Corpus overview


MeSH Disease

Human Phenotype


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    Outcome of Conservative Therapy in COVID-19 Patients Presenting with Gastrointestinal Bleeding

    Authors: DM Shalimar; Manas Vaishnav; Anshuman Elhence; Ramesh Kumar; Srikant Mohta; Chandan Palle; Peeyush Kumar; Mukesh Ranjan; Tanmay Vajpai; Shubham Prasad; Jatin Yegurla; Anugrah Dhooria; Vikas Banyal; Samagra Agarwal; Rajat Bansal; Sulagna Bhattacharjee; Richa Aggarwal; Kapil D Soni; Swetha Rudravaram; Ashutosh K Singh; Irfan Altaf; Avinash Choudekar; Soumya J Mahapatra; Deepak Gunjan; Saurabh Kedia; Govind Makharia; Anjan Trikha; Pramod Garg; Anoop Saraya

    doi:10.1101/2020.08.06.20169813 Date: 2020-08-07 Source: medRxiv

    Background: There is a paucity of data on the management of gastrointestinal(GI) bleeding in patients with COVID-19 amid concerns about the risk of transmission TRANS during endoscopic procedures.We aimed to study the outcomes of conservative treatment for GI bleeding in patients with COVID-19. Methods: In this retrospective analysis, 24 of 1342(1.8%) patients with COVID-19, presenting with GI bleeding from 22ndApril to 22ndJuly 2020, were included. Results: The mean age TRANS of patients was 45.8+/-12.7 years; 17(70.8%) were males TRANS; upper GI(UGI) bleeding: lower GI(LGI) 23:1. Twenty-two(91.6%) patients had evidence of cirrhosis HP- 21 presented with UGI bleeding while one had bleeding from hemorrhoids MESHD hemorrhoids HP. Two patients without cirrhosis HP were presumed to have non-variceal bleeding. The medical therapy for UGI bleeding included vasoconstrictors- somatostatin in 17(73.9%) and terlipressin in 4(17.4%) patients. All patients with UGI bleeding received proton pump inhibitors and antibiotics. Packed red blood SERO cells(PRBCs), fresh frozen plasma SERO and platelets were transfused in 14(60.9%), 3(13.0%) and 3(13.0%), respectively. The median PRBCs transfused was 1(0-3) unit(s). The initial control of UGI bleeding was achieved in all 23 patients and none required an emergency MESHD endoscopy. At 5-day follow-up, none rebled or died. Two patients later rebled, one had intermittent bleed due to gastric antral vascular ectasia MESHD, while another had rebleed 19 days after discharge. Three(12.5%) cirrhosis HP patients succumbed to acute hypoxemic respiratory failure HP during hospital stay. Conclusion: Conservative management strategies including pharmacotherapy, restrictive transfusion strategy, and close hemodynamic monitoring can successfully manage GI bleeding in COVID-19 patients and reduce need for urgent endoscopy.

    Implications of Liver Injury in Risk-Stratification and Management of Patients with COVID-19

    Authors: Jiaofang Shao; Yuan Liang; Yan Li; Rong Ding; Mengyan Zhu; Wenhua You; Ziyu Wang; Bing Huang; Min Wu; Tingting Zhang; Kening Li; Wei Wu; Lingxiang Wu; Qianghu Wang; Xinyi Xia; Shukui Wang; Ling Lu

    doi:10.21203/ Date: 2020-08-04 Source: ResearchSquare

    BackgroundInfection with SARS-CoV-2 has been associated with liver dysfunction, aggravation of liver burden, and liver injury. This study aimed to assess the effects of liver injuries on the clinical outcomes of patients with COVID-19.MethodsA total of 1,564 patients with severe or critical COVID-19 from Huoshenshan Hospital, Wuhan, were enrolled. Chronic liver disease MESHD (CLD) was confirmed by consensus diagnostic criteria. Laboratory test results were compared between different groups. scRNA-seq data and bulk gene expression profiles were used to identify cell types associated with liver injury.ResultsA total of 10.98% of patients with severe or critical COVID-19 developed liver injury after admission that was associated with significantly higher rates of mortality (21.74%, p<0.001) and intensive care unit admission (26.71%, p<0.001). A pre-existing CLD was not associated with a higher risk. However, fatty liver MESHD disease MESHD and cirrhosis HP were associated with higher risks, supported by evidences from single cell and bulk transcriptome analysis that showed more TMPRSS2+ cells in these tissues. By generating a model, we were able to predict the risk and severity of liver injury during hospitalization.ConclusionWe demonstrate that liver injury occurring during therapy in patients with COVID-19 is significantly associated with the severity of disease MESHD and mortality, but the presence of CLD is not associated. We provide a risk-score model that can predict whether patients with COVID-19 will develop liver injury or proceed to higher risk stages during subsequent hospitalizations. These findings may prove beneficial for the clinical management of patients infected with SARS-CoV-2.

    Poor Outcomes in Patients with Cirrhosis HP and COVID-19

    Authors: Shalimar; Anshuman Elhence; Manas Vaishnav; Ramesh Kumar; Piyush Pathak; Kapil Dev Soni; Richa Aggarwal; Manish Soneja; Pankaj Jorwal; Arvind Kumar; Puneet Khanna; Akhil Kant Singh; Ashutosh Biswas; Neeraj Nischal; Lalit Dhar; Aashish Choudhary; Krithika Rangarajan; Anant Mohan; Pragyan Acharya; Baibaswata Nayak; Deepak Gunjan; Anoop Saraya; Soumya Mahapatra; Govind Makharia; Anjan Trikha; Pramod Garg

    doi:10.21203/ Date: 2020-07-06 Source: ResearchSquare

    Background and AimThere is a paucity of data on the clinical presentations and outcomes of Coronavirus disease MESHD 2019(COVID-19) in patients with underlying liver disease MESHD. We aimed to summarize the presentations and outcomes of COVID-19 positive patients and compare with historical controls.MethodsPatients with known chronic liver disease MESHD who presented with superimposed COVID- 19(n=28) between 22nd April and 22nd June 2020 were studied. Seventy-eight cirrhotic patients from historical controls were taken as comparison group.ResultsA total of 28 COVID patients- two without cirrhosis HP, one with compensated cirrhosis HP, sixteen with acute decompensation (AD), and nine with acute-on-chronic liver failure MESHD(ACLF) were included. The etiology of cirrhosis HP was alcohol(n=9), non-alcoholic fatty liver disease MESHD(n=2), viral(n=5), autoimmune hepatitis MESHD hepatitis HP(n=4), and cryptogenic cirrhosis HP(n=6). The clinical presentations included complications of cirrhosis HP in 12(46.2%), respiratory symptoms in 3(11.5%) and combined complications of cirrhosis HP and respiratory symptoms in 11(42.3%) patients. The median hospital stay was 8(7-12) days. The mortality rate in COVID-19 patients was 42.3%(11/26), as compared to 23.1%(18/78) in the historical controls(p=0.077). All COVID-19 patients with ACLF(9/9) died compared to 53.3%(16/30) in ACLF of historical controls(p=0.015). Mortality rate was higher in COVID patients with compensated cirrhosis HP and AD as compared to historical controls 2/17(11.8%) vs 2/48(4.2%), though not statistically significant (p=0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio, 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully.ConclusionCOVID-19 is associated with poor outcomes in patients with cirrhosis HP, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.

    Cirrhosis HP and COVID-19: a fatal case of viral peritonitis MESHD peritonitis HP and disseminated infection MESHD

    Authors: Victor Cabelho Passarelli; Ana Helena Perosa; Luciano Luna; Danielle Dias Conte; Oliver A. Nascimento; Jaquelina Ota-Arakaki; Nancy Bellei

    doi:10.1101/2020.06.25.20139998 Date: 2020-06-29 Source: medRxiv

    Pathogenesis and clinical presentation of Coronavirus Disease MESHD-19 outside the respiratory tract remain to be understood, especially in the immunocompromised. We report an unique case of cirrhosis HP decompensation with ascites MESHD ascites HP and unprecedented evidence of SARS Coronavirus-2 peritonitis MESHD peritonitis HP and disseminated infection MESHD, demonstrated by viral RNA detection in peritoneal fluid, as well as in blood SERO serum SERO, nasopharyngeal and stool specimens.

    Pre-existing liver disease MESHD is associated with poor outcome in patients with SARS CoV2 infection MESHD; The APCOLIS Study (APASL COVID-19 Liver Injury Spectrum Study)

    Authors: Shiv Kumar Sarin; Ashok Choudhury; George K Lau; Ming-Hua Zheng; Dong Ji; Sherief Abd-Elsalam; Jaeseok Hwang; Xiaolong Qi; Ian Homer Cua; Jeong Ill Suh; Jun Gi Park; Opass Putcharoen; Apichat Kaewdech; Teerha Piratvisuth; Sombat Treeprasertsuk; Sooyoung Park; Salisa Wejnaruemarn; Diana A. Payawal; Oidov Baatarkhuu; Sang Hoon Ahn; Chang Dong Yeo; Uzziel Romar Alonzo; Tserendorj Chinbayar; Imelda M. Loho; Osamu Yokosuka; Wasim Jafri; Soeksiam Tan; Lau Ing Soo; Tawesak Tanwandee; Rino Gani; Lovkesh Anand; Eslam Saber Esmail; Mai Khalaf; Shahinul Alam; Chun-Yu Lin; Wan-Long Chuang; A S Soin; Hitendra K Garg; Kemal Kalista; Badamnachin Batsukh; Hery Djagat Purnomo; Vijay Pal Dara; Pravin Rathi; Mamun Al Mahtab; Akash Shukla; Manoj K Sharma; Masao Omata

    doi:10.21203/ Date: 2020-06-18 Source: ResearchSquare

    Background and Aims: COVID-19 is a dominant pulmonary disease MESHD, with multisystem involvement, depending upon co morbidities. Its profile in patients with pre-existing chronic liver disease MESHD (CLD) is largely unknown. We studied the liver injury patterns of SARS-Cov-2 in CLD patients, with or without cirrhosis HP. Methods: Data was collected from 13 Asian countries on patients with CLD, known or newly diagnosed, with confirmed COVID-19. Result: Altogether, 228 patients [185 CLD without cirrhosis HP and 43 with cirrhosis HP] were enrolled, with comorbidities in nearly 80%. Metabolism associated fatty liver MESHD disease MESHD (113, 61%) and viral etiology (26, 60%) were common. In CLD without cirrhosis HP, diabetes [57.7% vs 39.7%, OR=2.1(1.1-3.7), p=0.01] and in cirrhotics, obesity MESHD obesity HP, [64.3% vs. 17.2%, OR=8.1(1.9-38.8), p=0.002) predisposed more to liver injury than those without these. Forty three percent of CLD without cirrhosis HP presented as acute liver injury and 20% cirrhotics presented with either acute-on-chronic liver failure MESHD [5(11.6%)] or acute decompensation [4(9%)]. Liver related complications increased (p<0.05) with stage of liver disease MESHD; a Child TRANS-Turcotte Pugh score of 9 or more at presentation predicted high mortality [AUROC-0.94, HR=19.2(95CI 2.3-163.3), p<0.001, sensitivity SERO 85.7% and specificity 94.4%). In decompensated cirrhotics, the liver injury was progressive in 57% patients, with 43% mortality. Rising bilirubin and AST/ALT ratio predicted mortality among cirrhosis HP. Conclusions: SARS-Cov-2 infection MESHD causes significant liver injury in CLD patients, decompensating one fifth of cirrhosis HP, and worsening the clinical status of the already decompensated. The CLD patients with diabetes and obesity MESHD obesity HP are more vulnerable and should be closely monitored. 

    Continuing Our Work: Transplant Surgery And Surgical Oncology In A Tertiary Referral COVID-19 Center

    Authors: Giammauro Berardi; Marco Colasanti; Giovanni Battista Levi Sandri; Celeste Del Basso; Stefano Ferretti; Andrea Laurenzi; Nicola Guglielmo; Roberto Luca Meniconi; Mario Antonini; Gianpiero D’Offizi; Giuseppe Maria Ettorre

    doi:10.21203/ Date: 2020-05-06 Source: ResearchSquare

    Background. COVID-19 is rapidly spreading worldwide. Healthcare systems are struggling to properly allocate resources while ensuring cure for diseases MESHD outside of the infection MESHD. The aim of this study was to demonstrate how surgical activity was affected by the virus outbreak and show the changes in practice in a tertiary referral COVID-19 center.Methods. The official bulletins of the Italian National Institute for the Infectious Diseases MESHD “L. Spallanzani” were reviewed to retrieve the number of daily COVID-19 patients. Records of consecutive oncological and transplant procedures performed during the outbreak were reviewed. Patients with a high probability of postoperative intensive care unit (ICU) admission were considered as high-risk and defined by an ASA score ≥ III and/or a Charlson Comorbidity Index (CCI) ≥ 6 and/or a Revised Cardiac Risk Index for Preoperative Risk (RCRI) ≥ 3.Results. 72 patients were operated including 12 (16.6%) liver (n=6) and kidney (n=6) transplantations. Patients had few comorbidities (26.3%), low ASA score (1.9±0.5), CCI (3.7±1.3) and RCRI (1.2±0.6) and had low risk of postoperative ICU admission. Few patients had liver cirrhosis MESHD cirrhosis HP (12.5%) or received preoperative systemic therapy (16.6%). 36 (50%) high risk surgical procedures were performed including major hepatectomies, pancreaticoduodenectomies, total gastrectomies, multivisceral resections and transplantations. Despite this, only 15 patients (20.8%) were admitted to the ICU.Conclusions. Only oncologic cases and transplantations were performed during the COVID-19 outbreak. Careful selection of patients allowed to perform major cancer surgeries and transplantations without further stressing hospital resources, meanwhile minimizing collateral damage to patients.

    A gene locus that controls expression of ACE2 in virus infection MESHD

    Authors: M. Azim Ansari; Emanuele Marchi; Narayan Ramamurthy; Dominik Aschenbrenner; Carl-Philipp Hackstein; - STOP-HCV consortium; - ISARIC-4C Investigators; Shang-Kuan Lin; Rory Bowden; Eshita Sharma; Vincent Pedergnana; Suresh Venkateswaran; Subra Kugathasan; Angela Mo; Greg Gibson; John McLauchlan; Eleanor Barnes; John Kenneth Baillie; Sarah Teichmann; Alex Mentzer; John Todd; Julian Knight; Holm Uhlig; Paul Klenerman

    doi:10.1101/2020.04.26.20080408 Date: 2020-04-29 Source: medRxiv

    The SARS-CoV-2 pandemic has resulted in widespread morbidity and mortality globally. ACE2 is a receptor for SARS-CoV-2 and differences in expression may affect susceptibility to COVID-19. Using HCV-infected liver tissue from 195 individuals, we discovered that among genes negatively correlated with ACE2, interferon signalling pathways were highly enriched and observed down-regulation of ACE2 after interferon-alpha treatment. Negative correlation was also found in the gastrointestinal tract and in lung tissue from a murine model of SARS-CoV-1 infection MESHD suggesting conserved regulation of ACE2 across tissue and species. Performing a genome-wide eQTL analysis, we discovered that polymorphisms in the interferon lambda (IFNL) region are associated with ACE2 expression. Increased ACE2 expression in the liver was also associated with age TRANS and presence of cirrhosis HP. Polymorphisms in the IFNL region may impact not only antiviral responses but also ACE2 with potential consequences for clinical outcomes in distinct ethnic groups and with implications for therapeutic interventions.

    Clinical course and risk factors for mortality of COVID-19 patients with pre-existing cirrhosis HP: A multicenter cohort study

    Authors: Xiaolong Qi; Yanna Liu; Jonathan A. Fallowfield; Jitao Wang; Jianwen Wang; Xinyu Li; Jindong Shi; Hongqiu Pan; Shengqiang Zou; Hongguang Zhang; Zhenhuai Chen; Fujian Li; Yan Luo; Mei Mei; Huiling Liu; Zhengyan Wang; Jinlin Li; Hua Yang; Huihua Xiang; Xiaodan Li; Tao Liu; Ming-Hua Zheng; Chuan Liu; Yifei Huang; Dan Xu; Xiaoguo Li; Ning Kang; Qing He; Ye Gu; Guo Zhang; Chuxiao Shao; Dengxiang Liu; Lin Zhang; Xun Li; Norifumi Kawada; Zicheng Jiang; Fengmei Wang; Bin Xiong; Tetsuo Takehara; Don C. Rockey; COVID-Cirrhosis-CHESS Group

    doi:10.1101/2020.04.24.20072611 Date: 2020-04-28 Source: medRxiv

    Background: Patients with pre-existing cirrhosis HP are considered at increased risk of severe coronavirus disease MESHD 2019 (COVID-19) but the clinical course in these patients has not yet been reported. This study aimed to provide a detailed report of the clinical characteristics and outcomes among COVID-19 patients with pre-existing cirrhosis HP. Methods: In this retrospective, multicenter cohort study, we consecutively included all adult TRANS inpatients with laboratory-confirmed COVID-19 and pre-existing cirrhosis HP that had been discharged or had died by 24 March 2020 from 16 designated hospitals in China. Demographic, clinical, laboratory and radiographic findings on admission, treatment, complications during hospitalization and clinical outcomes were collected and compared between survivors and non-survivors. Findings: Twenty-one patients were included in this study, of whom 16 were cured and 5 died in hospital. Seventeen patients had compensated cirrhosis HP and hepatitis B MESHD hepatitis HP virus infection MESHD was the most common etiology. Lymphocyte and platelet counts were lower, and direct bilirubin levels were higher in patients who died than those who survived (p= 0.040, 0.032, and 0.006, respectively). Acute respiratory distress HP syndrome MESHD and secondary infection MESHD were both the most frequently observed complications. Only one patient developed acute on chronic liver failure MESHD. Of the 5 non-survivors, all patients developed acute respiratory distress HP syndrome MESHD and 2 patients progressed to multiple organ dysfunction syndrome MESHD. Interpretation: Lower lymphocyte and platelet counts, and higher direct bilirubin level might represent poor prognostic indicators in SARS-CoV-2-infected patients with pre-existing cirrhosis HP.

    Clinical Characteristics Hospitalized Patients with SARS-Cov-2 and HBV Co- infection MESHD

    Authors: Xiaoping Chen; Qunqun Jiang; Zhiyong Ma; Jiaxin Ling; Wenjia Hu; Qian Cao; Pingzheng Mo; Rongrong Yang; Shicheng Gao; Xien Gui; Yong Xiong; Jinlin Li; Yongxi Zhang

    doi:10.1101/2020.03.23.20040733 Date: 2020-03-27 Source: medRxiv

    Background & Aims The coronavirus disease MESHD 2019 (COIVD-19) caused by SARS-CoV-2 has been characterized as a pandemic, which causes a serious public health challenge in the world. A very large group of patients infected by HBV has been reported worldwide, especially in China. In order to answer whether specific treatment strategy on the patients coinfected with HBV and SARS-CoV-2, it requires profound understanding of the clinical characteristics on those patients. However, the impacts of SARS-CoV-2 infection MESHD on HBV patients remain largely unknown. Approach & Results In this retrospective investigation, we included 123 COVID-19 patients admitted to Zhongnan Hospital of Wuhan University, Wuhan, China, from January 5 to March 7, 2020. All enrolled patients are the laboratory confirmed COVID-19 pneumonia MESHD pneumonia HP cases according to the criteria reported previously. A total of 123 patients were analyzed for their Clinical records, laboratory results including the diagnosis of HBV infection MESHD and liver function. Among 123 confirmed COVID-19 patients, the mean age TRANS was 51 years old and 59.3% were females TRANS (73/123). Fifteen were previously HBV infected patients, 66.7% of them were males TRANS (10/15), patients with HBV infection MESHD appeared to have a higher incidence of liver cirrhosis MESHD cirrhosis HP and an increased level of total bilirubin. Seven (46.7%) patients with HBV infection MESHD were defined as severe cases, while the severity rate was 24.1% for the patients without HBV infection MESHD (26/108). The mortality of patients with HBV infection MESHD was 13.3% (2/15) compared to 2.8% (3/108) for the patients without HBV infection MESHD. Conclusions SARS-CoV-2 infection MESHD may cause liver function damage in COVID-19 cases and the patients with HBV infection MESHD are likely to have more severe disease MESHD outcome.

    Pathological Study of the 2019 Novel Coronavirus Disease MESHD (COVID-19) through Post-Mortem Core Biopsies

    Authors: Sufang Tian; Yong Xiong; Huan Liu; Li Niu; Jianchun Guo; Meiyan Liao; Shu-Yuan Xiao

    id:10.20944/preprints202003.0311.v1 Date: 2020-03-20 Source:

    Data on pathologic changes of the 2019 novel coronavirus disease MESHD (COVID-19) are scarce. To gain knowledge about the pathology that may contribute to disease progression MESHD and fatality, we performed post-mortem needle core biopsies of lung, liver, and heart in four patients who died of COVID-19 pneumonia MESHD pneumonia HP. The patients’ ages TRANS ranged from 59 to 81, including 3 males TRANS and 1 female TRANS. Each patient had at least one underlying disease MESHD, including immunocompromised status (chronic lymphocytic leukemia MESHD leukemia HP and renal transplantation) or other conditions ( cirrhosis HP, hypertension MESHD hypertension HP, and diabetes). Time from disease MESHD onset to death MESHD ranged from 15 to 52 days. All patients had elevated white blood SERO cell counts, with significant rise toward the end, and all had lymphocytopenia except for the patient with leukemia MESHD leukemia HP. Histologically, the main findings are in the lungs, including injury to the alveolar epithelial cells, hyaline membrane formation, and hyperplasia MESHD of type II pneumocytes, all components of diffuse alveolar damage. Consolidation by fibroblastic proliferation with extracellular matrix and fibrin forming clusters in airspaces is evident. In one patient, the consolidation consists of abundant intra-alveolar neutrophilic infiltration, consistent with superimposed bacterial bronchopneumonia MESHD. The liver exhibits mild lobular infiltration by small lymphocytes, and centrilobular sinusoidal dilation. Patchy necrosis MESHD is also seen. The heart shows only focal mild fibrosis MESHD and mild myocardial hypertrophy MESHD, changes likely related to the underlying conditions. In conclusion, the post-mortem examinations show advanced diffuse alveolar damage, as well as superimposed bacterial pneumonia MESHD pneumonia HP in some patients. Changes in the liver and heart are likely secondary or related to the underlying diseases MESHD.

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MeSH Disease
Human Phenotype

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