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SARS-CoV-2 proteins

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    Vascular Comorbidities Worsen Prognosis of Patients with Heart Failure Hospitalized with COVID-19 MESHD

    Authors: Jacob Mok; Juan Carlos Malpartida; Joshua Davis; Cuilan Gao; Harish Manyam

    doi:10.1101/2021.03.23.21254209 Date: 2021-03-26 Source: medRxiv

    Background: Prior diagnosis of heart failure MESHD ( HF MESHD) is associated with increased length of hospital stay (LOS) and mortality from Coronavirus disease-2019 ( COVID-19 MESHD). Associations between substance use, venous thromboembolism MESHD ( VTE MESHD), or peripheral arterial disease MESHD ( PAD MESHD) and its effects on LOS or mortality in patients with HF MESHD hospitalized with COVID-19 MESHD remains unknown. Objective: This study identified risk factors associated with poor in-hospital outcomes among patients with HF MESHD hospitalized with COVID-19 MESHD. Methods: Case control study was conducted of patients with prior diagnosis of HF MESHD hospitalized with COVID-19 MESHD at an academic tertiary care center from January 1, 2020 to February 28, 2021. Patients with HF MESHD hospitalized with COVID-19 MESHD with risk factors were compared with those without risk factors for clinical characteristics, length of stay (LOS), and mortality. Multivariate regression was conducted to identify multiple predictors of increased LOS and in-hospital mortality in patients with HF MESHD hospitalized with COVID-19 MESHD. Results: Total of 211 HF MESHD patients were hospitalized with COVID-19 MESHD. Females had longer LOS than males (9 days vs. 7 days; p < 0.001). Compared with patients without peripheral arterial disease MESHD ( PAD MESHD) or ischemic stroke MESHD, patients with PAD MESHD or ischemic stroke MESHD had longer LOS (7 days vs. 9 days; p = 0.012 and 7 days vs. 11 days, p < 0.001; respectively). Older patients (aged 65 and above) had increased in-hospital mortality compared to younger patients (Adjusted OR: 1.04; 95% CI: 1.00-1.07; p = 0.036). VTE MESHD increased mortality more than three-fold in patients with HF MESHD hospitalized with COVID-19 MESHD (Adjusted OR: 3.33; 95% CI: 1.29-8.43; p = 0.011). Conclusion: Vascular diseases increase LOS and mortality in patients with HF MESHD hospitalized with COVID-19 MESHD.

    Identifying Sequential Complication and Mortality Patterns in Diabetes Mellitus: Comparisons of Machine Learning Methodologies

    Authors: Jiandong Zhou; Sharen Lee; Wing Tak Wong; Tong Liu; Leonardo Roever; Kamalan Jeevaratnam; William KK Wu; Ian CK Wong; Gary Tse; Qingpeng Zhang

    doi:10.1101/2020.12.21.20248646 Date: 2020-12-22 Source: medRxiv

    Background: Diabetes mellitus MESHD-related complications adversely affect the quality of life. Better risk-stratified care through mining of sequential complication patterns is needed to enable early detection and prevention. Methods: Univariable and multivariate logistic regression was used to identify significant variables that can predict mortality. A sequence analysis method termed Prefixspan was applied to identify the most common couple, triple, quadruple, quintuple and sextuple sequential complication patterns in the directed comorbidity pathology network. A knowledge enhanced CPT HGNC+ (KCPT+) sequence prediction model is developed to predict the next possible outcome along the progression trajectories of diabetes MESHD-related complications. Findings: A total of 14,144 diabetic MESHD patients (51% males) were included. Acute myocardial infarction MESHD (AMI) without known ischaemic heart disease MESHD ( IHD MESHD) (odds ratio [OR]: 2.8, 95% CI: [2.3, 3.4]), peripheral vascular disease MESHD (OR: 2.3, 95% CI: [1.9, 2.8]), dementia MESHD (OR: 2.1, 95% CI: [1.8, 2.4]), and IHD MESHD with AMI (OR: 2.4, 95% CI: [2.1, 2.6]) are the most important multivariate predictors of mortality. KCPT+ shows high accuracy in predicting mortality (F1 score 0.90, ACU 0.88), osteoporosis MESHD (F1 score 0.86, AUC 0.82), ophthalmological complications (F1 score 0.82, AUC 0.82), IHD MESHD with AMI (F1 score 0.81, AUC 0.85) and neurological complications MESHD (F1 score 0.81, AUC 0.83) with a particular prior complication sequence. Interpretation: Sequence analysis identifies the most common pattern characteristics of disease-related complications efficiently. The proposed sequence prediction model is accurate and enables clinicians to diagnose the next complication earlier, provide better risk-stratified care, and devise efficient treatment strategies for diabetes mellitus MESHD patients.

    Patterns of Multimorbidity and Risk of Severe SARS-CoV-2 Infection MESHD: an observational study in the U.K.

    Authors: Yogini V Chudasama; Francesco Zaccardi; Clare L Gillies; Cameron Razieh; Thomas Yates; David E Kloecker; Alex V Rowlands; Melanie J Davies; Nazrul Islam; Samuel Seidu; Nita G Forouhi; Kamlesh Khunti

    doi:10.1101/2020.10.21.20216721 Date: 2020-10-23 Source: medRxiv

    Background Pre-existing comorbidities have been linked to SARS-CoV-2 infection MESHD but evidence is sparse on the importance and pattern of multimorbidity (2 or more conditions) and severity of infection indicated by hospitalisation or mortality. We aimed to use a multimorbidity index developed specifically for COVID-19 MESHD to investigate the association between multimorbidity and risk of severe SARS-CoV-2 infection MESHD. Methods We used data from the UK Biobank linked to laboratory confirmed test results for SARS-CoV-2 infection MESHD and mortality data from Public Health England between March 16 and July 26, 2020. By reviewing the current literature on COVID-19 MESHD we derived a multimorbidity index including: 1) angina MESHD; 2) asthma; 3) atrial fibrillation MESHD; 4) cancer MESHD; 5) chronic kidney disease MESHD; 6) chronic obstructive pulmonary disease MESHD; 7) diabetes mellitus MESHD; 8) heart failure MESHD; 9) hypertension MESHD; 10) myocardial infarction MESHD; 11) peripheral vascular disease MESHD; 12) stroke MESHD. Adjusted logistic regression models were used to assess the association between multimorbidity and risk of severe SARS-CoV-2 infection MESHD (hospitalisation or death MESHD). Potential effect modifiers of the association were assessed: age, sex, ethnicity, deprivation, smoking status, body mass index, air pollution, 25-hydroxyvitamin D, cardiorespiratory fitness MESHD, high sensitivity C-reactive protein HGNC. Results Among 360,283 participants, the median age was 68 [range, 48-85] years, most were White (94.5%), and 1,706 had severe SARS-CoV-2 infection MESHD. The prevalence of multimorbidity was more than double in those with severe SARS-CoV-2 infection MESHD (25%) compared to those without (11%), and clusters of several multimorbidities were more common in those with severe SARS-CoV-2 infection MESHD. The most common clusters with severe SARS-CoV-2 infection MESHD were stroke MESHD with hypertension MESHD (79% of those with stroke MESHD had hypertension MESHD); diabetes MESHD and hypertension MESHD (72%); and chronic kidney disease MESHD and hypertension MESHD (68%). Multimorbidity was independently associated with a greater risk of severe SARS-CoV-2 infection MESHD (adjusted odds ratio 1.91 [95% confidence interval 1.70, 2.15] compared to no multimorbidity). The risk remained consistent across potential effect modifiers, except for greater risk among men. Conclusion The risk of severe SARS-CoV-2 infection MESHD is higher in individuals with multimorbidity, indicating the need to target research and resources in people with SARS-CoV-2 infection MESHD and multimorbidity.

    Don’t stop walking: an in-home rehabilitation program for peripheral artery disease patients during the COVID-19 MESHD COVID-19 MESHD pandemic.

    Authors: Nicola Lamberti; Sofia Straudi; Roberto Manfredini; Alfredo De Giorgi; Vincenzo Gasbarro; Paolo Zamboni; Fabio Manfredini

    doi:10.21203/rs.3.rs-86871/v1 Date: 2020-10-02 Source: ResearchSquare

    Aims: We studied the outcomes of peripheral artery disease MESHD ( PAD MESHD) patients enrolled in a structured in-home walking program before the lockdown due to the SARS-CoV-2 epidemic emergency MESHD, to determine whether this intervention ensured the maintenance of mobility in the case of strict movement restrictions.Methods: We considered 83 patients (age 72±11, males n=65) enrolled in a rehabilitation program based on two daily 8-minute sessions of slow intermittent in-home walking at a prescribed cadence with circa-monthly hospital visits. During the lockdown period, the program was updated by phone. The 6-minute (6MWD) and pain MESHD-free walking distance (PFWD) were measured pre- and postlockdown. Body weight (BW), blood pressure (BP), and the ankle-brachial index (ABI) were also determined.Results: Sixty-six patients were measured 117±23 days after their previous visit. A safe, pain MESHD-free execution the prescribed sessions, with a median distance covered of 74 km, was reported. Overall, the 6MWD was stable, while PFWD improved (p<0.001). Decreased BW with stable BP and ABI values were also recorded. When considering the outcome values according to the time of enrollment before the lockdown, new-entry subjects (≤3 months; n=35) obtained significant improvements, while those previously enrolled (>3 months; n= 31) were stable.Conclusion: In PAD MESHD patients, a structured exercise program easily performed in a home corridor and guided with phone assistance was adhered to by patients and showed effectiveness in maintaining mobility and risk factor control during the COVID-19 MESHD COVID-19 MESHD pandemic. Safe structured exercise may involve frail subjects regardless of walking ability, type of home and external conditions.

    The global impact of the first Coronavirus Disease 2019 MESHD ( COVID-19 MESHD) pandemic wave on vascular services

    Authors: - Vascular and Endovascular Research Network; Ruth A Benson; Sandip Nandhra

    doi:10.1101/2020.07.16.20153593 Date: 2020-07-17 Source: medRxiv

    Background: The Coronavirus Disease 2019 MESHD ( COVID-19 MESHD) pandemic is having an unprecedented impact on healthcare delivery. This international qualitative study captured the global impact on vascular patient care during the first pandemic wave. Methods: An online structured survey was used to collect regular unit-level data regarding the modification to a wide range of vascular services and treatment pathways on a global scale. Results: The survey commenced on 23rd March 2020 worldwide. Over six weeks, 249 vascular units took part in 53 countries (465 individual responses). Overall, 65% of units stopped carotid surgery for anyone except patients with crescendo symptoms or offered surgery on a case-by-case basis, 25% only intervened for symptomatic aortic aneurysms MESHD cancelling all elective repairs. For patients with symptomatic peripheral arterial disease MESHD 60% of units moved to an endovascular-first strategy. For patients who had previously undergone endovascular aortic aneurysm MESHD repair, 31.8% of units stopped all postoperative surveillance. Of those units regularly engaging in multidisciplinary team meetings, 59.5% of units stopped regular meetings and 39.1% had not replaced them. Further, 20% of units did not have formal personal protective equipment (PPE) guidelines in place and 25% reported insufficient PPE availability. Conclusions: The COVID-19 pandemic MESHD has had a major impact on vascular services worldwide. There will be a significant vascular disease MESHD burden awaiting screening and intervention after the pandemic.

    The 4C Initiative (Clinical Care for Cardiovascular disease in the COVID-19 pandemic MESHD COVID-19 pandemic MESHD): monitoring the indirect impact of the coronavirus pandemic on services for cardiovascular diseases in the UK

    Authors: - TC CVD-COVID-UK Consortium; Simon Ball; Amitava Banerjee; Colin Berry; Jonathan Boyle; Benjamin Bray; William Bradlow; Afzal Chaudhry; Rikki Crawley; John Danesh; Alastair Denniston; Florian Falter; Jonine Figueroa; Christopher Hall; Harry Hemingway; Emily Jefferson; Tom Johnson; Graham King; Ken Lee; Paul McKean; Suzanne Mason; Nicholas Mills; Ewen Pearson; Munir Pirmohamed; Michael TC Poon; Rouven Priedon; Anoop Shah; Reecha Sofat; Jonathan Sterne; Fiona Strachan; Cathie LM Sudlow; Zsolt Szarka; William Whiteley; Mike Wyatt

    doi:10.1101/2020.07.10.20151118 Date: 2020-07-11 Source: medRxiv

    Background: The coronavirus ( COVID-19 MESHD) pandemic affects cardiovascular diseases MESHD ( CVDs MESHD) directly through infection and indirectly through health service reorganisation and public health policy. Real-time data are needed to quantify direct and indirect effects. We aimed to monitor hospital activity for presentation, diagnosis and treatment of CVDs MESHD during the pandemic to inform on indirect effects. Methods: We analysed aggregate data on presentations, diagnoses and treatments or procedures for selected CVDs MESHD (acute coronary syndromes, heart failure MESHD, stroke MESHD and transient ischaemic attack MESHD, venous thromboembolism MESHD, peripheral arterial disease MESHD and aortic aneurysm MESHD) in UK hospitals before and during the COVID-19 MESHD epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends. Findings: Nine hospitals across England and Scotland contributed hospital activity data from 28 Oct 2019 (pre- COVID-19 MESHD) to 10 May 2020 (pre-easing of lockdown), and for the same weeks during 2018-2019. Across all hospitals, total admissions and emergency department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1-58.6%) and 52.9% (52.2-53.5%) respectively compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1-2 weeks before lockdown, and fell by 31-88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm MESHD repair and peripheral arterial disease MESHD procedures. Compared with before the first UK COVID-19 MESHD (31 January 2020), activity declined across diseases and specialties between the first case and lockdown (total ED attendances RR 0.94, 0.93-0.95; total hospital admissions RR 0.96, 0.95-0.97) and after lockdown (attendances RR 0.63, 0.62-0.64; admissions RR 0.59, 0.57-0.60). There was limited recovery towards usual levels of some activities from mid-April 2020. Interpretation: Substantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.

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MeSH Disease
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