Corpus overview


Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Significant increase in the incidence of high-risk pulmonary embolism MESHD pulmonary embolism HP during the COVID-19 shutdown: the pandemic response causes serious collateral consequences

    Authors: Paul Gressenberger; Thomas Gary; Reinhard B. Raggam; Andrea Borenich; Gudrun Pregartner; Katharina Gütl; Viktoria Muster; Philipp Jud; Franz Hafner; Peter Rief; Gerald Seinost; Marianne Brodmann

    doi:10.21203/rs.3.rs-46099/v1 Date: 2020-07-20 Source: ResearchSquare

    Background Strict stay-at-home rules, along with fear of coronavirus infection MESHD, have kept many patients from timely seeking medical attention during the novel coronavirus disease MESHD (COVID-19) pandemic. This situation may have led to an increase in the number of patients arriving at hospital in deteriorated clinical condition. In this regard, we aimed to investigate the incidence of pulmonary embolism MESHD pulmonary embolism HP (PE) patients defined as high-risk according to the European Society of Cardiology (ESC) presenting at our emergency MESHD department during the shutdown.Methods A retrospective data analysis explored the impact of the COVID-19 shutdown on the presentation of acute PE patients admitted to University Hospital Graz, Austria. We compared percentages of high-risk PE patients admitted during shutdown and during two control periods: the corresponding period in 2019 and an earlier period in 2020. By including data from the previous year, a general increase of high risk PE cases in 2020 compared to 2019 was ruled out. Risk assessment was carried out in accordance with current ESC guidelines for the diagnosis and management of acute PE.Results The percentage of patients with high-risk PE increased significantly during the COVID-19 shutdown period compared to the two control periods (p = 0.003; p = 0.011). Time from onset of symptoms TRANS to hospital admission was significantly longer in the study period compared to the control periods (p = 0.046 and p = 0.044, respectively).Conclusion The current findings indicate a significant increase in high-risk PE cases as well as delayed hospital admission of symptomatic PE patients during the COVID-19 shutdown period.

    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.

    Acute Pulmonary Embolism MESHD Pulmonary Embolism HP in Coronavirus Disease MESHD 2019

    Authors: Yanan Guo; Wenwu Sun; Yanli Liu; Yanling Lv; Su Zhao; Liangkai Chen; Zhengqing Liu; Li Yu

    doi:10.21203/rs.3.rs-41996/v1 Date: 2020-07-13 Source: ResearchSquare

    Background Pulmonary embolism MESHD Pulmonary embolism HP is a severe condition prone to misdiagnosis given its nonspecific signs and symptoms MESHD. Previous studies on the pneumonia MESHD pneumonia HP outbreak caused by coronavirus disease MESHD 2019 (COVID-19) showed a number of patients with elevated d-dimer, whether those patients combined with pulmonary embolism MESHD pulmonary embolism HP got our attention. Methods Data on clinical manifestations, laboratory and radiological findings, treatment, and disease progression MESHD of 19 patients with laboratory-confirmed COVID-19 pneumonia MESHD pneumonia HP,who completed computed tomographic pulmonary angiography (CTPA) during hospitalization in the Central Hospital of Wuhan from January 2 to March 26, 2020, were reviewed. Results Of the 19 suspected pulmonary embolism MESHD pulmonary embolism HP and subjected to CTPA patients, six were diagnosed with pulmonary embolism MESHD pulmonary embolism HP. The Wells’ score of the six patients with pulmonary embolism MESHD pulmonary embolism HP was 0–1, which suggested a low risk of pulmonary embolism MESHD pulmonary embolism HP. The median level of d-dimers collected at the day before or on the day of CTPA completion in the patients with pulmonary embolism MESHD pulmonary embolism HP was 18.36 (interquartile range [IQR]: 6.69–61.46) µg/mL, which was much higher than that in the patients without pulmonary embolism MESHD pulmonary embolism HP (median 9.47 [IQR: 4.22–28.02] µg/mL). Of the 6 patients diagnosed with pulmonary embolism MESHD pulmonary embolism HP, all patients received anticoagulant therapy, 5 of which survived and were discharged and 1 died. Conclusion A potential causal relationship exists between COVID-19 infection MESHD and pulmonary embolism MESHD pulmonary embolism HP, but whether this phenomenon is common remains uncertain. The clinical manifestations of COVID-19 patients who developed pulmonary embolism MESHD pulmonary embolism HP are similar to those of patients with increased d-dimer alone, prompting a significant challenge on differential diagnoses.

    Clinical Characteristics of SARS-CoV-2 pneumonia MESHD pneumonia HP diagnosed in a primary care practice in Madrid (Spain)

    Authors: Marina Guisado-Clavero; Ana Herrero Gil; Marta Pérez Álvarez; Marta Castelo Jurado; Ana Herrera Marinas; Vanesa Aguilar Ruiz; Ileana Gefaell Iarrondo; Miguel Menéndez; Sara Ares-Blanco

    doi:10.21203/rs.3.rs-42357/v1 Date: 2020-07-13 Source: ResearchSquare

    Background: Possible cases of SARS-CoV-2 infection MESHD were diagnosed in primary care in Madrid, some of these cases had pneumonia MESHD pneumonia HP. Most of the SARS-CoV-2 pneumonia MESHD pneumonia HP published data came from hospitalised patients. This study set out to describe clinical characteristics of patients with SARS-CoV-2 pneumonia MESHD pneumonia HP diagnosed in primary care across age groups TRANS and type of pneumonia MESHD pneumonia HP.Methods: Observational retrospective study obtaining clinical data from the electronic health records of patients who were followed-up by SARS-CoV-2 possible infection MESHD in a primary care practice in Madrid. All the cases were collected by in-person or remote consultation during the 10th March to the 7th of April. Exposure: Diagnosis of SARS-CoV-2 pneumonia MESHD pneumonia HP by chest X-ray ordered by the GP. Main outcomes and measures: Symptoms of SARS-CoV-2 pneumonia MESHD pneumonia HP, physical examination and diagnostic tests as a blood SERO test, nasopharyngeal swab results for RT-PCR (Reverse transcriptase-polymerase chain reaction) and chest X-ray results. Results: The overall SARS-CoV-2 pneumonias MESHD pneumonias HP collected were 172 ( female TRANS 87 [50.6%], mean age TRANS 60.5 years (standard deviation [SD] 17.0). Comorbidities were body mass index ≥25 kg/m 2 (90 [52.3%]), hypertension MESHD hypertension HP 83 [48.3%]), dyslipidaemia (68 [39.5%]) and diabetes (33 [19.2%]). The sample was stratified by age groups TRANS (<50 years, 50-75 years and ≥75 years). Clinical manifestations at onset were fever MESHD fever HP (144 [83.7%]), cough MESHD cough HP (140 [81.4%]), dyspnoea (103 [59.9%]) and gastrointestinal disturbances (72 [41.9%]). Day 7.8 (SD:4.1) from clinical onset was the mean day of pneumonia MESHD pneumonia HP diagnosis. Bilateral pneumonia MESHD pneumonia HP was more prevalent than unilateral (126 [73.3%]) and 46 [26.7%]). Patients with unilateral pneumonia MESHD pneumonia HP were prone to higher pulse oximetry (96% vs 94%, p <0.001). We found differences between unilateral and bilateral cases in C-reactive protein (29.6 vs 81.5mg/L, p <0.001), and lymphocytes (1400.0 vs 1000.0E3/ml, p<0.001). Complications were registered: 42 (100%) of patients ≥75 years were admitted into hospital; pulmonary embolism MESHD pulmonary embolism HP was only present at bilateral pneumonia MESHD pneumonia HP (7 patients [5.6%]) and death MESHD occurred in 1 patient with unilateral pneumonia MESHD pneumonia HP (2.2%) vs 10 patients (7.9%) with bilateral pneumonia MESHD pneumonia HP ( p 0.170).Conclusion: Clinical manifestations of SARS-CoV-2 pneumonia MESHD pneumonia HP were fever MESHD fever HP, cough MESHD cough HP and dyspnoea; this was especially clear in the elderly TRANS. We described different characteristics between unilateral and bilateral pneumonia MESHD pneumonia HP.

    A case-report of widespread pulmonary embolism MESHD pulmonary embolism HP in a middle- aged TRANS male TRANS seven weeks after asymptomatic TRANS suspected COVID 19 infection MESHD

    Authors: Mats Beckman; Sven Nyren; Anna Kistner

    doi:10.21203/rs.3.rs-41128/v1 Date: 2020-07-11 Source: ResearchSquare

    We present a case of suspected Covid-19 with widespread pulmonary embolism MESHD pulmonary embolism HP in a patient unaware of having had the disease MESHD

    Clinical utility of targeted SARS-CoV-2 serology testing to aid the diagnosis and management of suspected missed, late or post-COVID-19 infection MESHD syndromes MESHD: results from a pilot service

    Authors: Nicola Sweeney; Blair Merrick; Suzanne Pickering; Rui Pedro Galao; Alina Botgros; Harry D. Wilson; Adrian W. Signell; Gilberto Betancor; Mark Kia Ik Tan; John Ramble; Neophytos Kouphou; Sam Acors; Carl Graham; Jeffrey Seow; Eithne MacMahon; Stuart J. D. Neil; Michael H. Malim; Katie Doores; Sam Douthwaite; Rahul Batra; Gaia Nebbia; Jonathan D. Edgeworth

    doi:10.1101/2020.07.10.20150540 Date: 2020-07-11 Source: medRxiv

    Objectives: Determine indications and clinical utility of SARS-CoV-2 serology testing in adults TRANS and children TRANS. Design: Prospective evaluation of initial three weeks of a daily Monday to Friday pilot SARS-CoV-2 serology service for patients. Setting: Early post 'first-wave' SARS-CoV-2 transmission TRANS period at single centre London teaching hospital that provides care to the local community, as well as regional and national referral pathways for specialist services. Participants: 110 (72 adults TRANS, 38 children TRANS, age TRANS range 0-83 years, 52.7% female TRANS (n=58)). Interventions: Patient serum SERO from vetted referrals tested on CE marked and internally validated lateral flow immunoassay SERO (LFIA) (SureScreen Diagnostics) detecting antibodies to SARS-CoV-2 SERO spike proteins, with result and clinical interpretation provided to the direct care team. Main outcome measures: Performance SERO characteristics, source and nature of referrals, feasibility and clinical utility of the service, particularly the benefit for clinical decision-making. Results: The LFIA was deemed suitable for clinical advice and decision making following evaluation with 310 serum samples SERO from SARS-CoV-2 PCR positive patients and 300 pre-pandemic samples, giving a sensitivity SERO and specificity of 96.1% and 99.3% respectively. For the pilot, 115 referrals were received leading to 113 tests performed on 108 participants (sample not available for two participants); paediatrics (n=35), medicine (n=69), surgery (n=2) and general practice (n=2). 43.4% participants (n=49) had detectable antibodies to SARS-CoV-2 SERO. There were three main indications for serology; new acute presentations potentially triggered by recent COVID-19 infection MESHD e.g. PIMS-TS (n=26) and pulmonary embolism MESHD pulmonary embolism HP (n=5), potential missed diagnoses in context of a recent compatible illness (n=40), and making infection MESHD control and immunosuppression treatment decisions in persistently SARS-CoV-2 RNA PCR positive individuals (n=6). Conclusions: This study shows acceptable performance SERO characteristics, feasibility and clinical utility of a SARS-CoV-2 serology service using a rapid, inexpensive and portable assay for adults TRANS and children TRANS presenting with a range of clinical indications. Results correlated closely with a confirmatory in-house ELISA SERO. The study showed the benefit of introducing a serology service where there is a reasonable pre-test probability, and the result can be linked with clinical advice or intervention. Experience thus far is that the volume of requests from hospital referral routes are manageable within existing clinical and laboratory services; however, the demand from community referrals has not yet been assessed. Given recent evidence for a rapid decline in antibodies SERO, particularly following mild infection MESHD, there is likely a limited window of opportunity to realise the benefit of serology testing for individuals infected during the 'first-wave' before they potentially fall HP below a measurable threshold. Rapidly expanding availability of serology services for NHS patients will also help understand the long-term implications of serostatus and prior infection MESHD in different patient groups, particularly before emergence of any 'second-wave' outbreak or introduction of a vaccination programme.

    Rotational Thromboelastometry predicts care level in Covid-19

    Authors: Lou Almskog; Agneta Wikman; Jonas Svensson; Michael Wanecek; Matteo Bottai; Jan van der Linden; Anna Agren

    doi:10.1101/2020.06.11.20128710 Date: 2020-06-12 Source: medRxiv

    Background High rates of thrombotic events in severely ill COVID-19 patients have been reported. Pulmonary embolism MESHD Pulmonary embolism HP as well as microembolisation of vital organs may be direct causes of death MESHD in COVID-19 positive individuals. If patients at high risk of developing thrombosis MESHD may be identified early, more effective prophylactic treatment could be applied. Objectives To test whether Rotational Thromboelastometry (ROTEM) indicates hypercoagulopathy in hospitalized COVID-19 patients, and whether patients with severe disease MESHD have a more pronounced hypercoagulopathy compared with less severely ill patients. Methods COVID-19 positive patients over 18 years admitted to St Gorans Hospital, Stockholm, Sweden were eligible for inclusion. Patients were divided into two groups depending on care level: 1) regular wards or 2) wards with specialized ventilation support. ROTEM was taken as soon after admission to hospital as possible (median day 1 after hospitalization). The data were compared with healthy controls. Results The ROTEM variables Maximum Clot Firmness (EXTEM-MCF and FIBTEM-MCF) were significantly higher in both groups of COVID-19 patients compared with healthy controls (p<0.001) and higher in severely ill patients compared with patients at regular wards (p<0.05). Coagulation Time (EXTEM-CT) was significantly longer and Clot Formation Time (EXTEM-CFT) significantly shorter in COVID-19 patients compared with healthy controls. Our results suggest that hypercoagulopathy is present in hospitalized patients with mild to severe COVID-19 pneumonia MESHD pneumonia HP. Conclusion ROTEM variables (EXTEM-MCF, FIBTEM-MCF, EXTEM-CT, EXTEM-CFT) were significantly different in COVID-19 patients early after admission compared with healthy controls. This pattern was more pronounced in patients with increased disease MESHD severity, suggesting that ROTEM-analysis could be a potentially useful predictor of thromboembolic complications and mortality in these patients.

    Acutely Altered Mental Status as the Main Clinical Presentation of Multiple Strokes MESHD Strokes HP in Critically Ill Patients With COVID-19.

    Authors: Carolina Díaz-Pérez; Carmen Ramos; Alberto López-Cruz; José Muñoz Olmedo; Jimena Lázaro González; Enrique de Vega-Ríos; Carmen González-Ávila; Carlos Hervás; Santiago Trillo; José Vivancos

    doi:10.21203/rs.3.rs-31769/v1 Date: 2020-05-26 Source: ResearchSquare

    Background and aims: Cerebral infarction MESHD in COVID-19 patients might be associated with a hypercoagulable state related to a systemic inflammatory response. Its diagnosis might be challenging. We present two critically ill patients with COVID-19 who presented acutely altered mental status as the main manifestation of multiple strokes MESHD strokes HP.Methods:Clinical presentation and diagnostic work-up of the patients.Results:Two patients in their sixties were hospitalized with a bilateral pneumonia MESHD pneumonia HP COVID-19. They developed respiratory failure HP and were admitted to ICU for mechanical ventilation and intense medical treatment. They were started on low-molecular-weight heparin since admission. Their laboratory results showed lymphopenia MESHD lymphopenia HP and increased levels of C-reactive protein and D-dimer. Case 1 developed hypofibrinogenemia HP and presented several cutaneous lesions with biopsy features of thrombotic vasculopathy. Case 2 was performed a CT pulmonary angiogram at ICU showing a bilateral pulmonary embolism MESHD pulmonary embolism HP. When waking up, both patients were conscious but with a remarkable global altered mental status without focal neurological deficits. A brain MRI revealed multiple acute bilateral ischemic lesions with areas of hemorrhagic transformation in both patients (Case 1: affecting the left frontal and temporal lobes and both occipital lobes; Case 2: affecting both frontal and left occipital lobes). Cardioembolic source and acquired antiphospholipid syndrome MESHD were ruled out. COVID-19-associated coagulopathy was suspected as the possible main etiology of the strokes MESHD strokes HP.Conclusion:Acutely altered mental status might be the main manifestation of multiple brain infarctions MESHD in critically ill COVID-19 patients. It should be specially considered in those with suspected COVID-19-associated coagulopathy. Full-dose anticoagulation and clinical-radiological monitoring might reduce their neurological consequences.

    COVID-19 Associated Coagulopathy In The Setting of Underlying Malignancy

    Authors: Su Lin Lim; Kok Hoe Chan; Gunwant Guron; Hamid S Shaaban

    doi:10.21203/rs.3.rs-31264/v1 Date: 2020-05-25 Source: ResearchSquare

    Coronavirus Disease MESHD 2019 (COVID-19) associated coagulopathy is growingly recognized as the predictor for morbidity and mortality in COVID-19 patients. Deep vein thrombosis MESHD (DVT) and pulmonary embolism MESHD pulmonary embolism HP (PE) have been increasingly observed in COVID-19 patients. Nonetheless, there are no consensus guidelines on the use of therapeutic coagulation in this group of patients. We herein presenting a unique case of a COVID-19 patient with metastatic ovarian cancer who presented with DVT/PE despite being on therapeutic anticoagulation, highlighting the unpredictability of COVID-19 associated coagulopathy. This is to raise the awareness that thrombophilic state in metastatic malignancies is potentially augmented by COVID-19. We also discussed the complexity of making anticoagulation treatment decision in COVID-19 patients in the absence of evidence-based guidelines.

    Acute Pulmonary Embolism MESHD Pulmonary Embolism HP in Critically Ill Patients with COVID-19

    Authors: Madhura Manjunath; Julio Miranda; Liana Fraenkel; Paul Manje Johansen; Blessing Phinney; Georgianne Valli-Harwood; Cynthia Callahan; Hafez Alsmaan; David Oelberg

    doi:10.1101/2020.05.22.20110270 Date: 2020-05-24 Source: medRxiv

    Since the discovery of the novel coronavirus (SARS-Co-V-2) in December 2019, multiple characteristics have been reported, as our understanding of this new disease MESHD unfolds. One such association is its tendency to cause thromboembolic events, particularly venous thromboembolism MESHD thromboembolism HP (1,2). In a four-week period during the initial spread of COVID-19 at a 300 bed community hospital in western Massachusetts, 23 patients who were PCR positive for SARS-CoV-2 RNA required treatment in either the intensive care unit (ICU) or intermediate/step-down unit (SDU). All patients were treated with standard DVT prophylaxis from the time of admission, except for two patients who were on full anticoagulation for chronic atrial fibrillation MESHD atrial fibrillation HP. Of the 23 patients, 7 (30%) were diagnosed with acute, clinically significant, pulmonary embolism MESHD pulmonary embolism HP (PE). Four of the 7 manifested evidence of acute cor pulmonale HP, one of whom succumbed as a direct consequence of a massive PE. Other markers were reviewed in the 7 patients to identify trends that could allow for early suspicion of PE in COVID-19 patients. Although D-dimer tended to rise during the hospitalization relative to the control group, the results were inconsistent, and there were no other meaningful distinguishing features between the groups at the time of admission.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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