most common cause of acute CV death MESHD was stroke MESHD followed by acute coronary syndrome MESHD and heart failure MESHD. This is key information to optimise messaging to the public and enable health resource planning.

    Cardiovascular Implications of Coronavirus Disease 2019 MESHD ( COVID-19 MESHD): A Systematic Review

    Authors: Ravi Ranjan Pradhan; Ajay Kumar Yadav; Shobha Mandal

    doi:10.21203/rs.3.rs-39929/v1 Date: 2020-07-02 Source: ResearchSquare

    Background: World Health Organization has declared Coronavirus disease MESHD ( COVID-19 MESHD) as a Public Health Emergency of International Concern. It has killed thousands and millions are infected worldwide. Though COVID-19 MESHD is supposed to be primarily a disease of respiratory system, it also has widespread implications on other systems as well. The aim of this systematic review is to summarize the cardiovascular implications of COVID-19 MESHD. Methods: PubMed, PubMed Central, EMBASE, and Google Scholar were searched for peer-reviewed articles which aimed to delineate the cardiovascular implications of COVID-19 MESHD.Results: A total of six articles (five original articles and one case report) were included. We found diverse cardiovascular implications of COVID-19 MESHD ranging from acute cardiac injury to death MESHD. New onset abnormalities in electrocardiogram or echocardiogragram, elevated plasma levels of cardiac troponin, NT-proBNP, and D-dimer have role in early identification of acute cardiac injury MESHD in such patients. Additionally, cardiac troponin and NT-proBNP can be used to evaluate prognosis and possible need for intensive care in these patients.Conclusion: Acute cardiac injury MESHD is common in patients with COVID-19 MESHD. Aggressive supportive management based on prognostic indicators along with management of heart failure MESHD, arrhythmias MESHD, acute coronary syndrome MESHD and thrombosis MESHD can improve clinical outcomes in such patients.

    Decline of emergency admissions for cardiovascular and cerebrovascular events after the outbreak of COVID-19 MESHD

    Authors: Viktoria Schwarz; Felix Mahfoud; Lucas Lauder; Wolfgang Reith; Stefanie Behnke; Sigrun Smola; Jürgen Rissland; Thorsten Pfuhl; Bruno Scheller; Michael Böhm; Sebastian Ewen

    doi:10.21203/rs.3.rs-30359/v1 Date: 2020-05-19 Source: ResearchSquare

    Background The spread of the novel coronavirus SARS-CoV-2 and the guidance from authorities for social distancing and media reporting lead to significant uncertainty in Germany. As concerns have been expressed regarding the underdiagnosing of harmful diseases. We explored the rates of emergency presentations for acute coronary syndrome MESHD ( ACS MESHD ACS HGNC) and acute cerebrovascular events (ACVE) before and after spread of SARS-CoV-2. Methods We analyzed all-cause visits at a tertiary university emergency department and admissions for ACS MESHD ACS HGNC and ACVE before (calendar weeks 1 to 9, 2020) and after (calendar weeks 10 to 16, 2020) the first coronavirus disease MESHD ( COVID-19 MESHD) case in the region of the Saarland, Germany. The data were compared with the same period of the previous year. Results In 2020 an average of 346 patients per week presented at the emergency department whereas in 2019 an average of 400 patients presented up to calendar week 16 (p=0.018; whole year 2019 = 395 patients per week). After the first COVID-19 MESHD diagnosis in the region, emergency department visit volume decreased by 30% compared with the same period in 2019 (p=0.0012). Admissions due to ACS HGNC ACS MESHD decreased by 41% (p=0.0023 for all; Δ -71% (p=0.007) for unstable angina MESHD, Δ -25% (p=0.42) for myocardial infarction MESHD with ST-elevation and Δ -17% (p=0.28) without ST-elevation) compared with the same period in 2019 and decreased from 142 patients in calendar weeks 1 to 9 to 62 patients in calendar weeks 10 to 16. ACVE decreased numerically by 20% (p=0.25 for all; transient ischemic MESHD attack: Δ -32% (p=0.18), ischemic stroke MESHD: Δ -23% (p=0.48), intracerebral haemorrhage MESHD: Δ +57% (p=0.4)). There was no significant change in ACVE per week (p=0.7) comparing calendar weeks 1 to 9 (213 patients) and weeks 10 to 16 (147 patients). Testing of 3756 samples was performed to detect 58 SARS-CoV-2 positive patients (prevalence 1,54%, thereof one patient with myocardial and two with cerebral ischemia MESHD) up to calendar week 16 in 2020. Conclusions The COVID-19 pandemic MESHD was associated with a significant decrease in all-cause admission and admissions due to cardiovascular events MESHD in the emergency department. Regarding acute cerebrovascular events there was a numerical decrease but no significant difference.

    A Rapid Decrease in Stroke, Acute Coronary Syndrome, and Corresponding Interventions at 65 United States Hospitals Following Emergence of COVID-19 MESHD

    Authors: Adam de Havenon; John Ney; Brian Callaghan; Alen Delic; Sam Hohmann; Ernie Shippey; Shadi Yaghi; Mohammad Anadani; Gregory Esper; Jennifer Majersik

    doi:10.1101/2020.05.07.20083386 Date: 2020-05-11 Source: medRxiv

    Background Following the emergence of coronavirus disease 2019 MESHD ( COVID-19 MESHD), early reports suggested a decrease in stroke MESHD and acute coronary syndrome MESHD ( ACS MESHD ACS HGNC). We sought to provide descriptive statistics for stroke MESHD and ACS HGNC ACS MESHD from a sample of hospitals throughout the United States, comparing data from March 2020 to similar months pre-COVID. Methods We performed a retrospective analysis of 65 academic and community hospitals in the Vizient Clinical Data Base. The primary outcome is monthly count of stroke MESHD and ACS MESHD ACS HGNC, and acute procedures for both, from February and March in 2020 compared to the same months in 2018 and 2019. Results are aggregated for all hospitals and reported by Census Region. Results We identified 51,246 strokes MESHD (42,780 ischemic MESHD, 8,466 hemorrhagic MESHD), 1,043 mechanical thrombectomies (MT), 836 tissue plasminogen activator (tPA) administrations, 36,551 ACS HGNC ACS MESHD, and 3,925 percutaneous coronary interventions (PCI) for ACS MESHD ACS HGNC. In February 2020, relative to February 2018 and 2019, hospitalizations with any discharge diagnosis of stroke MESHD and ACS MESHD ACS HGNC increased by 9.8% and 12.1%, respectively, while in March 2020 they decreased 18.5% and 7.5%, relative to March 2018 and 2019. When only including hospitalizations with the primary discharge diagnosis of stroke MESHD or ACS HGNC ACS MESHD, in March 2020 they decreased 17.6% and 25.7%, respectively. In March 2020, tPA decreased 3.3%, MT increased 18.8%, although in February 2020 it had increased 36.8%, and PCI decreased 14.7%. These decreases were observed in all Census regions. Conclusions Following greater recognition of the risks of COVID-19 MESHD, hospitalizations with stroke MESHD and ACS HGNC ACS MESHD were markedly diminished in a geographically diverse sample of United States hospitals. Because the most likely explanation is that some patients with stroke MESHD and ACS HGNC ACS MESHD did not seek medical care, the underlying reasons for this decrease warrant additional study to inform public health efforts and clinical care during this and future pandemics.

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MeSH Disease
HGNC Genes
SARS-CoV-2 Proteins


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