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Overview

MeSH Disease

Human Phenotype

Transmission

Seroprevalence
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    Echocardiographic patterns in critically ill COVID-19 patients.

    Authors: Antoine Vieillard-Baron; Cyril Charron; Ségolène Tran; Matthieu Godement; Xavier Repessé; Pierre-Alexandre Haruel; Amélie Prigent; Samuel Castro; Lola Girodias; Emilie Charbit; Foucault Isnard; Mohamed Saleh; Koceila Bouferrache; Bernard Page; Romain Jouffroy; Guillaume Geri

    doi:10.21203/rs.3.rs-52431/v1 Date: 2020-08-01 Source: ResearchSquare

    Background: Need for catecholamines is frequent in COVID-19 patients, but the main echocardiographic patterns are unknown. The objective was to report the main echo patterns in critically-ill COVID-19 patients. Methods: Observational and descriptive study in consecutive COVID-19 patients admitted to the ICU between March 12 and May 8, 2020. Systematic critical care echocardiography (CCE) was performed and retrospectively analyzed off-line. Echo values are reported in the overall population and in patients who required catecholamine infusion during the first 2 days following admission (D1-2) or afterwards until day 7 (D3-7). Results: Of the 79 patients (78% male TRANS; median age TRANS 63 [56-71]; body mass index 29 [26-30]) included, 90% had at least 1 comorbidity. PaO2/FiO2 at admission was 85 [67-162] mmHg. 53% of patients were mechanically ventilated. ICU length of stay was 9 [5-16] days and mortality 34%. 134 echocardiographic studies were performed during the first week in 65 patients. Pulmonary artery acceleration time was decreased (77 [65-97] ms), suggesting pulmonary hypertension MESHD hypertension HP. All 39 patients (49%) who required catecholamine infusion underwent CCE and 25.6% had left ventricular (LV) systolic dysfunction, 28.2% acute cor pulmonale HP (ACP), 7.7% hypovolemia MESHD hypovolemia HP, and 38.5% vasoplegia MESHD. Modification of echo patterns was observed at D3-7, with less LV systolic dysfunction and more ACP, which was the most frequent pattern. Computed tomography pulmonary angiography in 6 patients with ACP indicated intrapulmonary thrombus in 4. Conclusion: Different echocardiographic patterns were observed during the first week following ICU admission in COVID-19 patients. ACP was frequent and often related to thrombus in the pulmonary circulation. 

    Accelerated repurposing and drug development of pulmonary hypertension MESHD hypertension HP therapies for COVID-19 treatment using an AI-integrated biosimulation platform

    Authors: Kaushik Chakravarty; Victor Antontsev; Aditya Jagarapu; Yogesh Bundey; Hypatia Hou; Neha Maharao; Jyotika Varshney

    doi:10.21203/rs.3.rs-48619/v1 Date: 2020-07-24 Source: ResearchSquare

    A World Health Organization-declared pandemic, COVID-19, has affected more than 4 million people worldwide with over 100,000 deaths MESHD and growing in the United States. Due to the fast-spreading and multi-targeted nature of the virus, it is clear that drugs and/or vaccines need to be developed at an accelerated rate, and a combinatorial approach may stand to be more successful than a single drug therapy. Among several targets and pathways that are under investigation, the renin-angiotensin system (RAS) and specifically Angiotensin converting enzyme (ACE), and Ca2+ -mediated SARS-CoV-2 cellular entry and replication are noteworthy. A combination of ACE inhibitors (e.g. benazepril) and calcium channel blockers (CCB, e.g. amlodipine), a critical line of therapy for pulmonary hypertension MESHD hypertension HP, has shown therapeutic relevance in COVID-19 when investigated independently. To that end, we conducted in silico modeling using BIOiSIM, an AI-integrated mechanistic modeling platform by utilizing known preclinical in vitro and in vivo datasets to accurately simulate systemic therapy disposition and site-of-action penetration of the CCB and ACEI compounds to tissues implicated in COVID-19 pathogenesis.

    Accelerated repurposing and drug development of pulmonary hypertension MESHD hypertension HP therapies for COVID-19 treatment using an AI-integrated biosimulation platform

    Authors: Kaushik Chakravarty; Victor Antontsev; Aditya Jagarapu; Yogesh Bundey; Hypatia Hou; Neha Maharao; Jyotika Varshney

    doi:10.21203/rs.3.rs-48619/v2 Date: 2020-07-24 Source: ResearchSquare

    A World Health Organization-declared pandemic, COVID-19, has affected more than 4 million people worldwide with over 100,000 deaths MESHD and growing in the United States. Due to the fast-spreading and multi-targeted nature of the virus, it is clear that drugs and/or vaccines need to be developed at an accelerated rate, and a combinatorial approach may stand to be more successful than a single drug therapy. Among several targets and pathways that are under investigation, the renin-angiotensin system (RAS) and specifically Angiotensin converting enzyme (ACE), and Ca2+ -mediated SARS-CoV-2 cellular entry and replication are noteworthy. A combination of ACE inhibitors (e.g. benazepril) and calcium channel blockers (CCB, e.g. amlodipine), a critical line of therapy for pulmonary hypertension MESHD hypertension HP, has shown therapeutic relevance in COVID-19 when investigated independently. To that end, we conducted in silico modeling using BIOiSIM, an AI-integrated mechanistic modeling platform by utilizing known preclinical in vitro and in vivo datasets to accurately simulate systemic therapy disposition and site-of-action penetration of the CCB and ACEI compounds to tissues implicated in COVID-19 pathogenesis.

    National Smoking Rates Correlate Inversely with COVID-19 Mortality

    Authors: Michael J Norden; David H. Avery; Justin G Norden; David R Haynor

    doi:10.1101/2020.06.12.20129825 Date: 2020-06-14 Source: medRxiv

    ABSTRACT Introduction: Recent studies show cigarette smokers are markedly under-represented among patients hospitalized for COVID-19 in over a dozen countries. It is unclear if this may be related to confounding factors such as age TRANS distribution, access to care, and inaccurate records. We hypothesized that these concerns could be avoided by studying smoking prevalence SERO in relation to COVID-19 mortality. Since climate has been identified as a factor in COVID-19, we studied groups of countries with relatively comparable temperatures. Methods: The 20 hottest and 20 coldest countries in the Johns Hopkins Mortality Analysis database with a minimum mortality rate of .3 deaths MESHD/100,000 were selected on the basis of the average temperatures of their largest city. Mortality rates were determined as of May 1, 2020 and correlated with national smoking rate adjusting for sex ratio, obesity MESHD obesity HP, temperature, and elderly TRANS population. Results: A highly significant inverse correlation between current daily smoking prevalence SERO and COVID-19 mortality rate was noted for the group of hot countries (R=-.718, p = .0002), cold countries (R=-.567, p=.0046), and the combined group (R=-.324, p=.0207). However, after adjustments only the regression for hot countries and the combined group remained significant. In hot countries, for each percentage point increase in smoking rate mortality decreased by .147 per 100,000 population (95% CI .102- 192, p=.0066). This resulted in mortality rates several-fold elevated in the countries with the lowest smoking rates relative to the highest smoking rates. In the combined group, mortality decreased by .257 per 100,000 population (95% CI .175-.339, p=.0034). Discussion: These findings add support to the finding of an inverse relationship between current smoking and seriously symptomatic COVID-19. However, we conclude that the difference in mortality between the highest and lowest smoking countries appears too large to be due primarily to the effects of smoking per se. A potentially beneficial effect of smoking is surprising, but compatible with a number of hypothetical mechanisms which deserve exploration: 1) Studies show smoking alters ACE2 expression which may affect COVID-19 infection MESHD or its progression to serious lung pathology. 2) Nicotine has anti-inflammatory activity and also appears to alter ACE2 expression. 3) Nitric oxide in cigarette smoke is known to be effective in treating pulmonary hypertension MESHD hypertension HP and has shown in vitro antiviral effects including against SARS-CoV-2. 4) Smoking has complicated effects on the immune system involving both up and down regulation, any of which might alone or in concert antagonize progression of COVID-19. 5) Smokers are exposed to hot vapors which may stimulate immunity in the respiratory tract by various heat-related mechanisms (e.g. heat shock MESHD shock HP proteins). Studies of steam and sauna treatments have shown efficacy in other viral respiratory conditions. At this time there is no clear evidence that smoking is protective against COVID-19, so the established recommendations to avoid smoking should be emphasized. The interaction of smoking and COVID-19 will only be reliably determined by carefully designed prospective study, and there is reason to believe that there are unknown confounds that may be spuriously suggesting a protective effect of smoking. However, the magnitude of the apparent inverse association of COVID-19 and smoking and its myriad clinical implications suggest the importance of further investigation.

    Lung ultrasound and neonatal COVID-19 pneumonia MESHD pneumonia HP: A case report.

    Authors: Daniel Ibarra Ríos; Dina Villanueva García; Edna Patricia Vázquez Solano; Alfonso de Jesús Martínez García; Horacio Márquez González

    doi:10.21203/rs.3.rs-33182/v1 Date: 2020-06-02 Source: ResearchSquare

    Purpose: Severe Novel Coronavirus Disease MESHD 2019 (COVID-19) infection MESHD in neonates is possible but reports are scarce.  Lung ultrasound (LUS) has been reported useful for triaging, diagnosing, and monitoring of patients with COVID-19.Material and methods: We describe SARS-CoV-2 confirmed infection TRANS infection MESHD on a term newborn that developed pneumonia MESHD pneumonia HP and pulmonary hypertension MESHD hypertension HP requiring mechanical ventilation. Ultrasonographic follow up of COVID-19 pneumonia MESHD pneumonia HP and pulmonary hypertension MESHD hypertension HP was carried out. Results: A 3,140-g male TRANS infant born at 40.3 weeks’ gestation developed progressive respiratory distress HP requiring mechanical ventilation. Real time PCR respiratory tract swabs for SARS COV 2 sampled on day 3 were positive for the baby and both parents TRANS. Lung ultrasound showed an irregular pleural line (shred sign), multiple confluent B-lines and bilateral ≥ 0.5 cm subpleural consolidations. Improvement of the lung and cardiac conditions were documented by ultrasound. Conclusion: Our case represents a severe presentation of COVID-19 pneumonia MESHD pneumonia HP with pulmonary hypertension MESHD hypertension HP requiring mechanical ventilation. LUS showed to be useful for diagnosis and follow up. 

    Cardiac Structural and Functional Characteristics in Patients with Coronavirus Disease MESHD 2019: A Serial Echocardiographic Study

    Authors: Heng Ge; Mingli Zhu; Jing Du; Yong Zhou; Wei Wang; Wei Zhang; Handong Jiang; Zhiqing Qiao; Zhichun Gu; Fenghua Li; Jun Pu Jr.

    doi:10.1101/2020.05.12.20095885 Date: 2020-05-18 Source: medRxiv

    BACKGROUND: Increasing attention has been paid to cardiac involvement in patients with coronavirus disease MESHD 2019 (COVID-19). Yet, scarce information is available regarding the morphological and functional features of cardiac impairments in these patients. METHODS: We conducted a prospective and serial echocardiographic study to investigate the structural and functional cardiac changes among COVID-19 patients admitted to the intensive care unit (ICU). From January 21 to April 8, 2020, a total of 51 ICU patients (31 critically ill and 20 severely ill) with confirmed COVID-19 were monitored by serial transthoracic echocardiography examinations. Outcomes were followed up until April 8, 2020. RESULTS: Of 51 ICU patients, 33 (64.7%) had cardiovascular comorbidities. Elevations of levels of cardiac biomarkers including high- sensitivity SERO cardiac troponin-I (hs-cTnI) and brain natriuretic peptide were observed in 62.7% and 86.3% of patients, respectively. Forty-two (82.3%) had at least one left-heart and/or right-heart echocardiographic abnormality. The overall median left ventricular ejection fraction (LVEF) was 65.0% (IQR 58.0-69.0%), with most (44,86.3%) having preserved LVEF. Sixteen patients (31.4%) had increased pulmonary artery systolic pressure, and 14 (27.5%) had right-ventricle (RV) enlargement. During the study period, 12 (23.5%) patients died. LVEF was comparable between survivors and non-survivors, while non-survivors had more often pulmonary hypertension MESHD hypertension HP (58.3% vs. 23.1%; P=0.028) and RV enlargement (58.3% vs. 17.9%, P=0.011). Kaplan-Meier analysis demonstrated similar survival curves between patients with vs. without echocardiographic left-heart abnormalities (P=0.450 by log-rank test), while right-heart abnormalities had adverse impact on mortality (P=0.012 by log-rank test). CONCLUSIONS: Typical cardiac abnormality in ICU patients with COVID-19 was right-heart dysfunction with preserved LVEF. Echocardiographic right-heart dysfunction was associated with disease MESHD severity and increased mortality in patients affected by COVID-19.

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MeSH Disease
Human Phenotype
Transmission
Seroprevalence


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