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SPECT/CT Imaging Agent Helps Diagnose Difficult Cases of Infectious Endocarditis

By MedImaging International staff writers
Posted on 14 Aug 2012

When combined with conventional diagnostic tests, functional imaging procedures have been shown to reduce the rate of misdiagnosed instances of infectious endocarditis. According to new research, single photon emission computed tomography (SPECT)/computed tomography (CT) with ^99mTc-hexamethylpropleneamine oxime-labeled white blood cells (^99mTc-HMPAO-WBC) imaging can improve the diagnosis of infectious endocarditis in hard-to-diagnose instances.

Infectious endocarditis is an infection of the lining of the heart chambers and heart valves that is caused by fungi, bacteria, or other infectious substances. It affects two to four people per 100,000 each year, with 25%-50% of the cases occurring in patients older than 60 years. Mortality from infectious endocarditis remains high when this disorder is undiagnosed, and therefore, not sufficiently treated.

The diagnosis of infectious endocarditis is becoming increasingly more difficult in the past years because of a range of factors: the haphazard use of antimicrobial agents in some clinical environments, the increased number of individuals with predisposing or underlying conditions (such as the frail and elderly, immune-suppressed individuals), and the increasing number of interventional cardiovascular procedures and placement of valve prostheses, intravascular devices, and cardiac devices.

“SPECT/CT with ^99mTc-HMPAO-WBC is a nuclear medicine technique currently used for the management of patients with infection; its application in infectious endocarditis has been restricted to few reports,” said Paola A. Erba, MD, from the Regional Center of Nuclear Medicine, University of Pisa Medical School (Pisa, Italy), and lead author of the study. “With this work we aimed to open new perspective for the application of this technique.”

The study’s findings were published in the August 2012 issue of the Journal of Nuclear Medicine, single photon emission computed tomography (SPECT)/computed tomography (CT) with Researchers conducted ^99mTc-HMPAO-WBC SPECT/CT scans on 131 consecutive patients with suspected infectious endocarditis. Patients with permanent cardiac devices were excluded from the research as the devices might have introduced the infection. Findings from the scans were compared to diagnostic tests for standard infectious endocarditis--transthoracic or transesophageal echocardiography, blood cultures and the modified Duke Endocarditis Service criteria, which are recommended for classification.

Of the 131 patients, 97 were found to have uptake indicating infection. The ^99mTc-HMPAO-WBC SPECT/CT scan was true-positive in 46 of 51 patients and false-negative in five of 51 cases (90% sensitivity, 94% negative predictive value and 100% specificity and positive predictor value). In addition, septic embolism was detected in 41% of the patients.

“When the results of the ^99mTc-HMPAO-WBC SPECT/CT scan were associated with either positive echocardiography or a positive blood culture, no cases of infectious endocarditis went undiagnosed,” noted Dr. Erba. “This demonstrates the added value that ^99mTc-HMPAO-WBC SPECT/CT scans can provide to assist physicians in their diagnosis and treatment decisions.

Cardiologists and infectivologists dealing with infectious endocarditis should consider using ^99mTc-HMPAO-WBC when they are facing difficult situation.”

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64 (97.036361694336): select jos_twitters.link from jos_twitters where cat=10

65 (41.007995605469): select jos_facebook.link from jos_facebook where cat=10

66 (39.100646972656): select jos_google_plus.link from jos_google_plus where cat=10

67 (36.001205444336): select jos_linkedin.link from jos_linkedin where cat=10

68 (77.962875366211): SELECT fid FROM jos_deeppockets WHERE id=294742084 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294742084 AND published='1' LIMIT 1

69 (43.869018554688): 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=213 ORDER BY `ordering`

70 (272.03559875488): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742084 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (324.01084899902): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742084 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (61.988830566406): 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 (58.174133300781): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (25.98762512207): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (24.795532226562): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (576.97296142578): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742084 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (380.03921508789): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742084 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (258.9225769043): 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 (!!!!! 3650.9037017822): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (!!!!! 3984.9281311035): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (!!!!! 3901.0047912598): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (385.99967956543): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (!!!!! 7621.0498809814): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (450.13427734375): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (231.98127746582): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (275.85029602051): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (38.14697265625): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (355.95893859863): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (!!!!! 1221.1799621582): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (617.02728271484): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (42.200088500977): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (283.95652770996): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 4080.057144165): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

105 (215.05355834961): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

106 (!!!!! 10589.122772217): 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=294742084 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (209.80834960938): 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=294742084 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (!!!!! 5033.016204834): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

109 (!!!!! 1649.1413116455): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

110 (951.05171203613): 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=294742084 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (437.02125549316): 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=294742084 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (648.97537231445): 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 (499.01008605957): 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 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

115 (138.0443572998): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

116 (59.127807617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

117 (39.100646972656): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

118 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

119 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

120 (303.98368835449): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

121 (!!!!! 79728.126525879): 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

122 (114.91775512695): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

123 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

124 (509.02366638184): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742084 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742084 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (!!!!! 1379892.1108246): ( 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 (102.04315185547): ( 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 (70.095062255859): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

128 (51.021575927734): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

129 (64.13459777832): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

130 (42.915344238281): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

131 (43.153762817383): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

132 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

133 (477.07557678223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

134 (377.89344787598): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

135 (151.8726348877): SELECT name FROM jos_deeppockets WHERE id=213

136 (40.054321289062): SELECT name FROM jos_deeppockets WHERE id=213

137 (536.91864013672): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

138 (586.03286743164): 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 '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

139 (83.92333984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

140 (73.909759521484): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

141 (!!!!! 8911.8480682373): TRUNCATE TABLE jos_trademed_module

142 (!!!!! 4345.8938598633): 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=294742084 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

143 (200.03318786621): 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=294742084 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

144 (422.00088500977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

145 (!!!!! 5898.9524841309): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

146 (303.03001403809): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

147 (56.028366088867): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

148 (!!!!! 4607.9158782959): 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

149 (855.92269897461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

150 (!!!!! 2990.0074005127): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

151 (!!!!! 1794.0998077393): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294742084 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294742084 AND type='deeppockets_item' AND published='1' LIMIT 1

152 (!!!!! 1024.9614715576): 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=213 or channel_id is null)

153 (571.01249694824): 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=213 or channel_id is null)

154 (!!!!! 3598.9284515381): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

155 (260.1146697998): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

156 (!!!!! 7145.1663970947): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294742084 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294742084 AND published='1' LIMIT 1

157 (473.0224609375): select jos_twitters.link from jos_twitters where cat=10

158 (279.90341186523): select jos_facebook.link from jos_facebook where cat=10

159 (83.92333984375): select jos_google_plus.link from jos_google_plus where cat=10

160 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

161 (366.9261932373): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

162 (!!!!! 1074.0756988525): insert into jos_banners_delta values (14615,'2025-06-20 17:21:11','216.73.216.120','view'),(14202,'2025-06-20 17:21:11','216.73.216.120','view'),(14203,'2025-06-20 17:21:11','216.73.216.120','view')

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