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1.
Anal Methods ; 2022 Jan 10.
Article in English | MEDLINE | ID: covidwho-1617007

ABSTRACT

Improved diagnostics are needed to manage the ongoing COVID-19 pandemic. In this study, we enhanced the color changes and sensitivity of colorimetric SARS-CoV-2 RT-LAMP assays based on triarylmethane dyes. We determined a mechanism for the color changes and obtained sensitivities of 10 RNA copies per microliter.

2.
Journal of Engineering Technology ; 38(2):38-47, 2021.
Article in English | ProQuest Central | ID: covidwho-1610102

ABSTRACT

This work presents a project-based learning (PEL) study, through student design and fabrication of a low-cost, open source, easy-to-build, and easy-to-use bag valve mask (BVM) ventilator, to potentially serve COVID-19 patients during the incubation period. A new learning outcomes framework, "Profiles of Learning for Undergraduate Success," was adopted as the pedagogical model, with a focus on problem solver and innovator. Using a reciprocating motion system, the ventilator is capable of providing an air supply with adjustable breath frequencies. 3D printing was used to fabricate customized components. In parallel to the mechanical assembly of the ventilator, a CAD model was developed to understand the motion mechanisms in the ventilator, which can further help optimize the system. The open access design files are available at GitHub. In actual usage, the project would serve as a backup to handle a surge of patients who may need breathing assistance in hospitals across the nation. The feedback from participating students is very positive. The success of this PBL-based project using the profiles of learning for undergraduate success shows promise, and it can be extended to other student learning experiences.

3.
Front Psychol ; 12: 798115, 2021.
Article in English | MEDLINE | ID: covidwho-1604241

ABSTRACT

This study draws on the dynamic capabilities view and the firm's big data capability (BDC) in the new economic environment. It constructs an adjusted intermediary model to study the mechanism of BDC, strategic flexibility, and environmental dynamic affecting financial performance. We find that strategic flexibility plays an intermediary role in the "Converse-U" relationship between BDC and financial performance. Environmental dynamics adjust the relationship between BDC and financial performance positively and smooth the "Converse-U" relationship. The findings suggest building and managing BDC, combining BDC with the management process, and achieving continuous financial performance improvement in a dynamic environment. The paper also puts forward the nonlinear hypothesis, discusses the "Converse-U" relationship between BDC and enterprise financial performance in the Chinese context of digital economy explosion and growth, and considers the intermediary mechanism of strategic flexibility and the regulatory effect of environmental dynamics.

4.
Environ Res ; 206: 112597, 2021 Dec 24.
Article in English | MEDLINE | ID: covidwho-1587835

ABSTRACT

To prevent the transmission of the novel coronavirus disease 2019 (COVID-19), China adopted nationwide lockdown measures on January 25, 2020, leading to an evident diminution in the observed air pollutants. To investigate the influence of the lockdown on atmospheric chemistry, the specific molecular composition, oxidative potential of organic aerosols (OAs) in PM2.5 were studied using a high-resolution orbitrap mass spectrometry at a typical coal-combustion city, Linfen, in the North China Plain (NCP). The major air pollutants including PM2.5, PM10, SO2, NO2, and CO were observed to be diminished by 28.6-45.4%, while O3 was augmented by 52.5% during the lockdown compared to those before the lockdown. A significant decrease of oxygen-containing (CHO) compounds (24.7%) associated with anthropogenic acids was observed during the lockdown, implying a reduction in fossil fuel combustion. The coal-burning related sulfur-containing organosulfates (CHOS-) and nitrooxy-sulfates (CHONS-) have also shown attenuated in both their relative abundances and anthropogenic/biogenic ratios. Amine/amide-like CHON + components have decreased by 27.6%, while nitro/nitrooxy-containing CHON- compounds have only decreased by 7.1%. Multi-source nitrogen-containing (CHN) compounds have shown a moderate elimination of 24.0%, while the identified high-condensed azaarenes have fallen from 17.7% to 14.7%, implying a potential reduction in the health risk of OAs during quarantine. The measurement of OAs' oxidative potential through dithiothreitol (DTT) assay has confirmed that as it had dropped from 0.88 nmol min-1 m-3 to 0.80 nmol min-1 m-3. High correlations were observed between the abundance of OA subgroups with the concentration of PM2.5 after the execution of the lockdown, suggesting a potential elevation in the contribution of organic components to the total PM2.5 level. Our study provides insightful compositional and health-related information in the variation of OAs during the lockdown period and attests to the validity of joint-control strategy in controlling the level and health risks of numerous atmospheric pollutants.

5.
J Allergy Clin Immunol Pract ; 2021 Dec 28.
Article in English | MEDLINE | ID: covidwho-1587394

ABSTRACT

BACKGROUND: COVID-19 mRNA vaccination-associated acute-onset hypersensitivity reactions have caused anxiety and may be contributing to vaccine hesitancy. OBJECTIVE: Determine the incidence, severity, and risk factors for treated acute-onset COVID-19 mRNA vaccination-associated hypersensitivity reactions in a well-characterized population. METHODS: All Kaiser Permanente Southern California (KPSC) members who received COVID-19 mRNA vaccinations between 12-15-2020 and 3-11-2021 at a KPSC facility were identified and characterized, along with all treated acute-onset vaccination-associated hypersensitivity events. RESULTS: We identified 391,123 unique vaccine recipients, 59.18% female, age 64.19±17.86 years; 215,156 received 2 doses (53.54% Moderna), 157,615 only a first dose (50.13% Moderna) [1,961 (1.46%) >2 weeks late getting a second dose], and 18,352 (74.43% Moderna) only a second dose. Only 104 (0.028%), 85.58% female, age 53.18±15.96 years, had treated first dose events, 68 (0.030%) Moderna. Only 32 (0.014%), 93.75% female, age 57.28±17.09 years, had treated second dose events, 21 (0.016%) Moderna. Only 2 (0.00033%) vaccinations resulted in anaphylaxis. Only 27 (20.77%) of those with treated first dose reactions failed to get a second dose. Only 6/77 (7.8%) with first dose reactions also had second dose reactions. Individuals with treated events were more likely to be female (p < .0001), younger (p < .0001), and had more preexisting drug "allergies" (2.11 ± 2.12 versus 1.02 ± 1.41 (p <.0001) for average recipients). CONCLUSIONS: Treated acute-onset hypersensitivity events were mostly benign, more common with first COVID-19 mRNA vaccine doses, more likely to occur in younger females with typical risk factors associated with multiple drug intolerance syndrome, and very unlikely to be primarily immunologically mediated.

6.
Child Adolesc Psychiatry Ment Health ; 15(1): 80, 2021 Dec 27.
Article in English | MEDLINE | ID: covidwho-1582040

ABSTRACT

BACKGROUND: Depressive and anxiety symptoms are widespread among adolescents today, creating a large social problem. However, few previous studies have addressed depression and anxiety among adolescents in Chinese cohorts. The aim of this study was to evaluate the prevalence of and risk factors for depressive and anxiety symptoms among Chinese middle school adolescent students in the post-COVID-19 era. METHODS: A total of 22,380 middle school students from Jiangsu Province were surveyed online, and their general demographic data were collected. The Patient Health Questionnaire-9 (PHQ-9) was used to assess depressive symptoms, and the seven-item Generalized Anxiety Disorder (GAD-7) scale was used to measure anxiety symptoms. RESULTS: Of these participants (aged 12-17 years), 25.6% had depressive symptoms, 26.9% had anxiety symptoms, and 20.6% had a combination of depression and anxiety symptoms. The prevalence of depressive symptoms was higher in female adolescents (27.6%) than in male adolescents (23.7%; χ2 = 45.479, P = 0.000), and the proportion with anxiety symptoms was higher among female adolescents (28.6%) than among male adolescents (25.4%; χ2 = 29.390, P = 0.000). Furthermore, binary logistic regression analysis showed that gender, region, and parental relationship were significantly associated with depressive symptoms among adolescents, while age, gender, region, and parental relationship were significantly associated with anxiety symptoms. CONCLUSIONS: Our findings demonstrated that the prevalence of reported depressive and anxiety symptoms in Chinese adolescents are high. Female gender, urban region, and poor parental relationship may be risk factors for depressive and anxiety symptoms. Furthermore, policy makers, schools, and families need to pay more attention to the psychological health of adolescents, develop response plans and take early intervention measures to reduce the prevalence of adolescent depression and anxiety.

7.
Front Public Health ; 9: 736617, 2021.
Article in English | MEDLINE | ID: covidwho-1581126

ABSTRACT

Objectives: During the coronavirus disease 2019 (COVID-19) self-quarantine period, the transition to online-course has profoundly changed the learning modes of millions of school-aged children and put them at an increased risk of asthenopia. Therefore, we aimed to determine associations of the total screen/online-course time with asthenopia prevalence among that children during the COVID-19 pandemic, and whether the associations were mediated by psychological stress. Methods: Asthenopia was defined according to a validated computer vision syndrome questionnaire (CVS-Q). We used CVS-Q to collect the frequency and intensity of 16 asthenopia-related eye symptoms of 25,781 children. Demographic features, eye care habits, visual disorders, lifestyle, psychological and environmental factors, were also collected. Results: The overall asthenopia prevalence was 12.1%, varying from 5.4 to 18.2% across grade/gender-classified subgroups. A 100-h increment of total screen/online-course time were associated with an increased risk of asthenopia by 9% [odds ratio (OR) = 1.09] and 11% (OR = 1.11), respectively. Mediation analysis showed that the proportions of total effects mediated by psychological stress were 23.5 and 38.1%, respectively. Age, female gender, having myopia or astigmatism, bad habits when watching screens were also risk factors. Conversely, keeping 34-65 cm between eyes and screen, increased rest time between classes, and increased eye exercise were all associated with a decreased risk. Conclusion: Our study indicated that the influence of long total screen or online-course time on psychological stress increases asthenopia risk. The findings of this study have provided a new avenue for intervening screen-related asthenopia in addition to incorporating a reasonable schedule of online courses into educational policy.


Subject(s)
Asthenopia , COVID-19 , Asthenopia/epidemiology , Asthenopia/etiology , Child , Female , Humans , Pandemics , SARS-CoV-2 , Stress, Psychological/epidemiology
8.
Preprint | EuropePMC | ID: ppcovidwho-297098

ABSTRACT

Covid-19 has been recognized as a terrifying global health threat since its detection, with far-reaching consequences that are unprecedented in the modern era. Since the outbreak of the pandemic, social media and legacy media have collectively delivered health information related to COVID-19 to the public as a catalyst to community perception of risk. However, the existing literature exhibits different viewpoints toward the role of social media and legacy media in disseminating health information of COVID-19. In this regard, this article conducted a systematic literature review to provide an overview of the current state of research concerning individuals-level psychological and behavioral response to COVID-19 related information from different sources, as well as presents the challenges and future research directions.

9.
Atmosphere ; 12(12):1640, 2021.
Article in English | MDPI | ID: covidwho-1555014

ABSTRACT

Since the outbreak in late December 2019, the coronavirus disease 2019 (COVID-19) pandemic has spread across the globe, causing great damage to human life and property. A lot of researchers around the world have devoted themselves to the study of its origin, pathogenic mechanism, and transmission route, and this article gives a summary. First, both humans and animals can act as the host of coronavirus. In indoor environments, the virus may exist in aerosols, droplets, saliva, etc., from the nose and mouth connected to the respiratory system, as well as feces, urine, etc., from the digestive and urinary systems. In addition, other substances, such as breast milk, eye feces, and blood, released from the host can carry viruses. The virus transmitted indoors is affected by indoor machinery, natural forces, and human activities, and spreads in different distances. Second, the virus spreads outdoors through three kinds of media: solid, liquid, and gas, and is affected by their survival time, the temperature, and humidity in the environment.

10.
Cell Biosci ; 11(1): 199, 2021 Dec 05.
Article in English | MEDLINE | ID: covidwho-1556288

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly transmissible and has caused a pandemic named coronavirus disease 2019 (COVID-19), which has quickly spread worldwide. Although several therapeutic agents have been evaluated or approved for the treatment of COVID-19 patients, efficacious antiviral agents are still lacking. An attractive therapeutic target for SARS-CoV-2 is the main protease (Mpro), as this highly conserved enzyme plays a key role in viral polyprotein processing and genomic RNA replication. Therefore, the identification of efficacious antiviral agents against SARS-CoV-2 Mpro using a rapid, miniaturized and economical high-throughput screening (HTS) assay is of the highest importance at the present. RESULTS: In this study, we first combined the fluorescence polarization (FP) technique with biotin-avidin system (BAS) to develop a novel and step-by-step sandwich-like FP screening assay to quickly identify SARS-CoV-2 Mpro inhibitors from a natural product library. Using this screening assay, dieckol, a natural phlorotannin component extracted from a Chinese traditional medicine Ecklonia cava, was identified as a novel competitive inhibitor against SARS-CoV-2 Mpro in vitro with an IC50 value of 4.5 ± 0.4 µM. Additionally, dieckol exhibited a high affinity with SARS-CoV-2 Mpro using surface plasmon resonance (SPR) analysis and could bind to the catalytic sites of Mpro through hydrogen-bond interactions in the predicted docking model. CONCLUSIONS: This innovative sandwich-like FP screening assay enables the rapid discovery of antiviral agents targeting viral proteases, and dieckol will be an excellent lead compound for generating more potent and selective antiviral agents targeting SARS-CoV-2 Mpro.

12.
Preprint in English | EuropePMC | ID: ppcovidwho-295466

ABSTRACT

Covid-19 became a global health emergency when it threatened the catastrophic collapse of health systems as demand for health goods and services and their relative prices surged. Governments responded with lockdowns and increases in transfers. Empirical evidence shows that lockdowns and healthcare saturation contribute to explain the cross-country variation in GDP drops even after controlling for Covid-19 cases and mortality. We explain this output-pandemia tradeoff as resulting from a shock to subsistence health demand that is larger at higher capital utilization in a model with entrepreneurs and workers. The health system moves closer to saturation as the gap between supply and subsistence narrows, which worsens consumption and income inequality. An externality distorts utilization, because firms do not internalize that lower utilization relaxes healthcare saturation. The optimal policy response includes lockdowns and transfers to workers.

13.
Preprint in English | Other preprints | ID: ppcovidwho-294830

ABSTRACT

Background Approximately 67% of U.S. households have pets. Limited data are available on SARS-CoV-2 in pets. We assessed SARS-CoV-2 infection in pet cohabitants as a sub-study of an ongoing COVID-19 household transmission investigation. Methods Mammalian pets from households with ≥1 person with laboratory-confirmed COVID-19 were eligible for inclusion from April–May 2020. Demographic/exposure information, oropharyngeal, nasal, rectal, and fur swabs, feces, and blood were collected from enrolled pets and tested by rRT-PCR and virus neutralization assays. Findings We enrolled 37 dogs and 19 cats from 34 of 41 eligible households. All oropharyngeal, nasal, and rectal swabs tested negative by rRT-PCR;one dog’s fur swabs (2%) tested positive by rRT-PCR at the first animal sampling. Among 47 pets with serological results from 30 households, eight (17%) pets (4 dogs, 4 cats) from 6 (20%) households had detectable SARS-CoV-2 neutralizing antibodies. In households with a seropositive pet, the proportion of people with laboratory-confirmed COVID-19 was greater (median 79%;range: 40–100%) compared to households with no seropositive pet (median 37%;range: 13–100%) (p=0.01). Thirty-three pets with serologic results had frequent daily contact (≥1 hour) with the human index patient before the person’s COVID-19 diagnosis. Of these 33 pets, 14 (42%) had decreased contact with the human index patient after diagnosis and none (0%) were seropositive;of the 19 (58%) pets with continued contact, 4 (21%) were seropositive. Interpretations Seropositive pets likely acquired infection from humans, which may occur more frequently than previously recognized. People with COVID-19 should restrict contact with animals. Funding Centers for Disease Control and Prevention, U.S. Department of Agriculture

14.
Judgment and Decision Making ; 16(6):1507-1525, 2021.
Article in English | ProQuest Central | ID: covidwho-1548658

ABSTRACT

Keywords: social dilemmas, gain/loss domain, social motives, belief

15.
Preprint in English | EuropePMC | ID: ppcovidwho-293187

ABSTRACT

As the outbreak of COVID-19 has become a severe worldwide pandemic, every country fights against the spread of this deadly disease with incredible efforts. There are numerous researches along with every conceivable dimension for COVID-19. Among these researches, different demographic and contextual factors of populations and communities also play an essential role in providing more information for decision-makers. This paper mainly utilizes existing data on county contextual factors at the United States county-level to develop a model that can capture the dynamic trajectory of COVID-19 (i.e., cases) and its impacts across the United States. Moreover, our methods applied to contextual data achieves better results compared with existing measures of vulnerability.

16.
Front Cell Dev Biol ; 9: 696662, 2021.
Article in English | MEDLINE | ID: covidwho-1528812

ABSTRACT

A better understanding of the role of T cells in the immune response to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is helpful not only for vaccine development but also for the treatment of COVID-19 patients. In this study, we determined the existence of SARS-CoV-2-specific T cells in the blood of COVID-19 convalescents. Meanwhile, the specific T cell response in the non-RBD region was stronger than in the RBD region. We also found that SARS-CoV-2 S-specific reactive CD4+ T cells exhibited higher frequency than CD8+ T cells in recovered COVID-19 patients, with greater number of corresponding epitopes presented. Importantly, we isolated the SARS-CoV-2-specific CD4+ T cell receptors (TCRs) and inserted the TCRs into allogenic CD4+ T cells. These TCR-T cells can be activated by SARS-CoV-2 spike peptide and produce IFN-γ in vitro. These results might provide valuable information for the development of vaccines and new therapies against COVID-19.

17.
Front Med (Lausanne) ; 8: 637446, 2021.
Article in English | MEDLINE | ID: covidwho-1523713

ABSTRACT

Background: The associations of frailty with the risk of mortality and resource utilization in the elderly patients admitted to intensive care unit (ICU) remain unclear. To address these issues, we performed a meta-analysis to determine whether frailty is associated with adverse outcomes and increased resource utilization in elderly patients admitted to the ICU. Methods: We searched PubMed, EMBASE, ScienceDirect, and Cochrane Central Register of Controlled Trials through August 2021 to identify the relevant studies that investigated frailty in elderly (≥ 65 years old) patients admitted to an ICU and compared outcomes and resource utilization between frail and non-frail patients. The primary outcome was mortality. We also investigated the prevalence of frailty and the impact of frailty on the health resource utilization, such as hospital length of stay (LOS) and resource utilization of ICU. Results: A total of 13 observational studies enrolling 64,279 participants (28,951 frail and 35,328 non-frail) were finally included. Frailty was associated with an increased risk of short-term mortality (10 studies, relative risk [RR]: 1.70; 95% CI: 1.45-1.98), in-hospital mortality (five studies, RR: 1.73; 95% CI: 1.55-1.93), and long-term mortality (six studies, RR: 1.86; 95% CI: 1.44-2.42). Subgroup analysis showed that retrospective studies identified a stronger correlation between frailty and hospital LOS (three studies, MD 1.14 d; 95% CI: 0.92-1.36). Conclusions: Frailty is common in the elderly patients admitted to ICU, and is associated with increased mortality and prolonged hospital LOS. Trial registration: This study was registered in the PROSPERO database (CRD42020207242).

18.
Chin Med J (Engl) ; 134(16): 1920-1929, 2021 07 27.
Article in English | MEDLINE | ID: covidwho-1522371

ABSTRACT

BACKGROUND: The global pandemic coronavirus disease 2019 (COVID-19) has become a major public health problem and presents an unprecedented challenge. However, no specific drugs were currently proven. This study aimed to evaluate the comparative efficacy and safety of pharmacological interventions in patients with COVID-19. METHODS: Medline, Embase, the Cochrane Library, and clinicaltrials.gov were searched for randomized controlled trials (RCTs) in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/SARS-CoV. Random-effects network meta-analysis within the Bayesian framework was performed, followed by the Grading of Recommendations Assessment, Development, and Evaluation system assessing the quality of evidence. The primary outcome of interest includes mortality, cure, viral negative conversion, and overall adverse events (OAEs). Odds ratio (OR) with 95% confidence interval (CI) was calculated as the measure of effect size. RESULTS: Sixty-six RCTs with 19,095 patients were included, involving standard of care (SOC), eight different antiviral agents, six different antibiotics, high and low dose chloroquine (CQ_HD, CQ_LD), traditional Chinese medicine (TCM), corticosteroids (COR), and other treatments. Compared with SOC, a significant reduction of mortality was observed for TCM (OR = 0.34, 95% CI: 0.20-0.56, moderate quality) and COR (OR = 0.84, 95% CI: 0.75-0.96, low quality) with improved cure rate (OR = 2.16, 95% CI: 1.60-2.91, low quality for TCM; OR = 1.17, 95% CI: 1.05-1.30, low quality for COR). However, an increased risk of mortality was found for CQ_HD vs. SOC (OR = 3.20, 95% CI: 1.18-8.73, low quality). TCM was associated with decreased risk of OAE (OR = 0.52, 95% CI: 0.38-0.70, very low quality) but CQ_HD (OR = 2.51, 95% CI: 1.20-5.24) and interferons (IFN) (OR = 2.69, 95% CI: 1.02-7.08) vs. SOC with very low quality were associated with an increased risk. CONCLUSIONS: COR and TCM may reduce mortality and increase cure rate with no increased risk of OAEs compared with standard care. CQ_HD might increase the risk of mortality. CQ, IFN, and other antiviral agents could increase the risk of OAEs. The current evidence is generally uncertain with low-quality and further high-quality trials are needed.


Subject(s)
COVID-19 , Humans , Medicine, Chinese Traditional , Network Meta-Analysis , Pandemics , SARS-CoV-2
19.
National Bureau of Economic Research Working Paper Series ; No. 28247, 2020.
Article in English | NBER, Grey literature | ID: grc-748462

ABSTRACT

COVID-19 became a global health emergency when it threatened the catastrophic collapse of health systems as demand for health goods and services and their relative prices surged. Governments responded with lockdowns and increases in transfers. Empirical evidence shows that lockdowns and healthcare saturation contribute to explain the cross-country variation in GDP drops even after controlling for COVID-19 cases and mortality. We explain this output-pandemia tradeoff as resulting from a shock to subsistence health demand that is larger at higher capital utilization in a model with entrepreneurs and workers. The health system moves closer to saturation as the gap between supply and subsistence narrows, which worsens consumption and income inequality. An externality distorts utilization, because firms do not internalize that lower utilization relaxes healthcare saturation. The optimal policy response includes lockdowns and transfers to workers. Quantitatively, strict lockdowns and large transfer hikes can be optimal and yield sizable welfare gains because they prevent a sharp rise in inequality. Welfare and output costs vary in response to small parameter changes or deviations from optimal policies. Weak lockdowns coupled with weak transfers programs are the worst alternative and yet are in line with what several emerging and least developed countries have implemented.

20.
Front Cardiovasc Med ; 8: 720129, 2021.
Article in English | MEDLINE | ID: covidwho-1497030

ABSTRACT

Background: Epidemiological studies have shown that atrial fibrillation (AF) is a potential cardiovascular complication of coronavirus disease 2019 (COVID-19). We aimed to perform a systematic review and meta-analysis to clarify the prevalence and clinical impact of AF and new-onset AF in patients with COVID-19. Methods: PubMed, Embase, the Cochrane Library, and MedRxiv up to February 27, 2021, were searched to identify studies that reported the prevalence and clinical impact of AF and new-onset AF in patients with COVID-19. The study was registered with PROSPERO (CRD42021238423). Results: Nineteen eligible studies were included with a total of 21,653 hospitalized patients. The pooled prevalence of AF was 11% in patients with COVID-19. Older (≥60 years of age) patients with COVID-19 had a nearly 2.5-fold higher prevalence of AF than younger (<60 years of age) patients with COVID-19 (13 vs. 5%). Europeans had the highest prevalence of AF (15%), followed by Americans (11%), Asians (6%), and Africans (2%). The prevalence of AF in patients with severe COVID-19 was 6-fold higher than in patients with non-severe COVID-19 (19 vs. 3%). Furthermore, AF (OR: 2.98, 95% CI: 1.91 to 4.66) and new-onset AF (OR: 2.32, 95% CI: 1.60 to 3.37) were significantly associated with an increased risk of all-cause mortality among patients with COVID-19. Conclusion: AF is quite common among hospitalized patients with COVID-19, particularly among older (≥60 years of age) patients with COVID-19 and patients with severe COVID-19. Moreover, AF and new-onset AF were independently associated with an increased risk of all-cause mortality among hospitalized patients with COVID-19.

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