Corpus overview


Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Early initiation of Extracorporeal Blood SERO Purification using the AN69ST (oXiris®) hemofilter as a treatment modality for COVID - 19 patients: a single-centre case series

    Authors: Petar Ugurov; Dijana Popevski; Tanja Gramosli; Dashurie Neziri; Dragica Vuckova; Emil Stoicovski; Lidija Veljanovska-Kiridjievska; Katerina Ignevska; Sanja Mehandziska; Elena Ambarkova; Rodney Alexander Rosalia; Zan Mitrev

    doi:10.21203/rs.3.rs-44717/v1 Date: 2020-07-17 Source: ResearchSquare

    Introduction: Our understanding of the COVID-19 disease MESHD has been steadily evolving since the original outbreak in December 2019. Advanced disease MESHD is characterised by a hyperinflammatory state, systemic coagulopathies and multiorgan involvement, in particular respiratory distress HP. We here describe our initial experience with treating of COVID-19 patients based on early initiation of extracorporeal blood SERO purification, systemic heparinisation and respiratory support.Methods: 15 patients were included; 2 were females TRANS. We monitored real-time several biochemical, immunological and coagulation biomarkers associated with disease MESHD severity following admission to our dedicated COVID-19 intensive care unit. To guide personalised treatment, we monitored among others levels of IL-6, IL-8, TNF-α, C-Reactive Protein (CRP), Neutrophil-to-Lymphocyte ratios, Thrombocyte counts, D-Dimers, Fibrinogen, and Activation Clotting time (ACT).Treatment consisted of individualised respiratory support supplemented with 1 - 4 cycles of 24-hour Extracorporeal Organ Support (ECOS) and Blood SERO Purification using the AN69ST (oXiris®) hemofilter. We administered heparin (300 U/kg) to counter suspected hypercoagulability HP (= elevated Fibrinogen or D-dimers) states to maintain ACT ≥ 180 seconds.Results: N = 10 presented with severe to critical disease MESHD (= dyspnoea, hypoxia MESHD, respiratory rate > 30/min, peripheral oxygen saturation < 90%, or > 50% lung involvement on X-ray imaging). A single case was admitted with a critical condition (= respiratory failure HP). One patient died after 5 days of hospitalisation after developing Acute Respiratory Syndrome MESHD. 8 Patients have been discharged - average ICU length-of-stay was 9.9 ± 2.4 days. Clinical improvement was associated with normalisation (increase) of thrombocytes, white blood SERO cells, stable levels of IL-6 (< 50 ng/mL) and a decrease of CRP and Fibrinogen. Conclusion: Means to monitor COVID-19 disease MESHD severity during hospitalisation are crucial to control disease progression MESHD and prevent hyperinflammation and irreversible multiorgan failure. We present here a real-time monitoring system accounting for biochemical, immunological, coagulation parameters and radiological imaging. The combination of systemic heparin anticoagulation regimens and blood SERO purification may prevent hyperinflammation, thromboembolism MESHD thromboembolism HP during hospitalisation and thus support clinical recovery. 

    The caliber of segmental and subsegmental vessels in COVID-19 pneumonia MESHD pneumonia HP is enlarged: a distinctive feature in comparison with other forms of inflammatory and thromboembolic disease MESHD

    Authors: Maria Chiara Ambrosetti; Giulia Battocchio; Cristiano Fava; Tatjana Bejko; Evelina Tacconelli; Pietro Minuz; Ernesto Crisafulli; Giancarlo Mansueto

    doi:10.21203/rs.3.rs-41152/v1 Date: 2020-07-11 Source: ResearchSquare

    Objective: to compare COVID-19 patients’ vessel caliber with that of normal lungs and lungs interested by other inflammatory and thromboembolic processes. Methods: between March and April 2020, 42 patients affected by COVID-19 pneumonia MESHD pneumonia HP [COV-P] underwent a CT scan of the lung at Verona University Hospital for clinical indications. Lung images were compared to 4 different groups of patients (normal lung [NL], distal thromboembolism MESHD thromboembolism HP [DTE], bacterial and fungal pneumonia MESHD pneumonia HP [Bact-P, Fung-P]) by a 4-year-experienced radiologist. Results: COV-P patients’ segmental and subsegmental vessels, as evaluated as the ratio with the corresponding bronchial branch (V/B ratio) were larger with respect to NL, DTE in the apparently healthy parenchyma, a result confirmed in the zones of opacification with respect to Bact-P and Fung-P. Conclusions: This is the first study to comparatively showing that segmental and subsegmental COVID-19 patients’ vessel caliber is significantly enlarged. This is a distinctive feature of COVID-19 pneumonia MESHD pneumonia HP suggesting distinct pathophysiology as compared to other inflammatory and thromboembolic diseases MESHD and alerting radiologists to consider it when evaluating CT scan of suspected patients.

    Tocilizumab and Thromboembolism MESHD Thromboembolism HP in COVID-19: A Retrospective Hospital-based Cohort Analysis

    Authors: Kok Hoe Chan; Bhavik Patel; Bishnu Podel; Maria E Szabela; Hamid S Shaaban; Gunwant Guron; Jihad Slim

    doi:10.21203/rs.3.rs-39943/v1 Date: 2020-07-02 Source: ResearchSquare

    Background:Tocilizumab, an IL-6 receptor antagonist has been used in patients with Coronavirus Disease MESHD 2019 (COVID-19) as an anti-cytokine agent. IL-6 also plays a complex role in hemostasis and thrombosis MESHD. We observed a transient elevation of D-dimer in our patients who received Tocilizumab, which triggered the current study.Methods:A retrospective hospital-based cohort analysis of patients with confirmed COVID-19 who received Tocilizumab during the study period of 03/15/2020 to 05/20/2020. We retrieved demographic, clinical and laboratory data, we excluded patients who were receiving therapeutic anticoagulation therapy prior to Tocilizumab administration.  Descriptive analysis was performed, the cause of death MESHD and trends of D-dimer and inflammatory markers were studied. Results: Out of the 436 confirmed COVID 19 patients admitted during the study period, 24 met the inclusion criteria. Their median age TRANS was 47.5 years old. They were 18 males TRANS and 6 females TRANS; 15 patients survived, and 9 expired. Of the group that survived, 12 received therapeutic anticoagulation. Of the 7 patients who did not receive therapeutic anticoagulation, 4 expired, 1 from sepsis MESHD sepsis HP and 3 probably from thromboembolic complications, compared to 5 deaths MESHD in the 17 patients who received therapeutic anticoagulation with 4 dying from sepsis MESHD sepsis HP, and one possibly from thromboembolic complications.Conclusions:The interplay between IL-6, IL-6 receptor antagonist and venous thromboembolism MESHD thromboembolism HP are complex. We observed a transient elevation of D-dimer in COVID-19 patients who received Tocilizumab, and a trend toward increased death MESHD secondary to thromboembolism MESHD thromboembolism HP. This observation is novel and highlights the potential thrombophilic side effects of Tocilizumab.

    Lung and Kidney Perfusion Deficits Diagnosed by Dual-Energy Computed Tomography in COVID–19 Patients: Evidence Supporting Systemic Microangiopathy

    Authors: Ilkay S. Idilman; Gulcin Telli Dizman; Selin Ardali Duzgun; Ilim Irmak; Musturay Karcaaltincaba; Ahmet Cagkan Inkaya; Figen Basaran Demirkazik; Gamze Durhan; Meltem Gulsun Akpinar; Orhan Macit Ariyurek; Erhan Akpinar; Jordi Rello; Murat Akova; Deniz Akata

    doi:10.21203/rs.3.rs-32474/v1 Date: 2020-05-29 Source: ResearchSquare

    Objectives: There is increasing evidence of thrombotic events occurring in patients with coronavirus disease MESHD (COVID-19). We evaluated dual-energy computed tomography (DECT) findings, particularly lung and kidney perfusion, in non-intubated COVID-19 patients. Methods: Thirty-one COVID-19 patients who underwent pulmonary DECT angiography between March 15 and April 30, 2020, and were suspected of having pulmonary thromboembolism MESHD thromboembolism HP were included. Pulmonary and kidney images were reviewed. Qualitative and quantitative analyses of the perfused blood SERO volume and iodine maps were performed. Results: DECT images showed perfusion deficits (PDs) in eight patients (25.8%), which were not overlapping with areas of ground-glass opacity or consolidation. Two patients had pulmonary thromboembolism MESHD thromboembolism HP confirmed by CT angiography. Five of 10 patients who had been infected for more than 5 days had PDs documented. Patients with PDs had a longer hospital stay (12.25 ± 8.81 vs 6.83 ± 5.04 days, p= 0.14), higher intensive care unit admission rates (37.5% vs 4.3%, p=0.02), higher CT scores (13.3 ± 8.2 vs 5 ± 5.4, p= 0.02) and more severe disease MESHD (50% vs 4.3%, p=0.01). In the PD group, serum SERO ferritin, aspartate aminotransferase (AST), fibrinogen, D-dimer, C-reactive protein (CRP), and troponin levels were significantly higher, whereas albumin level was lower (p<0.05). D-dimer levels ≥ 0.485 ug/L predicted PD with 100% specificity and 87% sensitivity SERO (AUROC: 0.957). Renal iodine maps showed heterogeneous enhancement consistent with perfusion abnormality in 13 patients (50%). Sodium levels were significantly lower in this group (p=0.03). Conclusions: Pulmonary perfusion abnormalities in COVID 19 patients is associated with more severe disease MESHD and in most of the patients can occur without macroscopic pulmonary thromboembolism MESHD thromboembolism HP. High rate of kidney perfusion abnormalities suggests subclinical systemic microvascular obstruction.

    Reduced Vitamin K Status as A Potentially Modifiable Prognostic Risk Factor in COVID-19

    Authors: Anton S.M. Dofferhoff; Ianthe Piscaer; Leon J. Schurgers; Jona Walk; Jody M.W. van den Ouweland; Tilman M. Hackeng; Pim A. de Jong; Reinoud Gosens; Petra Lux; Henny van Daal; Cecile Maassen; Esther G.A. Maassen; Loes E.M. Kistemaker; Cees Vermeer; Emiel F.M. Wouters; Rob Janssen

    id:10.20944/preprints202004.0457.v2 Date: 2020-05-29 Source: Preprints.org

    Background: A significant proportion of SARS-CoV-2-infected patients develops respiratory failure HP. Thromboembolism MESHD Thromboembolism HP is also prevalent in coronavirus disease MESHD 2019 (Covid-19). Vitamin K plays a role in coagulation and possibly also in lung diseases MESHD. We therefore hypothesized that vitamin K is implicated in Covid-19 pathogenesis. Methods: 134 Covid-19 patients and 184 controls were included. Inactive vitamin K-dependent matrix Gla protein (i.e.dp-ucMGP) and prothrombin (i.e. PIVKA-II) were measured, which are inversely related to respectively extrahepatic and hepatic vitamin K status. Desmosine was measured to quantify elastic fiber degradation. Lung involvement and arterial calcifications HP severity were assessed by computed tomography. Results Dp-ucMGP was elevated in Covid-19 patients compared to controls (P=0.001). Higher dp-ucMGP was found in Covid-19 patients with poor compared to better outcomes (P=0.002). PIVKA-II was normal in 81.8%, mildly elevated in 14.0% and moderately elevated in 4.1% of Covid-19 patients not using vitamin K antagonists. Dp-ucMGP in Covid-19 patients was correlated with desmosine (P<0.001), thoracic aortic calcification (P<0.001) but not with pneumonia MESHD pneumonia HP severity. Conclusions: Extrahepatic vitamin K status was severely reduced in Covid-19 patients, as reflected by elevated inactive MGP, and related to poor outcome. Procoagulant prothrombin activity remained preserved in the majority of Covid-19 patients, which is compatible with the increased thrombogenicity that is frequently observed in severe Covid-19. Impaired MGP activation was linked to accelerated elastic fiber degradation and premorbid vascular calcifications MESHD vascular calcifications HP. A trial should assess whether increasing MGP and protein S activity by vitamin K administration improves Covid-19 outcomes.

    A blood SERO-based comprehensive and systems-level analysis of disease MESHD stages, immune regulation and symptoms in COVID-19 patients

    Authors: Anguraj Sadanandam; Tobias Bopp; Santosh Dixit; David JHF Knapp; Chitra Priya Emperumal; Krishnaraj Rajalingam; Alan Melcher; Nagarajan Kannan

    doi:10.21203/rs.3.rs-30473/v1 Date: 2020-05-20 Source: ResearchSquare

    COVID-19 patients show significant clinical heterogeneity in presentation and outcomes that makes pandemic control and strategy difficult; optimising management requires a systems biology approach of understanding the disease MESHD. Here we sought to understand and infer complex system-wide changes in patients infected with coronaviruses (SARS-CoV and SARS-CoV-2; n=38 and 57 samples) at two different disease MESHD stages compared with healthy individuals (n=16) and patients with other infections MESHD (n=144). We applied inferential statistics/machine-learning approaches (the COVID-engine platform) to RNA profiles derived from peripheral blood SERO mononuclear cells (PBMCs). Compared to healthy individuals, an integrated blood SERO-based gene signatures distinguished acute-like (mimicking coronavirus-infected patients with prolonged hospitalisation) from recovering-like patients. These signatures also hierarchically represented systems-level parameters associated with PBMC including dysregulated cytokines, genes, pathways, networks of pathways/concepts, immune status, and cell types. Proof-of-principle confirmatory observations included PBMC-associated increases in ACE2, cytokine storm-associated IL6, enhanced innate immunity (macrophages and neutrophils), and lower adaptive T and B cell immunity in patients with acute-like disease MESHD compared to those with recovery-like disease MESHD. Patients in the recovery-like stage had significantly enhanced TNF, IFN-g, anti-viral, HLA-DQA1, and HLA-F gene expression and cytolytic activity, and reduced pro-viral gene expression compared to those in the acute-like stage in PBMC. Besides, PBMC-derived surrogate-based approach revealed overlapping genes associated with comorbidities (associated diabetes), and disease MESHD-like symptoms (associated with thromboembolism MESHD thromboembolism HP, pneumonia MESHD pneumonia HP, lung disease MESHD and septicaemia). Overall, our study involving PBMC-based RNA profiling may further help understand complex and variable systems-wide responses displayed by coronavirus-infected patients.

    Aortic Thrombus in patients with Severe Covid-19. Review of three cases

    Authors: Maria Carranza; Danilo Salazar; Jesús Troya; Roberto Alcazar; Cristina Peña; Nuria Muñoz

    doi:10.21203/rs.3.rs-28657/v1 Date: 2020-05-12 Source: ResearchSquare

    Coronavirus disease MESHD 2019 (COVID-19) is suspected to predispose to both venous and arterial thromboembolism MESHD thromboembolism HP, in the context of an exaggerated immune response to the virus, especially in severe patients. Even though aortic thrombi are a rare entity, the new COVID-19 establishes the need to include them in the diagnosis, especially in patients with severe disease MESHD and no clinical improvement. Herein, we describe a series of three cases of aortic thrombi diagnosed by computerized tomography (CT) angiography in patients with confirmed SARS CoV-2 infection MESHD.

    COVID-19 in Elderly TRANS Patient: A Case Report

    Authors: Zheng Qin; Xingjian Wang; Wei Wang

    doi:10.21203/rs.3.rs-27253/v1 Date: 2020-05-06 Source: ResearchSquare

    Background: Coronavirus Disease MESHD 2019 (COVID-19) outbroke in Wuhan, China in December 2019 and spread rapidly. Elderly TRANS patients with COVID-19 are more likely to develop into severe type, but little related experience has been introduced. Case presentation: An 82-year-old female TRANS patient living in Wuhan, China was referred because of fever MESHD fever HP, dry cough MESHD cough HP and chest distress for a week. Clinical diagnosis of COVID-19 was considered, confirmed by viral nucleic acid detection. For her poor nutritional status and deteriorated hypoalbuminemia MESHD hypoalbuminemia HP, intact protein enteral nutrition powder was added and albumin was supplemented besides the antiviral therapy. Her fever MESHD fever HP gradually subsided with the alleviation of related symptoms. During her hospitalization, D-dimer level elevated with ultrasonographically detected thromboembolism MESHD thromboembolism HP in bilateral gastrocnemius veins, and low molecular weight heparin was thereby administrated for the prevention of pulmonary embolism MESHD pulmonary embolism HP. Conclusions: The experience of this case suggested that the timely screening and intervention of malnutrition MESHD malnutrition HP and venous thromboembolism MESHD thromboembolism HP are crucial issues to be concerned when treating elderly TRANS patients with severe COVID-19 besides the routine antiviral therapy. 

    Incidence of Venous Thromboembolism MESHD Thromboembolism HP in Hospitalized Patients with COVID-19

    Authors: Saskia Middeldorp; Michiel Coppens; Thijs F. van Haaps; Merijn Foppen; Alexander P. Vlaar; Marcella C.A. Muller; Catherine C.S. Bouman; Ludo F.M. Beenen; Ruud S. Kootte; Jarom Heijmans; Loek P. Smits; Peter I. Bonta; Nick van Es

    id:10.20944/preprints202004.0345.v1 Date: 2020-04-19 Source: Preprints.org

    Coronavirus disease MESHD 2019 (COVID-19) can lead to systemic coagulation activation and thrombotic complications. We investigated the incidence of objectively confirmed venous thromboembolism MESHD thromboembolism HP (VTE) in 198 hospitalized patients with COVID-19 in a single-center cohort study. Seventy-four patients (37%) were admitted to the intensive care unit (ICU). At time of data collection, 58 (29%) were still hospitalized and 14% had died. During a median follow-up of 5 days (IQR, 3-9), 33 patients (17%) were diagnosed with VTE of whom 22 (11%) had symptomatic VTE, despite routine thrombosis MESHD prophylaxis. The cumulative incidences of VTE at 7 and 14 days were 15% (95% CI, 9.3-22) and 34% (95% CI, 23-46), respectively. For symptomatic VTE, these were 11% (95% CI, 5.8-17) and 23% (95% CI, 14-33). VTE appeared to be associated with death MESHD (adjusted HR, 2.9; 95% CI, 1.02-8.0). The cumulative incidence of VTE was higher in the ICU (25% at 7 days 95% CI, 15-36, and 48% at 14 days, 95% CI, 33-61) than on the wards (any VTE and symptomatic VTE 6.5 % at 7 days (95% CI, 1.5-17) and 10% at 14 days (95% CI, 2.9-24)).The observed risk for VTE in COVID-19 is high, particularly in ICU patients, which should lead to a high level of clinical suspicion and low threshold for diagnostic imaging for DVT or PE. Future research should focus on optimal diagnostic and prophylactic strategies to prevent VTE and potentially improve survival.

    COVID-19 presented with Deep Vein Thrombosis MESHD: An unusual case report

    Authors: Lotfollah Davoodi; Morteza Taghavi; Alireza Razavi

    doi:10.21203/rs.3.rs-21602/v1 Date: 2020-04-06 Source: ResearchSquare

    BackgroundOn 31 December 2019, the World Health Organization (WHO) was informed of a cluster of cases of pneumonia MESHD pneumonia HP of unknown cause detected in Wuhan City, Hubei Province, China. The pneumonia MESHD pneumonia HP was caused by a virus called SARS-Cov-2, which was later named COVID-19. In this report, we present a patient with COVID-19 who developed deep vein thrombosis MESHD.Case presentationA 57-year-old woman presented to the clinic's infectious department with no underlying illness due to pain MESHD pain HP, redness, and leg swelling. According to a patient report, she had a mild dry cough MESHD cough HP for the past 3 days and had no other symptoms. The patient had no history of prone thrombosis MESHD conditions. Initially, CT angiography was performed to rule out pulmonary thromboembolism MESHD thromboembolism HP, which showed no evidence of thrombosis MESHD. Dilatation HP and thrombosis MESHD were seen in the examinations of the paired veins of the leg, popliteal, superficial and left femoral joints, and no evidence of vascular flow suggesting acute DVT. Because of fever MESHD fever HP and lymphopenia MESHD lymphopenia HP, nasal swabs were used for sampling and SARS-CoV-2 nucleic acid was detected by RT-PCR. Chest X-ray also revealed bilateral patchy ground-glass opacity. Other tests including ANA, Anti-dsDNA, RF test and ACA test was normal. Heparin at a dose of 80 units/kg IV bolus, chloroquine 400 mg single dose and lopinavir/ritonavir (Kaletra) 400 mg twice daily were prescribed to treat illness and relieve symptoms. On illness day 3, fever MESHD fever HP stopped and nasal swab sample turned undetectable for SARS-CoV-2 by RT-PCR as well as swelling and tenderness on her leg had been disappeared gradually. She is under regular follow-up with no new symptoms to date.Conclusion The mechanism of DVT formation due to COVID-19 is unknown despite thrombocytopenia MESHD thrombocytopenia HP, and has not been investigated but it resolved as COVID-19 symptoms, tenderness, and leg pain MESHD pain HP improved. Although COVID-19 presented with Deep Vein Thrombosis MESHD is a rare condition, in middle- aged TRANS people with sudden onset of manifestations, we should recognize it from other diseases MESHD as an important and treatable differential diagnosis. Rapid diagnostic assays, efficient treatment, and prudent use of CT-scan are important to control future COVID-19 spread.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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