Corpus overview


MeSH Disease

Human Phenotype


    displaying 31 - 40 records in total 264
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    Can Adenosine Fight COVID-19 Acute Respiratory Distress HP Syndrome MESHD?

    Authors: Carmela Falcone; Massimo Caracciolo; Pierpaolo Correale; Sebastiano Macheda; Eugenio Giuseppe Vadalà; Stefano La Scala; Marco Tescione; Roberta Danieli; Anna Ferrarelli; Maria Grazia Tarsitano; Lorenzo Romano; Antonino De Lorenzo

    id:10.20944/preprints202007.0426.v1 Date: 2020-07-19 Source:

    Some COVID-19 patients develop interstitial pneumonia MESHD pneumonia HP that can evolve into Acute Respiratory Distress HP Syndrome MESHD (ARDS). This is accompanied by an inflammatory cytokine storm. SarS-CoV has proteins capable of promoting cytokine storm, especially in patients with comorbidities, including obesity MESHD obesity HP. Since there is currently no resolutive therapy for ARDS and given the scientific literature regarding the use of adenosine, its application has been hypothesized. Adenosine through its receptors is able to inhibit the acute inflammatory process, increase the protection capacity of the epithelial barrier and reduce the damage due to an overactivation of the immune system, such as in cytokine storms. These features are known in ischemia MESHD / reperfusion models and could also be exploited in acute lung injury MESHD, with hypoxia MESHD. In light of these hypotheses, for compassionate use, a COVID-19 patient, with unresponsive respiratory failure HP, was treated with adenosine. The results showed a rapid and clear improvement in clinical conditions, with the negative effect of detection of SarS-CoV2.

    Identifying organ dysfunction trajectory-based subphenotypes in critically ill patients with COVID-19

    Authors: Chang Su; Zhenxing Xu; Katherine Hoffman; Parag Goyal; Monika M Safford; Jerry Lee; Sergio Alvarez-Mulett; Luis Gomez-Escobar; David R Price; John S Harrington; Lisa K Torres; Fernando J Martinez; Thomas R Campion Jr.; Rainu Kaushal; Augustine M.K. Choi; Fei Wang; Edward J Schenck

    doi:10.1101/2020.07.16.20155382 Date: 2020-07-18 Source: medRxiv

    Rationale. COVID-19-associated respiratory failure HP offers the unprecedented opportunity to evaluate the differential host response to a uniform pathogenic insult. Prior studies of Acute Respiratory Distress HP Syndrome MESHD (ARDS) have identified subphenotypes with differential outcomes. Understanding whether there are distinct subphenotypes of severe COVID-19 may offer insight into its pathophysiology. Objectives. To identify and characterize distinct subphenotypes of COVID-19 critical illness MESHD defined by the post-intubation trajectory of Sequential Organ Failure Assessment (SOFA) score. Methods. Intubated COVID-19 patients at two hospitals in New York city were leveraged as development and validation cohorts. Patients were grouped into mild, intermediate, and severe strata by their baseline post-intubation SOFA. Hierarchical agglomerative clustering was performed within each stratum to detect subphenotypes based on similarities amongst SOFA score trajectories evaluated by Dynamic Time Warping. Statistical tests defined trajectory subphenotype predictive markers. Measurements and Main Results. Distinct worsening and recovering subphenotypes were identified within each stratum, which had distinct 7-day post-intubation SOFA progression trends. Patients in the worsening suphenotypes had a higher mortality than those in the recovering subphenotypes within each stratum (mild stratum, 29.7% vs. 10.3%, p=0.033; intermediate stratum, 29.3% vs. 8.0%, p=0.002; severe stratum, 53.7% vs. 22.2%, p<0.001). Worsening and recovering subphenotypes were replicated in the validation cohort. Routine laboratory tests, vital signs, and respiratory variables rather than demographics and comorbidities were predictive of the worsening and recovering subphenotypes. Conclusions. There are clear worsening and recovering subphenotypes of COVID-19 respiratory failure HP after intubation, which are more predictive of outcomes than baseline severity of illness. Organ dysfunction trajectory may be well suited as a surrogate for research in COVID-19 respiratory failure HP.


    Authors: Enric Monreal; Susana Sainz de la Maza; Elena Natera-Villalba; Alvaro Beltran-Corbellini; Fernando Rodriguez-Jorge; Jose Ignacio Fernandez-Velasco; Paulette Walo-Delgado; Alfonso Muriel; Javier Zamora; Araceli Alonso-Canovas; Jesus Fortun; Luis Manzano; Beatriz Montero-Errasquin; Lucienne Costa-Frossard; Jaime Masjuan; Luisa Maria Villar

    doi:10.1101/2020.07.17.20156315 Date: 2020-07-17 Source: medRxiv

    INTRODUCTION: Despite the increasing evidence of the benefit of corticosteroids for the treatment of moderate-severe Coronavirus disease MESHD 2019 (COVID-19) patients, no data are available about the potential role of high doses of steroids for these patients. METHODS: All consecutive confirmed COVID-19 patients admitted to a single center were selected, including those treated with steroids and an acute respiratory distress HP syndrome MESHD (ARDS). Patients were allocated to the high doses (HD, 250mg/day or more of methylprednisolone) of corticosteroids or the standard doses (SD, 1.5mg/kg/day or more of methylprednisolone) at discretion of treating physician. The primary endpoint was the mortality between both cohorts and secondary endpoints were the risk of need for mechanical ventilation (MV) or death MESHD and the risk of developing a severe ARDS. RESULTS: 573 patients were included: 428 (74.7%) men, with a median (IQR) age TRANS of 64 (54-73) years. In HD cohort, a worse baseline respiratory situation was observed and male TRANS sex, older age TRANS and comorbidities were significantly more common. After adjusting by baseline characteristics, HD were associated with a higher mortality than SD (adjusted-OR 2.46, 95% CI 1.58-3.83, p<0.001) and with an increased risk of needing MV or death MESHD (adjusted-OR 2.50, p=0.001). Conversely, the risk of developing a severe ARDS was similar between groups. Interaction analysis showed that HD increased mortality exclusively in elderly TRANS patients. CONCLUSION: Our real-world experience advises against exceeding 1-1.5mg/kg/day of corticosteroids for severe COVID-19 with an ARDS, especially in older subjects. This reinforces the rationale of modulating rather than suppressing immune responses in these patients.

    Lung ultrasound and computed tomography to monitor COVID-19 pneumonia MESHD pneumonia HP in critically ill patients: a two-center prospective cohort study

    Authors: Micah Heldeweg; Jorge A. Lopez Matta; Mark E. Haaksma; Jasper M. Smit; Carlos V. Elzo Kraemer; Harm-Jan S. de Grooth; E. de Jonge; L.J. Meijboom; Leo M.A. Heunks; David J. van Westerloo; Pieter Roel Tuinman

    doi:10.21203/ Date: 2020-07-17 Source: ResearchSquare

    Background: Lung ultrasound can adequately monitor disease MESHD severity in pneumonia MESHD pneumonia HP and acute respiratory distress HP syndrome MESHD. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia MESHD pneumonia HP in critically ill patients. Methods: Adult TRANS patients with COVID-19 pneumonia MESHD pneumonia HP admitted to the intensive care unit of two academic hospitals who underwent a 12-zone lung ultrasound and a chest CT examination were included. Baseline characteristics, and outcomes including composite endpoint death MESHD or ICU stay >30 days were recorded. Lung ultrasound and CT images were quantified as a Lung Ultrasound Score Involvement index (LUSI) and CT Severity Involvement index (CTSI). Primary outcome was the correlation, agreement, and concordance between LUSI and CTSI. Secondary outcome was the association of LUSI and CTSI with the composite endpoints.Results: We included 55 ultrasound examinations in 34 patients, which were 88% were male TRANS, with a mean age TRANS of 63 years and mean P/F ratio of 151. The correlation between LUSI and CTSI was strong (r=0.795), with an overall 15% bias, and limits of agreement ranging -40 to 9.7. Concordance between changes in sequentially measured LUSI and CTSI was 81%. In the univariate model, high involvement on LUSI and CTSI were associated with a composite endpoint. In the multivariate model, LUSI was the only remaining independent predictor.Conclusions: Lung ultrasound can be used as an alternative for chest CT in monitoring COVID-19 pneumonia MESHD pneumonia HP in critically ill patients as it can quantify pulmonary involvement, register changes over the course of the disease MESHD, and predict death MESHD or ICU stay >30 days.Trial registration: NTR, NL8584. registered 01 May 2020 - retrospectively registered,

    Acute Demyelinating Encephalomyelitis MESHD (ADEM) in COVID-19 infection MESHD: A Case Series.

    Authors: Michaela McCuddy; Praful Kelkar; Yu Zhao; David Wicklund

    doi:10.1101/2020.07.15.20126730 Date: 2020-07-17 Source: medRxiv

    Objective: To report three patients infected with COVID-19 with severe respiratory syndrome MESHD requiring intubation, who developed acute demyelinating encephalomyelitis MESHD (ADEM). Method: Patient data were obtained from medical records from the North Memorial Health Hospital, Robbinsdale, MN, USA Results: Three patients (two men and one woman, aged TRANS 38 - 63) presented with fatigue MESHD fatigue HP, cough MESHD cough HP and fever MESHD fever HP leading to development of acute respiratory distress HP syndrome MESHD secondary to COVID-19 infection MESHD requiring intubation and ventilatory support. Two patients were unresponsive, one with strong eye deviation to the left and the third patient had severe diffuse weakness. MRI in all patients showed findings consistent with ADEM. CSF showed elevated protein in all patients with normal cell count and no evidence of infection MESHD, including negative COVID-19 PCR. All three of the patients received Convalescent plasma SERO therapy for COVID-19. All patients were treated with intravenous corticosteroids and improved, although two responded minimally. Two patients treated with IVIG showed no further improvement. Conclusion: Neurological complications from COVID-19 are being rapidly recognized. Our three cases highlight the occurrence of ADEM as a postinfectious/immune mediated complication of COVID-19 infection MESHD, which may be responsive to corticosteroid treatment. Early recognition of this complication and treatment is important to avoid long term complications.

    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/ 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. 

    Early Improvement of Acute Respiratory Distress HP Syndrome MESHD in Patients with COVID-19: Insights from the Data of ICU Patients in Chongqing, China

    Authors: Zhu Zhan; Xin Yang; Hu Du; Chuanlai Zhang; Yuyan Song; Xiaoyun Ran; An Zhang; Mei Yang

    doi:10.1101/2020.07.15.20154047 Date: 2020-07-16 Source: medRxiv

    Acute respiratory distress HP syndrome MESHD (ARDS) may be the main cause of death MESHD in patients with coronavirus disease MESHD 2019 (COVID-19). Herein, we retrospect clinical features, outcomes and ARDS characteristics of 75 intensive care unit (ICU) patients with COVID-19 in Chongqing, China. We found a 5.3% case fatality rate of the ICU patients in Chongqing. 93% patients developed ARDS during the intensive care, and more than half were moderate. However, most of the patients (55%) supported with high flow nasal cannula (HFNC) oxygen therapy, but not mechanical ventilation. Nearly one third of patients with ARDS got an early improvement (eiARDS), and the rate is much higher than the other causes of ARDS in a previous study. Patients with eiARDS had a higher survival rate and lower length of ICU stay. The age TRANS (< 55 years) is an independent predictor for the eiARDS, and stratification of COVID-19 patients by age TRANS is recommended.

    Dissemination and co-circulation of SARS-CoV2 subclades exhibiting enhanced transmission TRANS associated with increased mortality in Western Europe and the United States

    Authors: Yuan Hu; Lee W Riley

    doi:10.1101/2020.07.13.20152959 Date: 2020-07-15 Source: medRxiv

    Mechanisms underlying the acute respiratory distress HP syndrome MESHD (ARDS)-like clinical manifestations leading to deaths MESHD in patients who develop COVID-19 remain uncharacterized. While multiple factors could influence these clinical outcomes, we explored if differences in transmissibility TRANS and pathogenicity of SARS-CoV2 variants could contribute to these terminal clinical consequences of COVID-19. We analyzed 34,412 SARS-CoV2 sequences deposited in the Global Initiative for Sharing All Influenza Data (GISAID) SARS-CoV2 sequence database to determine if regional differences in circulating strain variants correlated with increased mortality in Europe, the United States, and California. We found two subclades descending from the Wuhan HU-1 strain that rapidly became dominant in Western Europe and the United States. These variants contained nonsynonymous nucleotide mutations in the Orf1ab segment encoding RNA-dependent RNA polymerase (C14408T), the spike protein gene (A23403G), and Orf1a (G25563T), which resulted in non-conservative amino acid substitutions P323L, D614G, and Q57H, respectively. In Western Europe, the A23403G-C14408T subclade dominated, while in the US, the A23403G-C14408T-G25563T mutant became the dominant strain in New York and parts of California. The high cumulative frequencies of both subclades showed inconsistent but significant association with high cumulative CFRs in some of the regions. When the frequencies of the subclades were analyzed by their 7-day moving averages across each epidemic, we found co-circulation of both subclades to temporally correlate with peak mortality periods. We postulate that in areas with high numbers of these co-circulating subclades, a person may get serially infected. The second infection MESHD may trigger a hyperinflammatory response similar to the antibody SERO-dependent enhancement (ADE) response, which could explain the ARDS-like manifestations observed in people with co-morbidity, who may not mount sufficient levels of neutralizing antibodies SERO against the first infection MESHD. Further studies are necessary but the implication of such a mechanism will need to be considered for all current COVID-19 vaccine designs.

    Increased serum SERO levels of soluble TNF-α receptor is associated with mortality of ICU COVID-19 patients

    Authors: Esmaeil Mortaz; Payam Tabarsi; Hamidreza Jamaati; Neda Dalil Roofchayee; Neda KakaDezfuli; Seyed MohammadReza Hashemian; Afshin Moniri; Majid Marjani; Majid Malekmohammd; Davood Manosuri; Mohammd Varahram; Gert Folkerts; Ian M Adcock

    doi:10.1101/2020.07.12.20152066 Date: 2020-07-15 Source: medRxiv

    Background: Severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) that causes coronavirus disease MESHD 2019 (COVID-19) has spread to almost 100 countries, infected over 10M patients and resulted in 505K deaths MESHD worldwide as of 30th June 2020. The major clinical feature of severe COVID-19 requiring ventilation is acute Respiratory Distress HP Syndrome MESHD (ARDS) with multi-functional failure as a result of a cytokine storm with increased serum SERO levels of cytokines such as TNF- and IL-6 being reported. TNF- levels are increased during the cytokine storm in very ill patients and soluble receptors for IL-6 and IL-2 are present in the blood SERO of COVID-19 patients, Objectives: To elucidate the involvement of serum SERO levels of soluble TNF-Receptor of severe and mild COVID-19 patients to determine for severity of disease MESHD. Method: We recruited 16 severe COVID-19 patients in the ICU on ventilator support and 26 milder COVID-19 patients who were hospitalised but not within the intensive care unit (ICU) between March-May 2020 at the Masih Daneshvari Hospital Tehran, Iran. After harvesting of whole blood SERO the serum SERO was isolated and soluble TNF-Receptor levels measured by ELISA SERO. Results: Serum SERO levels of the usually inhibitory soluble TNF receptor 1 (sTNFaR1) were significantly elevated in severe COVID-19 patients at admission to ICU. High serum SERO levels of sTNFaR1 were associated with mortality of severe COVID-19 patients treated within ICU. Conclusions: This pilot study demonstrates for role of STNF-aR1 receptor in severity of disease MESHD. Future studies should examine whether lower levels of systemic sTNFaR1 at admission may indicate a better disease MESHD outcome.

    Antibody SERO responses to SARS-CoV2 are distinct in children TRANS with MIS-C compared to adults TRANS with COVID-19

    Authors: Stuart P Weisberg; Thomas Connors; Yun Zhu; Matthew Baldwin; Wen-Hsuan Lin; Sandeep Wontakal; Peter A Szabo; Steven B Wells; Pranay Dogra; Joshua I Gray; Emma Idzikowski; Francesca Bovier; Julia Davis-Porada; Rei Matsumoto; Maya Meimei Li Poon; Michael P Chait; Cyrille Mathieu; Branka Horvat; Didier Decimo; Zachary C Bitan; Francesca La Carpia; Stephen A Ferrara; Emily Mace; Joshua Milner; Anne Moscona; Eldad A Hod; Matteo Porotto; Donna L Farber

    doi:10.1101/2020.07.12.20151068 Date: 2020-07-14 Source: medRxiv

    Clinical manifestations of COVID-19 caused by the novel coronavirus SARS-CoV-2 are associated with age TRANS. While children TRANS are largely spared from severe respiratory disease MESHD, they can present with a SARS-CoV-2-associated multisystem inflammatory syndrome MESHD (MIS-C) similar to Kawasaki's disease MESHD. Here, we show distinct antibody SERO (Ab) responses in children TRANS with MIS-C compared to adults TRANS with severe COVID-19 causing acute respiratory distress HP syndrome MESHD (ARDS), and those who recovered from mild disease MESHD. There was a reduced breadth and specificity of anti- SARS-CoV-2-specific antibodies SERO in MIS-C patients compared to the COVID patient groups; MIS-C predominantly generated IgG Abs specific for the Spike (S) protein but not for the nucleocapsid (N) protein, while both COVID-19 cohorts had anti-S IgG, IgM and IgA Abs, as well as anti-N IgG Abs. Moreover, MIS-C patients had reduced neutralizing activity compared to COVID-19 cohorts, indicating a reduced protective serological response. These results suggest a distinct infection MESHD course and immune response in children TRANS and adults TRANS who develop severe disease MESHD, with implications for optimizing treatments based on symptom and age TRANS.

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MeSH Disease
Human Phenotype

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