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SARS-CoV-2 proteins

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    Protection of health care workers from exhaled air of patients operated under local, regional, spinal or epidural anaesthesia during COVID 19 pandemic

    Authors: Kuldeep Atodaria; Mayank Singh; Vimalkumar S Prajapati; Kush Shaileshkumar Shahkush; Pradipkumar Raghuvirsinh Atodaria

    doi:10.1101/2020.11.26.20192823 Date: 2020-12-02 Source: medRxiv

    The SARS-CoV-2 ( COVID-19 MESHD) pandemic mandates the use of N-95/FFP-2 masks for healthcare workers, especially in operation room (OR) for surgical or aerosol producing procedures. During pandemic, surgical interventions such as limb trauma MESHD, limb amputations, and limb malignancies MESHD continued to flow into the hospitals and are normally performed under local, regional or spinal anaesthesia. N-95/FFP-2 masks normally do not prevent escape of exhaled air to surrounding and to avoid the escape of exhaled unfiltered air, sealing masks by taping its edges to face possibly serves the purpose, but causes significant discomfort to patients. HEPA filters, high vacuum suction apparatus, and negative pressure operating-room may protect partially against the-risk of infection if patients exhaled air is infected. In order to reduce risk of transmission from patients exhaled air to the healthcare workers, a technique has been designed to divert the patients exhaled air to outside the-OR using a suction machine. This technique is easy, simple and cost-effective and trial has been performed with four-volunteers to see feasibility to breathe through N-95 mask sealed by sticking its edges to face using tape. The trial reflected reduction in SpO2, causing increased respiratory-rate, tachycardia MESHD and hypertension MESHD, in-addition an un-acclimatized volunteers had difficulty in breathing through sealed N-95 masks, which was relieved by supplying oxygen to them. Attaching suction system to remove the-exhaled air aids to comfort levels. Treating exhaled-air with sodium-hypochlorite and diverting it externally to an open-space outside the-OR added to safety for the patients, surgical team and the hospital surroundings.

    Clinical characteristics, outcomes, and risk factors for mortality in hospitalized patients with COVID-19 MESHD and cancer history: a propensity score-matched study

    Authors: Majid Sorouri; Amir Kasaeian; Helia Mojtabavi; Amir Reza Radmard; Shadi Kolahdoozan; Amir Anushiravani; Bardia Khosravi; Seyed Mohammad Pourabbas; Masoud Eslahi; Azin Sirusbakht; Marjan Khodabakhshi; Fatemeh Motamedi; Fatemeh Azizi; Reza Ghanbari; Ali Reza Sima; Soroush Rad; Mohammad Abdollahi

    doi:10.21203/rs.3.rs-98559/v1 Date: 2020-10-26 Source: ResearchSquare

    Background: COVID-19 MESHD has caused great concern for patients with underlying medical conditions. We aimed to determine the prognosis of patients with current or previous cancer MESHD with either a PCR-confirmed COVID-19 MESHD infection or a probable diagnosis according to chest CT scan.Methods: We conducted a case control study in a referral hospital on confirmed COVID-19 MESHD adult patients with and without a history of cancer MESHD from February25th to April21st, 2020. Patients were matched according to age, gender, and underlying diseases. Demographic features, clinical and Para clinical data have been extracted from medical records. Multivariable logistic regression was used to estimate odd ratios and 95% confidence intervals of each factor of interest with outcomes. Results: Fifty-three confirmed COVID-19 MESHD patients with history of cancer MESHD were recruited and compared with 106 non-cancerous COVID-19 MESHD patients. Male to female ratio was 1.33 and 45% were older than 65. Dyspnea MESHD was significantly associated with an increased rate of mortality in the cancer MESHD subgroup (p=0.013). Twenty-six patients (49%) survived among the cancer MESHD group while 89 patients (84%) survived in control (p=0.000). Patients with hematologic cancer MESHD had 63% mortality while those with solid tumors MESHD had 37%. Multivariate analysis showed that cancer MESHD, impaired consciousness MESHD, tachypnea MESHD, tachycardia MESHD, leukocytosis MESHD and thrombocytopenia MESHD were associated with an increased risk of death MESHD.Conclusion: Cancer increased mortality rate and hospital stay of COVID-19 MESHD patients and remained significant after adjustment of confounders. Compared to solid tumors MESHD, hematologic malignancies MESHD have been associated with worse consequences and higher mortality. Clinical and Para clinical indicators were not appropriate to predict death MESHD.

    Long-term COVID-19 MESHD symptoms in a large unselected population

    Authors: Elizabeth Cirulli; Kelly M Schiabor Barrett; Stephen Riffle; Alexandre Bolze; Iva Neveux; Shaun Dabe; Joseph J Grzymski; James T Lu; Nicole L Washington

    doi:10.1101/2020.10.07.20208702 Date: 2020-10-11 Source: medRxiv

    It is increasingly recognized that SARS-CoV-2 can produce long-term complications after recovery from the acute effects of infection. Here, we report the analysis of 32 self-reported short and long-term symptoms in a general adult population cohort comprised of 233 COVID-19 MESHD+ cases, 3,652 SARS-CoV-2-negative controls, and 17,474 non-tested individuals. The majority of our COVID-19 MESHD+ cases are mild, with only 8 of the 233 COVID-19 MESHD+ cases having been hospitalized. Our results show that 43.4% of COVID-19 MESHD+ cases have symptoms lasting longer than 30 days, and 24.1% still have at least one symptom after 90 days. These numbers are higher for COVID-19 MESHD+ cases who were initially more ill, 59.4% at 30 days and 40.6% at 90 days, but even for very mild and initially asymptomatic cases, 14.3% have complications persist for 30 days or longer. In contrast, only 8.6% of participants from the general untested population develop new symptoms lasting longer than 30 days due to any illness during the same study period. The long-term symptoms most enriched in those with COVID-19 MESHD are anosmia MESHD, ageusia, difficulty concentrating, dyspnea MESHD, memory loss MESHD, confusion MESHD, headache MESHD, heart palpitations MESHD, chest pain MESHD, pain MESHD with deep breaths, dizziness MESHD, and tachycardia MESHD. We additionally observe that individuals who had an initial symptom of dyspnea MESHD are significantly more likely to develop long-term symptoms. Importantly, our study finds that the overall level of illness is an important variable to account for when assessing the statistical significance of symptoms that are associated with COVID-19 MESHD. Our study provides a baseline from which to understand the frequency of COVID-19 MESHD long-term symptoms at the population level and demonstrates that, although those most likely to develop long-term COVID-19 MESHD complications are those who initially have more severe illness, even those with mild or asymptomatic courses of infection are at increased risk of long-term complications.

    A case report of greater saphenous vein thrombosis in a patient with coronavirus ( COVID-19 MESHD) infection

    Authors: Negin Hesam-Shariati; Poya Fatehi; Fardin Fathi; Morteza Abouzaripour; Mohamad Bakhtiar Hesam Shariati

    doi:10.21203/rs.3.rs-86688/v1 Date: 2020-10-01 Source: ResearchSquare

    In December 2019, the World Health Organization (WHO) announced a series of pneumonia MESHD cases caused by an unknown origin, discovered in Wuhan, China. A dangerous virus called SARS-Cov-2 (severe acute respiratory syndrome coronavirus 2) caused a disease named acute respiratory syndrome MESHD, which was later popularly called coronavirus infection MESHD ( COVID-19 MESHD). Patients with acute COVID-19 MESHD are at high risk for thrombosis MESHD in various blood vessels due to over-coagulation, blood stasis, and endothelial damage. To date, very little research has been done on the number and side effects of thromboembolic disorders MESHD in patients with COVID-19 MESHD. In this study, we report a case with COVID-19 MESHD, who was hospitalized in one of the hospitals in Sanandaj, Iran. There were symptoms of fever MESHD, chills, muscle aches MESHD, cough, and tachycardia MESHD. Laboratory tests such as CRP, ESR, Ferritin CLIA, LDH and D-Dimer were observed in this patient at a high level. Doppler ultrasound of this patient revealed an abnormal finding, thrombosis MESHD in the right greater saphenous vein. This suggests that COVID-19 MESHD may lead to other side effects through damage to blood vessels.

    The involvement of Central Nervous System and sequence variability of Severe Adult Respiratory Syndrome – Coronavirus-2 revealed in autopsy tissue samples: a case report.

    Authors: Lis Høy Marbjerg; Christina Jacobsen; Jannik Fonager; Claus Bøgelund; Morten Rasmussen; Anders Fomsgaard; Jytte Banner; Veronika Vorobieva Solholm Jensen

    doi:10.21203/rs.3.rs-61471/v1 Date: 2020-08-18 Source: ResearchSquare

    Background: The case presented here illustrates that interdisciplinary teamwork can be essential for the understanding of the COVID-19 MESHD disease presentation and enlightening of the pathophysiology. Case presentation: A 60-years-old overweight woman without any comorbidities was found dead in her apartment after 14 days of home isolation due to suspicion on the Coronavirus disease 2019 MESHD ( COVID-19 MESHD). She had reported symptoms of tachycardia MESHD, fever MESHD, and increasing respiratory difficulty one day before her death MESHD. Due to the Danish legal act on sudden deaths a forensic autopsy was performed including a thorough examination and biosampling. The results of the forensic autopsy displayed sever densified, almost airless, firm lungs, and an unspecific reactive minimal focal perivascular inflammation MESHD consisting of macrophages of the brain tissue. The final diagnosis, COVID-19 MESHD with involvement of the central nervous system was established by use of the RT-RNA analysis on cerebrospinal fluid, as well as by serologic detection of the specific antibodies for SARS-CoV-2 in cerebrospinal fluid and serum. The genetic analysis displayed a 2 % variation between SARS-CoV-2 isolates recovered from the tracheal sample, cerebrospinal fluid, and tissues from both lungs.Conclusion: The combination of all available results revealed that the cause of death MESHD was COVID-19 MESHD with severe pulmonary disease MESHD and neuroinvasion, as well as renal affection resulting in hyponatremia MESHD. To our knowledge, it was not shown previously that neuroinvasion could be confirmed by the detection of specific antibodies for SARS-CoV-2 and SARS-CoV-2 specific RNA in cerebrospinal fluid. This case supports hypotheses that SARS-CoV-2 may cause central nervous system infection MESHD. The genetic distinction between SARS-CoV-2 isolates was done by whole-genome sequencing, where the isolate recovered from the cerebrospinal fluid was the most different. 

    EPI COVID19 MESHD: Psychometric assessment and validation of a short diagnostic scale for a rapid Covid-19 MESHD screening based on reported symptoms

    Authors: Luca Bastiani; Loredana Fortunato; Stefania Pieroni; Fabrizio Bianchi; Fulvio Adorni; Federica Prinelli; Andrea Giacomelli; Gabriele Pagani; Stefania Maggi; Caterina Trevisan; Marianna Noale; Nithiya Jesuthasan; Aleksandra Sojic; Carla Pettenati; Massimo Andreoni; Raffaele Antonelli Incalzi; Massimo Galli; Sabrina Molinaro

    doi:10.1101/2020.07.22.20159590 Date: 2020-07-25 Source: medRxiv

    Background Confirmed COVID-19 MESHD cases have been reported in 213 countries and regions and as of 12 July 2020, over 12 million cases, with 561617 deaths have been reported worldwide. The number of cases changes quickly and varies depending upon which source you use to track, so in the current epidemiological context, the early recognition is critical for the rapid identification of suspected cases (with SARS-CoV-2 infection MESHD-like symptoms and signs) to be immediately subjected to quarantine measures. Although surveys are widely used for identifying COVID-19 MESHD cases, outcomes and associated risks, no validated epidemiological tool exists for surveying SARS-CoV-2 infection MESHD in the population so far. Methods Our study is the phase II of the EPI COVID19 MESHD national survey, launched in April 2020 including a national convenience sample of 201121 adults, who voluntarily filled the EPI COVID19 MESHD questionnaire. The phase II questionnaire was mailed to all subjects who underwent tests for COVID-19 MESHD by nasopharyngeal swab (NPS) and who accepted to be involved in the second phase of the study, focused on the results reported for NPS and/or serological IgG/IgM tests. We evaluated the capability of the self-reported symptoms collected through the EPI COVID19 MESHD questionnaire to discriminate the COVID-19 MESHD among symptomatic subjects, in order to identify possible cases to undergo instrumental measurements and clinical examinations. We defined a method for the identification of a total score and validated it with reference to the serological and molecular clinical diagnosis, using four standard steps: identification of critical factors, confirmation of presence of latent variable, development of optimal scoring algorithm and validation of the scoring algorithm. Findings 2703 subjects [66% response rate] completed the Phase II questionnaire. Of 2703 individuals, 694 (25.7%) were NPS MESHD(+) and of these 84 (12.1% of the 694 NPS(+)) were asymptomatic. In the individuals who performed serological testing, of the 472 who did IgG(+) and 421 who did IgM(+), 22.9% and 11.6% tested positive, respectively. Among IgG(+) 1 of 108 subjects was asymptomatic (0.9%) while 5/49 subjects among IgM(+) were asymptomatic (10.2%). Compared with NPS(-), among NPS MESHD(+) subjects there was a higher rate for Fever MESHD (421 [60.7%] vs 391[19.5% ]; p<0.0001), Loss of Taste and/or Smell (365 [52.6%] vs 239 [11.9% ]; p<0.0001) and Cough (352 [50.7%] vs 580 [28.9% ]; p<0.0001). Also for other symptoms the frequencies were significantly higher in NPS MESHD(+) subjects than in NPS(-) ones (p<0.001). Among groups with serological tests, the symptoms with higher percentages in the subjects IgG(+) were Fever MESHD (65 [60.2%] vs 43[11.8% ]; p<0.0001) and Pain MESHD in muscles, bones, joints (73 [67.6%] vs 71 [19.5% ]; p<0.0001). For the COVID-19 MESHD self-reported symptoms items, exploratory (proportion variance explained [89.9%]) and confirmatory factor analysis results ( SMSR HGNC 0.072; RMSEA 0.052) highlights the presence of one latent variable (factor) underlying the symptoms. We define the one-factor solution as EPI COVID19 MESHD diagnostic scale and optimal score for each items was identified: Respiratory problems (1.03), Chest pain MESHD (1.07), Loss of Taste and/or Smell (0.97) and Tachycardia MESHD (palpitations) (1.05) were the most important symptoms. The cut-off score was 2.56 (Sensitivity 76.56%; Specificity 68.24%) in NPS MESHD(+) and 2.59 (Se 80.37; Sp 80.17) in IgG(+) subjects.

    Syncope at SARS-CoV-2 onset due to impaired baroreflex response

    Authors: Ciro Canetta; Silvia Accordino; Elisabetta Buscarini; Gianpaolo Benelli; Giuseppe La Piana; Alessandro Scartabellati; Giovanni Vigano'; Roberto Assandri; Alberto Astengo; Chiara Benzoni; Gianfranco Gaudiano; Daniele Cazzato; Sebastiano Davide Rossi; Susanna Usai; Irene Tramacere; Giuseppe Lauria

    doi:10.1101/2020.05.29.20114751 Date: 2020-06-02 Source: medRxiv

    We describe clinical and laboratory findings in 35 consecutive patients tested positive for SARS-CoV-2 by reverse transcriptase-polymerase chain reaction on nasopharyngeal swab that presented one or multiple syncopal MESHD events at disease onset. Neurological examination and electrocardiographic findings were normal. Chest computed tomography showed findings consistent with interstitial pneumonia MESHD. Arterial blood gas analysis showed low pO2, pCO2, and P/F ratio indicating hypocapnic hypoxemia MESHD, while patients did not show the expected compensatory heart rate increase. Such mechanism could have led to syncope MESHD. We speculate that SARS-CoV-2 could have caused angiotensin-converting enzyme-2 ( ACE2 HGNC) receptor internalization in the nucleus of the solitary tract (NTS), thus altering the baroreflex response and inhibiting the compensatory tachycardia MESHD during acute hypocapnic hypoxemia MESHD.

    Covid-19 MESHD only with gastrointestinal ( GI MESHD) symptoms: case report of a 14-year-old patient 

    Authors: Ladan Goshayeshi; Nasrin Milani; Robert Bergquist; Sayyed Majid Sadrzadeh; Farnood Rajabzadeh; Benyamin Hoseini

    doi:10.21203/rs.3.rs-27389/v4 Date: 2020-05-07 Source: ResearchSquare

    Coronavirus Disease 2019 MESHD ( Covid-19 MESHD) is expanding worldwide. Although it seems to be a purely r espiratory disease, MESHD occasional reports of lesions in other organs have been published. We report here an asymptomatic child Covid-19 MESHD patient with the main symptom of a bdominal pain MESHDdistension and without any respiratory symptoms. A 14-year-old male patient with main complaints of f ever, MESHD m alaise, MESHD a norexia, MESHD and severe a bdominal pain MESHDwas admitted to a hospital in Mashhad, Iran. Laparotomy revealed distension of the small intestine and an adhesive ileo-caecal band that had produced ileum herniation without free fluid in the abdomen. Chest X-ray and high-resolution computed tomography of the lungs showed bilateral, diffuse, peripheral dense areas of ground-glass appearance. A nasopharyngeal swab for Covid-19 MESHD diagnosis, ordered due to l ymphopenia MESHDtogether with these diffuse lung infiltrations, showed a positive result. This led to drug treatment with lopinavir/ritonavir, hydroxychloroquine, ribavirin/oseltamivir and meropenem. The patient was febrile and developed t achycardia MESHDon the third day accompanied with a respiratory rate of 44/min. At this point, tracheal intubation was done but the patient died after 3 hours due to c ardiac arrest. MESHD The case report brings forth the hypothesis that the gastrointestinal manifestation may be untypical symptoms of Covid-19 MESHD i nfection, MESHD and highlights the importance for the diagnosis to be based on combined laboratory-based data and scanning imagery.

    Acute Myocardial Injury of Patients with Coronavirus Disease 2019 MESHD

    Authors: Huayan Xu; Keke Hou; Hong Xu; Zhenlin Li; Huizhu Chen; Na Zhang; Rong Xu; Hang Fu; Ran Sun; Lingyi Wen; Linjun Xie; Hui Liu; Kun Zhang; Joseph B Selvanayagam; Chuan Fu; Shihua Zhao; Zhigang Yang; Ming Yang; Yingkun Guo

    doi:10.1101/2020.03.05.20031591 Date: 2020-03-08 Source: medRxiv

    Background: Since the outbreak of the Coronavirus Disease 2019 MESHD ( COVID-19 MESHD) in China, respiratory manifestations of the disease have been observed. However, as a fatal comorbidity, acute myocardial injury MESHD ( AMI MESHD) in COVID-19 MESHD patients has not been previously investigated in detail. We investigated the clinical characteristics of COVID-19 MESHD patients with AMI MESHD and determined the risk factors for AMI MESHD in them. Methods: We analyzed data from 53 consecutive laboratory-confirmed and hospitalized COVID-19 MESHD patients (28 men, 25 women; age, 19-81 years). We collected information on epidemiological and demographic characteristics, clinical features, routine laboratory tests (including cardiac injury MESHD biomarkers), echocardiography, electrocardiography, imaging findings, management methods, and clinical outcomes. Results: Cardiac complications were found in 42 of the 53 (79.25%) patients: tachycardia MESHD (n=15), electrocardiography abnormities (n=11), diastolic dysfunction MESHD (n=20), elevated myocardial enzymes (n=30), and AMI MESHD (n=6). All the six AMI MESHD patients were aged >60 years; five of them had two or more underlying comorbidities ( hypertension MESHD, diabetes MESHD, cardiovascular diseases MESHD, and chronic obstructive pulmonary disease MESHD). Novel coronavirus pneumonia MESHD ( NCP PROTEIN) severity was higher in the AMI MESHD patients than in patients with non-definite AMI MESHD (p<0.001). All the AMI MESHD patients required care in intensive care unit; of them, three died, two remain hospitalized. Multivariate analyses showed that C-reactive protein HGNC ( CRP HGNC) levels, NCP PROTEIN severity, and underlying comorbidities were the risk factors for cardiac abnormalities MESHD in COVID-19 MESHD patients. Conclusions: Cardiac complications MESHD are common in COVID-19 MESHD patients. Elevated CRP HGNC levels, underlying comorbidities, and NCP PROTEIN severity are the main risk factors for cardiac complications in COVID-19 MESHD patients.

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