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

Radiotherapy pre-treatment dose validation: A second verification of monitor units (MU) with a commercial software

Inversely planned intensity-modulated radiotherapy (IMRT) and stereotactic small field radiotherapy should be verified before treatment execution. A second verification is carried out for planned treatments in IMRT and 3D conformal radiotherapy (3D-CRT) using a monitor verification commercial dose calculation management software (DCMS). For the same reference point the ion-chamber measured doses are compared for IMRT plans. DCMS (Diamond) computes dose based on modified Clarkson integration, accounting for multi-leaf collimators (MLC) transmission and measured collimator scatter factors. DCMS was validated with treatment planning system (TPS) (Eclipse 6.5 Version, Varian, USA) separately. Treatment plans computed from TPS are exported to DCMS using DICOM interface. Doses are re-calculated at selected points for fields delivered to IMRT phantom (IBA Scanditronix Wellhofer) in high-energy linac (Clinac 2300 CD, Varian). Doses measured at central axis, for the same points using CC13 (0.13 cc) ion chamber with Dose 1 Electrometer (Scanditronix Wellhofer) are compared with calculated data on DCMS and TPS. The data of 53 IMRT patients with fields ranging from 5 to 9 are reported. The computed dose for selected monitor units (MU) by Diamond showed good agreement with planned doses by TPS. DCMS dose prediction matched well in 3D-CRT forward plans (0.8 ± 1.3%, n = 37) and in IMRT inverse plans (−0.1 ± 2.2%, n = 37). Ion chamber measurements agreed well with Eclipse planned doses (−2.1 ± 2.0%, n = 53) and re-calculated DCMS doses (−1.5 ± 2.6%, n = 37) in phantom. DCMS dose validation is in reasonable agreement with TPS. DCMS calculations corroborate well with ionometric measured doses in most of the treatment plans

A Rare Case of Adrenal Pheochromocytoma with Unusual Clinical and Biochemical Presentation: A Case Report and Literature Review

A 50-year-old Omani woman presented to the Outpatient Clinic, Royal Hospital, Oman with right upper abdominal pain and backache that had lasted 10 days. She had no palpitation, sweating, or hypertension (blood pressure 122/78mmHg). The patient’s history revealed that she had a similar incidence of abdominal pain two months prior, which was a "dull ache" in nature and somewhat associated with headache. The pain was relieved using a mild analgesic drug. Abdominal ultrasonography showed a right adrenal mass, and both computed tomography and magnetic resonance imaging of the adrenal glands confirmed a right adrenal mass consistent with adrenal pheochromocytoma. However, clinical biochemistry tests revealed normal levels of plasma catecholamines (dopamine, norepinephrine, and epinephrine) and metanephrine, which are unusual findings in adrenal pheochromocytoma. Meanwhile, the patient had markedly raised plasma normetanephrine (10-fold) which, together with the normal metanephrine, constitutes a metabolic profile that is compatible with extra-adrenal pheochromocytoma. The patient also had markedly raised chromogranin A (16-fold), consistent with the presence of a neuroendocrine tumor. Laparoscopic right adrenalectomy was done and the adrenal tumor was excised and retrieved in total. Histopathology and immunohistochemistry confirmed the diagnosis of adrenal pheochromocytoma; the tumor cells being positive for chromogranin, synaptophysin, and S-100 protein. Following surgery, the patient did well and showed full recovery at follow-up after three months. Molecular genetic testing showed no pathogenic mutation in pheochromocytoma genes: MAX, SDHA, SDHAF2, SDHB, SDHC, SDHD, VHL, and PRKAR1A. A review of the literature was conducted to identify the pathophysiology and any previous reports of such case. To our knowledge, this is the first report in Oman of the extremely rare entity of pheochromocytoma with an unusual clinical and biochemical scenario

Differential Expression of Oman’s Wild Lavender, Lavandula subnuda for Chemical Composition towards Medicinal and Aromatic Application

Plants have been used directly or indirectly as medicines for over 5000 years as a source of antibiotics, antineoplastics, analgesics, and cardio-protective, among others. Approximately 70–90% of the population in developing countries continue to use ancient medicines based on plant extracts for treatment. Recently, the isolation and identification of biologically active compounds and molecules from nature have led to the discovery of new therapeutics, prompting the improvement of the health and pharmaceutical sectors. Phytochemicals revolve around the pharmaceutical industry's research and development (R&D) sector as a source of new molecules leading to the development of new novel drugs. Given the above, the present investigation addresses the differential nature of wild lavender (Lavandula subnuda Benth) plants of diverse locations in Oman with respect to their chemical composition of the essential oil in addition to morphological characters and chlorophyll contents of leaves to explore the possibility of isolating its prime chemical compounds on a commercial scale in perfumery industry. There are no previous studies so far who have reported on essential oil recovery and chemical composition exclusively in respect of Lavandula subnuda. Composite samples of ten randomly selected plants were collected from wadi habitats of four diversified locations. Edaphic features of managed sites were recorded, and their soil chemical contents were determined following instructions using S1 Titan/Tracer 5/CTX equipment of Bruker developed based on energy dispersive X-ray fluorescence (EDXRF). Morphological traits were measured using a ruler, and chlorophyll contents were recorded using the atLEAF CHL Plus chlorophyll meter as atLEAF values. The essential oil was extracted using ETHO X's advanced microwave extraction system and analyzed for chemical compounds using GC-MS analysis on Shimadzu GC-2010 Plus gas chromatograph. The experimental data were analyzed statistically, wherever required, by applying basic statistics of the EXCEL -16 version. The results indicated that in general, the Lavandula subnuda plants of locations of high altitudes had higher expressivity in all the morphological traits and chlorophyll contents than those of low altitudes. The essential oil recovery, however, was found to be higher from the plant samples of lower altitudes (0.70 to 0.79% (w/w)) than from those of higher mountains/ altitudes (0.15 to 0.18% (w/w)). The pattern of values of commonly occurring chemical contents of essential oils was different. Each essential oil's top ten chemical compounds contributed about 80% of the total in four locations. Of the ten top chemical compounds, eight compounds, namely D-Germacrene (42.67%) from Wadi Al-Khod, Estragole (32%) and Linalool (23.89%) from Wadi Halban), trans-Borneol (23.46%) and 4-Terpineol (18.73%) from Wadi Najd Al-Waqba and Kessane (18.60%), beta-cis-Caryophyllene (13.68%) and beta-Elemene (10.618%) from Wadi Al-Hayul, were found highest in quantity and had huge potential for further application. It is concluded that there exists a higher possibility of adapting Good Agriculture Practice (GAP) to produce the highest herbage yield of vegetative parts of Lavandula subnuda plants based on morphological features under wild conditions to extract these compounds on a commercial scale in both the pharmaceutical and perfumery industries.Keywords: Morphology, Chlorophyll, Chemical compounds, Differential Expression, Lavandula subnuda,, Lamiacea

Differential Expression of Oman’s Wild Lavender, Lavandula subnuda for Chemical Composition towards Medicinal and Aromatic Application

Plants have been used directly or indirectly as medicines for over 5000 years as a source of antibiotics, antineoplastics, analgesics, and cardio-protective, among others. Approximately 70–90% of the population in developing countries continue to use ancient medicines based on plant extracts for treatment. Recently, the isolation and identification of biologically active compounds and molecules from nature have led to the discovery of new therapeutics, prompting the improvement of the health and pharmaceutical sectors. Phytochemicals revolve around the pharmaceutical industry's research and development (R&D) sector as a source of new molecules leading to the development of new novel drugs. Given the above, the present investigation addresses the differential nature of wild lavender (Lavandula subnuda Benth) plants of diverse locations in Oman with respect to their chemical composition of the essential oil in addition to morphological characters and chlorophyll contents of leaves to explore the possibility of isolating its prime chemical compounds on a commercial scale in perfumery industry. There are no previous studies so far who have reported on essential oil recovery and chemical composition exclusively in respect of Lavandula subnuda. Composite samples of ten randomly selected plants were collected from wadi habitats of four diversified locations. Edaphic features of managed sites were recorded, and their soil chemical contents were determined following instructions using S1 Titan/Tracer 5/CTX equipment of Bruker developed based on energy dispersive X-ray fluorescence (EDXRF). Morphological traits were measured using a ruler, and chlorophyll contents were recorded using the atLEAF CHL Plus chlorophyll meter as atLEAF values. The essential oil was extracted using ETHO X's advanced microwave extraction system and analyzed for chemical compounds using GC-MS analysis on Shimadzu GC-2010 Plus gas chromatograph. The experimental data were analyzed statistically, wherever required, by applying basic statistics of the EXCEL -16 version. The results indicated that in general, the Lavandula subnuda plants of locations of high altitudes had higher expressivity in all the morphological traits and chlorophyll contents than those of low altitudes. The essential oil recovery, however, was found to be higher from the plant samples of lower altitudes (0.70 to 0.79% (w/w)) than from those of higher mountains/ altitudes (0.15 to 0.18% (w/w)). The pattern of values of commonly occurring chemical contents of essential oils was different. Each essential oil's top ten chemical compounds contributed about 80% of the total in four locations. Of the ten top chemical compounds, eight compounds, namely D-Germacrene (42.67%) from Wadi Al-Khod, Estragole (32%) and Linalool (23.89%) from Wadi Halban), trans-Borneol (23.46%) and 4-Terpineol (18.73%) from Wadi Najd Al-Waqba and Kessane (18.60%), beta-cis-Caryophyllene (13.68%) and beta-Elemene (10.618%) from Wadi Al-Hayul, were found highest in quantity and had huge potential for further application. It is concluded that there exists a higher possibility of adapting Good Agriculture Practice (GAP) to produce the highest herbage yield of vegetative parts of Lavandula subnuda plants based on morphological features under wild conditions to extract these compounds on a commercial scale in both the pharmaceutical and perfumery industries.Keywords: Morphology, Chlorophyll, Chemical compounds, Differential Expression, Lavandula subnuda,, Lamiacea

Clinical prediction system of complications among patients with COVID-19: A development and validation retrospective multicentre study during first wave of the pandemic.

Clinical evidence suggests that some patients diagnosed with coronavirus disease 2019 (COVID-19) experience a variety of complications associated with significant morbidity, especially in severe cases during the initial spread of the pandemic. To support early interventions, we propose a machine learning system that predicts the risk of developing multiple complications. We processed data collected from 3,352 patient encounters admitted to 18 facilities between April 1 and April 30, 2020, in Abu Dhabi (AD), United Arab Emirates. Using data collected during the first 24 h of admission, we trained machine learning models to predict the risk of developing any of three complications after 24 h of admission. The complications include Secondary Bacterial Infection (SBI), Acute Kidney Injury (AKI), and Acute Respiratory Distress Syndrome (ARDS). The hospitals were grouped based on geographical proximity to assess the proposed system's learning generalizability, AD Middle region and AD Western & Eastern regions, A and B, respectively. The overall system includes a data filtering criterion, hyperparameter tuning, and model selection. In test set A, consisting of 587 patient encounters (mean age: 45.5), the system achieved a good area under the receiver operating curve (AUROC) for the prediction of SBI (0.902 AUROC), AKI (0.906 AUROC), and ARDS (0.854 AUROC). Similarly, in test set B, consisting of 225 patient encounters (mean age: 42.7), the system performed well for the prediction of SBI (0.859 AUROC), AKI (0.891 AUROC), and ARDS (0.827 AUROC). The performance results and feature importance analysis highlight the system's generalizability and interpretability. The findings illustrate how machine learning models can achieve a strong performance even when using a limited set of routine input variables. Since our proposed system is data-driven, we believe it can be easily repurposed for different outcomes considering the changes in COVID-19 variants over time

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-U.S. 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 &lt; 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

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

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