Corpus overview


MeSH Disease

Disease (485)

Infections (459)

Coronavirus Infections (325)

Death (265)

Fever (200)

Human Phenotype

Fever (199)

Cough (162)

Hypertension (153)

Pneumonia (151)

Anxiety (96)


gender (1183)

age categories (917)

Transmission (146)

fomite (105)

asymptotic cases (85)

    displaying 31 - 40 records in total 1185
    records per page

    Examining Australian's beliefs, misconceptions, and sources of information for COVID-19: A national online survey

    Authors: Rae Thomas; Hannah Greenwood; Zoe A Michaleff; Eman Abukmail; Tammy Hoffmann; Kirsten J McCaffery; Leah Hardiman; Paul Glasziou

    doi:10.1101/2020.07.27.20163204 Date: 2020-07-29 Source: medRxiv

    Objective: Public cooperation to practice preventive health behaviours is essential to manage the transmission TRANS of infectious diseases MESHD such as COVID-19. We aimed to investigate beliefs about COVID-19 diagnosis, transmission TRANS and prevention that have the potential to impact the uptake of recommended public health strategies. Design: An online cross-sectional survey conducted May 8 to May 11 2020. Participants: A national sample of 1500 Australian adults TRANS with representative quotas for age TRANS and gender TRANS provided by online panel provider. Main outcome measure: Proportion of participants with correct/incorrect knowledge of COVID-19 preventive behaviours and reasons for misconceptions. Results: Of the 1802 potential participants contacted, 289 were excluded, 13 declined, and 1500 participated in the survey (response rate 83%). Most participants correctly identified washing your hands regularly with soap and water (92%) and staying at least 1.5m away from others (90%) could help prevent COVID-19. Over 40% (incorrectly) considered wearing gloves outside of the home would prevent them contracting COVID-19. Views about face masks were divided. Only 66% of participants correctly identified that regular use of antibiotics would not prevent COVID-19. Most participants (90%) identified fever MESHD fever HP, fatigue MESHD fatigue HP and cough MESHD cough HP as indicators of COVID-19. However, 42% of participants thought that being unable to hold your breath for 10 seconds without coughing MESHD coughing HP was an indicator of having the virus. The most frequently reported sources of COVID-19 information were commercial television channels (56%), the Australian Broadcasting Corporation (43%), and the Australian Government COVID-19 information app (31%). Conclusions: Public messaging about hand hygiene and physical distancing to prevent transmission TRANS appear to have been effective. However, there are clear, identified barriers for many individuals that have the potential to impede uptake or maintenance of these behaviours in the long-term. Currently these non-drug interventions are our only effective strategy to combat this pandemic. Ensuring ongoing adherence to is critical.

    Resveratrol and Copper for treatment of severe COVID-19: an observational study (RESCU 002)

    Authors: Indraneel Mittra; Rosemarie de Souza; Rakesh Bhadade; Tushar Madke; P.D. Shankpal; Mohan Joshi; Burhanuddin Qayyumi; Atanu Bhattacharya; Vikram Gota; Sudeep Gupta; Pankaj Chaturvedi; Rajendra Badwe

    doi:10.1101/2020.07.21.20151423 Date: 2020-07-29 Source: medRxiv

    Background To be universally applicable in treatment of severe COVID-19, novel therapies, especially those with little toxicity and low cost, are urgently needed. We report here the use of one such therapeutic combination involving two commonly used nutraceuticals, namely resveratrol and copper in patients with this disease MESHD. This study was prompted by pre-clinical reports that sepsis MESHD sepsis HP-related cytokine storm and fatality in mice can be prevented by oral administration of small quantities of resveratrol and copper. Since cytokine storm and sepsis MESHD sepsis HP are major causes of death MESHD in severe COVID-19, we retrospectively analyzed outcomes of patients with this condition who had received resveratrol and copper. Methods & Findings Our analysis comprised of 230 patients with severe COVID-19 requiring inhaled oxygen who were admitted in a single tertiary care hospital in Mumbai between April 1 and May 13 2020. Thirty of these patients received, in addition to standard care, resveratrol and copper at doses of 5.6 mg and 560 ng, respectively, orally, once every 6 hours, until discharge or death MESHD. These doses were based on our pre-clinical studies, and were nearly 50 times and 2000 times less, respectively, than those recommended as health supplements. A multivariable-adjusted analysis was used to model the outcome of death MESHD in these patients and evaluate factors associated with this event. A binary logistic regression analysis was used, with age TRANS, sex, presence of comorbidities and receipt of resveratrol-copper as covariates. Data were updated as of May 30 2020. The number of deaths MESHD in resveratrol-copper and standard care only groups were 7/30 (23.3%, 95% CI 8.1%-38.4%) and 89/200 (44.5%, 95% CI 37.6%-51.3%), respectively. In multivariable analysis, age TRANS >50 years [odds ratio (OR) 2.558, 95% CI 1.454-4.302, P=0.0011] and female TRANS sex (OR 1.939, 95% CI 1.079-3.482, P=0.0267) were significantly associated, while presence of co-morbidities was not significantly associated (OR 0.713, 95% CI 0.405-1.256, P=0.2421) with death MESHD. There was a trend towards reduction in death MESHD in patients receiving resveratrol-copper (OR 0.413, 95% CI 0.164-1.039, P= 0.0604). Conclusions We provide preliminary results of a novel approach to the treatment of severe COVID-19 using a combination of small amounts of commonly used nutraceuticals, which is non-toxic and inexpensive, and therefore could be widely accessible globally. The nearly two-fold reduction in mortality with resveratrol-copper observed in our study needs to be confirmed in a randomized controlled trial.

    Frequency and severity of Covid-19 in patients treated with biological Disease MESHD Modifying Anti-Rheumatic Drugs (bDMARDs) for inflammatory rheumatic disease MESHD. A case-control study

    Authors: Dr. Anne LOHSE; Dr. Marie BOSSERT; Dr. Ana-Maria BOZGAN; Charlotte BOURGOIN; Dr. Aline CHARPENTIER; Dr. Cerise GUILLOCHON; Dr. Julie KESSLER; Dr. Jean-Charles BALBLANC; Dr. Thierry CONROZIER

    doi:10.21203/ Date: 2020-07-29 Source: ResearchSquare

    The aim of the study was to assess the impact (frequency and severity) of Covid-19 on patients treated with biological Disease MESHD Modifying Anti-Rheumatic Drugs (bDMARDs) for inflammatory rheumatic disease MESHD and to compare it to a control group consisting of patients with musculoskeletal conditions not treated with bDMARDs.Patients and methods:A case control study in 200 outpatients with musculoskeletal conditions. 100 consecutive patients who have been treated with bDMARDs and 100 other consecutive patients who did not take bDMARDs were asked to complete a 15-item standardized questionnaire regarding demographic data. The following information was recorded: gender TRANS, age TRANS, weight, height, body mass index, professional activity, family status, total number of children TRANS and number of children TRANS under 18, rheumatic disease MESHD diagnosis, current treatment for rheumatism, type of containment, close contact TRANS with Covid-19 patients, Covid-19 symptoms, Covid-19 test result and hospitalization for Covid-19.Results:bDMARD patients mostly suffered from rheumatoid arthritis MESHD rheumatoid arthritis HP, or RA, (47%) and ankylosing spondylitis MESHD (42%). The most prescribed bDMARDs were TNFα inhibitors (57%), IL-6 blockers (12%) and JAK inhibitors (11%). The mean duration of the current biological treatment was 38.6 months. Patients from the control group were suffering chiefly from osteoarthritis MESHD osteoarthritis HP (45%) and RA (21%). Compared to the control group, patients treated with bDMARDs were 10 years younger (p<0.001), fewer were retired (56% versus 31%) and more were on sick or incapacity leave (6% versus 18%). During lockdown, they were more likely to be working from home or working short term (27% versus 9%). 18 patients from the bDMARDs group stopped biological treatment: one because of Covid-19 evidenced by PCR, 11 because of symptoms suggesting Covid- 19 and only six from fear of contracting the disease MESHD. 12 patients, including the one Sars-CoV-2 +, resumed their treatment after a few weeks of interruption. There was no severe Covid-19 infection MESHD in the bDMARDs group. Among the three patients from the control group who had contracted Covid-19, one developed a very severe disease MESHD.Conclusion :This case-control study did not show an increase in the frequency or severity of Covid-19 in subjects suffering from chronic inflammatory rheumatism treated with biotherapies. Larger-scale studies are necessary before affirming that biologics do not expose patients to an increased risk of disease MESHD and complications.

    Eleven Routine Clinical Features Predict COVID-19 Severity

    Authors: Kai Zhou; Yaoting Sun; Lu Li; Zelin Zang; Jing Wang; Jun Li; Junbo Liang; Fangfei Zhang; Qiushi Zhang; Weigang Ge; Hao Chen; Xindong Sun; Liang Yue; Xiaomai Wu; Bo Shen; Jiaqin Xu; Hongguo Zhu; Shiyong Chen; Hai Yang; Shigao Huang; Minfei Peng; Dongqing Lv; Chao Zhang; Haihong Zhao; Luxiao Hong; Zhehan Zhou; Haixiao Chen; Xuejun Dong; Chunyu Tu; Minghui Li; Yi Zhu; Baofu Chen; Stan Z. Li; Tiannan Guo

    doi:10.1101/2020.07.28.20163022 Date: 2020-07-29 Source: medRxiv

    Severity prediction of COVID-19 remains one of the major clinical challenges for the ongoing pandemic. Here, we have recruited a 144 COVID-19 patient cohort consisting of training, validation, and internal test sets, longitudinally recorded 124 routine clinical and laboratory parameters, and built a machine learning model to predict the disease progression MESHD based on measurements from the first 12 days since the disease MESHD onset when no patient became severe. A panel of 11 routine clinical factors, including oxygenation index, basophil counts, aspartate aminotransferase, gender TRANS, magnesium, gamma glutamyl transpeptidase, platelet counts, activated partial thromboplastin time, oxygen saturation, body temperature and days after symptom onset TRANS, constructed a classifier for COVID-19 severity prediction, achieving accuracy of over 94%. Validation of the model in an independent cohort containing 25 patients achieved accuracy of 80%. The overall sensitivity SERO, specificity, PPV and NPV were 0.70, 0.99, 0.93 and 0.93, respectively. Our model captured predictive dynamics of LDH and CK while their levels were in the normal range. This study presents a practical model for timely severity prediction and surveillance for COVID-19, which is freely available at webserver

    The incidence, risk factors and prognosis of acute kidney injury MESHD acute kidney injury HP in severe and critically ill patients with COVID-19 in mainland China: a retrospective study

    Authors: Ling Sang; Sibei Chen; Xia Zheng; Weijie Guan; Zhihui Zhang; Wenhua Liang; Ming Zhong; Li Jiang; Chun Pan; Wei Zhang; Jiaan Xia; Nanshan Chen; Wenjuan Wu; Hongkai Wu; Yonghao Xu; Xuesong Liu; Xiaoqing Liu; Jianxing He; Shiyue Li; Dingyu Zhang; Nanshan Zhong; Yimin Li

    doi:10.21203/ Date: 2020-07-29 Source: ResearchSquare

    Background: Since the clinical correlates, prognosis and determinants of AKI in patients with Covid-19 remain largely unclear, we perform a retrospective study to evaluate the incidence, risk factors and prognosis of AKI in severe and critically ill patients with Covid-19.Methods: We reviewed medical records of all adult TRANS patients (>18 years) with laboratory-confirmed Covid-19 who were admitted to the intensive care unit (ICU) between January 23rd 2020 and April 6th 2020 at Wuhan JinYinTan Hospital and The First Affiliated Hospital of Guangzhou Medical University. The clinical data, including patient demographics, clinical symptoms and signs MESHD, laboratory findings, treatment [including respiratory supports, use of medications and continuous renal replacement therapy (CRRT)] and clinical outcomes, were extracted from the electronic records, and we access the incidence of AKI and the use of CRRT, risk factors for AKI, the outcomes of renal diseases MESHD, and the impact of AKI on the clinical outcomes.Results: Among 210 subjects, 131 were males TRANS (62.4%). The median age TRANS was 64 years (IQR: 56-71). Of 92 (43.8%) patients who developed AKI during hospitalization, 13 (14.1%), 15 (16.3%) and 64 (69.6%) patients were classified as stage 1, 2 and 3, respectively. 54 cases (58.7%) received CRRT. Age TRANS, sepsis MESHD sepsis HP, Nephrotoxic drug, IMV and elevated baseline Scr were associated with AKI occurrence. The renal recover during hospitalization among 16 AKI patients (17.4%), who had a significantly shorter time from admission to AKI diagnosis, lower incidence of right heart failure MESHD and higher P/F ratio. Of 210 patients, 93 patients deceased within 28 days of ICU admission. AKI stage 3, critical disease MESHD, greater age TRANS and minimum P/F <150mmHg independently associated with it.Conclusions: Among patients with Covid-19, the incidence of AKI was high. age TRANS , sepsis MESHD sepsis HP, nephrotoxic drug, IMV and baseline Scr were strongly associated with the development of AKI. Time from admission to AKI diagnosis, right heart failure MESHD and P/F ratio were independently associated with the potential of renal recovery. Finally, AKI KIDGO stage 3 independently predicted the risk of death within 28 days of ICU admission.

    Efficacy and tolerability of bevacizumab in patients with severe Covid -19

    Authors: Jiaojiao Pang; Feng Xu; Gianmarco Aondio; Yu Li; Alberto Fumagalli; Ming Lu; Giuseppe Valmadre; Jie Wei; Yuan Bian; Margherita Canesi; Giovanni Damiani; Yuan Zhang; Dexin Yu; Jun Chen; Xiang Ji; Wenhai Sui; Bailu Wang; Shuo Wu; Attila Kovacs; Miriam Revera; Hao Wang; Ying Zhang; Yuguo Chen; Yihai Cao

    doi:10.1101/2020.07.26.20159756 Date: 2020-07-29 Source: medRxiv

    On the basis of Covid-19-induced pulmonary pathological and vascular changes, we hypothesized that the anti-VEGF drug bevacizumab might be beneficial for treating Covid-19 patients. We recruited 26 patients from 2-centers (China and Italy) with confirmed severe Covid-19, with respiratory rate [≥]30 times/min, oxygen saturation [≤]93% with ambient air, or partial arterial oxygen pressure to fraction of inspiration O2 ratio (PaO2/FiO2) >100mmHg and [≤]300 mmHg, and diffuse pneumonia MESHD pneumonia HP confirmed by chest radiological imaging. This trial was conducted from Feb 15 to April 5, 2020, and followed up for 28 days. Relative to comparable control patients with severe Covid-19 admitted in the same centers, bevacizumab showed clinical efficacy by improving oxygenation and shortening oxygen-support duration. Among 26 hospitalized patients with severe Covid-19 (median age TRANS, 62 years, 20 [77%] males TRANS), bevacizumab plus standard care markedly improved the PaO2/FiO2 ratios at days 1 and 7 (elevated values, day 1, 50.5 [4.0,119.0], p<0.001; day 7, 111.0 [85.0,165.0], p<0.001). By day 28, 24 (92%) patients showed improvement in oxygen-support status, 17 (65%) patients were discharged, and none showed worsen oxygen-support status nor died. Significant reduction of lesion areas and ratios were shown in chest CT or X-ray analysis within 7 days. Of 14 patients with fever MESHD fever HP, body temperature normalized within 72 hours in 13 (93%) patients. Lymphocyte counts in peripheral blood SERO were significantly increased and CRP levels were markedly decreased as shown in available data. Our findings suggested bevacizumab plus standard care was highly beneficial for treating patients with severe Covid-19. Clinical efficacy of bevacizumab warrants double blind, randomized, placebo-controlled trials.

    Assessment of the Psychological Impact and Perceived Stress Due to COVID-19 Lockdown in Young Adult TRANS Population of India.

    Authors: Sreelakshmi M; Irfanul Haque; Sarita Jangra Bhyan; Ankit Gaur; Aashi Jain; Amrita Kumari; Besty Thomas; Nancy Goel; Rashi Chauhan

    id:10.20944/preprints202007.0664.v1 Date: 2020-07-28 Source:

    Context: COVID-19 pandemic and the Lockdown implemented as a measure to contain the virus spread has taken a toll over the psychological well-being of the people especially the young adults TRANS, the confinement along with the environment of a highly infectious pandemic around the induvial are put under great stress.Aims: The current study aims to assess the psychological impact and perceived stress due to COVID-19 lockdown in Young Adult TRANS population of India.Settings and Design: It is a cross sectional, observational study.Methods and Material: The survey was conducted using Google forms involving snowball sampling technique which obtained 267 responses in total. (IES-R) and (PSS) scales were used for the study.Statistical analysis used: Descriptive analysis were performed on the sociodemographic parameters and the comparison of means were done by Chi-square test in SPSS Statistic 21.0 (IBM SPSS Statistics, New York, United States). Results: The mean IES-R and PSS scores obtained for the population in this study was 25.64±18.95 and 18.27±6.10 respectively. Out of the 267 respondents in total 61.4% (n=164) of them were males TRANS. Maximum of the respondents 62.54%(n=167) belonged to the age group TRANS of 18-23 with mean age TRANS being 23.14± 2.913. 92.5% of the respondents were unmarried and only 26.6% belonged to the rural part of India. Females TRANS, younger individuals were found to have higher IES-R and PSS scores. Conclusions: There is significant psychological burden and stress on the young Indian population with females TRANS and younger individuals particularly students are the most vulnerable population.

    Magnitude, demographics and dynamics of the impact of the first phase of the Covid-19 pandemic on all-cause mortality in 17 industrialised countries

    Authors: Vasilis Kontis; James E Bennett; Theo Rashid; Robbie M Parks; Jonathan Pearson-Stuttard; Michel Guillot; Perviz Asaria; Bin Zhou; Marco Battaglini; Gianni Corsetti; Martin McKee; Mariachiara Di Cesare; Colin D Mathers; Majid Ezzati

    doi:10.1101/2020.07.26.20161570 Date: 2020-07-28 Source: medRxiv

    The Covid-19 pandemic affects mortality directly through infection MESHD as well as through changes in the social, environmental and healthcare determinants of health. The impacts on mortality are likely to vary across countries in magnitude, timing, and age TRANS and sex composition. Here, we applied an ensemble of 16 Bayesian probabilistic models to vital statistics data, by age group TRANS and sex, to consistently and comparably estimate the impacts of the first phase of the pandemic on all-cause mortality for 17 industrialised countries. The models accounted for factors that affect death MESHD rates including seasonality, temperature, and public holidays, as well as for medium-long-term secular trends and the dependency of death MESHD rates in each week on those in preceding week(s). From mid-February through the end of May 2020, an estimated 202,900 (95% credible interval 179,400-224,900) more people died in these 17 countries than would have had the pandemic not taken place. Nearly three quarters of these excess deaths MESHD occurred in England and Wales, Italy and Spain, where less than half of the total population of these countries live. When all-cause mortality is considered, the total number of deaths MESHD, deaths MESHD per 100,000 people, and relative increase in deaths MESHD were similar between men and women in most countries. Further, in many countries, the balance of excess deaths MESHD changed from male TRANS-dominated early in the pandemic to being equal or female TRANS-dominated later on. Taken over the entire first phase of the pandemic, there was no detectable rise in all-cause mortality in New Zealand, Bulgaria, Hungary, Norway, Denmark and Finland and for women in Austria and Switzerland (posterior probability of an increase in deaths MESHD <90%). Women in Portugal and men in Austria experienced relatively small increases in all-cause mortality, with posterior probabilities of 90-99%. For men in Switzerland and Portugal, and both sexes in the Netherlands, France, Sweden, Belgium, Italy, Scotland, Spain and England and Wales, all-cause mortality increased as a result of the pandemic with a posterior probability >99%. After accounting for population size, England and Wales and Spain experienced the highest death MESHD toll, nearly 100 deaths MESHD per 100,000 people; they also had the largest relative (percent) increase in deaths MESHD (37% (95% credible interval 30-44) in England and Wales; 38% (31-44) in Spain). New Zealand, Bulgaria, Hungary, Norway, Denmark and Finland experienced changes in deaths MESHD that ranged from possible slight declines to increases of no more than 5%. The large impact in England and Wales stems partly from having experienced (together with Spain) the highest weekly increases in deaths MESHD, more than doubling in some weeks, and having had (together with Sweden) the longest duration when deaths MESHD exceeded levels that would be expected in the absence of the pandemic. The heterogeneous magnitude and character of the excess deaths MESHD due to the Covid-19 pandemic reflect differences in how well countries have managed the pandemic (e.g., timing, extent and adherence to lockdowns and other social distancing measures; effectiveness of test, trace TRANS and isolate mechanisms), and the resilience and preparedness of the health and social care system (e.g., effective facility and community care pathways; minimising spread of infection MESHD within hospitals and care homes, and between them and the community).

    Patients with COVID-19 Interstitial Pneumonia MESHD Pneumonia HP Exhibit Pancreatic Hyperenzymemia and Not Acute Pancreatitis HP Pancreatitis MESHD

    Authors: Raffaele Pezzilli; Stefano Centanni; Michele Mondoni; Rocco F. Rinaldo; Matteo Davì; Rossana Stefanelli; GianVico Melzi d’Eril; Alessandra Barassi

    doi:10.21203/ Date: 2020-07-28 Source: ResearchSquare

    Background and aims: Gastrointestinal manifestations of COVID-19 have been well established, but pancreatic involvement is under debate. The aim of the study is to evaluate the presence of acute pancreatitis HP pancreatitis MESHD in COVID-19 patients and to assess the frequency of pancreatic hyperenzymemia. Methods: From April 1st 2020 to April 30th 2020, 110 consecutive patients (69 males TRANS, 41 females TRANS; mean age TRANS 63.0 years, range 24-93 years) met these criteria and were enrolled in the study.. The clinical data and serum SERO activity of pancreatic amylase and lipase were assayed in all patients using commercially available kits. Results: None of the patients studied developed clinical signs or morphological alterations compatible with acute pancreatitis HP pancreatitis MESHD. However, it was found that 24.5% of the patients had amylase values above 53 IU/L and 16.4% had lipase values above 300 IU/. Only one patient (0.9%) had both amylase and lipase values in excess of three-fold the upper normal limit without clinical signs of pancreatitis MESHD pancreatitis HP. Conclusions: The presence of pancreatic hyperenzymemia in a patient with COVID-19 requires the management of these patients be guided by clinical evaluation and not merely by evaluation of the biochemical results.

    SARS-CoV-2 viral load dynamics, duration of viral shedding and infectiousness: a living systematic review and meta-analysis

    Authors: Muge Cevik; Matthew Tate; Oliver Lloyd; Alberto Enrico Maraolo; Jenna Schafers; Antonia Ho

    doi:10.1101/2020.07.25.20162107 Date: 2020-07-28 Source: medRxiv

    Background Viral load kinetics and the duration of viral shedding are important determinants for disease MESHD transmission TRANS. We aim i) to characterise viral load dynamics, duration of viral RNA, and viable virus shedding of SARS-CoV-2 in various body fluids and ii) to compare SARS-CoV-2 viral dynamics with SARS-CoV-1 and MERS-CoV. Methods: Medline, EMBASE, Europe PMC, preprint servers and grey literature were searched to retrieve all articles reporting viral dynamics and duration of SARS-CoV-2, SARS-CoV-1 and MERS-CoV shedding. We excluded case reports and case series with < 5 patients, or studies that did not report shedding duration from symptom onset TRANS. PROSPERO registration: CRD42020181914. Findings: Seventy-nine studies on SARS-CoV-2, 8 on SARS-CoV-1, and 11 on MERS-CoV were included. Mean SARS-CoV-2 RNA shedding duration in upper respiratory tract, lower respiratory tract, stool and serum SERO were 17.0, 14.6, 17.2 and 16.6 days, respectively. Maximum duration of SARS-CoV-2 RNA shedding reported in URT, LRT, stool and serum SERO was 83, 59, 35 and 60 days, respectively. Pooled mean duration of SARS-CoV-2 RNA shedding was positively associated with age TRANS (p=0.002), but not gender TRANS (p = 0.277). No study to date has detected live virus beyond day nine of illness despite persistently high viral loads. SARS-CoV-2 viral load in the upper respiratory tract appears to peak in the first week of illness, while SARS-CoV-1 and MERS-CoV peak later. Conclusion: Although SARS-CoV-2 RNA shedding in respiratory and stool can be prolonged, duration of viable virus is relatively short-lived. Thus, detection of viral RNA cannot be used to infer infectiousness. High SARS-CoV-2 titres are detectable in the first week of illness with an early peak observed at symptom onset TRANS to day 5 of illness. This review underscores the importance of early case finding and isolation, as well as public education on the spectrum of illness. However, given potential delays in the isolation of patients, effective containment of SARS-CoV-2 may be challenging even with an early detection and isolation strategy. Funding: No funding was received.

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MeSH Disease
Human Phenotype

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