Corpus overview


Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Outcome of COVID-19 with co-existing surgical emergencies MESHD in children TRANS: our initial experiences and recommendations

    Authors: Md Samiul Hasan; Md Ayub Ali; Umama Huq

    doi:10.1101/2020.08.01.20166371 Date: 2020-08-04 Source: medRxiv

    Background: COVID 19 has changed the practice of surgery vividly all over the world. Pediatric surgery is not an exception. Prioritization protocols allowing us to provide emergency MESHD surgical care to the children TRANS in need while controlling the pandemic spread. The aim of this study is to share our experiences with the outcome of children TRANS with COVID 19 who had a co existing surgical emergency MESHD. Methods: This is a retrospective observational study. We reviewed the epidemiological, clinical, and laboratory data of all patients admitted in our surgery department through the emergency MESHD department and later diagnosed to have COVID 19 by RT PCR. The study duration was 3 months (April 2020 to June 2020). A nasopharyngeal swab was taken from all patients irrespective of symptoms to detect SARS CoV 2 by RT PCR with the purpose of detecting asymptomatic TRANS patients and patients with atypical symptoms. Emergency MESHD surgical services were provided immediately without delay and patients with positive test results were isolated according to the hospital protocol. We divided the test positive patients into 4 age groups TRANS for the convenience of data analysis. Data were retrieved from hospital records and analyzed using SPSS (version 25) software. Ethical permission was taken from the hospital ethical review board. Results: Total patients were 32. Seven (21.9%) of them were neonates. Twenty four (75%) patients were male TRANS. The predominant diagnosis was acute abdomen MESHD followed by infantile hypertrophic pyloric stenosis MESHD pyloric stenosis HP (IHPS), myelomeningocele HP, and intussusception MESHD intussusception HP. Only two patients had mild respiratory symptoms (dry cough MESHD cough HP). Fever MESHD Fever HP was present in 13 (40.6%) patients. Fourteen (43.8%) patients required surgical treatment. The mean duration of hospital stay was 5.5 days. One neonate with ARM died in the postoperative ward due to cardiac arrest HP. No patient had hypoxemia HP or organ failure. Seven health care workers (5.51%) including doctors & nurses got infected with SARS Co V2 during this period. Conclusion: Our study has revealed a milder course of COVID 19 in children TRANS with minimal infectivity even when present in association with emergency MESHD surgical conditions. This might encourage a gradual restart to mitigate the impact of COVID 19 on children TRANS surgery. Keywords: COVID 19, COVID 19 in children TRANS, Children TRANS Surgery, Surgical emergency MESHD, Surgery in COVID 19 positive patients.

    Mortality rate among critically ill patients with COVID-19 in a medical system with adequate hospital resources: a prospective observational study

    Authors: Christina Routsi; Eleni Magira; Stelios Kokkoris; Ilias Siembos; Charikleia Vrettou; Dimitris Zervakis; Eleni Ischaki; Sotiris Malahias; Ioanna Sigala; Andreas Asimakos; Theodora Daidou; Panagiotis Kaltsas; Evangelia Douka; Adamandia Sotiriou; Vassiliki Markaki; Prodromos Temberikidis; Apostolos Koroneos; Panagiotis Politis; Zafiria Mastora; Efrosini Dima; Theodoros Tsoutsouras; Ioannis Papahatzakis; Panagiota Gioni; Athina Strilakou; Aikaterini Maraguti; Eleftheria Mizi; Ageliki Kanavou; Aikaterini Sarri; Evdokia Gavrielatou; Spyros Mentzelopoulos; Ioannis Kalomenidis; Vassilios Papastamopoulos; Anastasia Kotanidou; Spyros G Zakynthinos

    doi:10.21203/rs.3.rs-52242/v1 Date: 2020-08-01 Source: ResearchSquare

    Background: For critically ill patients with coronavirus disease MESHD 2019 (COVID-19) who require intensive care unit (ICU) admission, mortality rates vary widely depending on many factors, among which hospital resources and clinical setting seem important. We sought to determine the outcome of critically ill patients admitted in the usual multidisciplinary ICUs of a big referral for COVID-19 tertiary-care hospital with adequate resources.Methods: We performed a prospective observational study of all adult TRANS patients with COVID-19 consecutively admitted to four COVID-designated ICUs at Evangelismos Hospital, Athens, Greece, from March 11 to April 27, 2020.Results: Among 50 critically ill patients, ICU and hospital mortality for the entire cohort was 32% (16/50), whereas 66% (33/50) of patients were discharged alive from the ICU and 2% (1/50) were still treated in the ICU until June 16, 2020. ICU and hospital mortality for those who received invasive mechanical ventilation was 39% (16/41). Patients who eventually died had already increased risk of death MESHD on ICU admission, as suggested by the high values of the Acute Physiology and Chronic Health Evaluation II and Sequential Organ Failure Assessment scores, the presence of current malignancy and occurrence of cardiac arrest HP in 44% (7/16) of patients, and the general need for circulatory support by noradrenaline. Median PaO2/FiO2 on ICU admission for the entire cohort was 121 mmHg [interquartile range (IQR), 86-171 mmHg] and most patients had moderate and severe acute respiratory distress HP syndrome MESHD (ARDS) according to the Berlin Definition. The primary cause of death MESHD of all patients was multi-organ failure, most commonly due to sepsis MESHD sepsis HP, whereas none died from refractory hypoxemia HP, neurologic dysfunction or withdrawal of life support. Hospital stay was long in patients who survived [median 24 days (IQR, 15-35 days)] and was frequently complicated by bacteremias MESHD bacteremias HP [36% (12/33)].Conclusion: Severely ill COVID-19 patients with moderate and severe ARDS may have equal or even lower mortality rates compared to ARDS due to other causes, when they are admitted in general ICUs with experienced and adequate staff without limitations in hospital resources, where established ARDS therapies are used. 

    A severe coronavirus disease MESHD 2019 patient with high-risk predisposing factors died from massive gastrointestinal bleeding: a case report

    Authors: Taojiang Chen; Qin Yang; Hongyu Duan

    doi:10.21203/rs.3.rs-45116/v1 Date: 2020-07-17 Source: ResearchSquare

    Background: SARS-CoV-2 is highly infectious and has been a significant public health threat. Despite typical manifestations of illness are dominated by respiratory symptom, some patients have concurrent gastrointestinal manifestations, including  nausea, diarrhea MESHD diarrhea HP, and vomiting MESHD vomiting HP. Massive gastrointestinal bleeding, however, has rarely been reported. Case presentation: We herein describe a case of severe SARS-CoV-2 infected patient with several risk factors for poor prognosis, including male TRANS, hypertension MESHD hypertension HP, old age TRANS, mixed bacterial infection MESHD and multilobular infiltration on radiological imaging. After improvement of respiratory status, the onset of gastrointestinal bleeding occurred, probably resulting from direct viral invasion as evidenced by the positive findings for SARS-CoV-2 in the repeat stool specimens. Although aggressive resuscitation was administered, hematochezia HP was uncontrolled. The patient rapidly deteriorated, suffered cardiac arrest HP, and expired. Conclusions: Digestive symptoms could be severe in SARS-CoV-2 infected patients, especially for the high-risk individuals with predisposing conditions. A more thorough protocol for preventing cross-infection MESHD through faecal-oral transmission TRANS should be implemented in the process of patient care and infection MESHD control.

    Place and causes of acute cardiovascular mortality during the COVID19 pandemic: retrospective cohort study of 580,972 deaths MESHD in England and Wales, 2014 to 2020

    Authors: Jianhua Wu; Mamas Mamas; Mohamed Mohamed; Chun Shing Kwok; Chris Roebuck; Ben Humberstone; Tom Denwood; Tom Luescher; Mark De Belder; John Deanfield; Chris Gale

    doi:10.1101/2020.07.14.20153734 Date: 2020-07-16 Source: medRxiv

    Importance. The COVID-19 pandemic has resulted in a decline in admissions with cardiovascular (CV) emergencies MESHD. The fatal consequences of this are unknown. Objectives - To describe the place and causes of acute CV death MESHD during the COVID-19 pandemic. Design - Retrospective nationwide cohort. Setting - England and Wales. Participants - All adult TRANS ( age TRANS [≥]18 years) acute CV deaths MESHD (n=580,972) between 1st January 2014 and 2nd June 2020. Exposure - The COVID-19 pandemic (defined as from the onset of the first COVID-19 death MESHD in England on 2nd March 2020). Main outcomes - Place (hospital, care home, home) and acute CV events directly contributing to death MESHD as stated on the first part of the Medical Certificate of Cause of Death MESHD. Results - After 2nd March 2020, there were 22,820 acute CV deaths MESHD of which 5.7% related to COVID-19, and an excess acute CV mortality of 1752 (+8%) compared with the expected daily deaths MESHD in the same period. Deaths MESHD in the community accounted for nearly half of all deaths MESHD during this period. Care homes had the greatest increase in excess acute CV deaths MESHD (1065, +40%), followed by deaths MESHD at home (1728, +34%) and in hospital (57, +0%). The most frequent cause of acute CV death MESHD during this period was stroke MESHD stroke HP (8,290, 36.3%), followed by acute coronary syndrome MESHD (ACS) (5,532, 24.2%), heart failure MESHD (5,280, 23.1%), pulmonary embolism MESHD pulmonary embolism HP (2,067, 9.1%) and cardiac arrest HP (1,037, 4.5%). Deep vein thrombosis MESHD had the greatest increase in cause of excess acute CV death MESHD (18, +25%), followed pulmonary embolism MESHD pulmonary embolism HP (340, +19%) and stroke MESHD stroke HP (782, +10%). The greatest cause of excess CV death MESHD in care homes was stroke MESHD stroke HP (700, +48%), compared with cardiac arrest HP (80, +56%) at home, and pulmonary embolism MESHD pulmonary embolism HP (126, +14%) and cardiogenic shock MESHD cardiogenic shock HP (41, +14%) in hospital. Conclusions and relevance - The COVID-19 pandemic has resulted in an inflation in acute CV deaths MESHD above that expected for the time of year, nearly half of which occurred in the community. The most common cause of acute CV death MESHD was stroke MESHD stroke HP followed by acute coronary syndrome MESHD and heart failure MESHD. This is key information to optimise messaging to the public and enable health resource planning.

    The Cardiac Toxicity of Chloroquine or Hydroxychloroquine in COVID-19 Patients: A Systematic Review and Meta-regression Analysis

    Authors: Imad Tleyjeh; Zakariya Kashour; Oweida AlDosary; Muhammad Riaz; Haytham Tlayjeh; Musa A Garbati; Rana Tleyjeh; Mouaz H Al-Mallah; Rizwan M Sohail; Dana Gerberi; Aref A Bin Abdulhak; John R Giudicessi; Michael John Ackerman; Tarek Kashour

    doi:10.1101/2020.06.16.20132878 Date: 2020-06-18 Source: medRxiv

    Abstract Importance The antimalarial agents chloroquine (CQ) and hydroxychloroquine (HCQ) have been proposed as a potential treatment for COVID-19 due their effect on several cellular processes that impact viral replication. Although more than 100 ongoing trials are testing their efficacy, CQ and HCQ are being used widely in clinical practice, exposing COVID-19 patients to potentially significant cardiac adverse effects. Objective To systematically review the literature and estimate the risk of cardiac toxicity in patients receiving CQ or HCQ for COVID-19. Data Sources A systematic search was conducted on May 27, 2020 of Ovid EBM Reviews, Ovid Embase (1974+), Ovid Medline (1946+ including epub ahead of print, in-process & other non-indexed citations), Scopus (1970+) and Web of Science (1975+) and preprint servers (Medrvix and ResearchSquare) and manual search of references lists. Study Selection Studies that included COVID-19 patients treated with CQ or HCQ, with or without azithromycin, were included as follows: (1) COVID-19 patient population, (2) the study included more than 10 patients receiving either one of the medications, (3) reported electrocardiographic changes and/or cardiac arrhythmias MESHD arrhythmias HP. Data Extraction and Synthesis Study characteristics and endpoints incidence were extracted. Due to the very low incidence of torsades de pointes MESHD torsades de pointes HP (TdP) and other endpoints (rare events), the arcsine transformation was used to obtain a pooled estimate of the different incidences using a random-effects meta-analysis. Meta-regression analyses were used to assess whether the incidence of different endpoints significantly varied by multiple study-level variables specified a priori. Main Outcomes and Measures Pooled Incidence of: (1) change in QTc value from baseline [≥] 60 ms, (2) QTc [≥] 500 ms, (3) the composite of endpoint 1 and 2, (4) TdP arrhythmia or ventricular HP ventricular tachycardia MESHD tachycardia HP (VT) or cardiac arrest HP, (5) discontinuation of treatment due to drug-induced QT prolongation or arrhythmias HP. Results A total of 19 studies with a total of 5652 patients were included. All included studies were of high methodological quality in terms of exposure ascertainment or outcome assessment. Among 2719 patients treated with CQ or HCQ, only two episodes of TdP were reported; the pooled incidence of TdP arrhythmia HP or VT or cardiac arrest HP was 3 per 1000, 95% CI (0-21), I2=96%, 18 studies with 3725 patients. Among 13 studies of 4334 patients, the pooled incidence of discontinuation of CQ or HCQ due to prolonged QTc or arrhythmias HP was 5%, 95% CI (1-11), I2=98%. The pooled incidence of change in QTc from baseline of [≥] 60 ms was 7%, 95% CI (3-14), I2=94% (12 studies of 2008 patients). The pooled incidence of QTc [≥] 500 ms was 6%, 95% CI (2-12), I2=95% (16 studies of 2317 patients). Among 11 studies of 3127 patients, the pooled incidence of change in QTc from baseline of [≥] 60 ms or QTc [≥] 500 ms was 9%, 95% CI (3-17), I2=97%. Mean/median age TRANS, coronary artery disease MESHD, hypertension MESHD hypertension HP, diabetes, concomitant QT prolonging medications, ICU care, and severity of illness in the study populations explained between-studies heterogeneity. Conclusions and Relevance Treatment of COVID-19 patients with CQ or HCQ is associated with a significant risk of drug-induced QT prolongation, which is a harbinger for drug-induced TdP/VT or cardiac arrest HP. CQ/HCQ use resulted in a relatively higher incidence of TdP as compared to drugs withdrawn from the market for this particular adverse effect. Therefore, these agents should be used only in the context of randomized clinical trials, in patients at low risk for drug-induced QT prolongation, with adequate safety monitoring.

    BRAIN MR SPECTROSCOPIC FINDINGS IN THREE CONSECUTIVE COVID-19 PATIENTS: PRELIMINARY OBSERVATIONS

    Authors: Otto Rapalino; Alika Weerasekera; Sarah J. Moum; Katharina Eikermann-Haerter; Brian L Edlow; David Fischer; Shibani Mukerji; Pamela Schaefer,; R. Gilberto Gonzalez; Michael Lev; Eva-Maria Ratai

    doi:10.1101/2020.06.10.20122465 Date: 2020-06-16 Source: medRxiv

    Brain magnetic resonance spectroscopic imaging (MRSI) was performed in three consecutive COVID-19 patients, as part of a pilot investigation of the pathophysiological processes underlying the brain involvement by the SARS-CoV-2 infection MESHD. These included one with necrotizing leukoencephalopathy MESHD leukoencephalopathy HP, one after recent PEA cardiac arrest HP without leukoencephalopathy MESHD leukoencephalopathy HP, and one without frank encephalopathy HP or recent severe hypoxic episode. The MRSI findings were compared to those of two patients with white matter pathology not SARS-CoV2 infection MESHD related, and a control patient without clinical encephalopathy HP. The N-acetyl-aspartate reduction, choline elevation, and glutamate/glutamine elevation found in the COVID necrotizing leukoencephalopathy MESHD leukoencephalopathy HP patient and, to a lesser degree, the COVID post- cardiac arrest HP patient, follow a similar pattern as seen with the delayed post-hypoxic leukoencephalopathy MESHD leukoencephalopathy HP patient. Lactate elevation was most pronounced in the patient with COVID necrotizing leukoencephalopathy MESHD leukoencephalopathy HP.

    Endothelial Shear Stress Enhancements: A Potential Solution for Critically Ill Covid-19 Patients

    Authors: Sayed Nour

    doi:10.21203/rs.3.rs-35793/v1 Date: 2020-06-15 Source: ResearchSquare

    Rationale: Most critically ill Covid-19 patients succumb to multiple organ failure MESHD and / or cardiac arrest HP as a result of comorbid endothelial dysfunction disorders which had probably aggravated by conventional mechanical assist devices. Even worse, mechanical ventilators prevent the respiratory pump from performing its crucial function as a potential generator of endothelial shear stress (ESS) which controls microcirculation and hemodynamics since birth. The purpose of this work is to bring our experience with ESS enhancement and pulmonary vascular resistance (PVR) management as a potential therapeutic solution in acute respiratory distress HP syndrome MESHD (ARDS). We propose a noninvasive device composed of thoracic and infradiaphragmatic compartments that will be pulsated in an alternating frequency (20/40 bpm) with low-pressure pneumatic generator (0.1-0.5 bar). Oxygen supply, nasogastric ± endotracheal tubes are considered. Proof-of-concept: prototypes were tested in pediatric models of refractory cardiac arrest HP (≥20min), showed restoration of hemodynamics (BP≥100 mm Hg) and urine output, regardless of heartbeats, pharmacological supports and mechanical ventilation. Conclusions ESS enhancement represents a more effective treatment to increase tissue oxygenation and improve hemodynamic in ARDS. A cost-effective method which could be induced with a non-invasive pulsatile device adaptable to cardiopulmonary-circulatory biophysics to maintain a fully functional respiratory pump and avoid confrontation of the opposite hydraulic circuits.

    Chloroquine, hydroxychloroquine, and COVID-19: systematic review and narrative synthesis of efficacy and safety

    Authors: Micheal takla; Kamalan Jeevaratnam

    doi:10.1101/2020.05.28.20115741 Date: 2020-05-30 Source: medRxiv

    Background: The COVID-19 pandemic has required clinicians to urgently identify new treatment options or the repurposing of existing drugs. Several drugs are now being repurposed with the aim of identifying if these drugs provide some level of disease MESHD resolution. Of particular interest are chloroquine (CQ) and hydroxychloroquine (HCQ), first developed as an antimalarial therapy. There is increasing concern with regards to the efficacy and safety of these agents. The aims of this review are to systematically identify and collate studies describing the use of CQ and HCQ in human clinical trials and provide a detailed synthesis of evidence of its efficacy and safety. Methods and Findings: Searches for (COVID AND chloroquine [title/abstract] AND outcomes[full text]) and two (COVID AND hydroxychloroquine[title/abstract] AND outcomes[full text]) yielded 272 unique articles. Unique articles were manually checked for inclusion and exclusion criteria and also subjected to a quality appraisal assessment. A total of 19 articles were included in the systematic review. Seventy-five percent of observational studies employing an endpoint specific to efficacy recorded no significant difference in the attainment of outcomes, between COVID-19 patients given a range of CQ and/or HCQ doses, and the control groups. All clinical trials and 82% of observational studies examining an indicator unique to drug safety discovered a higher probability of adverse events in those treated patients suspected of, and diagnosed with, COVID-19. Seventy-five percent of the total papers focusing on cardiac side-effects found a greater incidence among patients administered a wide range of CQ and/or HCQ doses, with QTc prolongation the most common finding, in addition to its consequences of VT and cardiac arrest HP. Of the total studies using mortality rate as an end-point, 60% reported no significant change in the risk of death MESHD, while 30% showed an elevation, and 10% a depression, in treated relative to control patients. Conclusion: The strongest available evidence suggests that, relative to standard in-hospital management of symptoms, the use of CQ and HCQ to treat hospitalised COVID-19 patients has likely been unsafe. At the very least, the poor quality of data failing to find any significant changes in the risk of VT should preclude definitive judgment on drug safety until the completion of high-quality randomised clinical trials.

    Clinical Investigations External Validation of Multimodal Termination of Resuscitation Rules for Out-of-hospital Cardiac Arrest MESHD Cardiac Arrest HP Patients in the Covid-19 Era

    Authors: Haewon Jung; Mijin Lee; Jae Wan Cho; Sang Hun Lee; Suk Hee Lee; You Ho Mun; Han-sol Chung; Yang Hun Kim; Gyun Moo Kim; Sin-youl Park; Jae Cheon Jeon; Changho Kim

    doi:10.21203/rs.3.rs-32324/v1 Date: 2020-05-29 Source: ResearchSquare

    Background:Futile resuscitation for out-of-hospital cardiac arrest MESHD cardiac arrest HP (OHCA) patients in the COVID-19 era can lead to risk of disease MESHD transmission TRANS and unnecessary transport. Various existing basic or advanced life support (BLS or ALS) rules for termination of resuscitation (TOR)have been derived and validated in North America and Asian countries. This study aimed to evaluate the external validation of these rules in predicting the survival outcomes of OHCA patients in the COVID-19 era.Methods: A multicenter observational study was performed using the WinCOVID-19 Daegu registry data collected from 18 February to 31March 2020. The outcomes of each rule were compared to the actual patient survival outcomes. The sensitivity SERO, specificity, false positive ratio (FPR), and positive predictive value SERO (PPV) of each TOR rule were evaluated. Results: Of the 184 OHCA patients, 170 patients,who showed cardiac arrest HP of presumed cardiac etiology, were enrolled. TOR was recommended for 122 patientsbased on the international BLS-TOR rule, which showed 85% specificity, 74% sensitivity SERO, 0.8% FPR, and 99% PPV for predicting unfavorable survival outcomes. When the traditional BLS-TOR rules and KoCARC TOR rule II were applied to our registry, one patient met the TOR criteria but survived at hospital discharge. With regard to the FPR (upper limit of 95% confidence interval<5%) and PPV (>99%) criteria, only the KoCARCTOR rule I, which included a combination ofthree factors including not being witnessed by emergency MESHD medical technicians, presenting with an asystole at the scene, and not experiencing prehospital shock MESHD shock HP delivery or ROSC, was found to be superiorto all other TOR rules. Conclusion: Among the previous nine BLS and ALS TOR rules, KoCARCTOR rule I was most suitable for predicting poor survival outcomes and showed improved diagnostic performance SERO. Further research on variations in resources and treatment protocols among facilities, regions, and cultures will be useful in determining the feasibility of TOR rules for COVID-19 patients worldwide.Trial registration: Not applicable

    Prone Cardiopulmonary Resuscitation: A Rapid Scoping and Expanded Grey Literature Review for the COVID-19 Pandemic

    Authors: Matthew John Douma; Ella MacKenzie; Tess Loch; Maria C Tan; Dustin Anderson; Christopher Picard; Lazar Milovanovic; Domhnall O'Dochartaigh; Peter G Brindley

    doi:10.1101/2020.05.21.20109710 Date: 2020-05-26 Source: medRxiv

    Prone Cardiopulmonary Resuscitation: A Rapid Scoping and Expanded Grey Literature Review for the COVID-19 Pandemic Aim To rapidly identify and summarize the available science on prone resuscitation. To determine the value of undertaking a systematic review on this topic; and to identify knowledge gaps to aid future research, education and guidelines. Methods This review was guided by specific methodological framework and reporting items (PRISMA-ScR). We included studies, cases and grey literature regarding prone position and CPR/ cardiac arrest HP. The databases searched were MEDLINE, Embase, CINAHL, Cochrane CENTRAL, Cochrane Database of Systematic Reviews, Scopus and Google Scholar. Expanded grey literature searching included internet search engine, targeted websites and social media. Results Of 453 identified studies, 24 (5%) studies met our inclusion criteria. There were four prone resuscitation-relevant studies examining: blood SERO and tidal volumes generated by prone compressions; prone compression quality metrics on a manikin; and chest computed tomography scans for compression landmarking. Twenty case reports/series described the resuscitation of 25 prone patients. Prone compression quality was assessed by invasive blood SERO pressure monitoring, exhaled carbon dioxide and pulse palpation. Recommended compression location was zero-to-two vertebral segments below the scapulae. Twenty of 25 cases (80%) survived prone resuscitation, although few cases reported long term outcome. Seven cases described full neurological recovery. Conclusion This scoping review did not identify sufficient evidence to justify a systematic review or modified resuscitation guidelines. It remains reasonable to initiate resuscitation in the prone position if turning the patient supine would lead to delays or risk to providers or patients. Prone resuscitation quality can be judged using end-tidal CO2, and arterial pressure tracing TRANS, with patients turned supine if insufficient. Key words CPR, prone, cardiopulmonary resuscitation, Scoping review, Resuscitation, covid-19, SARS-CoV-2

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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