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 < 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

Analysis of the restoration of cardiology diagnostics scope in the Russian Federation during the COVID-19 pandemic: results of the Russian segment of the INCAPS COVID 2 study under the auspices of the International Atomic Energy Agency

Aim. To assess the changes in cardiology diagnostics scope in the Russian Federation during the coronavirus disease 2019 (COVID-19) pandemic.Material and methods. In an online survey organized by the Division of Human Health of the International Atomic Energy Agency (IAEA), including questions about changes in the workflow of diagnostic laboratories and the scope of cardiac diagnostics from March 2019 (pre-pandemic) to April 2020 (first wave of the pandemic) and April 2021 (recovery stage), 15 Russian medical centers from 5 cities took part.Results. The decrease in the diagnostics scope by April 2020 by 59,3% compared to March 2019, by April 2021, stopped and was replaced by growth (+7,1%, the recovery rate, 112,1%). The greatest increase was in routine examinations, such as echocardiography (+11,6%), stress echocardiography (+18,7%), stress single photon emission computed tomography (+9,7%), and to a lesser extent resting computed tomography angiography (+7,0%) and magnetic resonance imaging (+6,6%). The performance of stress electrocardiography, stress magnetic resonance imaging and positron emission tomography for the diagnosis of endocarditis in April 2021 compared to March 2019 decreased by 10,3%, 63,2% and 62,5%, respectively.Conclusion. Due to the resumption of patient admissions for cardiac examinations during the ongoing COVID-19 pandemic, with the anti-epidemic measures taken and certain changes in the workflow, there has been a recovery in the diagnostics scope in most of the included centers

Radiotherapy capacity in Europe – Authors' reply

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Распространенность и интенсивность кариеса у детей, проживающих в условиях дефицита фтора в питьевой воде

Метою дослідження стало вивчення поширеності та інтенсивності карієсу у 6-річних дітей м. їернополя, де вміст фтору в питній воді в міських свердловинах не перевищує 0,2 мг/л. Визначали індекси, що відображають інтенсивність карієсу тимчасових (кпз і кпп) і постійних зубів (КПВз і КПВп), стан гігієни порожнини рота за показниками Silness-Loe і Stallard. Виявляли дітей з найвищою інтенсивністю карієсу (НІК). Рівень кореляційного зв’язку між інтенсивністю карієсу і гігієнічним станом порожнини рота визначали за Вісник проблем біології і медицини -2014 Вип. 2, Том 3 (109) 329 СТОМАТОЛОГІЯ коефіцієнтом Пірсона. Встановлено, що середні показники інтенсивності карієсу (КПВ 6,57±0,36) є високими для цієї вікової групи. При цьому у хлопчиків інтенсивність карієсу була вища, ніж у дівчаток. Практично у усіх дітей були каріозні порожнини в перших постійних зубах, які, як відомо, прорізуються тільки в 6 років.The problem of tooth decay in children is in the area of special attention, as the prevalence and intensity of his remains high. Scientists believe that dental disease in early childhood significantly affect the quality of life of children. It is known that the main cause demineralization of teeth is a microbial factor. But when considering the mechanisms of tooth decay in children is noteworthy variety of different risk factors, including lack of salivation, poor oral hygiene, the adverse environmental and hygienic factors and others. Thus a significant place among the risk factors given the deficit of fluoride in drinking water. Research objective. It was studying of prevalence and intensity of caries at 6-year-old children of Ternopol. The content of fluorine in drinking water in city wells doesn’t exceed 0,2 mg/l. The rationale to study the condition of the teeth in the age group of 6 years was the fact that this age is the beginning of the formation of permanent occlusion. Deficient in fluoride in drinking water can lead to disruption of mineralization of teeth and, as a result of tooth decay in permanent teeth that erupt. Methods. It examined 178 children of 6 years age. Among them was selected representative group that accurately represents the composition of the study population, the number of 30 children (14 boys and 16 girls) for research in these basic indicators of the intensity decay. We determined the indexes that reflect the intensity of caries of deciduous teeth (bullpen and PPC) and permanent teeth (KPVz and KPVp), the state of oral health indicators by Silness-loe and Stallard. Become important and research to identify children with the highest intensity of caries (NICs). The level of correlation between the intensity of dental caries and oral hygiene as measured by the coefficient of Pearson. Results and discussion. The research results are presented in Table 1, showed that the prevalence of dental caries among 6-year-olds was 75 %. The intensity decay was studied separately in boys and girls, and deduced the average values for the entire group surveyed children. It was established that the average intensity of caries – 6,57 ± 0,36- are high for this age group. Thus the intensity of caries in boys was higher than girls. Drew attention to the fact that almost all the children were cavities in the first permanent teeth that have been known to erupt in only 6 years. Children with the highest intensity decay (NIK) accounted for nearly 37 % of their average intensity decay were very high – more than 10 boys and carious lesion in one ‘s permanent molars met much more frequently (more than 3 times) than girls. Based on these results, it was concluded that 6 -year-olds living in the area of hipoftoroz, high intensity lesions tooth caries. In 37 % of the highest values detected intensity decay. Conclusion. Accommodation of children in an area with low fluoride content in drinking water affects dental health, contributing to the development of caries process.Целью исследования явилось изучение распространенности и интенсивности кариеса у 6-летних детей г Тернополя, где содержание фтора в питьевой воде в городских скважинах не превышает 0,2 мг/л. Определяли индексы, отражающие интенсивность кариеса временных (кпз и кп п) и постоянных зубов (КПУз и КПУп), состояние гигиены полости рта по показателям Silness-Loe и Stallard. Выявляли детей с наивысшей интенсивностью кариеса (НИК). Уровень корреляционной связи между интенсивностью кариеса и гигиеническим состоянием полости рта определяли по коэффициенту Пирсона. Установлено, что средние показатели интенсивности кариеса 6,57±0,36 являются высокими для данной возрастной группы. При этом у мальчиков интенсивность кариеса была выше, нежели у девочек. Практически у всех детей имелись кариозные полости в первых постоянных зубах, которые, как известно, прорезываются только в 6 лет

Global Impact of COVID-19 on Nuclear Medicine Departments: An International Survey in April 2020.

The coronavirus disease 2019 (COVID-19) pandemic has placed significant challenges on health-care systems worldwide, whether in the preparation, response, or recovery phase of the pandemic. This has been primarily managed by dramatically reducing in- and outpatient services for other diseases and implementing infection prevention and control measures. The impact of the pandemic on nuclear medicine departments and their services has not yet been established. The aim of this online survey was to evaluate the impact of COVID-19 on nuclear medicine departments. Methods: A web-based questionnaire, made available from April 16 to May 3, 2020, was designed to determine the impact of the pandemic on in- and outpatient nuclear medicine departments, including the number of procedures, employee health, availability of radiotracers and other essential supplies, and availability of personal protective equipment. The survey also inquired about operational aspects and types of facilities as well as other challenges. Results: A total of 434 responses from 72 countries were registered and analyzed. Respondents reported an average decline of 54% in diagnostic procedures. PET/CT scans decreased by an average of 36%, whereas sentinel lymph-node procedures decreased by 45%, lung scans by 56%, bone scans by 60%, myocardial studies by 66%, and thyroid studies by 67%. Of all participating centers, 81% performed radionuclide therapies, and they reported a reduction of 45% on average in the last 4 wk, ranging from over 76% in Latin America and South East Asia to 16% in South Korea and Singapore. Survey results showed that 52% of participating sites limited their 99mTc/99Mo generator purchases, and 12% of them temporarily cancelled orders. Insufficient supplies of essential materials (radioisotopes, generators, and kits) were reported, especially for 99mTc/99Mo generators and 131I, particularly in Africa, Asia, and Latin America. Conclusion: Both diagnostic and therapeutic nuclear medicine procedures declined precipitously, with countries worldwide being affected by the pandemic to a similar degree. Countries that were in the postpeak phase of the pandemic when they responded to the survey, such as South Korea and Singapore, reported a less pronounced impact on nuclear medicine services; however, the overall results of the survey showed that nuclear medicine services worldwide had been significantly impacted. In relation to staff health, 15% of respondents experienced COVID-19 infections within their own departments

Impact of COVID-19 on the imaging diagnosis of cardiac disease in Europe

OBJECTIVES We aimed to explore the impact of the COVID-19 pandemic on cardiac diagnostic testing and practice and to assess its impact in different regions in Europe. METHODS The online survey organised by the International Atomic Energy Agency Division of Human Health collected information on changes in cardiac imaging procedural volumes between March 2019 and March/April 2020. Data were collected from 909 centres in 108 countries. RESULTS Centres in Northern and Southern Europe were more likely to cancel all outpatient activities compared with Western and Eastern Europe. There was a greater reduction in total procedure volumes in Europe compared with the rest of the world in March 2020 (45% vs 41%, p=0.003), with a more marked reduction in Southern Europe (58%), but by April 2020 this was similar in Europe and the rest of the world (69% vs 63%, p=0.261). Regional variations were apparent between imaging modalities, but the largest reductions were in Southern Europe for nearly all modalities. In March 2020, location in Southern Europe was the only independent predictor of the reduction in procedure volume. However, in April 2020, lower gross domestic product and higher COVID-19 deaths were the only independent predictors. CONCLUSION The first wave of the COVID-19 pandemic had a significant impact on care of patients with cardiac disease, with substantial regional variations in Europe. This has potential long-term implications for patients and plans are required to enable the diagnosis of non-COVID-19 conditions during the ongoing pandemic

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 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

Correction (Journal of the American College of Cardiology (2021) 77(2) (173–185), (S0735109720378694), (10.1016/j.jacc.2020.10.054)

Einstein AJ, Shaw LJ, Hirschfeld C, Williams MC, Villines TC, Better N, Vitola JV, Cerci R, Dorbala S, Raggi P, Choi AD, Lu B, Sinitsyn V, Sergienko V, Kudo T, Nørgaard BL, Maurovich-Horvat P, Campisi R, Milan E, Louw L, Allam AH, Bhatia M, Malkovskiy E, Goebel B, Cohen Y, Randazzo M, Narula J, Pascual TNB, Pynda Y, Dondi M, Paez D, on behalf of the INCAPS COVID Investigators Group International Impact of COVID-19 on the Diagnosis of Heart Disease J Am Coll Cardiol 2021;77:173–85 The INCAPS COVID Investigators Group, listed in the appendix, was not coded properly when this article initially published. As a result, they were not indexed on PubMed. Their names have now been coded properly to facilitate inclusion in the PubMed indexing. The publisher apologizes for this error