Impact of COVID-19 pandemic healthcare restrictions on utilisation and diagnostic yield of outpatient transthoracic echocardiograms

BACKGROUND

During the COVID-19 pandemic, Kentucky prohibited elective medical procedures from 3/18/2020-4/27/2020. We sought to determine if cessation of elective procedures in Kentucky during the COVID-19 pandemic resulted in a decrease in the proportion of rarely appropriate outpatient transthoracic echocardiograms interpreted at the open echocardiography lab at Norton Children's Hospital.

METHODS

A retrospective chart review was conducted comparing proportions of rarely appropriate outpatient paediatric transthoracic echocardiograms performed pre-COVID (3/21/2019-4/28/2019) and during COVID (3/19/2020-4/27/2020). Transthoracic echocardiogram indication was determined by chart review and echocardiogram reports. Indication appropriateness was evaluated using paediatric appropriate use criteria for initial outpatient transthoracic echocardiogram or CHD follow-up as applicable.

RESULTS

Of transthoracic echocardiograms pre-COVID, 100 (37.7%) were rarely appropriate versus 18 (20.2%) during COVID. Pre-COVID, paediatric cardiologists tended to order fewer rarely appropriate transthoracic echocardiograms than paediatricians (35.9% versus 46.4%), although this difference was not statistically significant. Cardiologists ordered the majority of outpatient transthoracic echocardiograms during COVID (77/89, 86.5%), limiting the ability to compare transthoracic echocardiogram indications by provider type. There was no significant difference in diagnostic yield of initial outpatient transthoracic echocardiograms with (13.0%) abnormal studies pre-COVID versus 7 (15.5%) during COVID.

CONCLUSION

While elective procedures were prohibited in Kentucky during the COVID-19 pandemic, a decrease in the proportion of rarely appropriate outpatient paediatric transthoracic echocardiograms was observed. There was no significant difference in diagnostic yield of initial outpatient transthoracic echocardiograms between time periods, suggesting that clinically significant echocardiogram findings were still detected despite more prudent utilisation of echocardiography during this time.

Recurrent Antibiotic Use in Kentucky Children With 6 Years of Continuous Medicaid Enrollment

BACKGROUND

Little is known about the distribution of antibiotic use in individual children over time. The amoxicillin index is a recently proposed metric to assess first-line antibiotic prescribing to children.

METHODS

We constructed a cohort of continuously enrolled Medicaid children using enrollment claims from 2012 to 2017. Pharmacy claims were used to identify antibiotic prescription data.

RESULTS

Among 169 724 children with 6 years of Medicaid enrollment, 10 804 (6.4%) had no antibiotic prescription claims during the study period; 43 473 (25.6%) had 1-3 antibiotics; 34 318 (20.2%) had 4-6 antibiotics; 30 994 (18.3%) had 7-10; 35 018 (20.6%) had 11-20; and 15 117 (8.9%) children had more than 20 antibiotic prescriptions. Overall, the population had a median total of 6 antibiotic prescriptions during the study period, but use was higher in certain patient groups: younger age (8 antibiotic fills over the 6-year period, [IQR 4-14]), White children (7 [IQR 3-13], compared to 3 [IQR 1-6] in Black children), rural settings (9 [IQR 4-15]) and chronic conditions (8 [IQR 4-15]). Higher-use groups also had lower rates of amoxicillin fills, reported as amoxicillin indices.

CONCLUSIONS

Antibiotic use is common among most children insured by Kentucky Medicaid. A number of fills over time were higher in younger children, and in White children, children living in rural settings and children with chronic conditions. Patients with higher recurrent antibiotic use are important targets for designing high-impact antibiotic stewardship efforts.

Junctures to the therapeutic goal of diabetes mellitus: Experience in a tertiary care hospital of Kolkata

Introduction:

The World Health Organization has declared India as the “diabetic capital” of the world. In controlling of such chronic, mostly asymptomatic disease, patients’ role can’t be overemphasized.

Aims:

To assess the level of compliance to anti-diabetic therapies and to ascertain the determinants of non-compliance, if any.

Materials and Methods:

A cross-sectional observational study was conducted for 3 months in a diabetic clinic of R G Kar Medical College and Hospital, Kolkata. Data were collected by interviewing the patients, examining their prescriptions and laboratory reports and anthropometry after obtaining informed consent.

Results:

Blood report at the point of data collection revealed controlled glucose homeostasis in 38.93% patients but evaluation of past 3 months report showed only 24.3% had control over hyperglycemia. Glycemic control was seen to be positively related to short duration of disease, compliance to therapies, and high knowledge about diabetes. Compliance to therapies found in 32.22% of study subjects was in turn associated with short duration of disease. House-wives showed poor compliance; insulin treatment with or without oral-anti-diabetic agent showed better compliance. Knowledge of diabetes was significantly high among higher educated; poor among women, house-wives, and rural people.

Conclusion:

Patient-providers collaboration is to be developed through a patient-centered care model based on the mutual responsibility of both so that each patient is considered in the mesh of his/her other goals of life and helped to promote empowerment to take informed decision for behavioral change conducive to control the disease.

MRI in congenital duplication of urethra

Congenital urethral duplication is a rare anomaly, with less than 200 cases described in the literature. The investigations that are usually performed are micturating cystourethrography (MCU) and retrograde urethrography (RGU), which can diagnose the presence of duplication but cannot diagnose the precise relationship of the duplicated urethra with other pelvic structures. MRI, because of the excellent tissue contrast that it provides and its multiplanar ability, can demonstrate with precision, the size, shape and position of the two urethras. We describe below a case where MRI was able to show this exquisitely.

Conditional mutations in gamma-tubulin reveal its involvement in chromosome segregation and cytokinesis

gamma-Tubulin is a conserved essential protein required for assembly and function of the mitotic spindle in humans and yeast. For example, human gamma-tubulin can replace the gamma-tubulin gene in Schizosaccharomyces pombe. To understand the structural/functional domains of gamma-tubulin, we performed a systematic alanine-scanning mutagenesis of human gamma-tubulin (TUBG1) and studied phenotypes of each mutant allele in S. pombe. Our screen, both in the presence and absence of the endogenous S. pombe gamma-tubulin, resulted in 11 lethal mutations and 12 cold-sensitive mutations. Based on structural mapping onto a homology model of human gamma-tubulin generated by free energy minimization, all deleterious mutations are found in residues predicted to be located on the surface, some in positions to interact with alpha- and/or beta-tubulins in the microtubule lattice. As expected, one class of tubg1 mutations has either an abnormal assembly or loss of the mitotic spindle. Surprisingly, a subset of mutants with abnormal spindles does not arrest in M phase but proceeds through anaphase followed by abnormal cytokinesis. These studies reveal that in addition to its previously appreciated role in spindle microtubule nucleation, gamma-tubulin is involved in the coordination of postmetaphase events, anaphase, and cytokinesis.

Computed tomographic evaluation of pineal calcification

A prospective study to ascertain the incidence of normally calcified pineal gland, was carried out in 1000 consecutive patients from different parts of Uttar Pradesh (India), undergoing cranial computed tomography for reasons other than a pineal or parapineal pathology. A total of 167 (16.70%) patients were found to have calcified pineals. Of these 128 were males and 39 females. The incidence rose from 1.16 per cent in the first decade to 31.88 per cent above the age of 50 yr. The percentage incidence of normal pineal calcification was lower than that seen in the Western population. No significant difference was found between men and women in any age group. Although calcification appeared as early as the first decade, this percentage was significantly lower than in the higher age groups. Significantly higher incidence rates were seen in the second decade, third decade and sixth decade onwards.