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

Alteration of AP-endonuclease1 expression in curcumin-treated fibrotic rats

Background. Apurinic/apyrimidinic endonuclease1/ redox factor-1 (APE1/Ref-1) is a multifunctional protein involved in DNA base excision repair and redox regulation of many transcription factors. It is an important pro-survival protein activated in response to oxidative stress. Increased level of this essential redox sensi¬tive protein correlates closely with cellular survival against oxidative insults. Curcumin (diferuloylmethane) a naturally occurring compound derived from turmeric has attracted interest because of its anti-inflamma¬tory, anti-oxidative, and chemopreventive activities.Material and methods. The current study evaluates the in vivo role of curcumin in protecting and treating liver injury and fibrogenesis caused by carbon tetrachloride (CCl4) in rats. It also addresses the possible involvement of the multifunctional protein APE1 in hepatoprotection. Analysis of APE1 expression was performed at mRNA and protein levels by reverse trans¬criptase (RT)-PCR and western blotting respectively. Profile of HSCs-activation related genes were assayed by RT-PCR and pro-inflammatory cytokines levels were determined by enzyme-linked immune assays.Results. Here we show that oral administration of curcumin was accompanied by a robust increase in APE1 protein and mRNA levels, and improved the histological architecture of rat liver. In addition, curcumin attenuated oxidative stress by increasing the content of hepatic glutathione within normal values, leading to the re¬duction in the level of lipid hydroperoxide. Curcumin remarkably suppressed inflammation by reducing le¬vels of inflammatory cytokines, including tumor necrosis factor-α (TNF-α), nuclear factor-kappa B (NF-kB) and interleukin-6 (IL-6). It also inhibited hepatic stellate cells (HSCs) activation by elevating the level of PPARγ and reducing the abundance of transforming growth factor-β (TGF-β). We found that oral adminis¬tration of curcumin at 200 mg/kg dose not only protected against CCl4-induced hepatic injury, but also re¬sulted in more than two-fold induction of APE1 protein expression in CCl4-induced rat group.Conclusions. It can be concluded that curcumin reduced markers of liver damage in rats treated with CCl4, with conco¬mitant elevation in APE1 protein level indicating a possible protective effect with unknown mechanism. The induction of DNA repair enzymes may be an important and novel strategy for hepatic protection against oxidative injury

Understanding Antibiotic Use in Minya District, Egypt: Physician and Pharmacist Prescribing and the Factors Influencing Their Practices

Overuse of antibiotics has contributed to the emergence of antibiotic-resistant bacteria globally. In Egypt, patients can purchase antibiotics without a prescription, and we hypothesized frequent inappropriate antibiotic prescribing and dispensing. We interviewed physicians (n = 236) and pharmacists (n = 483) and conducted focus groups in Minya, Egypt, to assess attitudes and practices regarding antibiotic prescribing for outpatient acute respiratory infections (ARI). Antibiotics were reportedly prescribed most of the time or sometimes for colds by 150 (64%) physicians and 326 (81%) pharmacists. The most commonly prescribed antibiotics were β-lactams. Macrolides were the second most commonly prescribed for colds and sinusitis. The prescription of more than one antibiotic to treat pneumonia was reported by 85% of physicians. Most respondents thought antibiotic overuse contributes to resistance and reported “patient self-medication” as the biggest driver of overuse. Fifty physicians (21%) reported that they had prescribed antibiotics unnecessarily, citing patient over-the-counter access as the reason. Physicians &lt;40 years of age and those who treat adults were more likely to prescribe antibiotics for colds. Overall, we found a high rate of unwarranted outpatient antibiotic prescribing and dispensing for ARIs. Patient access to OTC antibiotics contributes to over-prescribing. National guidelines for ARI treatment, provider education and national policy requiring a physician’s prescription for antibiotics may improve appropriate antibiotic use in Egypt

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ABSTRACT Context Pancreatic heterotopia is a rare pathologic entity, previously reported in the stomach, duodenum and jejunum. It is mostly asymptomatic and rarely gives rise to complications. Localization of pancreatic heterotopia in the gallbladder is extremely rare and can be associated with cholecystitis or cholecystolithiasis. Case report We herein describe a case of a 39-year-old man who presented with biliary type pain with ultrasonographic evidence of a gallbladder polyp. Laparoscopic cholecystectomy was performed with uneventful recovery. Pathologic examination of the gallbladder detected a heterotopic focus of pancreatic tissue in its wall, associated with chronic cholecystitis with no gallstones. Conclusion Pancreatic heterotopia of the gallbladder is a very rare entity with unknown clinical significance. Awareness of this condition may facilitate its recognition which may shed more light on its clinical significance

Pancreatic Heterotopia in the Gallbladder Associated with Chronic Cholecystitis: A Rare Combination

Context Pancreatic heterotopia is a rare pathologic entity, previously reported in the stomach, duodenum and jejunum. It is mostly asymptomatic and rarely gives rise to complications. Localization of pancreatic heterotopia in the gallbladder is extremely rare and can be associated with cholecystitis or cholecystolithiasis. Case report We herein describe a case of a 39-year-old man who presented with biliary type pain with ultrasonographic evidence of a gallbladder polyp. Laparoscopic cholecystectomy was performed with uneventful recovery. Pathologic examination of the gallbladder detected a heterotopic focus of pancreatic tissue in its wall, associated with chronic cholecystitis with no gallstones. Conclusion Pancreatic heterotopia of the gallbladder is a very rare entity with unknown clinical significance. Awareness of this condition may facilitate its recognition which may shed more light on its clinical significance.Image: Features of chronic cholecystitis and pancreatic heterotopic tissue

Evaluating the ability of some natural phenolic acids to target the main protease and AAK1 in SARS COV-2

Abstract Researchers are constantly searching for drugs to combat the coronavirus pandemic caused by SARS-CoV-2, which has lasted for over two years. Natural compounds such as phenolic acids are being tested against Mpro and AAK1, which are key players in the SARS-CoV-2 life cycle. This research work aims to study the ability of a panel of natural phenolic acids to inhibit the virus's multiplication directly through Mpro and indirectly by affecting the adaptor-associated protein kinase-1 (AAK1). Pharmacophore mapping, molecular docking, and dynamic studies were conducted over 50 ns and 100 ns on a panel of 39 natural phenolic acids. Rosmarinic acid (16) on the Mpro receptor (− 16.33 kcal/mol) and tannic acid (17) on the AAK1 receptor (− 17.15 kcal/mol) exhibited the best docking energy against both receptors. These favourable docking score values were found to be superior to those of the co-crystallized ligands. Preclinical and clinical research is required before using them simultaneously to halt the COVID-19 life cycle in a synergistic manner