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MRI Screening May Help Identify Spinal Infections from Contaminated Drug Injections

By MedImaging International staff writers
Posted on 15 Jul 2013

Magnetic resonance imaging (MRI) at the site of injection of a contaminated lot of a steroid drug to treat symptoms such as back pain resulted in earlier identification of patients with probable or validated fungal spinal or paraspinal infection, allowing early start of medical and surgical treatment, according to recent findings.

The study results were published in the June 19, 2013, issue of the Journal of the American Medical Association (JAMA). “Fungal contamination of methylprednisolone prepared by a compounding pharmacy resulted in an unprecedented multistate outbreak of meningitis in the fall of 2012,” according to the authors. “Initially, these injections were complicated by meningitis. Within six weeks of the outbreak, meningitis became less frequent and localized spinal and paraspinal infections became the principal manifestations of contaminated steroid injections. In contrast to the relatively brief period in which meningitis cases appeared, a steady stream of spinal and paraspinal infections continue to present long after the injections were administered. Because patients received these injections to treat back pain or neuropathic symptoms, the presentation of a slowly developing spinal or paraspinal infection has been obscured.”

Anurag N. Malani, MD, from St. Joseph Mercy Hospital (Ann Arbor, MI, USA), and coworkers conducted a study to determine if patients who had not presented for medical care but who had received contaminated methylprednisolone developed spinal or paraspinal infection at the injection site detected using contrast-enhanced MRI screening. There were 172 patients who had received an injection of methylprednisolone from a highly contaminated lot at a pain facility but had not presented for medical care related to adverse effects after the injection. Screening MRI was performed between November 2012 and April 2013.

Of the 172 patients screened, 36 (21%) had an abnormality in their MRI scan. Thirty-five of the 36 patients with abnormal MRI scan met the US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) case definition for probable (17 patients) or confirmed (18 patients) fungal spinal or paraspinal infection. All 35 patients were treated with antifungal agents; 24 required surgical intervention. “At the time of surgery, 17 of 24 patients (71%), including 5 patients who denied having symptoms, had laboratory evidence of fungal infection,” the authors reported.

Data were obtained from 115 patients regarding the presence of new or worsening back or neck pain, radiculopathy, or lower-extremity weakness, 35 of the 115 patients (30%) had at least one of these symptoms.

“Our findings support obtaining contrast-enhanced MRI of the injection site in patients with persistent back pain even when their pain disorder has not worsened,” the researchers wrote in their article. “A proactive outreach to patients receiving injections from a highly contaminated lot, especially lot No. 06292012@26, is needed. Magnetic resonance imaging may detect infection earlier in some patients, leading to more efficacious medical and surgical treatment and improved outcomes,” the researchers concluded.

“Malani et al have demonstrated the possibility of largely asymptomatic fungal infection among patients previously exposed to injection with contaminated lots of methylprednisolone,” wrote George R. Thompson III, MD, of the University of California, Davis (USA), and colleagues wrote in an accompanying editorial. “These findings suggest MRI of the injection site may be an effective screening procedure in some patients but should not be widely adopted, particularly for patients who received peripheral joint injections, given the much lower attack rate. For patients who received spinal injections with steroids from an unknown lot number, MRI-based screening may be appropriate. Whether patients with normal initial MRI findings receive reimaging at a later date remains a difficult question in this evolving outbreak.”

Related Links:
St. Joseph Mercy Hospital
University of California, Davis

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59 (134.94491577148): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

60 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

61 (132.08389282227): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

62 (650.16746520996): SELECT fid FROM jos_deeppockets WHERE id=294747231 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294747231 AND published='1' LIMIT 1

63 (49.114227294922): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

64 (54.121017456055): select jos_twitters.link from jos_twitters where cat=10

65 (42.200088500977): select jos_facebook.link from jos_facebook where cat=10

66 (48.87580871582): select jos_google_plus.link from jos_google_plus where cat=10

67 (42.915344238281): select jos_linkedin.link from jos_linkedin where cat=10

68 (36.001205444336): SELECT fid FROM jos_deeppockets WHERE id=294747231 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294747231 AND published='1' LIMIT 1

69 (48.160552978516): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=212 ORDER BY `ordering`

70 (428.91502380371): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747231 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (284.91020202637): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747231 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (56.982040405273): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (73.19450378418): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (156.87942504883): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (37.908554077148): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (72.002410888672): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747231 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (37.908554077148): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747231 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (42.915344238281): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (82.969665527344): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (43.869018554688): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (104.90417480469): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (44.107437133789): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (40.054321289062): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (42.915344238281): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (87.02278137207): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

105 (59.843063354492): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

106 (77.009201049805): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294747231 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (70.095062255859): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294747231 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

109 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

110 (67.949295043945): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294747231 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (580.78765869141): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294747231 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (778.9134979248): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (456.09474182129): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (179.05235290527): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

115 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

116 (63.896179199219): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

117 (42.200088500977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

118 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

119 (36.954879760742): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

120 (61.03515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

121 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

122 (355.95893859863): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 21454.811096191): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (515.93780517578): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747231 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747231 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 8308.1722259521): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (79.870223999023): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (46.014785766602): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (30.040740966797): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (28.848648071289): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (416.99409484863): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (70.810317993164): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (44.822692871094): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (32.186508178711): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (491.85752868652): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (489.95018005371): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (229.1202545166): SELECT name FROM jos_deeppockets WHERE id=212

138 (310.89782714844): SELECT name FROM jos_deeppockets WHERE id=212

139 (741.95861816406): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (541.92543029785): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))212((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (935.07766723633): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

142 (101.08947753906): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

143 (!!!!! 30264.139175415): TRUNCATE TABLE jos_trademed_module

144 (265.12145996094): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294747231 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (!!!!! 2377.0332336426): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294747231 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (396.0132598877): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (178.09867858887): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (74.863433837891): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

149 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

150 (!!!!! 1389.9803161621): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (77.009201049805): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

152 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

153 (45.061111450195): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294747231 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294747231 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (566.95938110352): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

155 (80.108642578125): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=212 or channel_id is null)

156 (41.961669921875): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (!!!!! 3434.1812133789): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

158 (130.17654418945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294747231 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294747231 AND published='1' LIMIT 1

159 (56.982040405273): select jos_twitters.link from jos_twitters where cat=10

160 (30.994415283203): select jos_facebook.link from jos_facebook where cat=10

161 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

162 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

163 (341.89224243164): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

164 (!!!!! 3957.0331573486): insert into jos_banners_delta values (14615,'2025-06-25 06:59:56','216.73.216.120','view'),(14202,'2025-06-25 06:59:56','216.73.216.120','view'),(14203,'2025-06-25 06:59:56','216.73.216.120','view')

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