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

Diabetes Mellitus and Retinopathy in Rural Bangladesh: A population-based Study

Objective: The study aimed to estimate the prevalence of diabetes and retinopathy in people with normal and abnormal glucose metabolism in rural Bangladesh and to identify the associated risk factors for developing diabetes and retinopathy in this population. Methods: This population based cross-sectional study was conducted through screening in camp settings, which included a total of 836 participants (aged „d25 years) by following simple random procedure. Fasting blood glucose (FBG) and oral glucose tolerance test (OGTT) were performed for all participants to diagnosis diabetes according to the diagnostic criteria of World Health Organization. Retinopathy was determined by ophthalmoscopy and fundus photography. Anthropometric measurements (BMI and WHR), glycosylated hemoglobin, blood pressure, lipid profile and urine albumin creatinine ratio were also observed. Logistic regression analysis was used, without and with adjustment for potential confounders. Results: An increased prevalence of diabetes and retinopathy was found with 7.2% (95% CI 5.4-9.0) and 5.4% (95% CI 3.9-6.9) in the present study, respectively. Moreover, the prevalence of retinopathy among the diabetic, prediabetic and nondiabetic subjects were 21.6% (95% CI 11.2-32.0), 13% (95% CI 3.4-22.6) and 3.5% (95% CI 2.2-4.8), respectively. A superior agreement was observed between FBG and OGTT (Kappa value 0.86) among the study participants. After adjusting for potential confounders BMI, WHR, serum creatinine, triglyceride, total cholesterol and UACR were found as significant independent risk indicators for the occurrence of diabetes and age, BMI, hypertension, HbA1c, serum creatinine total cholesterol and UACR were also found as significant independent risk indicators for the occurrence of retinopathy in this population. Conclusion: The indices of obesity (increased BMI and WHR), hyperlipidemia (increased triglyceride and cholesterol), serum creatinine and urine ACR may at least in part explain the high prevalence of diabetes mellitus and retinopathy in this rural population of Bangladesh

透明ゼブラフィッシュ系統を用いた内分泌かく乱物質、ビスフェノールAの次世代の生殖機能に与える影響の評価

博士(学術)doctoral創造科学技術大学院静岡大学甲第935号non

Clinical Predictors of Neurocognitive Status in Children With Chronic Kidney Disease: Neurocognitive Status in Chronic Kidney Disease

Background and Aim: Chronic kidney disease (CKD) is often associated with a variety ofcognitive deficits. This will have significant lifelong implications. Therefore, we measure theclinical predictors of cognitive impairment.Methods: This cross-sectional study was conducted in a third-level hospital from October2017 to December 2018. A total of 41 patients with CKD stage III to V and V on dialysis,aged 6 to 14 years of both sexes were included in this study. CKD was staged according tothe estimated glomerular filtration rate (eGFR). The Wechsler intelligence scales for childrenrevised(WISC-R) were provided as an individualized measure of verbal and performanceabilities. Then individual score was compared among the study population.Results: A total of 41 patients were studied. The Mean±SD age was 10.35±2.19 years. Themajority were male (56%) and the male-to-female ratio was 1.3:1. Full-scale intelligencequotient (IQ) deficits were found in 31 patients (75.6%) and most of them had mild cognitivedeficits (96.8%). Among them, verbal IQ deficit was found in 7 patients (17.1%), performanceIQ deficit in 6(14.6%), and combined IQ deficit in 18(43.9%). IQ score did not depend onthe severity of the disease. The duration of the disease was longer and the age at initiationof renal replacement therapy (RRT) was lower, for those with the cognitive deficit, was notsignificant. School attendance and performance were significantly poor in cognitive deficitpatients but anemia and hypertension had no significant impact.Conclusion: The mild cognitive deficit was often associated with childhood CKD but notrelated to the severity of the disease. Therefore, the cognitive function should be routinelyscreened and monitored during the evaluation of children with CKD

Effect of nonpharmacological interventions on dietary practices, energy expenditure and biochemical parameters of hypercholesterolemic type 2 diabetic subjects

Nonpharmacological interventions play an important role in the management of diabetes and its complications. This study analyzed the effect of nonpharmacological interventions on dietary practices, energy expenditure and management outcome in terms of glycemic and lipidemic status of type 2 diabetic subjects with hypercholesterolemia. These interventions included dietary advice, leaflets, televised lectures, booklets, posters and a bimonthly publication in Bangla. Eighty newly diagnosed type 2 diabetic subjects (male: female ratio 47:33, age 46 ± 8 years) with hypercholesterolemia (fasting serum total cholesterol >200 mg/dl) were selected from BIRDEM by purposive sampling. The first interview was taken before any intervention while the second interview was taken after a minimum interval of 8 weeks. The daily intake of macro- and micro- nutrients was assessed by 24-hr recall method. Energy expenditure of the subjects was calculated by factorial method using physical activity level (WHO/FAO/UNU 1985). After intervention, the proportion of carbohydrate, protein and fat intake of the study subjects did not differ significantly compared to values before intervention. The daily intake of micronutrients also did not differ compared to those before intervention. No significant difference was found between pre and post intervention values of per day energy intake (kcal, 1621 ± 426 vs 1645 ± 623). Total energy expenditure after intervention was significantly higher (1649 ± 340) compared to before intervention (1519 ± 353, p<0.002). After intervention, fasting serum glucose level (7 ± 1.43 mmol/l), serum glucose 2 hrs after breakfast (11 ± 4.1 mmol/l) and total cholesterol (217 ± 35 mg/dl) were significantly reduced compared to before intervention values (9 ± 4, 16 ± 7, 231 ± 32 respectively; p=0.001 for FSG, p=0.001 for SGABF, p<0.001 for total cholesterol). Nonpharmacological intervention was found to be effective in improving the management of diabetes and its complications. Ibrahim Med. Coll. J. 2009; 3(2): 75-7

Original Article EFFECT OF NONPHARMACOLOGICAL INTERVENTIONS ON DIETARY PRACTICES, ENERGY EXPENDITURE AND BIOCHEMICAL PARAMETERS OF HYPERCHOLESTEROLEMIC TYPE 2 DIABETIC SUBJECTS

Nonpharmacological interventions play an important role in the management of diabetes and its complications. This study analyzed the effect of nonpharmacological interventions on dietary practices, energy expenditure and management outcome in terms of glycemic and lipidemic status of type 2 diabetic subjects with hypercholesterolemia. These interventions included dietary advice, leaflets, televised lectures, booklets, posters and a bimonthly publication in Bangla. Eighty newly diagnosed type 2 diabetic subjects (male: female ratio 47:33, age 46 ± 8 years) with hypercholesterolemia (fasting serum total cholesterol&gt;200 mg/dl) were selected from BIRDEM by purposive sampling. The first interview was taken before any intervention while the second interview was taken after a minimum interval of 8 weeks. The daily intake of macro- and micro- nutrients was assessed by 24hr recall method. Energy expenditure of the subjects was calculated by factorial method using physical activity level (WHO/FAO/UNU 1985). After intervention, the proportion of carbohydrate, protein and fat intake of the study subjects did not differ significantly compared to values before intervention. The daily intake of micronutrients also did not differ compared to those before intervention. No significant difference was found between pre and post intervention values of pe

Knowledge, Attitude and Practice of Hypercholesterolemic Type 2 Diabetic Subjects on Dyslipidemia

This study was undertaken to assess the knowledge, attitude and practice (KAP) of hypercholesterolemic type 2 diabetic subjects on dyslipidemia and to analyze the influence of some demographic and socioeconomic factors on the level of KAP.It was a descriptive cross-sectional survey. One hundred eleven newly diagnosed type 2 diabetic subjects (male 61%, female 39%, age 45±9 years, BMI 24±4.8 Kg/m2) with hypercholesterolemia (fasting plasma total cholesterol >200 mg/dl) were selected from the out patient department of BIRDEM by purposive sampling method. Data were collected by a pre-designed, pretested, interviewer-administered questionnaire. Three categories were defined on the basis of the score obtained by each subject namely low, medium and high as follows: knowledge-score 60%; attitude-score 80%; and practice-score 70% respectively. The levels of knowledge were low in 42%, medium in 35% and high in 23% of the study subjects. The corresponding attitude levels were low in 1%, medium in 31% and high in 68%, and the levels of practice were low in 80%, medium in 14% and high in 6% of the subjects. The knowledge score was higher in secondary and graduate (53.4±8.9%, and 54.9±10.1%) groups compared to illiterate-primary group (48.9±9.9%). Practice score of illiterate-primary group (34.5±16.8%) was lower than secondary and graduate (43.1±13.9% and 46.7±18.1%) groups, but they did not differ on attitude. The various income groups did not differ on knowledge. Attitude score of high-income group (78.7±8.4%) was better than low-income group (70.9±11.8%). Practice score in high-income group (44.7±16.0%) was better than medium income and low-income groups (31.3±14.5% and 28.6±15.0%). Knowledge and practice score in Bangladeshi hypercholesterolemic type 2 diabetic subjects are not satisfactory although they have fairly good attitude levels. Education and income status are the major determinants of knowledge, attitude and practice regarding dyslipidemia in diabetes. A coordinated policy is required to promote knowledge and attitude on healthy lifestyle and to translate those into practice. Ibrahim Med. Coll. J. 2011; 5(2): 37-4

Reduction of cardiac imaging tests during the COVID-19 pandemic: The case of Italy. Findings from the IAEA Non-invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Background: In early 2020, COVID-19 massively hit Italy, earlier and harder than any other European country. This caused a series of strict containment measures, aimed at blocking the spread of the pandemic. Healthcare delivery was also affected when resources were diverted towards care of COVID-19 patients, including intensive care wards. Aim of the study: The aim is assessing the impact of COVID-19 on cardiac imaging in Italy, compare to the Rest of Europe (RoE) and the World (RoW). Methods: A global survey was conducted in May–June 2020 worldwide, through a questionnaire distributed online. The survey covered three periods: March and April 2020, and March 2019. Data from 52 Italian centres, a subset of the 909 participating centres from 108 countries, were analyzed. Results: In Italy, volumes decreased by 67% in March 2020, compared to March 2019, as opposed to a significantly lower decrease (p &lt; 0.001) in RoE and RoW (41% and 40%, respectively). A further decrease from March 2020 to April 2020 summed up to 76% for the North, 77% for the Centre and 86% for the South. When compared to the RoE and RoW, this further decrease from March 2020 to April 2020 in Italy was significantly less (p = 0.005), most likely reflecting the earlier effects of the containment measures in Italy, taken earlier than anywhere else in the West. Conclusions: The COVID-19 pandemic massively hit Italy and caused a disruption of healthcare services, including cardiac imaging studies. This raises concern about the medium- and long-term consequences for the high number of patients who were denied timely diagnoses and the subsequent lifesaving therapies and procedures