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SARS-CoV-2 proteins

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    Clinical course and outcomes of critically ill COVID-19 MESHD patients in two successive pandemic waves

    Authors: Athanasios Chalkias; Ioannis Pantazopoulos; Nikolaos Papagiannakis; Anargyros Skoulakis; Eleni Laou; Konstantina Kolonia; Nicoletta Ntalarizou; Christos Kampolis; Luis Garcia de Guadiana Romualdo; Konstantinos Tourlakopoulos; Athanasios Pagonis; Salim S Hayek; Jesper Eugen-Olsen; Konstantinos Gourgoulianis; Eleni Arnaoutoglou

    doi:10.1101/2021.02.26.21251848 Date: 2021-03-02 Source: medRxiv

    Rationale: The progress of COVID-19 MESHD from moderate to severe may be precipitous, while the heterogenous characteristics of the disease pose challenges to the management of these patients. Objectives: To characterize the clinical course and outcomes of critically ill MESHD patients with COVID-19 MESHD during two successive waves. Methods: We leveraged the multi-center SuPAR in Adult Patients With COVID-19 MESHD (SPARCOL) study and collected data from consecutive patients requiring admission to the intensive care unit from April 1st to November 30th, 2020. Measurements and Main Results: Of 252 patients, 81 (32%) required intubation and mechanical ventilation. Of them, 17 (20.9%) were intubated during the first wave, while 64 (79%) during the second wave. The most prominent difference between the two waves was the overall survival (first wave 58.9% vs. second wave 15.6%, adjusted p-value=0.006). This difference is reflected in the prolonged hospitalization during the first wave. The mean ICU length of stay (19.1 vs. 11.7 days, p=0.022), hospital length of stay (28.5 vs. 17.1 days, p=0.012), and days on ventilator (16.7 vs. 11.5, p=0.13) were higher during the first wave. A significant difference between the two waves was the development of bradycardia MESHD. In the first wave, 2 (11.7%) patients developed sinus bradycardia MESHD only after admission to the intensive care unit, while in the second wave, 63 (98.4%) patients developed sinus bradycardia MESHD during hospitalization. Conclusions: Survival of critically ill MESHD patients with COVID-19 MESHD was significantly lower during the second wave. The majority of these patients developed sinus bradycardia MESHD during hospitalization.

    Impact of an Intermediate Respiratory Care Unit on Clinical Outcomes of COVID-19 MESHD Patients

    Authors: Guillermo Suarez-Cuartin; Merce Gasa; Guadalupe Bermudo; Yolanda Ruiz-Albert; Marta Hernandez-Argudo; Alfredo Marin; Pere Trias-Sabria; Ana Cordoba; Albert Ariza; Joan Sabater; Nuria Romero; Cristina Subirana; Maria Molina-Molina; Salud Santos

    doi:10.21203/rs.3.rs-124213/v1 Date: 2020-12-08 Source: ResearchSquare

    Background: Many severe COVID-19 MESHD patients require respiratory support and monitoring. An intermediate respiratory care unit (IMCU) may be a valuable element for optimizing patient care and limited health-care resources management. We aim to assess the impact of an IMCU in the management of severe COVID-19 MESHD.Methods: Observational, retrospective study including patients admitted to the IMCU due to COVID-19 MESHD pneumonia MESHD during the months of March and April 2020. Patients were stratified based on their requirement of transfer to the intensive care unit (ICU) and on survival status at the end of follow-up. A multivariable Cox proportional hazards method was used to assess risk factors associated with mortality.Results: A total of 253 patients were included. Of them, 68% were male and median age was 65 years (IQR 18 years). Ninety-two patients (36.4%) required ICU transfer. Patients transferred to the ICU had a higher mortality rate (44.6% Vs 24.2%; p<0.001). Multivariable proportional hazards model showed that age ³65 years (HR 4.14; 95%CI 2.31-7.42; p<0.001); chronic respiratory conditions (HR 2.34; 95%CI 1.38-3.99; p=0.002) and chronic kidney disease MESHD ( HR MESHD 2.96; 95%CI 1.61-5.43; p<0.001) were independently associated with mortality. High-dose systemic corticosteroids followed by progressive dose tapering showed a lower risk of death (HR 0.15; 95%CI 0.06-0.40; p<0.001). Conclusions: IMCU allow to safely and effectively manage severe COVID-19 MESHD patients requiring respiratory support and non-invasive monitoring, therefore reducing ICU burden. Older age and chronic respiratory or renal conditions MESHD are associated with worse clinical outcomes, while treatment with systemic corticosteroids may have a protective effect on mortality.

    Beneficial Effect of Corticosteroids in Preventing Mortality in Patients Receiving Tocilizumab to Treat Severe COVID-19 MESHD Illness

    Authors: Manuel Rubio-Rivas; Mar Ronda; Ariadna Padulles; Francesca Mitjavila; Antoni Riera-Mestre; Carlos Garcia-Forero; Adriana Iriarte; Jose M Mora; Nuria Padulles; Monica Gonzalez; Xavier Solanich; Merce Gasa; Guillermo Suarez; Joan Sabater; Xose L Perez-Fernandez; Eugenia Santacana; Elisabet Leiva; Albert Ariza-Sole; Paolo D Dallaglio; Maria Quero; Antonio Soriano; Alberto Pasqualetto; Maylin Koo; Virginia Esteve; Arnau Antoli; Rafael Moreno; Sergi Yun; Pau Cerda; Mariona Llaberia; Francesc Formiga; Marta Fanlo; Abelardo Montero; David Chivite; Olga Capdevila; Ferran Bolao; Xavier Pinto; Josep Llop; Antoni Sabate; Jordi Guardiola; Josep M Cruzado; Josep Comin-Colet; Salud Santos; Ramon Jodar; Xavier Corbella

    doi:10.1101/2020.08.31.20182428 Date: 2020-09-01 Source: medRxiv

    Introduction: On the basis of the preliminary report from the RECOVERY trial, the use of dexamethasone or alternative corticosteroids (CS) is currently recommended in severe COVID-19 MESHD patients requiring supplemental oxygen. However, last updated recommendations have not taken a position either for or against the use of other immunomodulators such as tocilizumab (TCZ), with or without CS, since results are still limited. Methods: From March 17 to April 7, 2020, a real-world observational retrospective analysis was conducted at our 750-bed university hospital to study the characteristics and risk factors for mortality in patients with severe COVID-19 MESHD treated with TCZ, with or without CS, in addition to standard of care (SOC). Data were obtained from routine clinical practice, stored in electronic medical records. The main outcome was all-cause in-hospital mortality. Results: A total of 1,092 COVID-19 MESHD patients were admitted during the study period. Of them, 186 (17%) were treated with TCZ, of which 129 (87.8%) in combination with CS. Of the total 186, 155 (83.3 %) patients were receiving non-invasive ventilation when TCZ, with or without CS was initiated. Mean time from symptoms onset and hospital admission to TCZ use was 12 (SD 4.3) and 4.3 days (SD 3.4), respectively. Overall, 147 (79%) survived and 39 (21%) died. By multivariate analysis, mortality was associated with older age (HR=1.09, p<0.001), chronic heart failure MESHD (HR=4.4, p=0.003), and chronic liver disease MESHD ( HR MESHD=4.69, p=0.004). The use of CS, in combination with TCZ, was the main protective factor against mortality (HR=0.26, p<0.001) in such severe COVID-19 MESHD patients receiving TCZ. No serious superinfections were observed after a 30-day follow-up. Conclusions: In severe COVID-19 MESHD patients receiving TCZ due to systemic host-immune inflammatory response syndrome, the use of CS in combined therapy with TCZ, was the main protective factor against in-hospital mortality.

    Correlation between meteorological factors and COVID-19 MESHD infection in the Belem Metropolitan Region

    Authors: Felix Lelis da Silva; Maryjane Diniz A. Gomes; Andrea Pereira Lelis da Silva; Samio Costa de Sousa; Marcos Francisco Serafim de Souza; Gabriel Lelis P. da Silva

    doi:10.1101/2020.06.10.20127506 Date: 2020-06-12 Source: medRxiv

    Many factors can influence then spread of viruses and respiratory infections MESHD. Studies have suggested that there is a direct relationship between environmental issues and population density with cases of COVID-19 MESHD. In this sense, this research aims to analyze, through correlational study and Krigagem, the relationship of meteorological and demographic variables with cases of COVID-19 MESHD in regions of subtropical climate in Brazil. The results suggest that population and demographic density (hab/km2) are risk factors for the spread of SAR-CoV-2 and an increase in the daily case record of COVID-19 MESHD. The distribution of cases according to age group did not present a significant disparity between men and women. Relative humidity (RH)%, average temperature Celsius, minimum temperature Celsius, maximum temperature Celsius, wind speed m/s and daily precipitation (rain) mm show negative relationships with cases of COVID-19 MESHD in regions of humid equatorial climate. Analysis between associations of environmental factors, wind, temperature and HR MESHD in a region is extremely important to understand the dynamics of SARS-CoV-2 in the environment. In the northern region of Brazil, low wind speed, high temperatures and high RH are observed, environmental factors that, when associated, reduce the transmission process because it hinders the movement of the virus in the environment. In this sense, it is suggested that the transmission of SARS-CoV-2 in this region is disseminated through fluids in the air between man/man and by contact between objects/men. Therefore, strategic public policies to combat the pandemic must consider the environmental factors of the regions involved and control and/or blocking the transit of people.

    Survival and predictors of deaths of patients hospitalized due to COVID-19 MESHD from a retrospective and multicenter cohort study in Brazil

    Authors: Marquiony Santos; Eudes ES Lucena; Kenio C Lima; Andiara AC Brito; Monica B Bay; Diego Bonfada

    doi:10.1101/2020.06.07.20125047 Date: 2020-06-09 Source: medRxiv

    The epidemic caused by COVID-19 MESHD in Brazil is associated with an unfavorable political scenario, aggravated by intense social inequality and low number of available hospital beds. Therefore, this study aimed to analyze the survival of patients admitted to Brazilian hospitals due to the COVID-19 MESHD and estimate prognostic factors. This is a retrospective, multicenter cohort study, based on data from 46285 hospitalizations for COVID-19 MESHD in Brazil. Survival functions were calculated using the Kaplan-Meier method. The Log-rank test compared the survival functions for each variable and from that, hazard ratios were calculated and the proportional hazards model was used in Cox multiple regression. The smallest survival curves were the ones for patients at the age of 68 years or more, black / brown race, illiterate, living in the countryside, dyspnea MESHD, respiratory distress, influenza-like outbreak, O2 saturation <95%, X-ray change, length of stay in the ICU, invasive ventilatory support, previous heart disease MESHD, pneumopathy, diabetes MESHD, down' s syndrome MESHD, neurological disease MESHD and kidney disease MESHD. Better survival was observed in the symptoms and in an asthmatic patient. The multiple model for increased risk of death MESHD when they were admitted to the ICU HR MESHD 1.28 (95% CI 1.21;1.35), diabetes HR MESHD 1.17 (95% CI 1.11;1.24), neurological disease HR MESHD 1.34 (95% CI 1.22;1.46), kidney disease HR MESHD 1.11 (95% CI 1.02;1.21), heart disease HR MESHD 1.14 (95% CI 1.08;1.20), black or brown race of HR 1.50 (95% CI 1.43;1.58), asthma HR MESHD 0.71 (95% CI 0.61;0.81) and pneumopathy HR 1.12 (95% CI 1.02;1.23). The overall survival time was low in hospitalizations for COVID-19 MESHD and this reinforces the importance of sociodemographic and clinical factors as a prognosis for death MESHD. The lack of a protocol for scientific clinical management puts a greater risk of death MESHD for about 80 million Brazilians, who are chronically ill or living in poverty. COVID-19 MESHD can promote selective mortality that borders the eugenics of specific social segments in Brazil.

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MeSH Disease
HGNC Genes
SARS-CoV-2 Proteins


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