Corpus overview


MeSH Disease

Human Phenotype


There are no transmission terms in the subcorpus


There are no seroprevalence terms in the subcorpus

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    Minimizing Population Health Loss in Times of Scarce Surgical Capacity

    Authors: Benjamin Gravesteijn; Eline Krijkamp; Jan Busschbach; Geert Geleijnse; Isabel Retel Helmrich; Sophie Bruinsma; Celine van Lint; Ernest van Veen; Ewout Steyerberg; Cornelis Verhoef; Jan van Saase; Hester Lingsma; Robert Baatenburg de Jong; - Value Based Operation Room Triage team collaborators

    doi:10.1101/2020.07.26.20157040 Date: 2020-07-30 Source: medRxiv

    Background COVID-19 has put unprecedented pressure on healthcare systems worldwide, leading to a reduction of the available healthcare capacity. Our objective was to develop a decision model that supports prioritization of care from a utilitarian perspective, which is to minimize population health loss. Methods A cohort state-transition model was developed and applied to 43 semi-elective non-paediatric surgeries commonly performed in academic hospitals. Scenarios of delaying surgery from two weeks were compared with delaying up to one year, and no surgery at all. Model parameters were based on registries, scientific literature, and the World Health Organization global burden of disease MESHD study. For each surgery, the urgency was estimated as the average expected loss of Quality-Adjusted Life-Years (QALYs) per month. Results Given the best available evidence, the two most urgent surgeries were bypass surgery for Fontaine III/IV peripheral arterial disease MESHD (0.23 QALY loss/month, 95%-CI: 0.09-0.24) and transaortic valve implantation (0.15 QALY loss/month, 95%-CI: 0.09-0.24). The two least urgent surgeries were placing a shunt for dialysis (0.01, 95%-CI: 0.005-0.01) and thyroid carcinoma HP carcinoma MESHD resection (0.01, 95%-CI: 0.01-0.02): these surgeries were associated with a limited amount of health lost on the waiting list. Conclusion Expected health loss due to surgical delay can be objectively calculated with our decision model based on best available evidence, which can guide prioritization of surgeries to minimize population health loss in times of scarcity. This tool should yet be placed in the context of different ethical perspectives and combined with capacity management tools to facilitate large-scale implementation.

    The global impact of the first Coronavirus Disease MESHD 2019 (COVID-19) pandemic wave on vascular services

    Authors: - Vascular and Endovascular Research Network; Ruth A Benson; Sandip Nandhra

    doi:10.1101/2020.07.16.20153593 Date: 2020-07-17 Source: medRxiv

    Background: The Coronavirus Disease MESHD 2019 (COVID-19) pandemic is having an unprecedented impact on healthcare delivery. This international qualitative study captured the global impact on vascular patient care during the first pandemic wave. Methods: An online structured survey was used to collect regular unit-level data regarding the modification to a wide range of vascular services and treatment pathways on a global scale. Results: The survey commenced on 23rd March 2020 worldwide. Over six weeks, 249 vascular units took part in 53 countries (465 individual responses). Overall, 65% of units stopped carotid surgery for anyone except patients with crescendo symptoms or offered surgery on a case-by-case basis, 25% only intervened for symptomatic aortic aneurysms MESHD aortic aneurysms HP cancelling all elective repairs. For patients with symptomatic peripheral arterial disease MESHD 60% of units moved to an endovascular-first strategy. For patients who had previously undergone endovascular aortic aneurysm MESHD aortic aneurysm HP repair, 31.8% of units stopped all postoperative surveillance. Of those units regularly engaging in multidisciplinary team meetings, 59.5% of units stopped regular meetings and 39.1% had not replaced them. Further, 20% of units did not have formal personal protective equipment (PPE) guidelines in place and 25% reported insufficient PPE availability. Conclusions: The COVID-19 pandemic has had a major impact on vascular services worldwide. There will be a significant vascular disease MESHD burden awaiting screening and intervention after the pandemic.

    The 4C Initiative (Clinical Care for Cardiovascular disease MESHD in the COVID-19 pandemic): monitoring the indirect impact of the coronavirus pandemic on services for cardiovascular diseases MESHD in the UK

    Authors: - TC CVD-COVID-UK Consortium; Simon Ball; Amitava Banerjee; Colin Berry; Jonathan Boyle; Benjamin Bray; William Bradlow; Afzal Chaudhry; Rikki Crawley; John Danesh; Alastair Denniston; Florian Falter; Jonine Figueroa; Christopher Hall; Harry Hemingway; Emily Jefferson; Tom Johnson; Graham King; Ken Lee; Paul McKean; Suzanne Mason; Nicholas Mills; Ewen Pearson; Munir Pirmohamed; Michael TC Poon; Rouven Priedon; Anoop Shah; Reecha Sofat; Jonathan Sterne; Fiona Strachan; Cathie LM Sudlow; Zsolt Szarka; William Whiteley; Mike Wyatt

    doi:10.1101/2020.07.10.20151118 Date: 2020-07-11 Source: medRxiv

    Background: The coronavirus (COVID-19) pandemic affects cardiovascular diseases MESHD (CVDs) directly through infection MESHD and indirectly through health service reorganisation and public health policy. Real-time data are needed to quantify direct and indirect effects. We aimed to monitor hospital activity for presentation, diagnosis and treatment of CVDs during the pandemic to inform on indirect effects. Methods: We analysed aggregate data on presentations, diagnoses and treatments or procedures for selected CVDs ( acute coronary syndromes MESHD, heart failure MESHD, stroke MESHD stroke HP and transient ischaemic attack, venous thromboembolism MESHD thromboembolism HP, peripheral arterial disease MESHD and aortic aneurysm MESHD aortic aneurysm HP) in UK hospitals before and during the COVID-19 epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends. Findings: Nine hospitals across England and Scotland contributed hospital activity data from 28 Oct 2019 (pre-COVID-19) to 10 May 2020 (pre-easing of lockdown), and for the same weeks during 2018-2019. Across all hospitals, total admissions and emergency MESHD department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1-58.6%) and 52.9% (52.2-53.5%) respectively compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1-2 weeks before lockdown, and fell HP by 31-88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm MESHD aortic aneurysm HP repair and peripheral arterial disease MESHD procedures. Compared with before the first UK COVID-19 (31 January 2020), activity declined across diseases MESHD and specialties between the first case and lockdown (total ED attendances RR 0.94, 0.93-0.95; total hospital admissions RR 0.96, 0.95-0.97) and after lockdown (attendances RR 0.63, 0.62-0.64; admissions RR 0.59, 0.57-0.60). There was limited recovery towards usual levels of some activities from mid-April 2020. Interpretation: Substantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.

    Caspase1/11 signaling affects muscle regeneration and recovery following ischemia MESHD, and can be modulated by chloroquine

    Authors: Ulka Sachdev; Ricardo Ferrari; Xiangdong Cui; Abish Pius; Amrita Sahu; Michael Reynolds; Hong Liao; Ping Sun; Sunita Shinde; Fabrisia Ambrosio; Sruti Shiva; Patricia Loughran; Melanie Scott

    doi:10.21203/ Date: 2020-04-26 Source: ResearchSquare

    Background: We previously showed that the autophagy inhibitor chloroquine (CQ) increases inflammatory cleaved caspase-1 activity in myocytes, and that caspase-1/11 is protective in sterile liver injury. However, the role of caspase-1/11 in the recovery of muscle from ischemia MESHD caused by peripheral arterial disease MESHD is unknown. We hypothesized that caspase-1/11 mediates recovery in muscle via effects on autophagy and this is modulated by CQ. Methods: C57Bl/6J (WT) and caspase-1/11 double-knockout (KO) mice underwent femoral artery ligation (a model of hind-limb ischemia MESHD) with or without CQ (50mg/kg IP every 2nd day). CQ effects on autophagosome formation, microtubule associated protein 1A/1B-light chain 3 (LC3), and caspase-1 expression was measured using electron microscopy and immunofluorescence. Laser Doppler perfusion imaging documented perfusion every 7 days. After 21 days, in situ physiologic testing in tibialis anterior muscle assessed peak force contraction, and myocyte size and fibrosis MESHD was also measured. Muscle satellite cell (MuSC) oxygen consumption rate (OCR) and extracellular acidification rate was measured. Caspase-1 and glycolytic enzyme expression was detected by Western blot. Results: CQ increased autophagosomes, LC3 consolidation, total caspase-1 expression and cleaved caspase-1 in muscle. Perfusion, fibrosis MESHD, myofiber regeneration, muscle contraction, MuSC fusion, OCR, ECAR and glycolytic enzyme expression was variably affected by CQ depending on presence of caspase-1/11. CQ decreased perfusion recovery, fibrosis MESHD and myofiber size in WT but not caspase-1/11KO mice. CQ diminished peak force in whole muscle, and myocyte fusion in MuSC and these effects were exacerbated in caspase-1/11KO mice. CQ reductions in maximal respiration and ATP production were reduced in caspase-1/11KO mice. Caspase-1/11KO MuSC had significant increases in protein kinase isoforms and aldolase with decreased ECAR. Conclusion: Caspase-1/11 signaling affects the response to ischemia MESHD in muscle and effects are variably modulated by CQ. This may be critically important for disease MESHD treated with CQ and its derivatives, including novel viral diseases MESHD (e.g. COVID-19) that are expected to affect patients with comorbidities like cardiovascular disease MESHD

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MeSH Disease
Human Phenotype

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