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SARS-CoV-2 proteins

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    COVID-19 MESHD and Cognitive Impairment: Severity, Evolution, and Functional Impact during Inpatient Rehabilitation

    Authors: Ruchi Patel; Irene Savrides; Christine Cahalan; Gargi Doulatani; Michael W. O'Dell; Joan Toglia; Abhishek Jaywant

    doi:10.1101/2021.03.15.21253637 Date: 2021-03-17 Source: medRxiv

    ObjectiveTo determine the frequency, magnitude, and change in cognitive impairment MESHD in patients with COVID-19 MESHD undergoing acute inpatient rehabilitation. We secondarily evaluated correlates of cognitive impairment MESHD and the relationship between cognition and functional gain. DesignCross-sectional observational study with assessments at admission and discharge SettingAcute inpatient rehabilitation unit within a large, urban academic medical center Participants77 patients hospitalized for COVID-19 MESHD and subsequently admitted to an inpatient rehabilitation unit between March-August 2020, 45 of whom were re-assessed at discharge. InterventionsN/A Main Outcome MeasuresMontreal Cognitive Assessment ( MoCA HGNC) scores on admission and discharge (when available) and Quality Indicator for Self-Care (QI-SC) scores on admission and discharge. Results62/77 (80.5%) of patients demonstrated cognitive deficits MESHD on the MoCA HGNC at admission: 39/77 (50.6%) were mildly impaired, 20/77 (26%) moderately impaired, and 3/77 (3.9%) severely impaired. Cognitive impairment MESHD was associated with a prior history of delirium MESHD, but not age or length of acute care hospitalization. 32/45 (71.1%) patients with discharge scores improved and met the MoCA HGNC minimally clinically important difference (MCID); however, 35/45 (77.8%) continued to score in the impaired range. Patients who met the MoCA HGNC MCID demonstrated significantly greater QI-SC score gains than those that did not meet the MCID (p=.02). ConclusionCognitive impairment MESHD is common among hospitalized COVID-19 MESHD patients requiring acute inpatient rehabilitation. Cognitive impairment MESHD improves over the course of inpatient rehabilitation, and is associated with functional gain. Nonetheless, cognitive deficits MESHD frequently remain present at discharge, indicating the need for systematic assessment and follow-up, especially given the association with functional outcome.

    COVID-19 MESHD Smart Chatbot Prototype for Patient Monitoring

    Authors: Hannah Lei; Weiqi Lu; Alan Ji; Emmett Bertram; Paul Gao; Xiaoqian Jiang; Arko Barman

    id:2103.06816v1 Date: 2021-03-11 Source: arXiv

    Many COVID-19 MESHD patients developed prolonged symptoms after the infection, including fatigue MESHD, delirium MESHD, and headache MESHD. The long-term health impact of these conditions is still not clear. It is necessary to develop a way to follow up with these patients for monitoring their health status to support timely intervention and treatment. In the lack of sufficient human resources to follow up with patients, we propose a novel smart chatbot solution backed with machine learning to collect information (i.e., generating digital diary) in a personalized manner. In this article, we describe the design framework and components of our prototype.

    Clinical presentation and in-hospital outcomes of older patients hospitalized with COVID-19 MESHD in Montreal, Canada: a retrospective review

    Authors: Sandrine Couture; Marc-Antoine Lepage; Claire Godard-Sebillotte; Nadia Sourial; Catherine Talbot-Hamon; Richard Kremer; Ami Grunbaum

    doi:10.1101/2021.02.27.21252596 Date: 2021-03-01 Source: medRxiv

    BackgroundOlder adults are more vulnerable to severe infection and mortality due to COVID-19 MESHD. They often have atypical presentations of the disease without respiratory symptoms MESHD, which makes early diagnosis clinically challenging. We aimed to compare the baseline characteristics, presentation, and disease course of older and younger patients hospitalized with COVID-19 MESHD. MethodsThe charts of 429 consecutive patients hospitalized in Montreal, Canada, with PCR-confirmed COVID-19 MESHD were retrospectively reviewed. Baseline health, presentation, in-hospital complications, and outcomes were recorded. Desegregation by age was performed to compare older ([≥]70) versus younger (<70) individuals. ResultsOlder patients presented with more comorbidities compared to younger patients as captured by the Charlson Comorbidity Index (mean 6 vs 2), including higher rates of cardiovascular, cerebrovascular, chronic obstructive pulmonary MESHD, and chronic kidney disease MESHD. Older patients were less likely than younger patients to present with cough MESHD (27% vs 47%) or dyspnea MESHD (33% vs 48%). Fifty-two (52%) had no respiratory symptoms on presentation compared to 32% in the younger group (p<0.001); however, they were more likely to present with geriatric syndromes such as delirium MESHD (29% vs 7%), functional decline (14% vs 0.6%), or falls (15% vs 5%). Twelve (12%) of older patients presented with a geriatric syndrome as their sole symptom compared to 3% in the younger group (p=0.002). Older adults were more likely to develop acute kidney injury MESHD (35% vs 22%), malnutrition MESHD (9% vs 4%), delirium MESHD (29% vs 17%) and hypernatremia MESHD (32% vs 17%). They had higher in-hospital mortality (33% vs 13%, p<0.001). DiscussionOlder adults presenting to hospital with COVID-19 MESHD commonly have no respiratory symptoms and can present with only a geriatric syndrome. A new geriatric syndrome in an older person should trigger isolation and evaluation for COVID-19 MESHD. Furthermore, older adults are particularly vulnerable to complications related to dehydration MESHD, warranting early initiation of multidisciplinary care.

    Metabolomics and Computational Analysis of the Role of Monoamine Oxidase Activity in Delirium and SARS-COV-2 Infection MESHD SARS-COV-2 Infection MESHD

    Authors: Miroslava Cuperlovic-Culf; Emma L. Cunningham; Hossen Teimoorinia; Anu Surendra; Xiaobei Pan; Steffany A.L. Bennett; Mijin Jung; Bernadette McGuiness; Anthony Peter Passmore; David Beverland; Brian D. Green

    doi:10.21203/rs.3.rs-242758/v1 Date: 2021-02-15 Source: ResearchSquare

    Delirium is an acute change in attention and cognition occurring in ~65% of severe SARS-CoV-2 cases. It is also common following surgery and an indicator of brain vulnerability and risk for the development of dementia MESHD. In this work we analyzed the underlying role of metabolism in delirium MESHD-susceptibility in the postoperative setting using metabolomic profiling of cerebrospinal fluid and blood taken from the same patients prior to planned orthopaedic surgery. Distance correlation analysis and Random Forest (RF) feature selection were used to determine changes in metabolic networks. We found significant concentration 2 differences in several amino acids, acylcarnitines MESHD and polyamines linking delirium MESHD-prone patients to known factors in Alzheimer’s disease MESHD such as monoamine oxidase B HGNC ( MAOB HGNC) protein. Subsequent computational structural comparison between MAOB HGNC and angiotensin converting enzyme 2 HGNC as well as protein-protein docking analysis showed that there potentially is strong binding of SARS-CoV-2 spike PROTEIN protein to MAOB HGNC. The possibility that SARS-CoV-2 influences MAOB HGNC activity leading to the observed neurological and platelet-based complications of SARS-CoV-2 infection MESHD requires further investigation.

    The systemic inflammatory response and clinicopathological characteristics in patients admitted to hospital with COVID-19 MESHD infection: Comparison of 2 consecutive cohorts

    Authors: Donogh Maguire; Donald McMillan

    doi:10.1101/2021.02.04.21250932 Date: 2021-02-06 Source: medRxiv

    Background: In order to manage the COVID-19 MESHD systemic inflammatory response, it is important to identify clinicopathological characteristics across multiple cohorts. Methods: Electronic patient records for 2 consecutive cohorts of patients admitted to two urban teaching hospitals with COVID-19 MESHD during two 7-week periods of the COVID-19 pandemic MESHD in Glasgow, U.K. (cohort 1: 17th March 2020 - 1st May 2020) and (cohort 2: 18th May 2020 - 6th July 2020) were examined for routine clinical, laboratory and clinical outcome data. Results: Compared with cohort 1, cohort 2 were older (p<0.001), more likely to be female (p<0.05) and have less independent living circumstances (p<0.001). More patients in cohort 2 were PCR positive, CXR negative (both p<0.001) and had low serum albumin HGNC concentrations (p<0.001). 30-day mortality was similar between both cohorts (23% and 22%). Over the 2 cohorts, age >70 (p<0.001), male gender (p<0.05), hypertension MESHD (p<0.01), heart failure MESHD (p<0.05), cognitive impairment MESHD (p<0.001), frailty (p<0.001), COPD (p<0.05), delirium MESHD (p<0.001), elevated peri-operative Glasgow Prognostic Score (p<0.001), elevated neutrophil-lymphocyte ratio (p<0.001), low haematocrit (p<0.01), elevated urea (p<0.001), creatinine (p<0.001), glucose (p<0.05) and lactate (p<0.01); and the 4C score were associated with 30-day mortality. When compared with the 4C score, greater frailty (OR 10.2, 95% C.I. 3.4 to 30.6, p<0.01) and low albumin HGNC (OR 5.6, 95% C.I. 2.0 to 15.6, p<0.01) were strongly independently associated with 30-day mortality. Conclusion: In addition to the 4C mortality score, frailty score and a low albumin HGNC were strongly independently associated with 30-day mortality in two consecutive cohorts of patients admitted to hospital with COVID-19 MESHD. Article summary: In two consecutive cohorts of patients with COVID-19 MESHD infection admitted to two urban teaching hospitals in Glasgow, UK, there were variations in a number of clinicopathological characteristics despite similar mortality (23 and 22%). In these two cohorts, in a multivariate analysis that included the 4C mortality score, clinical frailty score >3, low serum albumin HGNC concentration (<35 g/L), high neutrophil-lymphocyte ratio (>5), and abnormal serum sodium concentration (<133/>145 mmol/L) remained independently associated with 30-day mortality.

    COVID-19 MESHD in Adults With Dementia MESHD: Clinical Features and Predictive Factors of Mortality. A Clinical Cohort Study on 125 Patients

    Authors: Agathe Vrillon; Elsa Mhanna; Clément Aveneau; Manon Lebozec; Lina Grosset; Diane Nankam; Fernanda Albuquerque; Raphaelle Razou Feroldi; Barbara Maakaroun; Iana Pissareva; Dalenda Cherni Gherissi; Julien Azuar; Véronique François; Claire Hourrègue; Julien Dumurgier; Lisette Volpe-Gillot; Claire Paquet

    doi:10.21203/rs.3.rs-208272/v1 Date: 2021-02-04 Source: ResearchSquare

    BACKGROUNDThere is limited evidence on the characteristics and outcome of patients with dementia MESHD hospitalized for novel coronavirus infection MESHD ( COVID-19 MESHD).METHODWe conducted a prospective study in 2 gerontologic Covid Units in Paris, France, from March 14th 2020 to May 7th 2020. Patients with dementia MESHD hospitalized for confirmed COVID-19 MESHD infection were systematically enrolled. A binary logistic regression analysis was performed to identify factors associated with mortality at 21 days.RESULTSWe included 125 patients. Median age was 86 (IQI 82-90); 59.4% were female. Most common causes of dementia MESHD were Alzheimer’s disease MESHD, mixed dementia MESHD and vascular dementia MESHD. 67.2% had ≥2 comorbidities; 40.2% lived in a long-term care facility. The most common symptoms at COVID-19 MESHD onset were confusion MESHD and delirium MESHD (82.4%), asthenia MESHD (76.8%) and fever MESHD (72.8%) before polypnea (51.2%) and desaturation (50.4%). Falls were frequent at the initial phase of the disease (35.2%). The fatality rate at 21 days was 22.4%. Chronic kidney disease MESHD and CRP at admission were independent factors of death. Persisting confusion MESHD, mood MESHD and behavioral disorders MESHD were observed in survivors (19.2%).CONCLUSION COVID-19 MESHD in demented individuals is associated with severe outcome in SARS-CoV-2 infection MESHD and is characterized by specific clinical features and complications, with confusion MESHD and delirium MESHD at the forefront. COVID‐19 testing should be considered in front of any significant change from baseline.

    Six-month Neurological and Psychiatric Outcomes in 236,379 Survivors of COVID-19 MESHD

    Authors: Maxime Taquet; John R Geddes; Masud Husain; Sierra Luciano; Paul J Harrison

    doi:10.1101/2021.01.16.21249950 Date: 2021-01-24 Source: medRxiv

    BackgroundNeurological and psychiatric MESHD sequelae of COVID-19 MESHD have been reported, but there are limited data on incidence rates and relative risks. MethodsUsing retrospective cohort studies and time-to-event analysis, we estimated the incidence of ICD-10 diagnoses in the 6 months after a confirmed diagnosis of COVID-19 MESHD: intracranial haemorrhage MESHD; ischaemic stroke MESHD; Parkinsonism MESHD; Guillain-Barre syndrome MESHD; nerve/nerve root/plexus disorders; myoneural/muscle disease MESHD; encephalitis MESHD; dementia MESHD; mood, anxiety MESHD, and psychotic disorders MESHD; substance misuse; and insomnia MESHD. Data were obtained from the TriNetX electronic health records network (over 81 million patients). We compared incidences with those in propensity score-matched cohorts of patients with influenza or other respiratory infections MESHD using a Cox model. We investigated the effect on incidence estimates of COVID-19 MESHD severity, as proxied by hospitalization and encephalopathy MESHD (including delirium MESHD and related disorders). Findings236,379 patients survived a confirmed diagnosis of COVID-19 MESHD. Among them, the estimated incidence of neurological or psychiatric MESHD sequelae at 6 months was 33.6%, with 12.8% receiving their first such diagnosis. Most diagnostic categories were commoner after COVID-19 MESHD than after influenza or other respiratory infections MESHD (hazard ratios from 1.21 to 5.28), including stroke MESHD, intracranial haemorrhage MESHD, dementia MESHD, and psychotic disorders MESHD. Findings were equivocal for Parkinsonism and Guillain-Barre syndrome MESHD. Amongst COVID-19 MESHD cases, incidences and hazard ratios for most disorders were higher in patients who had been hospitalized, and markedly so in those who had experienced encephalopathy MESHD. Results were robust to sensitivity analyses, including comparisons against an additional four index health events. InterpretationThe study provides evidence for substantial neurological and psychiatric MESHD morbidity following COVID-19 MESHD infection. Risks were greatest in, but not limited to, those who had severe COVID-19 MESHD. The information can help in service planning and identification of research priorities. FundingNational Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre.

    Neurological Disorders associated with COVID-19 MESHD Hospital Admissions : Experience of a Single Tertiary Healthcare Centre

    Authors: Permesh Singh Dhillon; Robert Dineen; Haley Morris; Radu Tanasescu; Esmaeil Nikfekr; Jonathan Evans; Cris S Constantinescu; Akram A Hosseini

    doi:10.1101/2020.11.22.20235184 Date: 2020-12-11 Source: medRxiv

    BackgroundEarly reports have detailed a range of neurological symptoms MESHD in patients with the SARS-CoV-2 infection MESHD. However, there is a lack of detailed description and incidence of the neurological disorders MESHD amongst hospitalized COVID-19 MESHD patients. We describe a range of neurological disorders MESHD (other than non-specific neurological symptoms), including their clinical, radiological and laboratory findings, encountered in our cohort COVID-19 MESHD patients admitted to a large tertiary institution. MethodsWe reviewed our prospectively collated database of all adult Neurology referrals, Neurology and Stroke MESHD admissions and Neurological multi-disciplinary MESHD team meetings for all hospitalized patients with suspected or proven COVID-19 MESHD from 17 March 2020 to 31 August 2020. ResultsTwenty-nine of 1243 COVID-19 MESHD inpatients (2.3%) presented with COVID-19 MESHD-related neurological disorders MESHD. The mean age was 68.9 +/-13.5(SD) years, age range of 34-97 years, and there were 17 males. 22 patients had confirmed, 5 were probable and 2 had suspected COVID-19 MESHD infection according to the WHO case classification. Eight patients (27%) required critical care admission. Neurological symptoms MESHD at presentation included acute confusion MESHD and delirium MESHD, seizures MESHD, and new focal neurological deficits MESHD. Based on the pre-defined neurological phenotype, COVID-19 MESHD patients were grouped into four main categories. 16 patients had cerebrovascular events (13 with acute ischaemic stroke MESHD and 3 had haemorrhagic features), 7 patients were found to have inflammatory, non-inflammatory and autoimmune encephalopathy MESHD (including 2 with known Multiple Sclerosis MESHD), whilst movement and peripheral nervous system disorders MESHD were diagnosed in 3 patients each. ConclusionAlthough the exact prevalence and aetiology remains unclear, non-sporadic new onset of neurological disorders MESHD, in addition to anosmia MESHD, occurs during the acute COVID-19 MESHD-infection. Longitudinal follow-up of these patients is required to determine the long-term effects, treatment response and outcome of the SARS-CoV-2 infection MESHD.

    Incidence, Characteristics and Clinical Relevance of Acute Stroke in Old Patients Hospitalized With COVID-19 MESHD

    Authors: Aline Mendes; François Herrmann; Laurence Genton; Christine Serratrice; Emmanuel Carrera; Maria Isabel Vargas; Gabriel Gold; Christophe Graf; Dina Zekry; Max Scheffler

    doi:10.21203/rs.3.rs-110348/v1 Date: 2020-11-17 Source: ResearchSquare

    Background: Stroke MESHD in the course of coronavirus disease MESHD ( COVID-19 MESHD) was associated with higher severity of respiratory symptoms and mortality, but little knowledge exists on older populations. We aimed to investigate the incidence, characteristics, and prognosis of acute stroke MESHD in old patients hospitalized with COVID-19 MESHD.Methods: Monocentric retrospective study of 265 older patients hospitalized with COVID-19 MESHD in geriatric wards, 11 of which having presented a stroke MESHD episode during hospitalization. Mortality rates and two-group comparisons ( stroke MESHD vs non- stroke MESHD patients) were calculated and significant variables added in logistic regression models to investigate stroke MESHD risk factors.Results: Combined ischemic MESHD and hemorrhagic stroke MESHD incidence was 4.15%. 72.7% of events occurred during acute care. Strokes MESHD presented with altered state of consciousness and/or delirium MESHD in 81.8%, followed by a focal neurological deficit MESHD in 45.5%. Ischemic stroke MESHD was more frequently unilateral (88.8%) and localized in the middle cerebral artery territory (55.5%). Smoking and a history of previous stroke MESHD increased by more than seven (OR 7.44; 95% CI 1.75-31.64; p=0.007) and five times (OR 5.19; 95% CI 1.50-17.92; p=0.009), respectively, the risk of stroke MESHD. Each additional point in body mass index (BMI) reduced the risk of stroke MESHD by 14% (OR 0.86; 95% CI 0.74-0.98; p=0.03). In-hospital mortality (32.1% vs. 27.3%; p>0.999) and institutionalization at discharge (36.4% vs. 21.1%; p=0.258) were similar between patients with and without stroke MESHD.Conclusion: Incident stroke MESHD complicating COVID-19 MESHD in old patients was associated with active smoking, previous history of stroke MESHD, and low BMI. Acute stroke MESHD did not influence early mortality or institutionalization rate at discharge.

    Excessive sedation as a risk factor for delirium: a comparison between two cohorts of critically-ill patients with and without COVID-19 MESHD

    Authors: Frank A Rasulo; Stefano Calza; Simone Piva; Mattia Marchesi; Gian Piero Nocivelli; Sergio Cattaneo; Basil Matta; Daniel Cunningham; Matteo Filippini; Francesco Terranova; Silvia Beretta; Nicola Latronico

    doi:10.21203/rs.3.rs-106501/v1 Date: 2020-11-11 Source: ResearchSquare

    Background: Excessive sedation has been associated with poor outcome in critically-ill MESHD patients with acute respiratory Distress Syndrome MESHD ( ARDS MESHD). The on-going pandemic has seen many critically-ill COVID-19 MESHD with ARDS MESHD, yet the incidence of excessive sedation and its association to delirium MESHD in these patients has to date not been assessed. We aimed at comparing the incidence and outcome of excessive sedation and delirium MESHD in two cohorts of critically-ill patients. Methods: This was an international, dual center retrospective analysis of prospectively collected data from two cohorts of critically ill patients, with and without COVID-19 MESHD disease, pertaining to two different hospital settings. Depth of sedation was monitored through processed EEG and delirium MESHD through the Confusion MESHD Assessment Method for the ICU(CAM-ICU). The main outcomes were the incidence of excessive sedation and delirium MESHD between the two cohorts, and secondary outcomes were length of ICU and hospital stay and mechanical ventilation duration.Results: Fifty-seven non- COVID-19 MESHD and 21 COVID-19 MESHD patients were included, 38(49%) of whom had ARDS MESHD. Twenty-seven(47.3%) non- COVID-19 MESHD and 11(52.3%) COVID-19 MESHD patients fulfilled the criteria for excessive sedation. Excessively sedated patients were older(p=0.034) and had delirium MESHD more frequently(p<0.001). There was a trend in excessive sedation in ARDS MESHD patients, while there was no correlation between excessive sedation and COVID-19 MESHD diagnosis. COVID-19 MESHD with ARDS MESHD was related to delirium MESHD at the limit of significance. On adjusted analysis excessive sedation was independently related to delirium MESHD(p=0.008). Patients with delirium MESHD had longer MV duration, ICU-LOS and H-LOS. In the adjusted analysis, delirium MESHD was an independent predictor of ICU-LOS(p=0.005) and MV duration(p=0.039). SAPS II MESHD was higher in the non- COVID-19 MESHD patients when compared to COVID-19 MESHD patients. Despite this, COVID-19 MESHD patients remained ventilated for a longer period of time, had a longer ICU and H-LOS. Conclusion: Besides age, excessive sedation might represent an important risk factor for delirium MESHD in COVID-19 MESHD and non- COVID-19 MESHD critically ill patients, which may lead to an increased ICU-LOS, H-LOS and MV duration. The use of continuous EEG-based monitoring for quantification of sedation depth, along with frequent delirium MESHD assessment in critically-ill COVID-19 MESHD patients is warranted along with larger prospective trials aimed at verifying weather the use of EEG-based monitoring leads to improved outcome.

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MeSH Disease
HGNC Genes
SARS-CoV-2 Proteins


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