Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Effects of high doses of genistein on mammary gland of female rat

PURPOSE: to evaluate the effects of high doses of genistein on the mammary glands of adult female rats. METHODS: Twenty-eight days after oophorectomy, 50 adult female rats were divided into five groups, as follows: a control group (Ctrl), three rats that received genistein (GEN) at the doses of 46 mg/kg (GEN46;), 125 mg/kg (GEN125) and 250 mg/kg (GEN250); one group received conjugated equine estrogen at the dose of 50 µg/g (ECE50). The substances were administered daily for 30 consecutive days by gavage and in the last week of the period of treatment, colpocytological exams were carried out for seven consecutive days. After treatment, the animals were anesthetized, blood samples were collected for estradiol and progesterone determination and the first pair of inguinal mammary glands was removed and processed for histomorphometric analysis. Collected data were subjected to analysis of variance supplemented by the Tukey-Kramer test (p<0.05). RESULTS: the ctrl group and the ones treated with different doses of GEN showed atrophic mammary glands, whereas the glands were more developed in the ECE group, where numerous mammary ducts and alveoli were observed. Morphometry showed a larger area of mammary parenchyma in the ECE group (98.870.1±550.4 µm²* per mm²; p<0.05) compared with other groups (Ctrl=36.875.6±443.4; GEN46=37.001.7±557.4; GEN125=36.480.8±658.3 and GEN250=37.502.8±669.3). The same occurred in the number of alveoli in the ECE group (33.2±6.9* per mm²; p<0.05) compared to the other groups (Ctrl=10.4±2.1, GEN46=11.2±3.1; GEN125=11.6±2.1 and GEN250=12.3±2.3). The estradiol level was higher in the ECE group compared to the other groups (9.4±1.7 pg/mL; p<0.05), whereas serum levels of progesterone were similar in all groups. CONCLUSION: the administration of genistein at high doses had no trophic effect on the mammary glands of rats.OBJETIVO: avaliar os efeitos de altas doses de genisteína sobre o epitélio mamário de ratas adultas. MÉTODOS: após 28 dias da ooforectomia, cinquenta ratas adultas foram divididas em cinco grupos, a saber: um controle (Ctrl), três que receberam genisteína (GEN) nas doses de 46 mg/kg (GEN46), 125 mg/kg (GEN125) e 250 mg/kg (GEN250), e um que recebeu estrogênios conjugados equinos na dose de 50 µg/kg (ECE). As substâncias foram administradas diariamente durante 30 dias consecutivos por gavagem e na última semana de tratamento foi efetuado exame colpocitológico durante sete dias consecutivos. Após o tratamento, os animais foram anestesiados, amostras de sangue foram retiradas para determinação do estradiol e da progesterona, e o primeiro par de mamas inguinais retirado e processado para análise histomorfométrica. Os dados obtidos foram submetidos à análise de variância complementada pelo teste de Tukey-Kramer (p<0,05). RESULTADOS: nos grupos Ctrl e tratados com as diferentes doses de GEN as mamas apresentaram-se atróficas, no entanto mostraram-se desenvolvidas no grupo ECE, onde se notou a presença de inúmeros ductos e alvéolos mamários contendo material eosinófilo em seu interior. A morfometria mostrou maior área de parênquima mamário no grupo ECE (98.870,1±550,4 µm²* por mm²; p<0,05) comparado aos outros grupos (Ctrl=36.875,6±443,4; GEN46=37.001,7±557,4; GEN125=36.480,8±658,3 e GEN250=37.502,8±669,3). O mesmo ocorreu em relação ao número de alvéolos e ductos mamários no grupo ECE (33,2±6,9* por mm²; p<0,05) em relação aos outros grupos (Ctrl=10,4±2,1, GEN 46=11,2±3,1; GEN 125=11,6±2,1 e GEN 250=12,3±2,3). Os níveis de estradiol mostraram-se aumentados no grupo ECE em relação aos outros grupos (9,4±1,7 pg/mL; p<0,05), sendo que os níveis séricos de progesterona mostraram-se semelhantes em todos os grupos de estudo. CONCLUSÃO: a administração de genisteína em altas doses não apresentou efeito proliferativo no tecido mamário de ratas

Miradas Semióticas. Arte - diseño - ciudad

Este trabajo nace de un proyecto de investigación denominado “Nuevas tendencias y propuestas de la semiótica de la imagen”, adscrito en el Área de Semiótica del Diseño, teniendo como objetivo principal explorar y reflexionar sobre la interacción del diseño con otras disciplinas buscando enriquecer la semiótica de la imagen. La publicación de este material se hace como un trabajo colaborativo entre distintas instancias de la División de Ciencias y Artes para el Diseño de la Universidad Autónoma Metropolitana, Unidad Azcapotzalco, los ejes de reflexión como: el signo, la significación, la semiosis y el sentido en el diseño y las artes, la transdisciplinariedad del diseño desde la semiótica de la cultura, el lenguaje, la intertextualidad, la traducción y la retórica, como ejes analíticos entre el diseño y las artes desde la semiótica. El resultado es la recopilación de interesantes textos que, desde diferentes enfoques, encontraron el espacio en que el diseño y las artes escénicas dialogan con ellas mismas y otras disciplinas, explorando los distintos caminos en donde el sentido y la significación se entretejen como parte de la realidad del espacio cotidiano en el que habitamos

Multiplicity dependence of light (anti-)nuclei production in p–Pb collisions at sNN=5.02 TeV

The measurement of the deuteron and anti-deuteron production in the rapidity range −1 < y < 0 as a function of transverse momentum and event multiplicity in p–Pb collisions at √sNN = 5.02 TeV is presented. (Anti-)deuterons are identified via their specific energy loss dE/dx and via their time-of- flight. Their production in p–Pb collisions is compared to pp and Pb–Pb collisions and is discussed within the context of thermal and coalescence models. The ratio of integrated yields of deuterons to protons (d/p) shows a significant increase as a function of the charged-particle multiplicity of the event starting from values similar to those observed in pp collisions at low multiplicities and approaching those observed in Pb–Pb collisions at high multiplicities. The mean transverse particle momenta are extracted from the deuteron spectra and the values are similar to those obtained for p and particles. Thus, deuteron spectra do not follow mass ordering. This behaviour is in contrast to the trend observed for non-composite particles in p–Pb collisions. In addition, the production of the rare 3He and 3He nuclei has been studied. The spectrum corresponding to all non-single diffractive p-Pb collisions is obtained in the rapidity window −1 < y < 0 and the pT-integrated yield dN/dy is extracted. It is found that the yields of protons, deuterons, and 3He, normalised by the spin degeneracy factor, follow an exponential decrease with mass number