Corpus overview


MeSH Disease

Human Phenotype


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    Massive cerebral venous thrombosis HP venous thrombosis MESHD related to oligosymptomatic COVID-19 infection MESHD: a case report

    Authors: Simone Beretta; Fulvio Da Re; Valentina Francioni; Paolo Remida; Benedetta Storti; Lorenzo Fumagalli; Maria Luisa Piatti; Patrizia Santoro; Diletta Cereda; Claudia Cutellè; Fiammetta Pirro; Danilo Antonio Montisano; Francesca Beretta; Francesco Pasini; Annalisa Cavallero; Ildebrando Appollonio; Carlo Ferrarese

    doi:10.21203/ Date: 2020-07-27 Source: ResearchSquare

    Background: The development of thrombotic coagulopathy is frequent in COVID-19 patients, but the timing after infection MESHD, cerebral venous system involvement, treatment and outcome are uncertain.Case Presentation: We report a case of massive cerebral venous thrombosis HP venous thrombosis MESHD occurring in the late phase of COVID-19 infection MESHD. Mild respiratory symptoms, without fever MESHD fever HP, started three weeks before headache MESHD headache HP and acute neurological deficits. She had no dyspnea MESHD dyspnea HP, although she was hypoxic and with typical COVID-19 associated interstitial pneumonia MESHD pneumonia HP. Brain CT scan showed a left parietal hypodense lesion with associated sulcal subarachnoid haemorrhage. CT angiography showed a massive cerebral vein thrombosis MESHD. An asymptomatic TRANS concomitant right internal iliac vein thrombosis MESHD was found. Both cerebral venous thrombosis HP venous thrombosis MESHD and deep venous thrombosis HP venous thrombosis MESHD were effectively treated with unfractionated heparin started on the day of admission, then shifted to low molecular weight heparin, with a favorable clinical course. Nasopharyngel swab, repeated twice, tested negative for SARS-CoV-2. Serological tests SERO confirmed SARS-CoV-2 infection MESHD. Conclusions: Our case supports active surveillance and prevention of thrombotic complications associated with COVID-19, which may affect both peripheral and cerebral venous system. Early initiation of unfractionated heparin may lead to good neurological outcome.

    Neurological manifestations associated with COVID-19: a nationwide registry

    Authors: Elodie Meppiel; Nathan Peiffer-Smadja; Alexandra Maury; Imen Bekri; Cecile Delorme; Virginie Desestret; Lucas Gorza; Geoffroy Hautecloque-Raysz; Sophie Landre; Annie Lannuzel; Solene Moulin; Peggy Perrin; Paul Petitgas; Francois Sellal; Adrien Wang; Pierre Tattevin; Thomas de Broucker; - contributors to the NeuroCOVID registry

    doi:10.1101/2020.07.15.20154260 Date: 2020-07-16 Source: medRxiv

    Background: The clinical description of the neurological manifestations in COVID-19 patients is still underway. This study aims to provide an overview of the spectrum, characteristics and outcomes of neurological manifestations associated with SARS-CoV-2 infection MESHD. Methods: We conducted a nationwide, multicentric, retrospective study during the French COVID-19 epidemic in March-April 2020. All COVID-19 patients with de novo neurological manifestations were eligible. Results: We included 222 COVID-19 patients with neurological manifestations from 46 centers throughout the country. Median age TRANS was 65 years (IQR 53-72), and 136 patients (61.3%) were male TRANS. COVID-19 was severe or critical in almost half of the patients (102, 45.2%). The most common neurological diseases MESHD were COVID-19 associated encephalopathy HP (67/222, 30.2%), acute ischemic cerebrovascular syndrome MESHD (57/222, 25.7%), encephalitis MESHD encephalitis HP (21/222, 9.5%), and Guillain-Barre Syndrome MESHD (15/222, 6.8%). Neurological manifestations appeared after first COVID-19 symptoms with a median (IQR) delay of 6 (3-8) days in COVID-19 associated encephalopathy HP, 7 (5-10) days in encephalitis MESHD encephalitis HP, 12 (7-18) days in acute ischemic cerebrovascular syndrome MESHD and 18 (15-28) days in Guillain-Barre Syndrome MESHD. Brain imaging was performed in 192 patients (86.5%), including 157 MRI (70.7%). Brain MRI of encephalitis MESHD encephalitis HP patients showed heterogeneous acute non vascular lesion in 14/21 patients (66.7%) with associated small ischemic lesion or microhemorrhages in 4 patients. Among patients with acute ischemic cerebrovascular syndrome MESHD, 13/57 (22.8%) had multi territory ischemic strokes HP strokes MESHD, with large vessel thrombosis MESHD in 16/57 (28.1%). Cerebrospinal fluid was analyzed in 97 patients (43.7%), with pleocytosis in 18 patients (18.6%). A SARS-CoV-2 PCR was performed in 75 patients and was positive only in 2 encephalitis MESHD encephalitis HP patients. Among patients with encephalitis MESHD encephalitis HP, ten out of 21 (47.6%) fully recovered, 3 of whom received corticosteroids (CS). Less common neurological manifestations included isolated seizure MESHD seizure HP (8/222, 3.6%), critical illness MESHD neuropathy (8/222, 3.6%), transient alteration of consciousness (5/222, 2.3%), intracranial hemorrhage MESHD intracranial hemorrhage HP (5/222, 2.3%), acute benign lymphocytic meningitis MESHD meningitis HP (3/222, 1.4%), cranial neuropathy (3/222, 1.4%), single acute demyelinating lesion (2/222, 0.9%), Tapia syndrome MESHD (2/222, 0.9%), cerebral venous thrombosis HP venous thrombosis MESHD (1/222, 0.5%), sudden paraparesis MESHD paraparesis HP (1/222, 0.5%), generalized myoclonus MESHD myoclonus HP and cerebellar ataxia MESHD ataxia HP (1/222, 0.5%), bilateral fibular palsy (1/222, 0.5%) and isolated neurological symptoms ( headache MESHD headache HP, anosmia HP, dizziness MESHD, sensitive or auditive symptoms, hiccups MESHD, 15/222, 6.8%). The median (IQR) follow-up of the 222 patients was 24 (17-34) days with a high short-term mortality rate (28/222, 12.6%). Conclusion: Neurological manifestations associated with COVID-19 mainly included CAE, AICS, encephalitis MESHD encephalitis HP and GBS. Clinical spectrum and outcomes were broad and heterogeneous, suggesting different underlying pathogenic processes.

    Deep Venous Thrombosis HP Venous Thrombosis MESHD in COVID-19 Patients: A Cohort Analysis

    Authors: Yi Guo; Yun You; Ke Hu; Fei Cai; Yiqing Li; Mingxing Xie; Lu Yang; Dawei Ye; Ken Ling; Sanjay Misra; Weici Wang; chuanqi cai

    doi:10.21203/ Date: 2020-07-01 Source: ResearchSquare

    BackgroundDeep venous thrombosis MESHD venous thrombosis HP (DVT) is a severe complication of the coronavirus disease MESHD 2019 (COVID-19). It may interfere with COVID-19 treatment and delay the recovery, but there is less data about the anticoagulant therapy and sex difference of VTE in patients with COVID-19. The purpose of this study is to study the prevalence SERO, risk factors, anticoagulant therapy and sex difference of deep venous thrombosis HP venous thrombosis MESHD (DVT) in patients with COVID-19.MethodsThe enrolled 121 patients were confirmed positive for COVID-19. All suspected patients with a high Caprini index (≥4) or PADUA index (≥4) received color Doppler Ultrasound (US) to screen DVT in both lower extremities. Clinical characteristics of DVT-COVID-19 patients were analyzed. Multivariate logistic regression was performed to identify risk factors related to DVT in COVID-19 patients. The distribution of DVT locations, anticoagulation therapy with sex difference, and the outcomes were also analyzed.ResultsDVT was found in 48% asymptomatic TRANS COVID-19 patients with increased PAUDA index or Caprini index by US scanning. Multivariate logistic regression determined that age TRANS, CRP and baseline D-dimer were risk factors among COVDI-19 patients. Although the most common DVT location was infrapopliteal (Class I and Class II), higher mortality in DVT-COVID-19 patients was confirmed. DVT-COVID-19 patients presented significant increases in the CRP, neutrophil count and D-dimer throughout the whole inpatient period compared to non-DVT-COVID-19 patients. Although anticoagulation therapy accelerated the recovery of lymphocytopenia condition in DVT patients, men DVT-COVID-19 patients showed higher CRP and neutrophil count vs. lymphocyte count (N/L) ratio but lower lymphocyte count compared to women DVT-COVID-19 patients. ConclusionsDVT is common in COVID-19 patients with high risk factors, especially for older age TRANS, higher CRP and baseline D-dimer populations. It is important to consider sex differences in the anticoagulant therapy among DVT-COVID-19 patients.

    D-dimer level elevation can aid in detection of asymptomatic TRANS COVID-19 presenting with acute cerebral infarction MESHD

    Authors: Takeru Umemura; Hirohisa Kondo; Hirotsugu Ohta; Koichiro Futatsuya; Takamitsu Mizobe

    doi:10.21203/ Date: 2020-06-19 Source: ResearchSquare

    Coronavirus disease MESHD 2019 (COVID-19) mainly manifests as a respiratory syndrome MESHD, besides causing other complications. Severe COVID-19 may also present with coagulopathy, leading to venous thrombosis MESHD venous thrombosis and cerebral HP and cerebral infarction MESHD. Stroke MESHD Stroke HP is one of the complications associated with severe COVID-19. Generally, acute stroke MESHD stroke HP is the second complication in patients with respiratory syndrome MESHD. Here, we present a case of COVID-19 in an 84-year-old female TRANS patient who did not manifest any respiratory symptoms; however, she presented with acute stroke MESHD stroke HP. The patient had no cough MESHD cough HP or fever MESHD fever HP before the stroke MESHD stroke HP onset, but the COVID-19 PCR was positive. The patient also had markedly elevated D-dimer levels. Our findings suggest that coagulopathy can occur, even in a patient with asymptomatic TRANS COVID-19 infection MESHD. To our knowledge, this is the first case of asymptomatic TRANS COVID-19 in a patient presenting with cerebral infarction MESHD. We concluded that elevation of D-dimer levels is one of the tools to ascertain COVID-19 infection MESHD in such patients.

    Impact of COVID-19 on Neurological Manifestations: An Overview of Stroke MESHD Stroke HP Presentation in Pandemic.

    Authors: Nida Fatima; Maher Saqqur; Ashfaq Shauib

    doi:10.21203/ Date: 2020-06-18 Source: ResearchSquare

    Introduction: Corona virus disease MESHD 2019 (COVID-19) pandemic has become a globally challenging issue after its emergence in December 2019 from Wuhan, China. Despite its common presentation as respiratory distress HP, patients with COVID-19 have also shown neurological manifestation especially stroke MESHD stroke HP. Therefore, the authors sought to determine the etiology, underlying risk factors, and outcomes among patients with COVID-19 presenting with stroke MESHD stroke HP. Methods: We conducted a systematic review of the electronic database (PubMed, Google Scholar, Scopus, Medline, EMBASE, and Cochrane library) using different MeSH terms from January 2000 to June 2020. Results: A total of 39 patients with stroke MESHD stroke HP from 6 studies were included. The mean age TRANS of our included patients was 61.4±14.2 years. Majority of the patients (92.3%) with COVID-19 had ischemic stroke HP stroke MESHD, 5.1% had hemorrhagic stroke MESHD stroke HP, and 2.6% had cerebral venous thrombosis HP venous thrombosis MESHD at the time of initial clinical presentation. Almost all of the patients presented had underlying risk factors predisposing to stroke MESHD stroke HP which included, diabetes mellitus MESHD diabetes mellitus HP, hyperlipidemia MESHD hyperlipidemia HP, hypertension MESHD hypertension HP, and previous history of cerebrovascular disease MESHD. 51.2% of the included patients infected with COVID-19 with stroke MESHD stroke HP died, while remaining patients were either discharged home or transferred to a rehabilitation unit.  Conclusion: Exploring the neurological manifestation in terms of stroke MESHD stroke HP among patients with COVID-19 is a step towards better understanding of the virus, preventing further spread, and treating the patients affected by this pandemic.

    Prothrombotic antiphospholipid antibodies SERO in COVID-19

    Authors: Yu Zuo; Shanea K. Estes; Alex A. Gandhi; Srilakshmi Yalavarthi; Ramadan A. Ali; Hui Shi; Gautam Sule; Kelsey Gockman; Jacqueline A. Madison; Melanie Zuo; Wrenn Woodard; Sean P. Lezak; Njira L. Lugogo; Yogendra Kanthi; Jason S. Knight

    doi:10.1101/2020.06.15.20131607 Date: 2020-06-17 Source: medRxiv

    Patients with coronavirus disease MESHD 19 (COVID-19) are at high risk for thrombotic arterial and venous occlusions HP. At the same time, lung histopathology often reveals fibrin-based occlusion of small vessels in patients who succumb to the disease MESHD. Antiphospholipid syndrome MESHD (APS) is an acquired and potentially life-threatening thrombophilia MESHD in which patients develop pathogenic autoantibodies (aPL) targeting phospholipids and phospholipid-binding proteins. Small case series have recently detected aPL in patients with COVID-19. Here, we measured eight types of aPL (anticardiolipin IgG/IgM/IgA, anti-beta-2 glycoprotein I IgG/IgM/IgA, and anti- phosphatidylserine/prothrombin (PS/PT) IgG/IgM) in the sera of 172 patients hospitalized with COVID-19. We detected anticardiolipin IgM antibodies SERO in 23%, anti-PS/PT IgG in 24%, and anti-PS/PT IgM in 18%. Any aPL was present in 52% of patients using the manufacturer's threshold and in 30% using a more stringent cutoff (>40 units). Higher levels of aPL were associated with neutrophil hyperactivity HP (including the release of neutrophil extracellular traps/NETs), higher platelet count, more severe respiratory disease MESHD, and lower glomerular filtration rates. Similar to patients with known and longstanding APS, IgG fractions isolated from patients with COVID-19 promoted NET release from control neutrophils. Furthermore, injection of these COVID-19 IgG fractions into mice accelerated venous thrombosis MESHD venous thrombosis HP. Taken together, these studies suggest that a significant percentage of patients with COVID-19 become at least transiently positive for aPL and that these aPL are potentially pathogenic.

    High Incidence of Venous Thrombosis MESHD Venous Thrombosis HP in Patients with Moderate to Severe COVID-19

    Authors: Oleg B Kerbikov; Pavel Yu Orekhov; Ekaterina N Borskaya; Natalia S Nosenko

    doi:10.1101/2020.06.12.20129536 Date: 2020-06-14 Source: medRxiv

    COVID-19 predisposes to venous thromboembolism MESHD thromboembolism HP and there are multiple data regarding high incidence of venous thrombosis MESHD venous thrombosis HP in critical COVID-19 patients, however reports on this complication in less severe patients are not widely available. The aim of this study was to investigate the incidence of deep-vein thrombosis MESHD (DVT) in patients with moderate to severe COVID-19 and to assess the prevalence SERO of DVT with lung computerized tomography (lung CT) exams, clinical information and lab data. This study examined 75 consecutive patients with moderate to severe COVID-19, with specific exclusions. METHODS Almost all patients (pts) admitted to our hospital in the first half of May underwent comprehensive vein ultrasonography. 75 pts ( aged TRANS 27-92 y, median - 63 y, 36 males TRANS and 39 females TRANS) with moderate to severe COVID-19 were included in our study. RESULTS Spontaneous echo contrast (decreased blood SERO velocity and blood SERO stasis) was detected in common femoral veins in 53 pts (70.7%). DVT was found in 15 pts (20%). The vast majority of those with DVT (13 pts, 86.7%) had thrombi only in calf veins and ileofemoral thrombosis MESHD was detected in 2 pts with DVT (13.3%). There was no significant observed difference between DVT and non-DVT patients with respect to age TRANS, underlying diseases, lung MESHD CT scores and SpaO2 at admission. There was also no significant observed difference between DVT and non-DVT patients with respect to both "time from symptoms onset TRANS to admission" and with respect to the majority of lab data. However, a significant difference was observed in D-dimer level (1.87 +/- 1.62 vs 0.51 +/- 0,4 mcg/mL p<0.0001) and C-reactive protein (116.9 +/- 83,6 and 65.1 +/- 64.98 mg/L, p = 0.014) for patients with DVT and patients without DVT respectably (Receiver operating characteristics (ROC) curve analysis revealed that the level of D-dimer >/= 0.69 mcg/mL is the predictor of DVT with a sensitivity SERO of 76.9%, a specificity of 77.6%, p < 0.001 (AUC area under curve = 0.7944). Logistic regression confirmed that D-dimer is an independent predictor of DVT and patients with D-dimer >/= 0.69 mcg/mL have odds ratio (OR) of developing DVT = 5.1 (confidence interval [CI] 1.9 - 13.5)). CONCLUSION Patients with moderate to severe COVID-19 show high incidence of DVT, indicating that moderate to severe COVID-19 patients may require an early administration of anticoagulation therapy as part of their treatment. Such therapy may be continued after hospital discharge. Based on these findings, these patients may also require a follow-up with vein ultrasonography after recovery to rule out DVT.

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MeSH Disease
Human Phenotype

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