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

Positive association between fractional anisotropy and memory deficits in mild acute traumatic brain injury patients

Faculty Advisor: Uzma SamadaniThis research was supported by the Undergraduate Research Opportunities Program (UROP)

Retinal structural-vascular-functional relationship using optical coherence tomography and optical coherence tomography – angiography in myopia

Abstract Background To examine the retinal structure–vascular-function relationship using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in myopia. Methods This was a prospective cross-sectional study comprising 86 eyes of 45 individuals with varying axial lengths and spherical equivalents and no posterior segment abnormalities. All eyes underwent optical coherence tomography with the Spectralis SD-OCT and OCTA with RTVue-XR Avanti; Optovue. Individual macular retinal layer thicknesses and flow areas and vessel densities were measured on OCT and OCTA, respectively. Linear correlations were made between the macular layer thicknesses, flow areas and vessel densities with axial length, spherical equivalent and visual acuity. Results The participants’ mean ages were 33.34 ± 14.45 years, mean spherical equivalent refractions were − 7.17 ± 5.71 D and axial lengths were 25.95 ± 2.41 mm. There were significant positive correlations of foveal angle (r = 0.757, p = 0.001), inner retinal (r = 0.764, p = 0.001) and outer plexiform layer (r = 0.771, p = 0.001) thickness on OCT and vessel densities in deep capillary plexus (r = 0.313, p = 0.003) on OCTA with axial length and negative correlations with spherical equivalents and visual acuity. Significant negative correlations of outer nuclear layer (r = − 0.560, p = 0.03) and photoreceptor outer segment layer thickness (r = − 0.856, p < 0.001) were noted on OCT with axial length and positive correlations with spherical equivalents and visual acuity. Conclusion The lateral retinal stretching in myopia could possibly explain the correlation between retinal layer thickness, vascular density and visual acuity in these eyes. Further research is required to investigate this

Recommendations for initial diabetic retinopathy screening of diabetic patients using large language model-based artificial intelligence in real-life case scenarios

Abstract Purpose To study the role of artificial intelligence (AI) to identify key risk factors for diabetic retinopathy (DR) screening and develop recommendations based on clinician and large language model (LLM) based AI platform opinions for newly detected diabetes mellitus (DM) cases. Methods Five clinicians and three AI applications were given 20 AI-generated hypothetical case scenarios to assess DR screening timing. We calculated inter-rater agreements between clinicians, AI-platforms, and the “majority clinician response” (defined as the maximum number of identical responses provided by the clinicians) and “majority AI-platform” (defined as the maximum number of identical responses among the 3 distinct AI). Scoring was used to identify risk factors of different severity. Three, two, and one points were given to risk factors requiring screening immediately, within a year, and within five years, respectively. After calculating a cumulative screening score, categories were assigned. Results Clinicians, AI platforms, and the “majority clinician response” and “majority AI response” had fair inter-rater reliability (k value: 0.21–0.40). Uncontrolled DM and systemic co-morbidities required immediate screening, while family history of DM and a co-existing pregnancy required screening within a year. The absence of these risk factors required screening within 5 years of DM diagnosis. Screening scores in this study were between 0 and 10. Cases with screening scores of 0–2 needed screening within 5 years, 3–5 within 1 year, and 6–12 immediately. Conclusion Based on the findings of this study, AI could play a critical role in DR screening of newly diagnosed DM patients by developing a novel DR screening score. Future studies would be required to validate the DR screening score before it could be used as a reference in real-life clinical situations. Clinical trial registration Not applicable

Genetic significance of muscle segment homeo box1 gene in South Indian population for cleft lip and palate

Background: Oral clefts having a prehistoric existence and the latest scientific technologies have shown new insights in identifying the cause and management. So this is a DNA/gene based study has been presented in this article which comprises the significance of MSX1 gene in cleft samples of major states of South India. Aims: To evaluate the significance of MSX1 gene in South Indian population having cleft lip and palate. Settings and Design: Four states of native population were set for the study. From each state renowned cleft operating center was selected with the prior ethical and suitable permission and patient consent was taken. Blood samples were collected from each effected sibling were studied and their details were coded. The collected blood samples were used for DNA isolation, PCR amplification and sequencing. Materials and Methods: Eighty patients with non-syndromic CL/CLP/CP from various cleft operating centers in southern states (Karnataka, Tamilnadu, Kerala and Andhra Pradesh) with different ethnic/cultural background were taken. Twenty samples (families) were collected from each state and sequenced and compared with earlier data. Results: Analysis of this study indicates that mutation of either G273A/C or C102G seems to cause cleft formation. In this analysis, we found a novel mutation (414G to T) which is submitted to NCBI Gene data bank (EF065625). Conclusion: This study supports MSX1 gene leading to cleft lip and palate in the samples studied