Vascular service provision during the COVID-19 pandemic worsened major amputation rates in socially deprived diabetic populations

IntroductionThe Coronavirus Disease – 2019 (COVID-19) pandemic significantly impacted healthcare service provision and put diabetic patients at increased risk of adverse health outcomes. We aimed to assess the impact of the COVID-19 pandemic on the incidence and demographic shift of major lower-limb amputation in diabetic patients.MethodsWe performed a retrospective analysis of diabetic patient records undergoing major lower-limb amputation between 01/03/2019 and 01/03/2021 at the Royal Sussex County Hospital, the regional arterial hub for Sussex. Primary outcomes were amputation incidence rates and patient demographics compared between the prepandemic and pandemic cohorts.ResultsThe incidence rate ratio of major lower-limb amputations shows a drop in amputations during the pandemic compared to pre-pandemic (IRR 0.82; 95% CI 0.57–1.18). Data suggests a shift in the social deprivation background of patients receiving amputations to disproportionately affect those in the more deprived 50% of the population (p=0.038). Younger patients received more amputations during the pandemic compared to prepandemic levels (p=0.001).ConclusionResults suggest that during the COVID-19 pandemic there was a paradoxical reduction in amputations compared to prepandemic levels. However, changes to the demographic makeup of patient’s receiving amputations are alarming as younger, and more deprived patients have been disproportionately affected by the pandemic

Role of Factor Xa Inhibitors in Cancer-Associated Thrombosis: Any New Data?

The association between cancer and venous thromboembolism (VTE) has been well documented in the literature. Prevention and treatment of VTE in cancer patients is imperative. Typically, the mainstay regimen for VTE prevention and treatment has been anticoagulation therapy, unless contraindicated. This therapy consists of unfractionated heparin (UFH), low-molecular-weight heparin (LMWH), factor Xa inhibitor, or vitamin K antagonist (VKA). Current guidelines recommend LMWH over VKA for the treatment of VTE in cancer patients. Factor-specific anticoagulants have been proven safe and effective, and recently factor Xa inhibitors have emerged as a treatment alternative to heparins and VKA. Currently, three factor Xa inhibitors have been identified: fondaparinux (the only one approved so far by the US Food and Drug Administration), idraparinux (in clinical trials), and idrabiotaparinux (in clinical trials). This paper will examine the role of these agents, focusing on fondaparinux, for the prevention and treatment of VTE in cancer patients

Saddle Pulmonary Embolism in a Cancer Patient with Thrombocytopenia: A Treatment Dilemma

The association between cancer and venous thromboembolism (VTE) is well established. Saddle pulmonary embolism is not uncommon in hospitalized cancer patients and confers a higher mortality. We report a case of saddle pulmonary embolism in a cancer patient with thrombocytopenia, discuss the bleeding risks, complexity of managing such patients and review current guidelines

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The association between cancer and venous thromboembolism (VTE) is well established. Saddle pulmonary embolism is not uncommon in hospitalized cancer patients and confers a higher mortality. We report a case of saddle pulmonary embolism in a cancer patient with thrombocytopenia, discuss the bleeding risks, complexity of managing such patients and review current guidelines

Evaluation of Contemporary Echocardiographic and Histomorphology Parameters in Predicting Mortality in Patients With Endomyocardial Biopsy-Proven Cardiac AL Amyloidosis

INTRODUCTION: This study examined the role of echocardiographic and cardiac histomorphology parameters in predicting mortality in patients with cardiac AL amyloidosis. METHODS: Patients with endomyocardial biopsy-proven cardiac AL amyloidosis treated at MD Anderson Cancer Center between 6/2011 and 6/2020 were identified. Stored echocardiographic images and endomyocardial biopsy samples were processed for myocardial strain analysis and a detailed histomorphology characterization. RESULTS: Of 43 patients; 44% were women and 63% white. Median age was 65 years; 51% underwent stem cell transplantation (SCT). Thirty patients (70%) died during follow up (median follow up: 4.1 years). Lower LA strain ( CONCLUSION: Lower LA strain independently predicted mortality in our cohort, and its performance in the routine assessment of AL amyloidosis may be beneficial. Furthermore, SCT for cardiac AL amyloidosis was associated with improved OS. These findings need to be confirmed by larger studies in the era of contemporary systemic therapies

The age of computational cardiology and future of long-term ablation target prediction for ventricular tachycardia

Ventricular arrhythmias, particularly ventricular tachycardia, are ubiquitously linked to 300,000 deaths annually. However, the current interventional procedure-the cardiac ablation-predict only short-term responses to treatment as the heart constantly remodels itself post-arrhythmia. To assist in the design of computational methods which focuses on long-term arrhythmia prediction, this review postulates three interdependent prospectives. The main objective is to propose computational methods for predicting long-term heart response to interventions in ventricular tachycardia Following a general discussion on the importance of devising simulations predicting long-term heart response to interventions, each of the following is discussed: (i) application of "metabolic sink theory" to elucidate the "re-entry" mechanism of ventricular tachycardia; (ii) application of "growth laws" to explain "mechanical load" translation in ventricular tachycardia; (iii) derivation of partial differential equations (PDE) to establish a pipeline to predict long-term clinical outcomes in ventricular tachycardia

Coverage and throughput analysis of an energy efficient UAV base station positioning scheme

Recently, the use of unmanned aerial vehicles (UAVs) for wireless communications has attracted much research attention. However, most applications of UAVs for wireless communication provisioning are not feasible as researchers fail to consider some vital aspects of their deployment, especially the energy requirements of both the UAV and communication system. The considerable energy consumption overhead involved in flying or hovering UAVs makes them less appealing for green wireless communications. Therefore, in this work, we examine the feasibility of an alternative energy-efficient deployment scheme where UAVs can be made to land-on designated locations, also known as landing stations (LSs). The idea of LS makes the UAV-based wireless communication more durable and advantageous, since the total energy consumption is reduced by minimizing the flying/hovering energy consumption, which, in turn, enables diverse set of applications including emergency and pop-up networking. We evaluate the impact of the separation distance between these LSs and the Optimal Hovering Position (OHP) on the network performance. Specifically, we develop mathematical frameworks to model the relationship between UAV power consumption, coverage probability, throughput, and separation distance. Numerical results reveal that a significant energy reduction can be achieved when the LS concept is exploited with a slight compromise in coverage probability and throughput. However, the choice of a suitable LS location depends on the users’ service requirements, transmit power, and frequency band utilized

Access and utilisation of primary health care services comparing urban and rural areas of Riyadh Providence, Kingdom of Saudi Arabia

The Kingdom of Saudi Arabia (KSA) has seen an increase in chronic diseases. International evidence suggests that early intervention is the best approach to reduce the burden of chronic disease. However, the limited research available suggests that health care access remains unequal, with rural populations having the poorest access to and utilisation of primary health care centres and, consequently, the poorest health outcomes. This study aimed to examine the factors influencing the access to and utilisation of primary health care centres in urban and rural areas of Riyadh province of the KSA

The age of computational cardiology and future of long-term ablation target prediction for ventricular tachycardia

Ventricular arrhythmias, particularly ventricular tachycardia, are ubiquitously linked to 300,000 deaths annually. However, the current interventional procedure—the cardiac ablation—predict only short-term responses to treatment as the heart constantly remodels itself post-arrhythmia. To assist in the design of computational methods which focuses on long-term arrhythmia prediction, this review postulates three interdependent prospectives. The main objective is to propose computational methods for predicting long-term heart response to interventions in ventricular tachycardia Following a general discussion on the importance of devising simulations predicting long-term heart response to interventions, each of the following is discussed: (i) application of “metabolic sink theory” to elucidate the “re-entry” mechanism of ventricular tachycardia; (ii) application of “growth laws” to explain “mechanical load” translation in ventricular tachycardia; (iii) derivation of partial differential equations (PDE) to establish a pipeline to predict long-term clinical outcomes in ventricular tachycardia

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

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