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

Residual stress analysis in weldments

Residual stresses caused by welding may be of the order of the yield strength. This study aims at estimating these residual stresses through a blend of experimental and theoretical approaches. The factors which affect residual stress build up are many, so it is difficult to completely model thermal-elasto-plastic deformation due to welding. To simplify the analysis rotational symmetry in the case of pipes and plane strain assumption in the case of thick weldments are made. These assumptions need not be always true. In the present approach three-dimensional nature of the problem is preserved. It is validated using some standard test problems. The developed method is applied to some practical cases and the results are presented

Structural dynamic analysis of composite beams

In the treatment of the structural dynamic problem of composite materials, two alternate types of formulations, based on the elastic modulus and compliance quantities, exist in the literature. The definitions of the various rigidities are observed to differ in these two approaches. Following these two types of formulation, the structural dynamic characteristics of a composite beam are analyzed. The results of the analysis are compared with those available in the literature. Based on the comparison, the influence of the warping function in defining the coupling terms in the modulus approach and also on the natural frequencies of the beam has been identified. It is found from the analysis that, in certain cases, the difference between the results of the two approaches is appreciable. These differences may be attributed to the constraints imposed on the deformation and flexibility of the beam by the choice of the description of the warping behaviour. Finally, the influence of material properties on the structural dynamic characteristics of the beam is studied for different composites for various angles of orthotropy

Spindle cell carcinoma of the gingiva: A rare occurrence

Of the many neoplasms known, squamous cell carcinoma (SCC) is the most common to affect the oral cavity. Spindle cell carcinoma (SpCC) is considered a rare high malignant variant of SCC occurring predominantly in the upper aerodigestive tract. Soft-tissue spindle cell neoplasms are quite uncommon in the oral cavity reportedly accounting for lesser than 1% of all tumors in the oral region. Our case shows an unusual presentation of SpCC involving the mandibular gingiva in a 46-year-old smoker patient, which presented as a firm, erythematous swelling with surface necrosis. An incisional biopsy was performed for microscopic evaluation to confirm the clinical diagnosis and for treatment planning

Management of a rare case of peripheral squamous odontogenic tumor of the gingiva

Odontogenic tumors (OTs) arising from the periodontium are quite rare. Squamous OT (SOT) is one such neoplasm which has an exceedingly rare occurrence. According to the literature, there have been very few reported cases of SOT with a very small percentage involving the gingiva. Most of the times, these tumors are located within the bone, only a very few peripheral cases been noted so far. Although predominantly benign, the possibility of a malignant transformation prevails. Our case describes a rare presentation of a peripheral SOT involving the upper anterior gingiva in a 59-year-old patient, which presented clinically as a firm and fibrotic swelling. An excisional biopsy was performed as a part of surgical management and for microscopic evaluation to confirm the clinical diagnosis. A soft tissue graft was harvested from an edentulous area to cover the deficit at the surgical site. The patient was evaluated at periodic intervals to assess the healing outcome and for any recurrence of the lesion

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