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

Caracterización volumétrica del glioblastoma multiforme y correlación con el Tensor de Difusión mediante imágenes de Resonancia Magnética.

Tesis de Maestría en Ciencias con Especialidad en Física Médica. El objetivo de este trabajo de investigación consistió en relacionar las características volumétricas cerebrales asociadas al glioblastoma multiforme y el tensor de difusión con los grupos de severidad tumoral mediante los modelos de red neuronal y análisis discriminante.l Glioblastoma multiforme (GBM) es el tipo más común de tumor cerebral maligno y representa del 40-50% de todas las neoplasias cerebrales primarias en adultos [1]. En México poco se sabe sobre la epidemiología de los tumores del Sistema Nervioso Central. El diagnóstico por imágenes se realiza mediante la tomografía axial computarizada o la resonancia magnética, que permiten conocer la localización y el tamaño del tumor. Sin embargo la resonancia magnética se encuentra subutilizada. Existen varias métricas asociadas al tensor de difusión y volúmenes de los componentes quístico y necrótico tumorales (susceptibles de obtenerse mediante resonancia magnética) que pudieran servir para conocer la severidad del Glioblastoma Multiforme y facilitar la toma temprana de decisiones en cuanto a la planificación del tratamiento. El objetivo de este trabajo fue relacionar las características volumétricas cerebrales asociadas al GBM y el tensor de difusión con los grupos de severidad tumoral mediante los modelos de red neuronal y análisis discriminante. Se realizó un estudio retrospectivo de 36 pacientes enfermos de GBM con comprobación histopatológica. Se evaluaron imágenes de Resonancia Magnética potenciadas a T1, pre y post contraste (gadolinio), T2 y FLAIR para obtener los siguientes volúmenes: CFS, Gray Matter, White Matter, Necrotic, Non Enhancing, Enhancing y Edema. También se tomaron en consideración las imágenes con DTI para la obtención de métricas asociadas al tensor de difusión (DT): MD, FA, RA, RD, AD, Cs, p, q, L, Cl, Cp y Ca. Además se realizó una clasificación de los pacientes en relación a la severidad del GBM en base a su capacidad invasiva y probable zona anatómica de origen. Con esto se obtuvo un total de 50 variables. Posteriormente, se elaboró un modelo de Red Neuronal Artificial que permite pronosticar la severidad del tumor a partir de los volúmenes cerebrales y las métricas provenientes del DT. Para poder interpretar de forma más clara la interrelación de las variables, se realizó un Análisis Discriminante con las 25 de mayor importancia en la Red Neuronal Artificial. De esta forma quedaron 2 variables, la Cs del Edema y la FA de la Necrosis. Posteriormente se compararon los modelos de Red Neuronal Artificial y Análisis Discriminante en términos de sensibilidad especificidad, valor predictivo positivo, valor predictivo negativo, razón de verosimilitud positiva, razón de verosimilitud negativa, curvas ROC y medidas de las AUROC. Cómo resultados se tiene en primer lugar, la creación de modelos clasificatorios eficaces, siendo el Análisis Discriminante casi tan bueno como la Red Neuronal Artificial en términos de eficiencia diagnóstica, pero de más fácil interpretación. En segundo lugar, la Fracción de Anisotropía de la Necrosis juega un papel importante en ambos modelos, lo cual puede ser un indicador de queConsejo Mexiquense de Ciencia y Tecnología Instituto Nacional de Neurología y Neurocirugía (INNN

Caracterización volumétrica del glioblastoma multiforme y correlación con el Tensor de Difusión mediante imágenes de Resonancia Magnética

Tesis de Maestría en especialidad en física médicaEl Glioblastoma multiforme (GBM) es el tipo más común de tumor cerebral maligno yrepresenta del 40-50% de todas las neoplasias cerebrales primarias en adultos [1]. En México poco se sabe sobre la epidemiología de los tumores del Sistema Nervioso Central. El diagnóstico por imágenes se realiza mediante la tomografía axial computarizada o la resonancia magnética, que permiten conocer la localización y el tamaño del tumor. Sin embargo la resonancia magnética se encuentra subutilizada. Existen varias métricas asociadas al tensor de difusión y volúmenes de los componentes quístico y necrótico tumorales (susceptibles de obtenerse mediante resonancia magnética) que pudieran servir para conocer la severidad del Glioblastoma Multiforme y facilitar la toma temprana de decisiones en cuanto a la planificación del tratamiento. El objetivo de este trabajo fue relacionar las características volumétricas cerebrales asociadas al GBM y el tensor de difusión con los grupos de severidad tumoral mediante los modelos de red neuronal y análisis discriminante. Se realizó un estudio retrospectivo de 36 pacientes enfermos de GBM con comprobación histopatológica. Se evaluaron imágenes de Resonancia Magnética potenciadas a T1, pre y post contraste (gadolinio), T2 y FLAIR para obtener los siguientes volúmenes: CFS, Gray Matter, White Matter, Necrotic, Non Enhancing, Enhancing y Edema. También se tomaron en consideración las imágenes con DTI para la obtención de métricas asociadas al tensor de difusión (DT): MD, FA, RA, RD, AD, Cs, p, q, L, Cl, Cp y Ca. Además se realizó una clasificación de los pacientes en relación a la severidad del GBM en base a su capacidad invasiva y probable zona anatómica de origen. Con esto se obtuvo un total de 50 variables. Posteriormente, se elaboró un modelo de Red Neuronal Artificial que permite pronosticar la severidad del tumor a partir de los volúmenes cerebrales y las métricas provenientes del DT. Para poder interpretar de forma más clara la interrelación de las variables, se realizó un Análisis Discriminante con las 25 de mayor importancia en la Red Neuronal Artificial. De esta forma quedaron 2 variables, la Cs del Edema y la FA de la Necrosis. Posteriormente se compararon los modelos de Red Neuronal Artificial y Análisis Discriminante en términos de sensibilidad especificidad, valor predictivo positivo, valor predictivo negativo, razón de verosimilitud positiva, razón de verosimilitud negativa, curvas ROC y medidas de las AUROC. Cómo resultados se tiene en primer lugar, la creación de modelos clasificatorios eficaces, siendo el Análisis Discriminante casi tan bueno como la Red Neuronal Artificial en términos de eficiencia diagnóstica, pero de más fácil interpretación. En segundo lugar, la Fracción de Anisotropía de la Necrosis juega un papel importante en ambos modelos, lo cual puede ser un indicador de que el grado de severidad tumoral esté asociado a un proceso de necrosis infiltrante.Consejo Mexiquense de Ciencia y Tecnología Instituto Nacional de Neurología y Neurocirugía (INNN

Entrapment Efficiency (EE) and Release Mechanism of Rhodamine B Encapsulated in a Mixture of Chia Seed Mucilage and Sodium Alginate

Chia seed mucilage is a polysaccharide capable of forming hydrogels with excellent water-binding capacity due to its physical and chemical properties and favorable characteristics for encapsulating and protecting valuable hydrophilic molecules in the food, pharmaceutical, and cosmetic industries. This research aimed to show that mixtures of chia seed mucilage and sodium alginate used as wall materials to encapsulate hydrophilic molecules are suitable. We analyzed the relationship between the mucilage–alginate solution’s properties and the capsules obtained; we quantified the entrapment efficiency (EE%) and the release of rhodamine B; and we proposed a method to follow the rhodamine B release using confocal laser scanning microscopy (CLSM). We found that more viscous solutions are obtained when the mucilage concentration increases, making it difficult to produce capsules with less sphericity. The best entrapment efficiency was found when the proportion of the polymers was close to 1:1, based both on the properties of the capsules obtained and on the characterization of the release kinetics of rhodamine B; the analysis performed by fitting rhodamine B release data to theoretical models describe the diffusion process. Our results show that the use of chia seed mucilage as a wall material to trap and retain hydrophilic molecules is convenient

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

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