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Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Montelukast in Hospitalized Patients Diagnosed with COVID-19

    Authors: Ahsan Khan; Christian Misdary; Nikhil Yegya-Raman; Sinae Kim; Navaneeth Narayanan; Sheraz Siddiqui; Padmini Salgame; Jared Radbel; Frank De Groote; Carl Michel; Janice Mehnert; Caleb Hernandez; Thomas Braciale; Jyoti Malhotra; Michael A. Gentile; Salma K. Jabbour

    doi:10.21203/rs.3.rs-52430/v1 Date: 2020-08-01 Source: ResearchSquare

    Background Several therapeutic agents have been assessed for the treatment of COVID-19, but few approaches have been proven efficacious. Because leukotriene receptor antagonists such as montelukast have been shown to reduce both cytokine release and lung inflammation MESHD in preclinical models of viral influenza and acute respiratory distress HP syndrome MESHD, we hypothesized that therapy with montelukast would reduce clinical deterioration MESHD as measured by the COVID-19 Ordinal Scale.Methods We performed a retrospective analysis of COVID-19 confirmed hospitalized patients treated with or without montelukast. We used “clinical deterioration” as the primary endpoint, a binary outcome defined as any increase in the Ordinal Scale value from Day 1 to Day 3 of hospital stay, as these data were uniformly available for all admitted patients before hospital discharge. Rates of clinical deterioration MESHD between the montelukast and non-montelukast groups were compared using the Fisher’s exact test. Univariate logistic regression was also used to assess the association between montelukast use and clinical deterioration MESHD.Results A total of 92 patients were analyzed, 30 received montelukast at the discretion of the treating physician and 62 patients who did not receive montelukast. Patients receiving montelukast experienced significantly fewer events of clinical deterioration MESHD compared to patients not receiving montelukast (10% vs 32%, p = 0.022). Sensitivity SERO analysis among those without asthma MESHD asthma HP showed a trend toward fewer clinical deterioration MESHD events in the montelukast group than non-montelukast groups (11% vs 33%, p = 0.077). Sensitivity SERO analysis among those who did not receive azithromycin showed fewer clinical deterioration MESHD events in the montelukast group vs. non-montelukast groups (8% vs 32%, p = 0.030).Conclusions Our findings suggest that montelukast associates with a reduction in clinical deterioration MESHD for COVID-19 confirmed patients as measured on the COVID-19 Ordinal Scale. Montelukast may have activity in COVID-19 infection MESHD, and future efforts should evaluate this potential therapy.

    Tuberculous Pericarditis MESHD Pericarditis HP with tamponade in COVID-19: A case report

    Authors: SHIUN WOEI WONG; Jessica Ng Ke Xuan; Chia Yew Woon

    doi:10.21203/rs.3.rs-45055/v1 Date: 2020-07-17 Source: ResearchSquare

    IntroductionTuberculous pericarditis MESHD pericarditis HP is a rare manifestation of tuberculosis MESHD infection MESHD. COVID-19 pandemic poses a challenge in detecting uncommon disease MESHD. Pericardial effusion MESHD Pericardial effusion HP with tamponade has been described with COVID-19 but the association with tuberculosis MESHD is not yet known. Case presentationA 47-year-old man was admitted with symptoms of COVID-19 infection MESHD. Rapid progression of cardiomegaly MESHD cardiomegaly HP on radiograph with clinical deterioration MESHD were suggestive of pericardial tamponade. Urgent pericardiocentesis revealed hemoserous fluid, elevated adenosine deaminase and positive TB PCR. He was started on steroid, anti-tuberculous therapy and Remdesivir with marked improvement of symptoms. Repeat echocardiogram and CT Thorax showed resolution of pericardial fluid and patient was discharged well. ConclusionsThis case highlights the difficulty in detecting a concomitant rare but important disease MESHD. The development of massive pericardial tamponade acutely is not pathognomonic for COVID-19, and a careful diagnostic process involving multi-modality imaging, occurred to arrive at a diagnosis of tuberculosis MESHD.

    Favipiravir versus other antiviral or standard of care for COVID-19 treatment: A rapid systematic review and meta-analysis

    Authors: Dhan Bahadur Shrestha; Pravash Budhathoki; Sitaram Khadka; Prajwol Bikram Shah; Nisheem Pokharel; Prama Rashmi

    doi:10.21203/rs.3.rs-40775/v1 Date: 2020-07-09 Source: ResearchSquare

    Background The coronavirus, cause of COVID-19 is an enveloped, RNA virus that utilizes an enzyme RNA dependent RNA polymerase for its replication. Favipiravir (FVP) triphosphate, a purine nucleoside analog, inhibits that enzyme. We have conducted this systematic review and meta-analysis on efficacy and safety of drug FVP as a treatment for COVID-19.Methods Databases like Pubmed, Medline, Google Scholar, preprint sites, and clinicaltirals.gov were searched. Studies including FVP along with the standard of care (SOC) were taken in the treatment arm and SOC including other antivirals, and supportive care as control arm. Quantitative synthesis done using RevMan 5.4. Clinical improvement, negative conversion of reverse transcription-polymerase chain reaction (RT-PCR), adverse effects, and oxygen requirement were studied.Results We identified a total of 824 studies after electronic database searching. Five in qualitative studies and three studies in quantitative synthesis meet the criteria. There was a significant clinical improvement on FVP arms on 14th day compared to control arms (RR 1.41, 1.10–1.80). Clinical deterioration MESHD rates was significantly unlikely in FVP group (OR 0.21, 0.08–0.58) at the endpoint of study. The meta-analysis showed no significant differences between two arms on virological clearance (Day 14: RR 1.03, 0.64–1.67), oxygen requirement (OR 0.47, 0.21–1.04), and adverse effects (OR 0.42, 0.03–6.05). There are 25 Randomized controlled trials (RCTs) registered in different parts of the world focusing FVP for COVID-19 treatment.Conclusion There is significant clinical and radiological improvement following treatment with FVP in comparison to the standard of care with no significant differences on virological clearance, oxygen support requirement and side effect profile.

    Short-term Moderate-dose Corticosteroid Plus Immunoglobulin Effectively Reverses Covid-19 Patients Who Have Failed Low-dose Therapy

    Authors: Zhi-Guo Zhou; Shu-min Xie; Jing Zhang; Fang Zheng; Ji-Heng Liu; Chun-Lin Cai; Hui Li; Di-Xuan Jiang; Lei Zhang

    doi:10.21203/rs.3.rs-34078/v1 Date: 2020-06-08 Source: ResearchSquare

    Background: The coronavirus disease MESHD-19 (COVID-19) has spread globally with more than 6,750,000 people infected, and nearly 400,000 patients died. Currently, we are in an urgent need for effective treatment strategy to control the clinical deterioration MESHD of COVID-19 patients.Methods: The clinical data of 10 COVID-19 patients receiving short-term moderate-dose corticosteroid (160mg/d) plus immunoglobulin (20g/d) were studied in the North Yard of The First Hospital of Changsha, Hunan from January 17th to February 27th, 2020. Epidemiological, clinical, laboratory, radiological findings were analyzed. Results: After treatment with combination of low-dose corticosteroid (40-80mg/d) and immunoglobulin (10g/d), patients’ lymphocyte count (0.88±0.34 vs 0.59±0.18, P<0.05), oxygenation index including SPO2 (94.90±2.51 vs 90.50±5.91, P<0.05) and PaO2/FiO2 (321.36±136.91 vs 129.30±64.97, P<0.05) were significantly lower than pre-treatment, and CT showed that the pulmonary lesion deteriorated in all patients. While after treatment of short-term moderate-dose corticosteroid plus immunoglobulin, patients’ APACHE Ⅱ score (9.10±6.15 vs 5.50±9.01, P<0.05), body temperature (37.59±1.16 vs 36.46±0.25, P<0.05), lymphocyte count (0.59±0.18 vs 1.36±0.51, P<0.05), Lactate dehydrogenase (419.24±251.31 vs 257.40±177.88, P<0.05), and C-reactive protein (49.94±26.21 vs 14.58±15.25, P<0.05) significantly improved compared with post-treatment with low-dose therapy. In addition, oxygenation index including SPO2 (90.50±5.91 vs 97.50±1.18, P<0.05), PaO2 (60.47±14.53 vs 99.07±34.31, P<0.05), and PaO2/FiO2 (129.30±64.97 vs 340.86±146.72, P<0.05) significant improved. Furthermore, CT showed that pulmonary lesions obviously improved in 7 patients. After systematic therapy, 4 out of 10 COVID-19 patients recovered and discharged.Conclusions: Short-term moderate-dose corticosteroid plus immunoglobulin is effective for reversing the continued deterioration of COVID-19 patients who failed to respond to the low-dose therapy.

    Fatal outcome in a COVID-19 patient despite IL 6 blockage in cytokine storm

    Authors: Michael Bovet; Daniel Wadsack; Florentina Kosely; Wolfgang Zink; Ralf Zahn

    doi:10.21203/rs.3.rs-26470/v1 Date: 2020-05-02 Source: ResearchSquare

    A 59 year old male TRANS patient was admitted to our hospital diagnosed with COVID-19 associated pneumonia MESHD pneumonia HP. Upfront treatment with hydroxychloroquine and azithromycin was started. Because of clinical deterioration MESHD with ARDS, circulatory shock MESHD shock HP and increased hyperinflammatory markers six days later, a cytokine storm rose to the top of differential diagnosis and off-label treatment with IL 6 receptor antagonist Tocilizumab was initiated. Subsequently we observed a dramatic rise of D-dimers indicating coagulopathy. Perimyocarditis with severe cardiac arrhythmia MESHD arrhythmia HP occurred after a second dose was administered. Later the patient died due to multi organ failure. Exacerbation of cytokine storm following treatment with Tocilizumab could not be ruled out, despite a hitherto unreported relationship with COVID-19. 

    Risk factors and clinical features of deterioration in COVID-19 patients in Zhejiang, China: a single- centre, retrospective study

    Authors: Ping Yi; Xiang Yang; Cheng Ding; Yanfei Chen; Kaijin Xu; Qing Ni; Hong Zhao; Yongtao Li; Xuan Zhang; Jun Liu; Jifang Sheng; Lanjuan Li

    doi:10.21203/rs.3.rs-22481/v2 Date: 2020-04-11 Source: ResearchSquare

    Background Severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) infection MESHD swept through Wuhan and spread across China and overseas beginning in December 2019. To identify predictors associated with disease progression MESHD, we evaluated clinical risk factors for exacerbation of SARS-CoV-2 infection MESHD. Methods A retrospective analysis was used for PCR-confirmed COVID-19 ( coronavirus disease MESHD 2019)-diagnosed hospitalized cases between January 19, 2020, and February 19, 2020, in Zhejiang, China. We systematically analysed the clinical characteristics of the patients and predictors of clinical deterioration MESHD.Results One hundred patients with COVID-19, with a median age TRANS of 54 years, were included. Among them, 49 patients (49%) had severe and critical disease MESHD. Age TRANS ([36-58] vs [51-70], P=0.0001); sex (49% vs 77.6%, P=0.0031); BMI ([21.53-25.51] vs [23.28-27.01], P=0.0339); hypertension MESHD hypertension HP (17.6% vs 57.1%, P<0.0001); IL-6 ([6.42-30.46] vs [16.2-81.71], P=0.0001); IL-10 ([2.16-5.82] vs [4.35-9.63], P<0.0001); T lymphocyte count ([305- 1178] vs [167.5-440], P=0.0001); B lymphocyte count ([91-213] vs [54.5-163.5], P=0.0001); white blood SERO cell count ([3.9-7.6] vs [5.5-13.6], P=0.0002); D2 dimer ([172-836] vs [408-953], P=0.005), PCT ([0.03-0.07] vs [0.04-0.15], P=0.0039); CRP ([3.8-27.9] vs [17.3-58.9], P<0.0001); AST ([16, 29] vs [18, 42], P=0.0484); artificial liver therapy (2% vs 16.3%, P=0.0148); and glucocorticoid therapy (64.7% vs 98%, P<0.0001) were associated with the severity of the disease MESHD. Age TRANS and weight were independent risk factors for disease MESHD severity. Conclusion Deterioration among COVID-19-infected patients occurred rapidly after hospital admission. In our cohort, we found that multiple factors were associated with the severity of COVID19. Early detection and monitoring of these indicators may reduce the progression of the disease MESHD. Removing these factors may halt the progression of the disease MESHD. In addition, early treatment with low doses of glucocorticoids and liver therapy, when necessary, may help reduce mortality in critically ill patients.

    Short-Term Moderate-Dose Corticosteroid Plus Immunoglobulin Effectively Reverses COVID-19 Patients Who Have Failed Low-Dose Therapy

    Authors: Zhi-Guo Zhou; Shu-Min Xie; Jing Zhang; Fang Zheng; Di-Xuan Jiang; Ke-Yu Li; Qi Zuo; Yu-Sheng Yan; Ji-Yang Liu; Yuan-Lin Xie; Hong Peng; Lei Zhang

    id:202003.0065/v2 Date: 2020-03-08 Source: Preprints.org

    Background: The coronavirus disease MESHD-19 (COVID-19) has spread globally with more than 80,000 people infected, and nearly 3000 patients died. Currently, we are in an urgent need for effective treatment strategy to control the clinical deterioration MESHD of COVID-19 patients. Methods: The clinical data of 10 COVID-19 patients receiving short-term moderate-dose corticosteroid (160mg/d) plus immunoglobulin (20g/d) were studied in the North Yard of The First Hospital of Changsha, Hunan from January 17th to February 27th, 2020. Epidemiological, clinical, laboratory, radiological findings were analyzed. Results: After treatment with combination of low-dose corticosteroid (40-80mg/d) and immunoglobulin (10g/d), patients’ lymphocyte count (0.88±0.34 vs 0.59±0.18, P<0.05), oxygenation index including SPO2 (94.90±2.51 vs 90.50±5.91, P<0.05) and PaO2/FiO2 (321.36±136.91 vs 129.30±64.97, P<0.05) were significantly lower than pre-treatment, and CT showed that the pulmonary lesion deteriorated in all patients. While after treatment of short-term moderate-dose corticosteroid plus immunoglobulin, patients’ APACHE Ⅱ score (9.10±6.15 vs 5.50±9.01, P<0.05), body temperature (37.59±1.16 vs 36.46±0.25, P<0.05), lymphocyte count (0.59±0.18 vs 1.36±0.51, P<0.05), Lactate dehydrogenase (419.24±251.31 vs 257.40±177.88, P<0.05), and C-reactive protein (49.94±26.21 vs 14.58±15.25, P<0.05) significantly improved compared with post-treatment with low-dose therapy. In addition, oxygenation index including SPO2 (90.50±5.91 vs 97.50±1.18, P<0.05), PaO2 (60.47±14.53 vs 99.07±34.31, P<0.05), and PaO2/FiO2 (129.30±64.97 vs 340.86±146.72, P<0.05) significant improved. Furthermore, CT showed that pulmonary lesions obviously improved in 7 patients. After systematic therapy, 4 out of 10 COVID-19 patients recovered and discharged. Conclusions: Short-term moderate-dose corticosteroid plus immunoglobulin is effective for reversing the continued deterioration of COVID-19 patients who failed to respond to the low-dose therapy. Funding: This work was supported by the Innovative Major Emergency MESHD Project Funding against the New Coronavirus Pneumonia MESHD Pneumonia HP in Hunan Province (Dr. Ji-Yang Liu, number 2020SK3014; Dr. Yuan-Lin Xie, number 2020SK3013).

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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