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Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Cerebral Microvascular Injury in Severe COVID-19

    Authors: John Conklin; Matthew P. Frosch; Shibani Mukerji; Otto Rapalino; Mary Maher; Pamela W. Schaefer; Michael H. Lev; Ramon G. Gonzalez; Sudeshna Das; Samantha N. Champion; Colin Magdamo; Pritha Sen; George Kyle Harrold; Haitham Alabsi; Erica Normandin; Bennett Shaw; Jacob Lemieux; Pardis Sabeti; John A. Branda; Emery N. Brown; M. Brandon Westover; Susie Y. Huang; Brian L Edlow

    doi:10.1101/2020.07.21.20159376 Date: 2020-07-24 Source: medRxiv

    IMPORTANCE: Microvascular lesions are common in patients with severe COVID-19. Radiologic-pathologic correlation in one case suggests a combination of microvascular hemorrhagic and ischemic lesions that may reflect an underlying hypoxic mechanism of injury, which requires validation in larger studies. OBJECTIVE: To determine the incidence, distribution, and clinical and histopathologic correlates of microvascular lesions in patients with severe COVID-19. DESIGN: Observational, retrospective cohort study: March to May 2020. SETTING: Single academic medical center. PARTICIPANTS: Consecutive patients (16) admitted to the intensive care unit with severe COVID-19, undergoing brain MRI for evaluation of coma MESHD coma HP or focal neurologic deficits. EXPOSURES: Not applicable. MAIN OUTCOME AND MEASURES: Hypointense microvascular lesions identified by a prototype ultrafast high-resolution susceptibility-weighted imaging (SWI) MRI sequence, counted by two neuroradiologists and categorized by neuroanatomic location. Clinical and laboratory data (most recent measurements before brain MRI). Brain autopsy and cerebrospinal fluid PCR for SARS-CoV 2 in one patient who died from severe COVID-19. RESULTS: Eleven of 16 patients (69%) had punctate and linear SWI lesions in the subcortical and deep white matter, and eight patients (50%) had >10 SWI lesions. In 4/16 patients (25%), lesions involved the corpus callosum. Brain autopsy in one patient revealed that SWI lesions corresponded to widespread microvascular injury, characterized by perivascular and parenchymal petechial hemorrhages MESHD and microscopic ischemic lesions. CONCLUSIONS AND RELEVANCE: SWI lesions are common in patients with neurological manifestations of severe COVID-19 ( coma MESHD coma HP and focal neurologic deficits). The distribution of lesions is similar to that seen in patients with hypoxic respiratory failure HP, sepsis MESHD sepsis HP, and disseminated intravascular coagulation MESHD disseminated intravascular coagulation HP. Collectively, these radiologic and histopathologic findings suggest that patients with severe COVID-19 are at risk for multifocal microvascular hemorrhagic and ischemic lesions in the subcortical and deep white matter.

    Machine learning based prognostic model for predicting infection MESHD susceptibility of COVID-19 using health care data 

    Authors: R Srivatsan; Prithviraj N Indi; Swapnil Agrahari; Siddharth Menon; Dr. S. Denis Ashok

    doi:10.21203/rs.3.rs-46681/v1 Date: 2020-07-21 Source: ResearchSquare

    From public health perspectives of COVID-19 pandemic, accurate estimates of infection MESHD severity of individuals are extremely valuable for the informed decision making and targeted response to an emerging pandemic.  This paper presents machine learning based prognostic model for providing early warning to the individuals for COVID-19 infection MESHD using the health care data set. In the present work, a prognostic model using Random Forest classifier and support vector regression is developed for predicting the susceptibility of COVID-19 infection MESHD and it is applied on an open health care data set containing 27 field values. The typical fields of the health care data set include basic personal details such as age TRANS, gender TRANS, number of children TRANS in the household, marital status along with medical data like Coma MESHD Coma HP score, Pulmonary score, Blood SERO Glucose level, HDL cholesterol etc. An effective preprocessing method is carried out for handling the numerical, categorical values (non-numerical), missing data in the health care data set. Principal component analysis is applied for dimensionality reduction of the health care data set. From the classification results, it is noted that the random forest classifier provides a higher accuracy as compared to Support vector regression for the given health data set. Proposed machine learning approach can help the individuals to take additional precautions for protecting against COVID-19 infection MESHD. Based on the results of the proposed method, clinicians and government officials can focus on the highly susceptible people for limiting the pandemic spread. Methods In the present work, Random Forest classifier and support vector regression techniques are applied to a medical health care dataset containing 27 variables for predicting the susceptibility score of an individual towards COVID-19 infection MESHD and the accuracy of prediction is compared. An effective preprocessing is carried for handling the missing data in the health care data set. Principal Component Analysis is carried out on the data set for dimensionality reduction of the feature vectors. Results From the classification results, it is noted that the Random Forest classifier provides an accuracy of 90%, sensitivity SERO of 94% and specificity of 81% for the given medical data set.Conclusion Proposed machine learning approach can help the individuals to take additional precautions for protecting people from the COVID-19 infection MESHD, clinicians and government officials can focus on the highly susceptible people for limiting the pandemic spread. 

    Validation and comparison of PICTURE analytic and Epic Deterioration Index for COVID-19

    Authors: Brandon C Cummings; Sardar Ansari; Jonathan R Motyka; Guan Wang; Richard P Medlin Jr.; Steven L Kronick; Karandeep Singh; Pauline K Park; Lena M Napolitano; Robert P Dickson; Michael R Mathis; Michael W Sjoding; Andrew J Admon; Kevin R Ward; Christopher E Gillies

    doi:10.1101/2020.07.08.20145078 Date: 2020-07-10 Source: medRxiv

    Introduction The 2019 coronavirus (COVID-19) has led to unprecedented strain on healthcare facilities across the United States. Accurately identifying patients at an increased risk of deterioration may help hospitals manage their resources while improving the quality of patient care. Here we present the results of an analytical model, PICTURE (Predicting Intensive Care Transfers and other UnfoReseen Events), to identify patients at a high risk for imminent intensive care unit (ICU) transfer, respiratory failure HP, or death MESHD with the intention to improve prediction of deterioration due to COVID-19. We compare PICTURE to the Epic Deterioration Index (EDI), a widespread system which has recently been assessed for use to triage COVID-19 patients. Methods The PICTURE model was trained and validated on a cohort of hospitalized non-COVID-19 patients using electronic health record data from 2014-2018. It was then applied to two hold-out test sets: non-COVID-19 patients from 2019 and patients testing positive for COVID-19 in 2020. PICTURE results were aligned to the EDI for head-to-head comparison via Area Under the Receiver Operator Curve (AUROC) and Area Under the Precision Recall SERO Curve (AUPRC). We compared the models' ability to predict an adverse event (defined as ICU transfer, mechanical ventilation use, or death MESHD) at two levels of granularity: (1) maximum score across an encounter with a minimum lead time before the first adverse event and (2) predictions at every observation with instances in the last 24 hours before the adverse event labeled as positive. PICTURE and the EDI were also compared on the encounter level using different lead times extending out to 24 hours. Shapley values were used to provide explanations for PICTURE predictions. Results PICTURE successfully delineated between high- and low-risk patients and consistently outperformed the EDI in both of our cohorts. In non-COVID-19 patients, PICTURE achieved an AUROC (95% CI) of 0.819 (0.805 - 0.834) and AUPRC of 0.109 (0.089 - 0.125) on the observation level, compared to the EDI AUROC of 0.762 (0.746 - 0.780) and AUPRC of 0.077 (0.062 - 0.090). On COVID-19 positive patients, PICTURE achieved an AUROC of 0.828 (0.794 - 0.869) and AUPRC of 0.160 (0.089 - 0.199), while the EDI scored an AUROC of 0.792 (0.754 - 0.835) and AUPRC of 0.131 (0.092 - 0.159). The most important variables influencing PICTURE predictions in the COVID-19 cohort were a rapid respiratory rate, a high level of oxygen support, low oxygen saturation, and impaired mental status (Glasgow coma MESHD coma HP score). Conclusion The PICTURE model is more accurate in predicting adverse patient outcomes for both general ward patients and COVID-19 positive patients in our cohorts compared to the EDI. The ability to consistently anticipate these events may be especially valuable when considering a potential incipient second wave of COVID-19 infections MESHD. PICTURE also has the ability to explain individual predictions to clinicians by ranking the most important features for a prediction. The generalizability of the model will require testing in other health care systems for validation.

    Low-Dose Whole-Lung Radiation for COVID-19 Pneumonia MESHD Pneumonia HP: Planned Day-7 Interim Analysis of a Registered Clinical Trial

    Authors: Clayton B Hess; Zachary S Buchwald; William Stokes; Jeffrey M Switchenko; Tahseen H Nasti; Brent D Weinberg; James P Steinberg; Karen D Goddette; Rafi Ahmed; Walter J Curran; Mohammad K Khan

    doi:10.1101/2020.06.03.20116988 Date: 2020-06-08 Source: medRxiv

    Background: Individuals with advanced age TRANS and comorbidities face higher risk of death MESHD from COVID-19, especially once ventilator-dependent. Respiratory decline in COVID-19 is mediated by a pneumonic aberrant immune cytokine storm. Low-dose radiation was used to treat pneumonia MESHD pneumonia HP in the pre-antibiotic era. Radiation immunomodulatory effects may improve outcomes in COVID-19. Methods: We performed a single-institution phase I/II trial evaluating the safety and efficacy of single-fraction, low-dose, whole-lung radiation for COVID-19 pneumonia MESHD pneumonia HP. Eligible patients were hospitalized, had radiographic pneumonic infiltrates, required supplemental oxygen, and were clinically deteriorating. Results: Of nine patients screened, five were treated with whole-lung radiation from April 23-28, 2020 and followed for 7 days. Median age TRANS was 90 (range 64-94); four were nursing home residents with multiple comorbidities. Within 24 hours of radiation, three patients (60%) weaned from supplemental oxygen to ambient air, four (80%) exhibited radiographic improvement, and median Glasgow coma MESHD coma HP score improved from 10 to 14. A fourth patient (80% overall recovery) weaned from oxygen at hour 96. Mean time to clinical recovery was 35 hours. There were no acute skin, pulmonary, GI, GU toxicities. Conclusions: In a pilot trial of five oxygen-dependent patients with COVID-19 pneumonia MESHD pneumonia HP, low-dose whole-lung radiation led to rapid improvement in clinical status, encephalopathy HP, and radiographic infiltrates without acute toxicity. Low-dose whole-lung radiation is safe, shows early promise of efficacy, and warrants further study in larger prospective trials. NCT04366791

    Cytokine Release Syndrome MESHD-Associated Encephalopathy HP in Patients with COVID-19

    Authors: Peggy Perrin; Nicolas Collongues; Seyyid Baloglu; Dimitri Bedo; Xavier Bassand; Thomas Lavaux; Gabriela Gautier; Nicolas Keller; Stephane Kremer; Samira Fafi-Kremer; Bruno Moulin; Ilies Benotmane; Sophie Caillard

    id:10.20944/preprints202006.0103.v1 Date: 2020-06-07 Source: preprints.org

    Severe disease MESHD and uremia MESHD are risk factors for neurological complications of coronavirus disease MESHD-2019 (COVID-19). An in-depth analysis of a case series was conducted to describe the neurological manifestations of patients with COVID-19 and gain pathophysiological insights that may guide clinical decision-making – especially with respect to the cytokine release syndrome MESHD (CRS). Extensive clinical, laboratory, and imaging phenotyping was performed in five patients. Neurological presentation included confusion MESHD confusion HP, tremor MESHD tremor HP, cerebellar ataxia MESHD ataxia HP, behavioral alterations, aphasia MESHD aphasia HP, pyramidal syndrome MESHD, coma MESHD coma HP, cranial nerve palsy, dysautonomia, and central hypothyroidism HP hypothyroidism MESHD. Neurological disturbances were remarkably accompanied by laboratory evidence of CRS. SARS-CoV-2 was undetectable in the cerebrospinal fluid. Hyperalbuminorachy and increased levels of the astroglial protein S100B were suggestive of blood SERO-brain barrier (BBB) dysfunction. Brain MRI findings comprised evidence of acute leukoencephalitis (n = 3, of whom one with a hemorrhagic form), cytotoxic edema MESHD edema HP mimicking ischemic stroke HP stroke MESHD (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted – resulting in rapid recovery from neurological disturbances in two cases. Patients with COVID-19 can develop neurological manifestations that share clinical, laboratory, and imaging similarities with those of chimeric antigen receptor-T cell-related encephalopathy HP. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune-mediated mechanisms.

    Delirium MESHD Delirium HP Incidence, Duration and Severity in Critically Ill Patients with COVID-19

    Authors: Sikandar H Khan; Heidi Lindroth; Anthony J Perkins; Yasser Jamil; Sophia Wang; Scott Roberts; Mark O Farber; Omar Rahman; Sujuan Gao; Edward R Marcantonio; Malaz Boustani; Roberto Machado; Babar A Khan

    doi:10.1101/2020.05.31.20118679 Date: 2020-06-01 Source: medRxiv

    Background Delirium MESHD Delirium HP incidence, duration and severity in patients admitted to the intensive care unit (ICU) due to COVID-19 is not known. Methods We conducted an observational study at two large urban academic Level 1 trauma centers. Consecutive patients admitted to the ICU with a positive SARS-CoV-2 nasopharyngeal swab polymerase chain reaction test from March 1st, 2020 to April 27, 2020 were included. Individuals younger than 18 years of age TRANS, without any documented delirium MESHD delirium HP assessments (CAM-ICU), or without a discharge disposition were excluded. The primary outcomes were delirium MESHD delirium HP rates and delirium MESHD delirium HP duration and the secondary outcome was delirium MESHD delirium HP severity. Outcomes were assessed for up to the first 14 days of ICU stay. Results Of 243 consecutive patients with confirmed COVID-19 admitted to the ICU, 144 met eligibility criteria and were included in the analysis. Delirium MESHD Delirium HP occurred in 73.6% (106/144) and delirium MESHD delirium HP or coma MESHD coma HP occurred in 76.4% (110/144). Sixty-three percent of patients were positive for delirium MESHD delirium HP on the first CAM-ICU assessment. The median duration of delirium MESHD delirium HP and coma MESHD coma HP was 7 days (IQR: 3-10), and the median delirium MESHD delirium HP duration was 5 days (IQR: 2-7). The median CAM-ICU-7 score was 6 (IQR: 4-7) representing severe delirium MESHD delirium HP. Mechanical ventilation was associated with greater odds of developing delirium MESHD delirium HP (OR: 42.1, 95%CI: 13.0-137.1). Mortality was 26.4% in patients with delirium MESHD delirium HP compared to 15.8% in patients without delirium MESHD delirium HP. Conclusions 73.6% of patients admitted to the ICU with COVID-19 experience delirium MESHD delirium HP that persists for approximately 1 week. Invasive mechanical ventilation is significantly associated with odds of delirium MESHD delirium HP. Clinical attention to prevent and manage delirium MESHD delirium HP and reduce delirium MESHD delirium HP duration and severity is urgently needed for patients with COVID-19.

    Cerebrovascular complications in patients with SARS-CoV-2 infection MESHD: Case series 

    Authors: Mauro Morassi; Daniele Bagatto; Milena Cobelli; Serena D’Agostini; Gian Luigi Gigli; Claudio Bnà; Alberto Vogrig

    doi:10.21203/rs.3.rs-23137/v1 Date: 2020-04-15 Source: ResearchSquare

    Background: Italy is one of the most affected countries by the Coronavirus disease MESHD 2019 (COVID-19). The responsible pathogen is named Severe Acute Respiratory Syndrome MESHD Coronavirus (SARS-CoV-2). The clinical spectrum ranges from asymptomatic infection MESHD asymptomatic TRANS infection to severe HP pneumonia MESHD pneumonia HP leading to intensive care unit admission. Evidence of cerebrovascular complications associated with SARS-CoV-2 is limited. We herein report 6 patients who developed acute stroke MESHD stroke HP during COVID-19 infection MESHD. Methods: Retrospective case series of patients diagnosed with COVID-19 using reverse-transcriptase–polymerase-chain-reaction (RT-PCR) on nasopharyngeal swabs, who developed clinical and neuroimaging evidence of acute stroke MESHD stroke HP during SARS-CoV-2 infection MESHD.Results: Six patients were identified (5 men); median age TRANS was 69 years (range: 57-82). Stroke MESHD Stroke HP subtypes were ischemic (4, 67%) and hemorrhagic (2, 33%). All patients but 1 had pre-existing vascular risk factors. One patient developed encephalopathy HP prior to stroke MESHD stroke HP, characterized by focal seizures MESHD seizures HP and behavioral abnormalities HP. COVID-19-related pneumonia MESHD pneumonia HP was severe (i.e. requiring critical care support) in 5/6 cases (83%). Liver enzyme alteration and lactate dehydrogenase (LDH) elevation was registered in all cases. Four patients (67%) manifested acute kidney failure prior to stroke MESHD stroke HP. Four patients (67%) had abnormal coagulation tests. Outcome was poor in the majority of the patients: 4 died (67%), 1 is still in coma MESHD coma HP (20%) and the remaining 1 remains severely neurologically affected (mRS: 4).Conclusions: Acute stroke MESHD stroke HP can complicate the course of COVI-19 infection MESHD. In our series, stroke MESHD stroke HP developed mostly in patients with severe pneumonia MESHD pneumonia HP and multi organ failure, liver MESHD enzymes and LDH were markedly increased in all cases, and the outcome was poor.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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