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MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Sex-specificity of mortality risk factors among hospitalized COVID-19 patients in New York City: prospective cohort study

    Authors: Tomi Jun; Sharon Nirenberg; Patricia Kovatch; Kuan-lin Huang

    doi:10.1101/2020.07.29.20164640 Date: 2020-08-01 Source: medRxiv

    Objective: To identify sex-specific effects of risk factors for in-hospital mortality among COVID-19 patients admitted to a hospital system in New York City. Design: Prospective observational cohort study with in-hospital mortality as the primary outcome. Setting: Five acute care hospitals within a single academic medical system in New York City. Participants: 3,086 hospital inpatients with COVID-19 admitted on or before April 13, 2020 and followed through June 2, 2020. Follow-up till discharge or death MESHD was complete for 99.3% of the cohort. Results: The majority of the cohort was male TRANS (59.6%). Men were younger (median 64 vs. 70, p<0.001) and less likely to have comorbidities such as hypertension MESHD hypertension HP (32.5% vs. 39.9%, p<0.001), diabetes (22.6% vs. 26%, p=0.03), and obesity MESHD obesity HP (6.9% vs. 9.8%, p=0.004) compared to women. Women had lower median values of laboratory markers associated with inflammation MESHD compared to men: white blood SERO cells (5.95 vs. 6.8 K/uL, p<0.001), procalcitonin (0.14 vs 0.21 ng/mL, p<0.001), lactate dehydrogenase (375 vs. 428 U/L, p<0.001), C-reactive protein (87.7 vs. 123.2 mg/L, p<0.001). Unadjusted mortality was similar between men and women (28.8% vs. 28.5%, p=0.84), but more men required intensive care than women (25.2% vs. 19%, p<0.001). Male TRANS sex was an independent risk factor for mortality (OR 1.26, 95% 1.04-1.51) after adjustment for demographics, comorbidities, and baseline hypoxia MESHD. There were significant interactions between sex and coronary artery disease MESHD (p=0.038), obesity MESHD obesity HP (p=0.01), baseline hypoxia MESHD (p<0.001), ferritin (p=0.002), lactate dehydrogenase (p=0.003), and procalcitonin (p=0.03). Except for procalcitonin, which had the opposite association, each of these factors was associated with disproportionately higher mortality among women. Conclusions: Male TRANS sex was an independent predictor of mortality, consistent with prior studies. Notably, there were significant sex-specific interactions which indicated a disproportionate increase in mortality among women with coronary artery disease MESHD, obesity MESHD obesity HP, and hypoxia MESHD. These new findings highlight patient subgroups for further study and help explain the recognized sex differences in COVID-19 outcomes.

    Risk Factors for COVID-19-associated hospitalization: COVID-19-Associated Hospitalization Surveillance Network and Behavioral Risk Factor Surveillance System

    Authors: Jean Y. Ko; Melissa L. Danielson; Machell Town; Gordana Derado; Kurt J. Greenland; Pam Daily Kirley; Nisha B. Alden; Kimberly Yousey-Hindes; Evan J. Anderson; Patricia A. Ryan; Sue Kim; Ruth Lynfield; Salina M. Torres; Grant R. Barney; Nancy M. Bennett; Melissa Sutton; H. Keipp Talbot; Mary Hill; Aron J. Hall; Alicia M. Fry; Shikha Garg; Lindsay Kim; - COVID-NET Investigation Group

    doi:10.1101/2020.07.27.20161810 Date: 2020-07-29 Source: medRxiv

    Background: Identification of risk factors for COVID-19-associated hospitalization is needed to guide prevention and clinical care. Objective: To examine if age TRANS, sex, race/ethnicity, and underlying medical conditions is independently associated with COVID-19-associated hospitalizations. Design: Cross-sectional. Setting: 70 counties within 12 states participating in the Coronavirus Disease MESHD 2019-Associated Hospitalization Surveillance Network (COVID-NET) and a population-based sample of non-hospitalized adults TRANS residing in the COVID-NET catchment area from the Behavioral Risk Factor Surveillance System. Participants: U.S. community-dwelling adults TRANS ([≥]18 years) with laboratory-confirmed COVID-19-associated hospitalizations, March 1- June 23, 2020. Measurements: Adjusted rate ratios (aRR) of hospitalization by age TRANS, sex, race/ethnicity and underlying medical conditions ( hypertension MESHD hypertension HP, coronary artery disease MESHD, history of stroke MESHD stroke HP, diabetes, obesity MESHD obesity HP [BMI [≥]30 kg/m2], severe obesity MESHD obesity HP [BMI[≥]40 kg/m2], chronic kidney disease HP kidney disease MESHD, asthma MESHD asthma HP, and chronic obstructive pulmonary disease MESHD chronic obstructive pulmonary disease HP). Results: Our sample included 5,416 adults TRANS with COVID-19-associated hospitalizations. Adults TRANS with (versus without) severe obesity MESHD obesity HP (aRR:4.4; 95%CI: 3.4, 5.7), chronic kidney disease HP kidney disease MESHD (aRR:4.0; 95%CI: 3.0, 5.2), diabetes (aRR:3.2; 95%CI: 2.5, 4.1), obesity MESHD obesity HP (aRR:2.9; 95%CI: 2.3, 3.5), hypertension MESHD hypertension HP (aRR:2.8; 95%CI: 2.3, 3.4), and asthma MESHD asthma HP (aRR:1.4; 95%CI: 1.1, 1.7) had higher rates of hospitalization, after adjusting for age TRANS, sex, and race/ethnicity. In models adjusting for the presence of an individual underlying medical condition, higher hospitalization rates were observed for adults TRANS [≥]65 years, 45-64 years (versus 18-44 years), males TRANS (versus females TRANS), and non-Hispanic black and other race/ethnicities (versus non-Hispanic whites). Limitations: Interim analysis limited to hospitalizations with underlying medical condition data. Conclusion: Our findings elucidate groups with higher hospitalization risk that may benefit from targeted preventive and therapeutic interventions.

    Higher Comorbidities and Early Death MESHD is Characteristic of Hospitalized African-American Patients with COVID-19

    Authors: Raavi Gupta; Raag Agrawal; Zaheer Bukhari; Absia Jabbar; Donghai Wang; John Diks; Mohamed Alshal; Dokpe Yvonne Emechebe; F. Charles Brunicardi; Jason M Lazar; Robert Chamberlain; Aaliya Burza; M. A. Haseeb

    doi:10.1101/2020.07.15.20154906 Date: 2020-07-16 Source: medRxiv

    Background African-Americans/Blacks have suffered higher morbidity and mortality from COVID-19 than all other racial groups. This study aims to identify the causes of this health disparity, determine prognostic indicators, and assess efficacy of treatment interventions. Method We performed a retrospective cohort study of clinical features and laboratory data of COVID-19 patients admitted over a five-week period at the height of the pandemic in the United States. This study was performed at an urban academic medical center in New York City, declared a COVID-only facility, serving a majority Black population Result Of the 1,070 consecutive patients who tested positive for COVID-19, 496 critically ill patients were hospitalized and included in the study. 88% of patients were Black; and a majority (53%) were 61-80 years old with a mean body mass index in the 'obese' range. 97% had one or more comorbidities. Hypertension MESHD Hypertension HP was the most common (84%) pre-existing condition followed by diabetes mellitus MESHD diabetes mellitus HP (57%) and chronic kidney disease HP kidney disease MESHD (24%). Patients with chronic kidney disease HP kidney disease MESHD and end-stage renal disease MESHD who received hemodialysis were found to have significantly lower mortality, then those who did not receive it, suggesting benefit from hemodialysis (11%, OR, 0.35, CI, 0.17 - 0.69 P=0.001). Age TRANS >60 years and coronary artery disease MESHD were independent predictors of mortality in multivariate analysis. Cox Proportional Hazards modeling for time to death MESHD demonstrated a significantly high ratio for COPD/ Asthma MESHD Asthma HP, and favorable effects on outcomes for pre-admission ACE inhibitors and ARBs. CRP (180, 283 mg/L), LDH (551, 638 U/L), glucose (182, 163 mg/dL), procalcitonin (1.03, 1.68 ng/mL), and neutrophil / lymphocyte ratio (8.5, 10.0) were predictive of mortality on admission and at 48-96 hrs. Of the 496 inpatients, 48% died, one third of patients died within the first three days of admission. 54/488 patients received invasive mechanical ventilation, of which 87% died and of the remaining patients, 32% died. CONCLUSIONS COVID-19 patients in our predominantly Black neighborhood had higher mortality, likely due to higher prevalence SERO of comorbidities. Early dialysis and pre-admission intake of ACE inhibitors/ARBs improved patient outcomes. Early escalation of care based on comorbidities and key laboratory indicators is critical for improving outcomes in African-American patients.

    Causally Associations of Blood SERO Lipids Levels with COVID-19 Risk: Mendelian Randomization Study

    Authors: Kun Zhang; Yan Guo; Zhuo-Xin Wang; Jing-Miao Ding; Shi Yao; Hao Chen; Dong-Lin Zhu; Kun Zhang; Wei Huang; Shan-Shan Dong; Tie-Lin Yang

    doi:10.1101/2020.07.07.20147926 Date: 2020-07-07 Source: medRxiv

    Background: Coronavirus disease MESHD 2019 (COVID-19) is a global pandemic caused by the severe acute respiratory syndrome MESHD coronavirus 2 (SARS-Cov-2). It has been found that coronary artery disease MESHD (CAD) is a comorbid condition for COVID-19. As the risk factors of CAD, whether blood SERO lipids levels are causally related to increasing susceptibility and severity of COVID-19 is still unknown. Design: We performed two-sample Mendelian Randomization (MR) analyses to explore whether dyslipidemia, low density lipoprotein cholesterol (LDL-c), high density lipoprotein cholesterol (HDL-c), triglyceride (TG) and total cholesterol (TC) were causally related to COVID-19 risk and severity. The GWAS summary data of blood SERO lipids involving in 188,578 individuals and dyslipidemia in a total of 53,991 individuals were used as exposures, respectively. Two COVID-19 GWASs including 1,221 infected patients and 1,610 severe patients defined as respiratory failure HP were employed as outcomes. Based on the MR estimates, we further carried out gene-based and gene-set analysis to explain the potential mechanism for causal effect. Results: The MR results showed that dyslipidemia was casually associated with the susceptibility of COVID-19 and induced 27% higher odds for COVID-19 infection MESHD (MR-IVW OR = 1.27, 95% CI: 1.08 to 1.49, p-value = 3.18 x 10-3). Moreover, the increasing level of blood SERO TC will raise 14 % higher odds for the susceptibility of COVID-19 (MR-IVW OR = 1.14, 95% CI: 1.04 to 1.25, p-value = 5.07 x 10-3). Gene-based analysis identified that ABO gene was associated with TC and the gene-set analysis found that immune processes were involved in the risk effect of TC. Conclusions: We obtained three conclusions: 1) Dyslipidemia is casually associated with the susceptibility of COVID-19; 2) TC is a risk factor for the susceptibility of COVID-19; 3) The different susceptibility of COVID-19 in specific blood SERO group may be partly explained by the TC concentration in diverse ABO blood SERO groups.

    Red blood SERO cell distribution width (RDW) in Hospitalized COVID-19 Patients

    Authors: Preethi Ramachandran; Mahesh Gajendran; Abhilash Perisetti; Karim Osama Elkholy; Abhishek Chakraborti; Giuseppe Lippi; Hemant Goyal

    doi:10.1101/2020.06.29.20143081 Date: 2020-07-03 Source: medRxiv

    Introduction: Coronavirus disease MESHD-2019 (COVID-19), caused by severe acute respiratory syndrome MESHD coronavirus-2 (SARS-CoV-2), is causing dramatic morbidity and mortality worldwide. The Red Blood SERO Cell Distribution Width (RDW) has been strongly associated with increased morbidity and mortality in multiple diseases MESHD. Objective: To assess if elevated RDW is associated with unfavorable outcomes in hospitalized COVID-19. Methods: We retrospectively studied clinical outcomes of hospitalized COVID-19 patients for their RDW values. In-hospital mortality was defined as primary outcome, while septic shock MESHD shock HP, need for mechanical ventilation, and length of stay (LOS) were secondary outcomes. Results- A total of 294 COVID-19 patients were finally studied. Overall prevalence SERO of increased RDW was 49.7% (146/294). RDW was associated with increased risk of in-hospital mortality (aOR, 4.5; 95%CI, 1.4-14.3) and septic shock MESHD shock HP (aOR, 4.6; 95%CI, 1.4-15.1) after adjusting for anemia MESHD anemia HP, ferritin, and lactate. The association remained unchanged even after adjusting for other clinical confounders such as age TRANS, sex, body mass index, coronary artery disease MESHD, hypertension MESHD hypertension HP, diabetes mellitus MESHD diabetes mellitus HP, and chronic obstructive pulmonary disease MESHD chronic obstructive pulmonary disease HP. No association was found instead with mechanical ventilation and median LOS. Conclusion: Elevated RDW in hospitalized COVID-19 patients is associated with a significantly increased risk of mortality and septic shock MESHD shock HP.

    Identifying main and interaction effects of risk factors to predict intensive care admission in patients hospitalized with COVID-19: a retrospective cohort study in Hong Kong

    Authors: Jiandong Zhou; Gary Tse; Sharen Lee; Tong Liu; William KK Wu; zhidong cao; Dajun Zeng; Ian CK Wong; Qingpeng Zhang; Bernard MY Cheung

    doi:10.1101/2020.06.30.20143651 Date: 2020-07-02 Source: medRxiv

    Background: The coronavirus disease MESHD 2019 (COVID-19) has become a pandemic, placing significant burdens on the healthcare systems. In this study, we tested the hypothesis that a machine learning approach incorporating hidden nonlinear interactions can improve prediction for Intensive care unit (ICU) admission. Methods: Consecutive patients admitted to public hospitals between 1st January and 24th May 2020 in Hong Kong with COVID-19 diagnosed by RT-PCR were included. The primary endpoint was ICU admission. Results: This study included 1043 patients (median age TRANS 35 (IQR: 32-37; 54% male TRANS). Nineteen patients were admitted to ICU (median hospital length of stay (LOS): 30 days, median ICU LOS: 16 days). ICU patients were more likely to be prescribed angiotensin converting enzyme inhibitors/angiotensin receptor blockers, anti-retroviral drugs lopinavir/ritonavir and remdesivir, ribavirin, steroids, interferon-beta and hydroxychloroquine. Significant predictors of ICU admission were older age TRANS, male TRANS sex, prior coronary artery disease MESHD, respiratory diseases MESHD, diabetes, hypertension MESHD hypertension HP and chronic kidney disease HP kidney disease MESHD, and activated partial thromboplastin time, red cell count, white cell count, albumin and serum SERO sodium. A tree-based machine learning model identified most informative characteristics and hidden interactions that can predict ICU admission. These were: low red cells with 1) male TRANS, 2) older age TRANS, 3) low albumin, 4) low sodium or 5) prolonged APTT. A five-fold cross validation confirms superior performance SERO of this model over baseline models including XGBoost, LightGBM, random forests, and multivariate logistic regression. Conclusions: A machine learning model including baseline risk factors and their hidden interactions can accurately predict ICU admission in COVID-19.

    Association of Smoking Status with Outcomes in Hospitalized COVID-19 Patients

    Authors: Muhammad Adrish; Sridhar Chilimuri; Nikhitha Mantri; Haozhe Sun; Maleeha Zahid; Sudharsan Gongati; Ked Fortuzi; Abhishrut Pramod Jog; Pravish Purmessur; Ravish Singhal

    doi:10.21203/rs.3.rs-39752/v1 Date: 2020-07-01 Source: ResearchSquare

    Introduction: Smoking causes inflammation MESHD of the lung epithelium by releasing cytokines and impairing muco-ciliary clearance. Some studies have linked smoking with severity of illness of COVID-19 whereas others have found no such association.Methods: This was a retrospective analysis of all adults TRANS hospitalized with COVID-19 from March 09 to May 18, 2020. Results: 1173 patients met the study criteria. 837 patients never smoked and 336 patients were either current smokers or past smoker and were grouped together in smokers group. Patients in smokers group were more likely to be male TRANS and had higher incidence of underlying COPD (19% vs. 6%, p<0.001), human immunodeficiency HP virus infection MESHD (11% vs. 5%,p<0.001), cancer (11% vs. 6%, p=0.005), congestive heart failure HP heart failure MESHD (15% vs. 8%, p<0.001), coronary artery disease MESHD (15% vs. 9%, p=0.027), chronic kidney disease HP kidney disease MESHD (11% vs. 8%, p=0.037), and end-stage renal disease MESHD (10% vs. 6%, p=0.009) compared to non-smokers. Smokers were more likely to develop critical illness MESHD requiring mechanical ventilation (47% vs. 37% p=0.005). Univariate Cox model for survival analysis by smoking status showed that smokers only current smokers had higher risk of death MESHD compared to never-smokers (HR 1.61, 95% confidence interval 1.22–2.12, p<0.001). In the multivariate approach Cox model for the survival, female TRANS sex, age TRANS, LDH and systemic steroid use were associated with overall survival.Conclusion: In our large single center retrospective database of patients hospitalized with COVID-19, smoking was associated with development of critical illness MESHD and higher likelihood of death MESHD

    Outcomes and Cardiovascular Comorbidities in a Predominantly African-American Population with COVID-19

    Authors: Ann B. Nguyen; Gaurav A. Upadhyay; Ben Chung; Bryan Smith; Stephanie A. Besser; Julie A. Johnson; John Blair; R. Parker Ward; Jeanne DeCara; Tamar Polonsky; Amit R. Patel; Jonathan Grinstein; Luise Holzhauser; Rohan Kalathiya; Atman P. Shah; Jonathan Paul; Sandeep Nathan; James Liao; Roberto M. Lang; Krysta Wolfe; Ayodeji Adegunsoye; David Wu; Bhakti Patel; Monica E. Peek; Doriane Miller; Dinesh J. Kurian; Stephen R. Estime; Allison Dalton; Avery Tung; Michael F. O'Connor; John P. Kress; Francis J. Alenghat; Roderick Tung

    doi:10.1101/2020.06.28.20141929 Date: 2020-06-29 Source: medRxiv

    Importance: Racial disparities in COVID-19 outcomes have been amplified during this pandemic and reports on outcomes in African-American (AA) populations, known to have higher rates of cardiovascular (CV) comorbidities, remain limited. Objective: To examine prevalence SERO of comorbidities, rates of hospitalization and survival, and incidence of CV manifestations of COVID-19 in a predominantly AA population in south metropolitan Chicago. Design, Setting, Participants: This was an observational cohort study of COVID-19 patients encountered from March 16 to April 16, 2020 at the University of Chicago. Deidentified data were obtained from an institutional data warehouse. Group comparisons and logistic regression modeling based on baseline demographics, clinical characteristics, laboratory and diagnostic testing was performed. Exposures: COVID-19 was diagnosed by nasopharyngeal swab testing and clinical management was at the discretion of treating physicians. Main Outcomes and Measures: Primary outcomes were hospitalization and in-hospital mortality, and secondary outcomes included incident CV manifestations of COVID-19 in the context of overall cardiology service utilization. Results: During the 30 day study period, 1008 patients tested positive for COVID-19 and 689 had available encounter data. Of these, 596 (87%) were AA and 356 (52%) were hospitalized, of which 319 (90%) were AA. Age TRANS > 60 years, tobacco use, BMI >40 kg/m2, diabetes mellitus MESHD diabetes mellitus HP (DM), insulin use, hypertension MESHD hypertension HP, chronic kidney disease HP kidney disease MESHD, coronary artery disease MESHD (CAD), and atrial fibrillation MESHD atrial fibrillation HP (AF) were more common in hospitalized patients. Age TRANS > 60 years, tobacco use, CAD, and AF were associated with greater risk of in-hospital mortality along with several elevated initial laboratory markers including troponin, NT-proBNP, blood SERO urea nitrogen, and ferritin. Despite this, cardiac manifestations of COVID-19 were uncommon, coincident with a 69% decrease in cardiology service utilization. For hospitalized patients, median length of stay was 6.2 days (3.4-11.9 days) and mortality was 13%. AA patients were more commonly hospitalized, but without increased mortality. Conclusions and Relevance: In this AA-predominant experience from south metropolitan Chicago, CV comorbidities and chronic diseases MESHD were highly prevalent and associated with increased hospitalization and mortality. Insulin-requiring DM and CKD emerged as novel predictors for hospitalization. Despite the highest rate of comorbidities reported to date, CV manifestations of COVID-19 and mortality were relatively low. The unexpectedly low rate of mortality merits further study.

    Clinical characteristics of Covid-19 patients with re-positive test results: an observational study

    Authors: Ying Su; Ling-Shuang Zhu; Yong Gao; Yuncheng Li; Zhanlu Xiong; Bo Hu; Jiao Yuan; Zhao Zhang; Xiaoxiong Wu; Chunchen Feng; Fanjun Cheng; Yang Jin; Yu Zhang; Youming Lu; Hongbo Wang; Ling-Qiang Zhu

    doi:10.1101/2020.06.23.20138149 Date: 2020-06-23 Source: medRxiv

    Background: With coronavirus disease MESHD 2019 (Covid-19) ravaging the global, concern has been aroused whether discharged Covid-19 patients with reappeared positive nucleic acid test results are infected again. Objective: To analyze the clinical characteristics of discharged Covid-19 patients with reappeared positive nucleic acid test results and to track clinical outcomes of them. Methods: We extracted clinical data on 938 Covid-19 patients from Wuhan Union Hospital (West Branch), and we obtained information about residual symptoms and nucleic acid tests after discharge through follow-up study. We evaluated the relationship of clinical characteristics and reappeared positive results. Each patient had at least 44 days of follow-up. Results: Of 938 discharged patients, a total of 58 (6.2%) had reappeared positive nucleic acid test results and 880 remain negative. Among patients over the age TRANS of 50, the factors we found to be associated with re-positive results were coronary artery disease MESHD (14.1%, vs. 5.5% among those without coronary artery disease MESHD; odds ratio, 2.81; 95% confidence interval [CI], 1.28 to 6.15), and hypertension MESHD hypertension HP (9.5%, vs. 4.9% among those without hypertension MESHD hypertension HP; odds ratio, 2.05; 95% CI, 1.10 to 3.82). As of May 11, 2020, 54 (93.1%) re-positive patients turned negative again while two patients remained positive, and two patients was lost to the second follow-up. Conclusion: Coexisting diseases MESHD including coronary artery disease MESHD and hypertension MESHD hypertension HP were substantial risk factors for re-positive outcomes among patients over 50. And most re-positive patients tended to return negative eventually.

    COVID-19 Comorbidity and Metabolic Syndrome MESHD: Is There a Molecular Basis?

    Authors: Madhurima Basu; Chinmay Saha; Kamalika Roy Choudhury; Susmita Dutta; Sujoy Ghosh; Subhankar Chowdhury; Satinath Mukhopadhyay; Nitai P. Bhattacharyya

    id:10.20944/preprints202006.0245.v1 Date: 2020-06-21 Source: Preprints.org

    The risk factors associated with COVID-19 related severity, morbidity, and mortality, i.e., obesity MESHD obesity HP (often associated with NAFLD), hyperglycemia MESHD hyperglycemia HP, hypertension MESHD hypertension HP and dyslipidemia all cluster together as metabolic syndrome MESHD (MetS). Instead of studying association of these risk factors with COVID-19, it makes sense studying the association between MetS on one hand and COVID-19 on the other. This study explores a molecular basis underpinning the above association. Severity of COVID-19 patients with MetS could be due to functional alterations of host proteins due to their interactions with viral proteins. We collected data from Enrichr (https://amp.pharm.mssm.edu/Enrichr/), DisGeNET (https://www.disgenet.org/) and others and carried out enrichment analysis using Enrichr. Various biological processes and pathways associated with viral protein interacting partners are known to involve in metabolic diseases MESHD. The molecular pathways underlying insulin resistance MESHD insulin resistance HP, insulin signaling and insulin secretion are not only involved in diabetes but also in CVD and obesity MESHD obesity HP (associated with non-alcoholic fatty liver disease MESHD; NAFLD). Lipid metabolism/lipogenesis, fatty acid oxidation and inflammation MESHD are associated with MetS. Viral interacting host proteins are associated and enriched with terms like hyperglycemia MESHD hyperglycemia HP, coronary artery disease MESHD, hypertensive disease MESHD related to CVD and liver diseases MESHD in DisGeNET. Association of viral interacting proteins with disease MESHD-relevant biological processes, pathways and disease MESHD-related terms suggests that altered host protein function following interaction with viral proteins might contribute to frequent occurrence and/or severity of COVID-19 in subjects with MetS. Such analysis not only provides a molecular basis of comorbidity but also incriminates host proteins in viral replication, growth and identifies possible drug targets for intervention.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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