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

Locomotor function recovering and histomorphometric study of spinal cord injury in the rat: effects of methylprednisolone and ganglioside G(M1)

A metilprednisolona (MP) e o gangliosídeo GM-1 são drogas de uso clínico estabelecido para o tratamento da lesão medular em humanos, embora sua eficácia e seus mecanismos de ação ainda não sejam totalmente entendidos. O objetivo do presente trabalho foi avaliar os resultados da recuperação da função locomotora e comparar com as alterações histomorfométricas da medula de ratos com lesão medular medicados com MP; GM-1 e sua associação. A lesão medular foi produzida pelo sistema New York University® em 24 ratos Wistar, divididos em quatro grupos: controle (n=6), MP (n=6), GM1 (n=6) e MP+GM1 (n=6). A avaliação da recuperação da função locomotora dos ratos foi realizada utilizando-se a escala de BBB no 2º, 7º e 14º dias após lesão medular e sacrificados no 14º dia para análise histológica e morfométrica de área total, área preservada e percentual de área preservada. Concluímos que a MP e sua associação com o GM-1 mostraram-se eficazes na recuperação da função locomotora e que todos os ratos medicados demonstraram melhora no percentual de área preservada superior ao grupo controle. Os Grupos MP e GM1 foram superiores na preservação de substância branca e o GM-1 demonstrou efeitos benéficos na preservação de substância cinzenta no centro da lesão. A substância cinzenta demonstrou ser mais suscetível à lesão que a substância branca e não houve correlação entre os achados histológicos e a recuperação da função locomotora.The methylprednisolone and the GM-1 ganglioside are drugs with established clinical usage for the treatment of spinal cord injury in human; however its efficiency and its active mechanisms are not completely understood yet. The objective of the present paper has been to evaluate the results from the neurological function recovering and to compare these with the histomorphometric alterations in rats with spinal cord injury, prescribed with methylprednisolone; GM-1 and its association. The spinal cord injury has been done by the New York University system® in 24 Wistar rats which were assigned to one of four groups: control (n=6), MP (n=6), GM1 (n=6) and MP+GM1 (n=6). The evaluation of the neurological function outcome has been carried out using BBB locomotor rating scale on the second, seventh and fourteenth days after the injury and sacrificed on the fourteenth day for histological and morphometric analyses of total cross-sectional area, spared area and percentage of spared area. We concluded that the methylprednisolone and its association with the GM-1 revealed themselves effective concerning to the locomotor function recover and that every medicated rat demonstrated an improvement in the preserved area percentage superior to the control group. The MP and GM1 Groups were superior in the white matter preservation and the GM-1 demonstrated beneficial effects regarding the gray matter preservation at the injury epicenter. The gray matter has been more sensitive for damaged than the white matter and there has not been correlation between the histological findings and the locomotor function recovering

Monitoração intraoperatória com teste de estimulação eletromiográfica dos instrumentais de pacientes submetidos à correção cirúrgica de escoliose idiopática

OBJETIVO: apresentar a metodologia empregada na monitoração neurofisiológica de pacientes submetidos a tratamento para correção de escoliose idiopática com instrumentação cirúrgica, utilizando parafusos pediculares torácicos e lombares. MÉTODOS: foram estudados, retrospectivamente, 32 prontuários de pacientes operados no Serviço de Cirurgia da Coluna Vertebral do Instituto da Coluna,Jundiaí, São Paulo, entre os anos de 2004 e 2008. A idade variou de 11 a 18 anos, e a maioria era do sexo feminino (93,75%). RESULTADOS: verificou-se que em seis pacientes houve relação entre a incidência de positividade no teste com estimulação eletromiográfica dos instrumentais e mau posicionamento dos parafusos pediculares, sem evidências de complicações após correção dos mesmos. CONCLUSÃO: os resultados confirmam a eficácia da monitoração intraoperatória

STANDARDIZED TERMINOLOGY OF ADULT SPINE DEFORMITY FOR BRAZILIAN PORTUGUESE

Objective : To develop a consensus for translation of the most relevant terms used in the study of Adult Spinal Deformity, from their original languages into Brazilian Portuguese. Methods : A panel of 12 experts in spine surgery from the five Brazilian regions was constituted. To obtain the standardization of terminology, the Delphi method with an electronic questionnaire was administered to participants about their opinion on the translation of 13 relevant terms chosen by literature review. Each term was considered standard when there was consensus, that is, concordance higher than 80% among participants as to the suggestion to be adopted, and then on the acceptance of the term and its abbreviation in Portuguese. Results : Initially there was consensus (over 80% concordance) on the translation of seven terms in the electronic questionnaire. The other six terms that have not reached consensus were discussed at a meeting among the participants, relying on the opinion of a specialized professional in simultaneous translation of orthopedic terms in Portuguese and other professional majored in Portuguese language. It was decided how these terms should be translated and there was a consensus among all participants regarding their acceptance. Finally, there was consensus among the participants, who agreed with the translation and abbreviation of the 13 propose terms, defining its standardization for Brazilian Portuguese. Conclusion : We present a standard terminology used in the study of Adult Spinal Deformity through consensus among experts, seeking uniformity in the use of these terms in Brazilian Portuguese

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

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