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

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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Detecting defects in software requirements specification

AbstractThis research is concerned with detecting defects in software requirements specification. Motivated by both the problem of producing reliable requirements and the limitations of existing taxonomies to provide a satisfactory level of information about defects in the requirements phase, we focus on providing a better tool for requirements analysts. Only few attempts have been made to classify defects and defect detection techniques. Scattered knowledge about defects and defect detection techniques needs compilation and re-evaluation in order to enhance the ability to discover defects in the requirements phase. Toward this end, this work presents a taxonomy of requirements defects and the causes of their occurrences. The purpose is to reach a comprehensive understanding of both the sources of the problem and the solutions of possible defects and defect detection techniques. The taxonomy’s design is based on the analysis of each defect and its sources. In addition, this paper proposes a combined-reading technique for defects in requirements. The proposed technique avoids the shortcomings of other reading techniques. The result of applying the recommendations of this work specifically improves the quality of the requirements specification and generally software quality

Role of brain magnetic resonance spectroscopy in the evaluation of suspected mitochondrial diseases in children: Experience in 30 pediatric cases

Introduction: Mitochondrial diseases are a group of inherited disorders caused by derangement of mitochondrial respiration. MR spectroscopy (MRS) has been shown to detect abnormal accumulation of lactate in brain parenchyma and CSF in patients with mitochondrial disorders, but the frequency of detection is largely unknown. Aim of the work: To evaluate the role of brain MR spectroscopy in the assessment of suspected mitochondrial diseases in the pediatric age group. Patients and methods: Thirty children with suspected mitochondrial diseases were examined by MRS. Examination was done using multisection technique and multiple echo times mainly short (35 ms) and intermediate (144 ms). Mitochondrial disease criteria scoring system was used to confirm the suspected diagnosis. Results: All patients showed elevated lactate peak with the CSF being the most sensitive (100%). Among the 30 patients, 26 (86.7%) had elevated levels of blood lactate/pyruvate ratio. Conventional MRI showed highly suggestive features in 15 patients while non specific findings were detected in 11 patients and 4 showed normal appearing brain. Conclusions: MRS provides a noninvasive tool for the diagnosis of mitochondrial diseases, especially in children with non specific findings on MRI, normal appearing MRI or a normal blood lactate/pyruvate ratio

The role of MRI and MRS in the diagnosis of non hydrocephalic macrocrania in infancy and early childhood

The aim of this study was to determine the key MRI findings in different disease causing macrocrania in early childhood that will help in early detection and diagnosis. Patients and methods: This study was conducted on 20 patients (their age ranged from 3.5 months to 5 years) referred to the radiodiagnosis department in the period between February 2013 and June 2014. All patients were subjected to conventional MRI. MRS was done in 8 cases using PRESS 3D multi-voxel chemical shift imaging. Results: The patients subdivided into 7 groups. Glutaric aciduria type 1 (40%) MRI showed wide operculum sign; MRS done in 4 patients showed elevated choline with preserved NAA peak. Benign macrocrania of infancy (15%), and MRI showed enlarged cranio-cortical and inter-hemispheric subarachnoid spaces beyond 5 mm, mildly dilated ventricles. Van der Knaap disease (15%) showed bilateral symmetrical confluent white matter dysmyelination with bilateral fronto-temporal subcortical cystic changes .MRS done in 2 patients showed increase in Cho/NAA ratios. Mucopolysaccharidosis (10%) showed dilated Virchow Robin spaces. MRS done in one patient showed decreased NAA, and increased choline/creatine ratio. Canavan disease (10%) MRI showed bilateral symmetrical extensive white matter dysmyelination. MRS showed markedly elevated NAA. Alexander disease (5%) showed bilateral symmetrical white matter dysmyelination with frontal predilection. MRS revealed increased NAA/Cr, increased myo-inositol/Cr, and lactate doublet. Gangliosidosis (5%) MRI showed bilateral symmetrical T2 and FLAIR hyperintense putamen. CT showed bilateral symmetric thalamic hyperdensities. Conclusion: MRI can diagnose different causes of non hydrocephalic macrocrania. MRS is helpful in differentiating benign macrocrania of infancy from dysmyelinating diseases and is specific in Canavan Disease

Evaluation of the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease

Abstract Background Dexmedetomidine infusion improves oxygenation and lung mechanics in patients with chronic obstructive lung disease; however, its effect in patients with restrictive lung disease has not been thoroughly investigated yet. The aim of this work was to evaluate the effects of dexmedetomidine infusion on oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease. Methods Forty-two morbidly obese patients scheduled for bariatric surgery were included in the study. Patients were randomized to receive either dexmedetomidine infusion at a bolus dose of 1mcg/Kg followed by infusion at 1 mcg/Kg/hour for 90 min (Dexmedetomidine group), or normal saline infusion (Control group). Both groups were compared with regard to: oxygenation {P/F ratio: PaO2/fraction of inspired oxygen (FiO2)}, lung compliance, dead space, plateau pressure, blood pressure, and heart rate. Results Dexmedetomidine group showed significant improvement of the PaO2/FiO2 ratio, and higher lung compliance compared to control group by the end of drug infusion. Dexmedetomidine group demonstrated decreased dead space, plateau pressure, blood pressure, and heart rate compared to control group by the end of drug infusion. Conclusion A 90-min dexmedetomidine infusion resulted in moderate improvement in oxygenation and lung mechanics in morbidly obese patients with restrictive lung disease. Trial registration clinicaltrials.gov: NCT02843698 on 20 July 2016

Impact of COVID-19 Pandemic on Cardiovascular Testing in Asia: The IAEA INCAPS-COVID Study

Background: The coronavirus disease-2019 (COVID-19) pandemic significantly affected management of cardiovascular disease around the world. The effect of the pandemic on volume of cardiovascular diagnostic procedures is not known. Objectives: This study sought to evaluate the effects of the early phase of the COVID-19 pandemic on cardiovascular diagnostic procedures and safety practices in Asia. Methods: The International Atomic Energy Agency conducted a worldwide survey to assess changes in cardiovascular procedure volume and safety practices caused by COVID-19. Testing volumes were reported for March 2020 and April 2020 and were compared to those from March 2019. Data from 180 centers across 33 Asian countries were grouped into 4 subregions for comparison. Results: Procedure volumes decreased by 47% from March 2019 to March 2020, showing recovery from March 2020 to April 2020 in Eastern Asia, particularly in China. The majority of centers cancelled outpatient activities and increased time per study. Practice changes included implementing physical distancing and restricting visitors. Although COVID testing was not commonly performed, it was conducted in one-third of facilities in Eastern Asia. The most severe reductions in procedure volumes were observed in lower-income countries, where volumes decreased 81% from March 2019 to April 2020. Conclusions: The COVID-19 pandemic in Asia caused significant reductions in cardiovascular diagnostic procedures, particularly in low-income countries. Further studies on effects of COVID-19 on cardiovascular outcomes and changes in care delivery are warranted