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

Endoscopic Ultrasound Biopsy Needle

In the past few years, endoscopic ultrasound (EUS)-guided fine-needle biopsy (EUS-FNB) has superseded EUS-fine-needle aspiration (EUS-FNA) for EUS-guided tissue acquisition. EUS-FNA does not retain the stroma as well as the surrounding tissue architecture and therefore had limitations in achieving a definitive diagnosis. Development of EUS-FNB needles had improved the diagnostic ability of EUS by providing core tissue sample that not only preserves surrounding tissue architecture but also provides adequate material for molecular typing and gene profiling of sampled lesions. At present, there are three commercially available third-generation EUS-FNB needles with unique needle tip designs. In this review, we aim to elucidate the technical aspects of the available EUS-FNB needles

Impact of Direct Endoscopic Necrosectomy on Recurrence of Symptoms or Fluid Collections Following Successful Endoscopic Transmural Drainage of Walled-off Necrosis in Disconnected Pancreatic Duct

Background The impact of direct endoscopic necrosectomy (DEN) on risk of recurrence of symptoms or pancreatic fluid collections (PFCs) in patients with disconnected pancreatic duct (DPD) has not been previously evaluated

Effect of Fatigue Protocols on Upper Extremity Neuromuscular Function and Implications for Ulnar Collateral Ligament Injury Prevention

Background: As the incidence of overuse injuries to the medial elbow in overhead athletes continues to rise, recent evidence suggests a link between these injuries and alterations in biomechanics produced by athlete fatigue. Previous studies have evaluated the effect of fatigue on elbow injuries using a wide array of fatigue protocols/athletic tasks, and, as a consequence, the results have been heterogeneous. Purpose: To determine whether there is a uniform alteration in neuromuscular function or biomechanics as the overhead athlete fatigues. Furthermore, this study sought to determine whether player fatigue should be accounted for in ulnar collateral ligament (UCL) injury prevention programs. Study Design: Systematic review. Methods: A systematic review of the literature using PubMed and MEDLINE databases was performed. Keywords included Results: A total of 35 studies involving 644 athletes (90 females, 554 males; mean age, 20.2 years) met the inclusion criteria. General fatigue protocols were used in 2 investigations, peripheral protocols were used in all 35 studies, and 5 different athletic tasks were studied (simulated baseball game, overhead throwing, high-effort swimming, simulated tennis game, and overhead serving). There was a uniform decrease in muscle force production and proprioception in athletes after completing a fatigue protocol. However, there was no consistency among studies when evaluating other important upper limb biomechanical factors. The fatigue protocols did not consistently produce statistically significant changes in elbow torque, pitching biomechanics, or ball velocity. Conclusion: A uniform decrease in muscle force production and proprioception was found after fatigue protocols; however, a majority of fatigue protocols published in the current literature are inconsistently measured and produce heterogeneous results. Therefore, currently, no recommendations can be made for changes in UCL injury prevention training programs to account for potential effects of fatigue. The effect of muscle force production and proprioception on upper extremity injuries should be evaluated in future studies

ACL Reconstruction Basics: Quadruple (4-Strand) Hamstring Autograft Harvest

Hamstring tendon autograft remains a popular graft choice for anterior cruciate ligament (ACL) reconstruction. Although there are a variety of autograft and allograft options available for ACL reconstruction, advantages of hamstring tendon autografts include decreased postoperative knee pain and an overall easier surgical recovery compared with bone patellar tendon bone autograft. In addition, 4-stranded (quadruple) hamstring grafts are among the strongest grafts biomechanically (at time equals zero). Although the technique of hamstring autograft harvest is relatively straightforward, it is critical to pay attention to several technical steps to avoid iatrogenic neurovascular damage as well as to avoid premature amputation of the graft while using a tendon stripper. In this Technical Note, we describe a technique of hamstring autograft harvest for ACL reconstruction for a quadruple (4-strand) hamstring graft using the gracilis and semitendinosus tendons

Social media, endometriosis, and evidence-based information : an analysis of Instagram content

Social media platforms are used for support and as resources by people from the endometriosis community who are seeking advice about diagnosis, education, and disease management. However, little is known about the scientific accuracy of information circulated on Instagram about the disease. To fill this gap, this study analysed the evidence-based nature of content on Instagram about endometriosis. A total of 515 Instagram posts published between February 2022 and April 2022 were gathered and analysed using a content analysis method, resulting in sixteen main content categories, including “educational”, which comprised eleven subcategories. Claims within educational posts were further analysed for their evidence-based accuracy, guided by a process which included fact-checking all claims against the current scientific evidence and research. Of the eleven educational subcategories, only four categories (cure, scientific article, symptoms, and fertility) comprised claims that were at least 50% or greater evidence-based. More commonly, claims comprised varying degrees of evidence-based, mixed, and non-evidence-based information, and some categories, such as surgery, were dominated by non-evidence-based information about the disease. This is concerning as social media can impact real-life decision-making and management for individuals with endometriosis. Therefore, this study suggests that health communicators, clinicians, scientists, educators, and community groups trying to engage with the endometriosis online community need to be aware of social media discourses about endometriosis, while also ensuring that accurate and translatable information is provided