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SARS-CoV-2 proteins

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    Proteomic Profiling of MIS HGNC-C Patients Reveals Heterogeneity Relating to Interferon Gamma HGNC Dysregulation and Vascular Endothelial Dysfunction

    Authors: Caroline Diorio; Rawan Shraim; Laura A Vella; Josephine R Giles; Amy E Baxter; Derek A Oldridge; Scott W Canna; Sarah E Henrickson; Kevin O McNerney; Frances Balamuth; Chakkapong Burudpakdee; Jessica Lee; Tomas Leng; Alvin Farrel; Michele P Lambert; Kathleen E Sullivan; E. John Wherry; David T Teachey; Hamid Bassiri; Edward M Behrens

    doi:10.1101/2021.04.13.21255439 Date: 2021-04-20 Source: medRxiv

    Multi-system Inflammatory Syndrome in Children ( MIS HGNC-C) is a major complication of the Severe Acute Respiratory Syndrome Coronavirus 2 MESHD (SARS-CoV-2) pandemic in pediatric patients. Weeks after an often mild or asymptomatic initial infection with SARS-CoV-2 children may present with a severe shock MESHD-like picture and marked inflammation MESHD. Children with MIS HGNC-C present with varying degrees of cardiovascular and hyperinflammatory symptoms MESHD. We performed a comprehensive analysis of the plasma proteome of more than 1400 proteins in children with SARS-CoV-2. We hypothesized that the proteome would reflect heterogeneity in hyperinflammation and vascular injury MESHD, and further identify pathogenic mediators of disease. Protein signatures demonstrated overlap between MIS HGNC-C, and the inflammatory syndromes macrophage activation syndrome MESHD ( MAS MESHD) and thrombotic microangiopathy MESHD ( TMA MESHD). We demonstrate that PLA2G2A HGNC is a key marker of MIS HGNC-C that associates with TMA MESHD. We found that IFN{gamma HGNC} responses are dysregulated in MIS HGNC-C patients, and that IFN{gamma HGNC} levels delineate clinical heterogeneity.

    Factors associated with increased mortality in critically ill COVID-19 MESHD patients in a Mexican public hospital: the other faces of health system oversaturation.

    Authors: Mariana Jocelyn Macias Guzman; Alejandro Castillo Gonzalez; Jose Lenin Beltran Gonzalez; Mario Gonzalez Gamez; Emmanuel Antonio Mendoza Enciso; Itzel Ovalle Robles; Andrea Lucia Garcia Diaz; Cesar Mauricio Gutierrez Pena; Lucila Martinez Medina; Victor Antonio Monroy Colin; Jose Manuel Arreola Guerra

    doi:10.1101/2021.03.04.21252084 Date: 2021-03-08 Source: medRxiv

    BACKGROUND The lethality rate of COVID-19 MESHD in Mexico is one of the highest worldwide, but in-hospital factors associated with this increased rate have yet to be explored. This study aims to evaluate those factors that could be associated with mortality at 28 days in critically ill COVID-19 MESHD patients in Mexico. METHODS This is a retrospective post hoc analysis of the clinical trial (NCT04381858) comparing the safety and efficacy of administering convalescent plasma from COVID-19 MESHD patients or human immunoglobulin. The primary outcome, death MESHD at 28 days, was analyzed. Results Between May and October 2020, 196 predominantly male patients (n=122, 62.2%) with an average of 58.1 years (plus-or-minus sign 15.5), were included in the cohort. Mortality at 28 days was 44.3 % (n = 84). Patients included in the second trimester had a greater mortality rate when compared with those recruited in the first trimester (54.1 vs 32.1, p < 0.01). On multivariate analysis, the detected protective factors were the use of fentanyl HR 0.51 (95%CI 0.31 - 0.85, p=0.01), the use of antibiotics HR 0.22 (95% CI 0.13 - 0.36, p < 0.01), and a previously healthy state (no comorbidities other than obesity MESHD) HR 0.58 (95%CI 0.35 - 0.94, p = 0.03); risk factors were severe kidney injury (AKIN3) HR MESHD 1.74 (95%CI 1.04 - 2.9, p=0.035), elevated D-Dimer levels HR 1.02 (95%CI 1.007 - 1.04, p=0.005), shock MESHD OR 5.8 (2.4 - 13.8, p < 0.01), and recruitment in the second trimester OR 2.3 (95%CI 1.1 - 4.8, p=0.02). Conclusion In-hospital mortality in critically ill COVID-19 MESHD patients has increased in our center. The appropriate use of antibiotics, the type of sedation, and AKIN3 are modifiable factors directly related to this increased mortality. The increase in mortality observed in the second trimester is explained by hospital overcrowding that began in August 2020.

    Epidemiological and Economic Impact of COVID-19 MESHD in the US

    Authors: Jiangzhuo Chen; Anil Vullikanti; Joost Santos; Srinivasan Venkatramanan; Stefan Hoops; Henning Mortveit; Bryan Lewis; Wen You; Stephen Eubank; Madhav Marathe; Chris Barrett; Achla Marathe

    doi:10.1101/2020.11.28.20239517 Date: 2020-11-30 Source: medRxiv

    This research measures the epidemiological and economic impact of COVID-19 MESHD spread in the US under different mitigation scenarios, comprising of non-pharmaceutical interventions. A detailed disease model of COVID-19 MESHD is combined with a model of the US economy to estimate the direct impact of labor supply shock MESHD to each sector arising from morbidity, mortality, and lock down, as well as the indirect impact caused by the interdependencies between sectors. During a lockdown, estimates of jobs that are workable from home in each sector are used to modify the shock to labor supply. Results show trade-offs between economic losses, and lives saved and infections averted are non-linear in compliance to social distancing and the duration of lockdown. Sectors that are worst hit are not the labor-intensive sectors such as Agriculture and Construction, but the ones with high valued jobs such as Professional Services, even after the teleworkability of jobs is accounted for. Additionally, the findings show that a low compliance to interventions can be overcome by a longer shutdown period and vice versa to arrive at similar epidemiological impact but their net effect on economic loss depends on the interplay between the marginal gains from averting infections and deaths, versus the marginal loss from having healthy workers stay at home during the shutdown.

    Identification of a unique TCR repertoire, consistent with a superantigen selection process in Children with Multi-system Inflammatory Syndrome

    Authors: Rebecca A Porritt; Lisa Paschold; Magali Noval Rivas; Mary Hongying Cheng; Lael M Yonker; Harsha Chandnani; Merrick Lopez; Donjete Simnica; Christoph Schultheiss; Chintda Santiskulvong; Jennifer Van Eyk; Alessio Fasano; Ivet Bahar; Mascha Binder; Moshe Arditi

    doi:10.1101/2020.11.09.372169 Date: 2020-11-09 Source: bioRxiv

    Multisystem Inflammatory Syndrome in Children ( MIS HGNC-C), a hyperinflammatory syndrome MESHD associated with SARS-CoV-2 infection MESHD, shares many clinical features with toxic shock syndrome MESHD, which is triggered by bacterial superantigens. The superantigen specificity for binding different Vbeta-chains results in Vbeta-skewing, whereby T cells with specific Vbeta-chains and diverse antigen specificity are overrepresented in the TCR repertoire. Here, we characterized the TCR repertoire of MIS HGNC-C patients and found a profound expansion of TCR Beta Variable gene (TRBV)11-2. Furthermore, TRBV11-2 skewing was remarkably correlated with MIS HGNC-C severity and serum cytokine levels. Further analysis of TRBJ gene usage and CDR3 length distribution of MIS HGNC-C expanding TRBV11-2 clones revealed extensive junctional diversity, indicating a superantigen-mediated selection process for TRBV expansion. In silico modelling indicates that polyacidic residues in TCR Vbeta11-2 engage in strong interactions with the superantigen-like motif of SARS-CoV-2 spike PROTEIN glycoprotein. Overall, our data indicate that the immune response in MIS HGNC-C is consistent with superantigenic activation.

    COVID-19 MESHD cytokines and the hyperactive immune response: Synergism of TNF-α HGNC and IFN-γ HGNC in triggering inflammation, tissue damage, and death

    Authors: Evan Peter Williams; Lillian Zalduondo; Colleen Beth Jonsson; Alex R Schuurman; Jan Verhoeff; Saskia D van Asten; Hetty J Bontkes; Siebe G Blok; Janwillem Duitman; Harm Jan Bogaard; Leo Heunks; Rene Lutter; Tom van der Poll; Juan J Garcia Vallejo; Qiqi Cao; Fangjin Chen; Yuqing Chen; Xuelian Cheng; Guohong Deng; Wenyu Ding; Yingmei Feng; Rui Gan; Chuang Guo; Shuai He; Chen Jiang; Juanran Liang; Yi-Min Li; Jun Lin; Yun Ling; Haofei Liu; Jianwei Liu; Nianping Liu; Yang Liu; Meng Luo; Qiang Ma; Qibing Song; Wujianan Sun; Gaoxiang Wang; Feng Wang; Ying Wang; Xiaofeng Wen; Qian Wu; Xiaowei Xie; Xinxin Xiong; Xudong Xing; Hao Xu; Chonghai Yin; Dongdong Yu; Kezhuo Yu; Biao Zhang; Tong Zhang; Jincun Zhao; Peidong Zhao; Jianfeng Zhou; Wei Zhou; Sujuan Zhong; Xiaosong Zhong; Shuye Zhang; Lin Zhu; Ping Zhu; Bing Zou; Jiahua Zou; Zengtao Zuo; Fan Bai; Xi Huang; Xiuwu Bian; Penghui Zhou; Qinghua Jiang; Zhiwei Huang; Jin-Xin Bei; Lai Wei; Xindong Liu; Tao Cheng; Xiangpan Li; Fu-Sheng Wang; Hongyang Wang; Bing Su; Kun Qu; Xiaoqun Wang; JieKai Chen; Ronghua Jin; Zemin Zhang

    doi:10.1101/2020.10.29.361048 Date: 2020-10-29 Source: bioRxiv

    The COVID-19 MESHD COVID-19 MESHD pandemic has caused significant morbidity and mortality. Currently, there is a critical shortage of proven treatment options and an urgent need to understand the pathogenesis of multi-organ failure MESHD and lung damage MESHD. Cytokine storm is associated with severe inflammation MESHD and organ damage during COVID-19 MESHD. However, a detailed molecular pathway defining this cytokine storm is lacking, and gaining mechanistic understanding of how SARS-CoV-2 elicits a hyperactive inflammatory response is critical to develop effective therapeutics. Of the multiple inflammatory cytokines produced by innate immune cells during SARS-CoV-2 infection MESHD, we found that the combined production of TNF- and IFN-{gamma} specifically induced inflammatory cell death MESHD, PANoptosis, characterized by gasdermin-mediated pyroptosis, caspase-8 HGNC-mediated apoptosis, and MLKL HGNC-mediated necroptosis. Deletion of pyroptosis, apoptosis, or necroptosis mediators individually was not sufficient to protect against cell death. However, cells deficient in both RIPK3 HGNC and caspase-8 HGNC or RIPK3 HGNC and FADD HGNC were resistant to this cell death. Mechanistically, the STAT1 HGNC/ IRF1 HGNC axis activated by TNF- and IFN-{gamma} co-treatment induced iNOS for the production of nitric oxide. Pharmacological and genetic deletion of this pathway inhibited pyroptosis, apoptosis, and necroptosis in macrophages. Moreover, inhibition of PANoptosis protected mice from TNF- and IFN-{gamma}-induced lethal cytokine shock MESHD that mirrors the pathological symptoms of COVID-19 MESHD. In vivo neutralization of both TNF- and IFN-{gamma} in multiple disease models associated with cytokine storm showed that this treatment provided substantial protection against not only SARS-CoV-2 infection MESHD, but also sepsis MESHD, hemophagocytic lymphohistiocytosis MESHD, and cytokine shock models, demonstrating the broad physiological relevance of this mechanism. Collectively, our findings reveal that blocking the COVID-19 MESHD cytokine-mediated inflammatory cell death MESHD signaling pathway identified in this study may benefit patients with COVID-19 MESHD or other cytokine storm-driven syndromes by limiting inflammation MESHD and tissue damage. The findings also provide a molecular and mechanistic description for the term cytokine storm. Additionally, these results open new avenues for the treatment of other infectious and autoinflammatory diseases MESHD and cancers MESHD where TNF- and IFN-{gamma} synergism play key pathological roles.

    Causes of death in mental health service users during the first wave of the COVID-19 MESHD COVID-19 MESHD pandemic: South London and Maudsley data from March to June 2020, compared with 2015-2019.

    Authors: Robert Stewart; Amelia Jewell; Matthew Broadbent; Ioannis Bakolis; Jayati Das-Munshi

    doi:10.1101/2020.10.25.20219071 Date: 2020-10-27 Source: medRxiv

    The COVID-19 MESHD COVID-19 MESHD pandemic is likely to have had a particularly high impact on the health and wellbeing of people with pre-existing mental disorders MESHD. This may include higher than expected mortality rates due to severe infections themselves, due to other comorbidities, or through increased suicide rates during lockdown. However, there has been very little published information to date on causes of death MESHD in mental health service users. Taking advantage of a large mental healthcare database linked to death registrations, we describe numbers of deaths within specific underlying-cause-of-death groups for the period from 1st March to 30th June in 2020 and compare these with the same four-month periods in 2015-2019. In past and current service users, there were 2561 deaths in March-June 2020, compared to an average of 1452 for the same months in 2015-19: an excess of 1109. The 708 deaths with COVID-19 MESHD as the underlying cause in 2020 accounted for 63.8% of that excess. The remaining excess was accounted for by unnatural/unexplained deaths and by deaths recorded as due to neurodegenerative conditions MESHD, with no excess in those attributed to cancer MESHD, circulatory disorders MESHD, digestive disorders, respiratory disorders MESHD, or other disease codes. Of 295 unexplained deaths in 2020 with missing data on cause, 162 (54.9%) were awaiting a formal death notice (i.e. the group that included deaths awaiting a coroner inquest), an excess of 129 compared to the average of previous years, accounting for 11.6% of the excess in total deaths.

    DEVELOPING AND VALIDATING COVID-19 MESHD ADVERSE OUTCOME RISK PREDICTION MODELS FROM A BI-NATIONAL EUROPEAN COHORT OF 5594 PATIENTS.

    Authors: Espen Jimenez Solem; Tonny Studsgaard Petersen; Christina Lioma; Christian Igel; Wouter Boomsma; Oswin Krause; Casper Hansen; Christian Hansen; Stephan Lorentzen; Raghavendra Selvan; Janne Petersen; Martin Erik Nyeland; Mikkel Zoellner Ankarfeldt; Gert Mehl Virenfeldt; Mathilde Winther-Jensen; Allan Linneberg; Mostafa Mediphour Ghazi; Nicki Detlefsen; Andreas Lauritzen; Abraham George Smith; Marleen de Bruijne; Bulat Ibragimov; Jens Petersen; Martin Lillholm; Marie Helleberg; Benjamin Skov Kaas-Hansen; Jon Middleton; Stine Hasling Mogensen; Hans Christian Thorsen-Meyer; Anders Perner; Mikkel Bonde; Alexander Bonde; Akshay Pai; Mads Nielsen; Martin Sillesen

    doi:10.1101/2020.10.06.20207209 Date: 2020-10-11 Source: medRxiv

    Background: Patients with severe COVID-19 MESHD have overwhelmed healthcare systems worldwide. We hypothesized that Machine Learning (ML) models could be used to predict risks at different stages of management (at diagnosis, hospital admission and ICU admission) and thereby provide insights into drivers and prognostic markers of disease progression and death MESHD. Methods: From a cohort of approx. 2.6 million citizens in the two regions of Denmark, SARS-CoV-2 PCR tests were performed on subjects suspected for COVID-19 MESHD disease; 3944 cases had at least one positive test and were subjected to further analysis. A cohort of SARS-CoV-2 positive cases from the United Kingdom Biobank was used for external validation. Findings: The ML models predicted the risk of death (Receiver Operation Characteristics Area Under the Curve, ROC-AUC) of 0.904 at diagnosis, 0.818, at hospital admission and 0.723 at Intensive Care Unit (ICU) admission. Similar metrics were achieved for predicted risks of hospital and ICU admission and use of mechanical ventilation. We identified some common risk factors, including age, body mass index (BMI) and hypertension MESHD as driving factors, although the top risk features shifted towards markers of shock MESHD and organ dysfunction MESHD in ICU patients. The external validation indicated fair predictive performance for mortality prediction, but suboptimal performance for predicting ICU admission. Interpretation: ML may be used to identify drivers of progression to more severe disease and for prognostication patients in patients with COVID-19 MESHD. Prognostic features included age, BMI and hypertension MESHD, although markers of shock MESHD and organ dysfunction became more important in more severe cases. We provide access to an online risk calculator based on these findings.

    COVID-19 MESHD: The Information Warfare Paradigm Shift

    Authors: Jan Kallberg; Rosemary A. Burk; Bhavani Thuraisingham

    id:2009.01267v1 Date: 2020-09-02 Source: arXiv

    In Kuhn's The Structure of Scientific Revolutions, the critical term is paradigm-shift when it suddenly becomes evident that earlier assumptions no longer are correct and the plurality of the scientific community that studies this domain accepts the change. These types of events can be scientific findings or as in social science system shock MESHD that creates a punctured equilibrium that sets the stage in the developments. In information warfare, recent years studies and government lines of efforts have been to engage fake news, electoral interference, and fight extremist social media as the primary combat theater in the information space, and the tools to influence a targeted audience. The COVID-19 pandemic MESHD COVID-19 pandemic MESHD generates a rebuttal of these assumptions. Even if fake news and extremist social media content may exploit fault lines in our society and create a civil disturbance, tensions between federal and local government, and massive protests, it is still effects that impact a part of the population. What we have seen with COVID-19 MESHD, as an indicator, is that what is related to public health is far more powerful to swing public sentiment and create reactions within the citizenry that are trigger impact at a larger magnitude that has rippled through society in multiple directions.

    Understanding the patterns of repeated testing for COVID-19 MESHD: Association with patient characteristics and outcomes

    Authors: Stephen Salerno; Zhangchen Zhao; Swaraaj Prabhu Sankar; Maxwell Salvatore; Tian Gu; Lars G. Fritsche; Seunggeun Lee; Lynda D Lisabeth; Thomas S Valley; Bhramar Mukherjee

    doi:10.1101/2020.07.26.20162453 Date: 2020-07-29 Source: medRxiv

    Importance The diagnostic tests for COVID-19 MESHD have a high false negative rate, but not everyone with an initial negative result is re-tested. Michigan Medicine, being one of the primary regional centers accepting COVID-19 MESHD cases, provided an ideal setting for studying COVID-19 MESHD repeated testing patterns during the first wave of the pandemic. Objective To identify the characteristics of patients who underwent repeated testing for COVID-19 MESHD and determine if repeated testing was associated with patient characteristics and with downstream outcomes among positive cases. Design This cross-sectional study described the pattern of testing for COVID-19 MESHD at Michigan Medicine. The main hypothesis under consideration is whether patient characteristics differed between those tested once and those who underwent multiple tests. We then restrict our attention to those that had at least one positive test and study repeated testing patterns in patients with severe COVID-19 MESHD related outcomes (testing positive, hospitalization and ICU care). Setting Demographic and clinical characteristics, test results, and health outcomes for 15,920 patients presenting to Michigan Medicine between March 10 HGNC and June 4, 2020 for a diagnostic test for COVID-19 MESHD were collected from their electronic medical records on June 24, 2020. Data on the number and types of tests administered to a given patient, as well as the sequences of patient-specific test results were derived from records of patient laboratory results. Participants Anyone tested between March 10 HGNC and June 4, 2020 at Michigan Medicine with a diagnostic test for COVID-19 MESHD in their Electronic Health Records were included in our analysis. Exposures Comparison of repeated testing across patient demographics, clinical characteristics, and patient outcomes Main Outcomes and Measures Whether patients underwent repeated diagnostic testing for SARS CoV-2 in Michigan Medicine Results Between March 10th and June 4th, 19,540 tests were ordered for 15,920 patients, with most patients only tested once (13596, 85.4%) and never testing positive (14753, 92.7%). There were 5 patients who got tested 10 or more times and there were substantial variations in test results within a patient. After fully adjusting for patient and neighborhood socioeconomic status MESHD ( NSES MESHD) and demographic characteristics, patients with circulatory diseases MESHD (OR: 1.42; 95% CI: (1.18, 1.72)), any cancer MESHD (OR: 1.14; 95% CI: (1.01, 1.29)), Type 2 diabetes MESHD (OR: 1.22; 95% CI: (1.06, 1.39)), kidney diseases MESHD (OR: 1.95; 95% CI: (1.71, 2.23)), and liver diseases MESHD (OR: 1.30; 95% CI: (1.11, 1.50)) were found to have higher odds of undergoing repeated testing when compared to those without. Additionally, as compared to non-Hispanic whites, non-Hispanic blacks were found to have higher odds (OR: 1.21; 95% CI: (1.03, 1.43)) of receiving additional testing. Females were found to have lower odds (OR: 0.86; 95% CI: (0.76, 0.96)) of receiving additional testing than males. Neighborhood poverty level also affected whether to receive additional testing. For 1% increase in proportion of population with annual income below the federal poverty level, the odds ratio of receiving repeated testing is 1.01 (OR: 1.01; 95% CI: (1.00, 1.01)). Focusing on only those 1167 patients with at least one positive result in their full testing history, patient age in years (OR: 1.01; 95% CI: (1.00, 1.03)), prior history of kidney diseases MESHD (OR: 2.15; 95% CI: (1.36, 3.41)) remained significantly different between patients who underwent repeated testing and those who did not. After adjusting for both patient demographic factors and NSES MESHD, hospitalization (OR: 7.44; 95% CI: (4.92, 11.41)) and ICU-level care (OR: 6.97; 95% CI: (4.48, 10.98)) were significantly associated with repeated testing. Of these 1167 patients, 306 got repeated testing and 1118 tests were done on these 306 patients, of which 810 (72.5%) were done during inpatient stays, substantiating that most repeated tests for test positive patients were done during hospitalization or ICU care. Additionally, using repeated testing data we estimate the "real world" false negative rate of the RT-PCR diagnostic test was 23.8% (95% CI: (19.5%, 28.5%)). Conclusions and Relevance This study sought to quantify the pattern of repeated testing for COVID-19 MESHD at Michigan Medicine. While most patients were tested once and received a negative result, a meaningful subset of patients (2324, 14.6% of the population who got tested) underwent multiple rounds of testing (5,944 tests were done in total on these 2324 patients, with an average of 2.6 tests per person), with 10 or more tests for five patients. Both hospitalizations and ICU care differed significantly between patients who underwent repeated testing versus those only tested once as expected. These results shed light on testing patterns and have important implications for understanding the variation of repeated testing results within and between patients.

    Point-of-care ultrasound for COVID-19 MESHD pneumonia patients in the ICU

    Authors: zouheir bitar; Mohammed Shamsah; Omar Bamasood; Ossama Maadrani; Huda Al foudri

    doi:10.21203/rs.3.rs-49196/v1 Date: 2020-07-26 Source: ResearchSquare

    BackgroundPoint-of-care ultrasound (POCUS) has a major role in the management of patients with acute hypoxic respiratory and circulatory failure MESHD and guides hemodynamic management. There is scarce literature on POCUS assessment characteristics in COVID-19 MESHD pneumonia MESHD with hypoxic respiratory failure MESHD.MethodsThe study is an observational, prospective, single‐center study conducted in the intensive care unit of Adan General Hospital from May 1st, 2020, to June 25, 2020. The study included adults suspected to have COVID-19 MESHD transferred to the intensive care unit (ICU) with fever MESHD or suspected respiratory infection MESHD. Patients were transferred to the ICU directly from the ED or general medical wards after reverse transcriptase-polymerase chain reaction (RT-PCR) testing. A certified intensivist in critical care ultrasound who was blinded to the RT-PCR results, if available at the time of examination, performed the lung ultrasound and echocardiology within 12 hours of the patient’s admission to the ICU. We calculated the E/e’, E/A ratio, left ventricular ejection fraction EF, IVC diameter, RV size and systolic function. We performed ultrasound in 12 chest areas.ResultsOf 92 patients with suspected COVID-19 MESHD pneumonia MESHD, 77 (84%) cases were confirmed. The median age of the patients was 53 (82-36) years, and 71 (77%) were men.In the group of patients with confirmed COVID-19 MESHD pneumonia MESHD, echocardiographic findings showed normal E/e’, deceleration time (DT), and transmittal E/A ratio in comparison to the non- COVID19 MESHD patients (P .001 for both). The IVC diameter was <2 cm with > 50% collapsibility in 62 (81%) patients with COVID-19 MESHD pneumonia MESHD; a diameter of > 2 cm and < 50% collapsibility in all patients, with a P value of 0.001, was detected among those with non- COVID-19 MESHD pneumonia MESHD. There were 3 cases of myocarditis MESHD with poor EF (5.5%), severe RV dysfunction MESHD was seen in 9 cases (11.6%), and 3 cases showed RV thrombus MESHD.Chest US revealed four signs suggestive of COVID-19 MESHD pneumonia MESHD in 77 patients (98.6%) (sensitivity 96.9%, CI 85%‐99.5%) when compared with RT-PCR results.ConclusionPOCUS plays an important role in bedside diagnosis, hemodynamic assessment and management of patients with acute hypoxic respiratory and circulatory failure MESHD in patients with COVID-19 MESHD pneumonia MESHD.

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HGNC Genes
SARS-CoV-2 Proteins


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