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

Evaluación de la variación somaclonal en vitroplantas de caña de azúcar mediante marcadores moleculares Evaluation of somaclonal variation in in vitro produced sugarcane plants through molecular markers

El cultivo in vitro de tejidos vegetales puede producir variación somaclonal, fenómeno que consiste en modificaciones genéticas en las células y tejidos cultivados. Esto puede limitar la aplicación de dicha técnica para la micropopagación masiva, especialmente si la variación provoca un cambio fenotípico de importancia agronómica. En este trabajo se optimizó una metodología basada en la comparación de perfiles de marcadores moleculares AFLP (del inglés "Amplified Fragment Length Polymorphism"), para la detección de la variación somaclonal en vitroplantas de caña de azúcar. Para la optimización de la técnica de AFLP en caña de azúcar, se utilizaron plantas de seis genotipos propagados convencionalmente y dos tipos de muestras: hojas tiernas y meristemas. La variación somaclonal fue evaluada en líneas de vitroplantas de los mismos genotipos al final del cultivo in vitro, luego de seis meses de micropropagación. Con las 19 combinaciones de cebadores utilizadas, se diferenciaron los perfiles moleculares de los seis genotipos. En los plantines micropropagados se detectaron perfiles diferenciales en las variedades LCP85-384 y TUCCP77-42 con 3 de las 19 combinaciones de cebadores utilizadas. Este resultado muestra la validez de la técnica para detectar variantes somaclonales, y deja en evidencia la diferencia de susceptibilidad de los genotipos al cultivo in vitro. Esto permitió ajustar la metodología de micropropagación para cada genotipo multiplicado y asegurar la pureza genética de cada vitroplanta.<br>In vitro culture of plant tissue can produce somaclonal variation, which consists of genetic modifications in cultured cells and tissues. This may constrain the use of this technique in massive micropopagation, especially if such change causes an agronomically relevant phenotypical modification. In this work, a methodology based on the comparison of AFLP (Amplified Fragment Length Polymorphism) molecular marker profiles was developed for detecting somaclonal variation in in vitro propagated sugarcane plants. To optimize AFLP technique application to sugarcane plants, six conventionally propagated genotypes and two types of samples (tender leaves and meristems) were used. Somaclonal variation was determined in micropropagated lines of these genotypes after six months of micropropagation. Molecular profile differentiation of the selected genotypes was achieved with 19 primer combinations. Differential profiles were detected in LCP85-384 and TUCCP77-42 micropropagated lines with 3 of the 19 primer combinations. This result demonstrated that the technique can be used to detect somaclonal variants and that there are different susceptibility levels to in vitro culture among genotypes. Therefore, micropropagation methodology was adjusted to each multiplied genotype so as to ensure genetic purity of in vitro propagated plants

Derechos humanos en Paraguay 2003

Índice. Presentación. 1. Análisis socio-político y económico: Análisis de coyuntura sociopolítica / María Lis Rodríguez. Análisis Económico: El sistema económico heredado / Lila Molinier. 2. Derecho a la Vida: Violencia policial, fatales desenlaces / Hugo Valiente. 3. Derecho a la libertad, seguridad personal e integridad física: Tortura: impunidad garantizada / Hugo Valiente. La crisis del sistema penitenciario paraguayo no es nueva / Elizabeth Flores Negri, Hernán Mayor y Jorge Rolón Luna. 4. Derecho a la protección judicial: Estalla la crisis del sistema de justicia / Luis Emilio Escobar Faella. Derecho a las Garantías Judiciales y al Debido Proceso / Alfredo Enrique Kronawetter Zarza. Signo de esperanza de lograr la reparación: la Comisión Verdad y Justicia / Dionisio Gauto y Raquel Talavera. 5. Derecho a la igualdad y a la no discriminación: La igualdad de las mujeres y los desafíos ante el nuevo gobierno / Ofelia Martínez y Myrian González. Institucionalidad de género: El acceso a cargos en la administración de justicia / Carmen Vallejo. Buscando un espacio contra la intolerancia / Grupo de Acción Gay Lésbico (GAG-L). Situación de los migrantes en el país / Tomás Palau Viladesau. La situación de exclusión de las personas con discapacidad en las políticas sociales nacionales / Claudia Pacheco y Martha Horvath. 6. Derecho a la libertad ideológica, religiosa y de conciencia: La objeción de conciencia: 10 años de crecimiento constante / Orlando Castillo Caballero y Enrique Gauto Bozzano. 7. Derecho a la información y a la libertad de expresión: No disminuyen obstáculos para el acceso a información pública / Sindicato de Periodistas del Paraguay (SPP). Libertad de expresión a través de las radios comunitarias / Mirian Candia S. Derechos humanos, sociedad de la información y acceso informacional / Roberto L. Céspedes y Luis Ortiz Sandoval. 8. Derecho a la asociación, reunión y participación: Organizaciones campesinas / Quintin Riquelme. Movimiento sindical: aún mucho por resolver / Roberto Villalba. La participación para la defensa de los derechos / Laura Bareiro. 9. Derechos Políticos: Elecciones generales 2003: avances y retrocesos de la participación ciudadana / Rossana Gómez. 10. Derecho al Desarrollo Sostenible: Pobreza y desigualdad / Domingo M. Rivarola. Un año de intensa "descampesinización" por empobrecimiento / Gladys Fariña. 11. Derecho al Empleo: Un marco normativo global que atienda condiciones particulares / Verónica Serafini Geoghegan y Hugo Royg Aranda. 12. Derecho a la Seguridad Social: El estado del Derecho a la Seguridad Social en Paraguay / José María Amarilla. 13. Derecho a la Salud: Se aguardan medidas en el sector salud / Esperanza Martínez. La reestructuración de los servicios de atención en salud mental / Carlos Portillo. 14. Derecho a la Seguridad Alimentaria: Seguridad alimentaria: cada vez menos segura, cada vez menos alimentaria / Tomás Palau Viladesau. 15. Derecho a la Educación: Desafíos impostergables en Educación / Cristina Coronel y Marta Almada Denis. 16. Derechos Culturales: Cultura: el derecho postergado / Gabriel Lema. 17. Derecho a la Vivienda: El déficit de vivienda crece año a año / Cristina Vila y Ricardo Canese. 18. Derechos de la Infancia y la Adolescencia: Avances que se deben consolidar / Heve Otero. 19. Derechos de los Pueblos Indígenas: Pocos avances para los pueblos indígenas / Andrés Ramírez. 20. Derecho a la Paz y al Desarme: El riesgo de la militarización de los problemas sociales / Orlando Castillo. Víctimas de violencia institucional en las Fuerzas Armadas / María Noguera y Andrés Vázquez. 21. Derecho al Ambiente Sano: La falta de políticas públicas y de instituciones como contraste / Beatriz Silvero. 22. Cumplimiento de Compromisos Internacionales: Aumenta la conciencia ciudadana a favor de una política exterior en pro de los derechos humanos / Raquel Talavera. 23. Temas del Año: Oportunidad para la democracia del Paraguay: implementación y funcionamiento de la Comisión de Verdad y Justicia / Aldo Antonio Pelli. Significativo aumento de la criminalización de las luchas sociales / Marielle Palau y Raquel Talavera. Síntesis General de las recomendaciones. Directorio de organizaciones integrantes de la CODEHUPY

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p&lt;0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p&lt;0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology

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

International Impact of COVID-19 on the Diagnosis of Heart Disease

Background: The coronavirus disease 2019 (COVID-19) pandemic has adversely affected diagnosis and treatment of noncommunicable diseases. Its effects on delivery of diagnostic care for cardiovascular disease, which remains the leading cause of death worldwide, have not been quantified. Objectives: The study sought to assess COVID-19's impact on global cardiovascular diagnostic procedural volumes and safety practices. Methods: The International Atomic Energy Agency conducted a worldwide survey assessing alterations in cardiovascular procedure volumes and safety practices resulting from COVID-19. Noninvasive and invasive cardiac testing volumes were obtained from participating sites for March and April 2020 and compared with those from March 2019. Availability of personal protective equipment and pandemic-related testing practice changes were ascertained. Results: Surveys were submitted from 909 inpatient and outpatient centers performing cardiac diagnostic procedures, in 108 countries. Procedure volumes decreased 42% from March 2019 to March 2020, and 64% from March 2019 to April 2020. Transthoracic echocardiography decreased by 59%, transesophageal echocardiography 76%, and stress tests 78%, which varied between stress modalities. Coronary angiography (invasive or computed tomography) decreased 55% (p &lt; 0.001 for each procedure). In multivariable regression, significantly greater reduction in procedures occurred for centers in countries with lower gross domestic product. Location in a low-income and lower–middle-income country was associated with an additional 22% reduction in cardiac procedures and less availability of personal protective equipment and telehealth. Conclusions: COVID-19 was associated with a significant and abrupt reduction in cardiovascular diagnostic testing across the globe, especially affecting the world's economically challenged. Further study of cardiovascular outcomes and COVID-19–related changes in care delivery is warranted