Identification of high-risk imaging features in hypertrophic cardiomyopathy using electrocardiography: A deep-learning approach.

BACKGROUND: Patients with hypertrophic cardiomyopathy (HCM) are at risk of sudden death, and individuals with ≥1 major risk markers are considered for primary prevention implantable cardioverter-defibrillators. Guidelines recommend cardiac magnetic resonance (CMR) imaging to identify high-risk imaging features. However, CMR imaging is resource intensive and is not widely accessible worldwide. OBJECTIVE: The purpose of this study was to develop electrocardiogram (ECG) deep-learning (DL) models for the identification of patients with HCM and high-risk imaging features. METHODS: Patients with HCM evaluated at Tufts Medical Center (N = 1930; Boston, MA) were used to develop ECG-DL models for the prediction of high-risk imaging features: systolic dysfunction, massive hypertrophy (≥30 mm), apical aneurysm, and extensive late gadolinium enhancement. ECG-DL models were externally validated in a cohort of patients with HCM from the Amrita Hospital HCM Center (N = 233; Kochi, India). RESULTS: ECG-DL models reliably identified high-risk features (systolic dysfunction, massive hypertrophy, apical aneurysm, and extensive late gadolinium enhancement) during holdout testing (c-statistic 0.72, 0.83, 0.93, and 0.76) and external validation (c-statistic 0.71, 0.76, 0.91, and 0.68). A hypothetical screening strategy using echocardiography combined with ECG-DL-guided selective CMR use demonstrated a sensitivity of 97% for identifying patients with high-risk features while reducing the number of recommended CMRs by 61%. The negative predictive value with this screening strategy for the absence of high-risk features in patients without ECG-DL recommendation for CMR was 99.5%. CONCLUSION: In HCM, novel ECG-DL models reliably identified patients with high-risk imaging features while offering the potential to reduce CMR testing requirements in underresourced areas.

Bayés syndrome secondary to atrial lipoma.

This case describes a 74-year-old male who presented with rapid atrial flutter in association with large atrial lipoma along the interatrial septum. Conversion to sinus rhythm revealed the electrocardiographic criteria for advanced interatrial block. Interatrial block results from disruption of conduction through Bachmann's bundle, most commonly due to progressive atrial fibrosis. Bayés syndrome is recognized as the association of atrial arrhythmias with underlying interatrial block. This case supports the concept that localized disruption of atrial conduction via Bachmann's bundle from an atrial lipoma can produce the electrophysiologic substrate for atrial arrhythmias and the Bayés syndrome.

Effects of structured exercise regime on lipid profile and renal function tests in gestational diabetes mellitus patients:A pilot study.

NOTE OF CONCERN: Article published in Journal of Pakistan Medical Association J Pak Med Assoc.February 2021, No. 2-A,Volume 72 Pages 505-507. This editorial expression of concern serves to notify readers that the Editorial Board has identified discernible weaknesses in the study design, statistical concerns and conclusion drawn regarding this previously published article, titled: "Effects of structured exercise regime on lipid profile and renal function tests in gestational diabetes mellitus patients-A pilot study" J Pak Med Assoc. Vol. 71, No. 2-A, February 2021pages 505-507. The Editorial Board has determined that : 1. The article did not discuss the feasibility of the pilot study, instead attempted to draw inference from the analytical outcomes, which does not allow readers to interpret the desired implications correctly. 2. The statistical methods applied were not at par and did not use the baseline data. The authors did not make full use of the data to add to the scientific weightage of the study, which could have been reported in the text. 3. The conclusion only points towards the positive impacts on serum markers for diabetes mellitus and renal functions. Considering the very small sample size used, this is an unjustified extrapolation. The authors did not attempt to mention the feasibility of the whole process, including participants' willingness, management, and resources that should have been assessed and reported to benefit the planning of the full-scale RCT. The editorial board of JPMA decided to publish this editorial expression of concern when we were made aware of deficiencies in the published article so that future researchers can plan their work on better scientific footings OBJECTIVE: To determine the effects of structured exercise regime on biochemical markers of patients of gestational diabetes mellitus during the third trimester. METHODS: The two-arm pilot study was conducted at the Fauji Foundation Hospital, Rawalpindi, Pakistan, from March to July 2019, and comprised women aged 20-40 years with gestational age >20 weeks who were diagnosed with gestational diabetes mellitus and who were able to do 6min walk test under severity level on the 0-10 Borg scale. The subjects were randomized into two groups using the sealed envelope method. The intervention group received 5 weeks of structured exercise programme. including aerobics, stabilisation and pelvic floor muscle training, while the control group only received postural education. Data was noted at baseline and after intervention, and was analysed using SPSS 20. RESULTS: Of the 16 subjects, there were 8(50%) in each of the two groups. The mean age was 31.5±4.17 years in the interventional group and it was 35.0±6.30 years in the control group. Serum low-density lipoprotein and serum creatinine showed significant differences between the groups (p<0.05), while the rest of markers were non-significant (p>0.05). CONCLUSIONS: Structured exercise regime was found to have a positive effect in reducing serum low-density lipoprotein and serum creatinine levels in gestational diabetes mellitus during the third trimester.

Association of breastfeeding cessation with health-related quality of life in working multiparous women of Rawalpindi and Islamabad.

Breastfeeding rates in Pakistan are the lowest in South Asia. Multiparous working women in Rawalpindi-Islamabad often think if cessation of breastfeeding will affect their and their baby's health. A descriptive cross sectional survey was conducted on 200 multiparous working women to evaluate the association between cessation of breastfeeding and health-related quality of life in multiparous working women and to determine the common reasons of breastfeeding cessation. A modified SF-36 QOL questionnaire was used. The mothers who breastfed their babies for less than or up to six months reported their general health worse at the time of study than one year ago, which accounts for 34(68%) of the entire data, 42(21%) women ceased to breastfeed their babies due to less milk production and 31 (15.5%) women due to the nature of their job. Chi-Square test showed that there is a significant association (i.e. p-value < 0.001) between health-related quality of life and early breastfeeding cessation.

Giant cell arteritis: advances in diagnosis and management.

Giant cell arteritis has been widely studied throughout the world. Involvement of cranial vessels can lead to visual loss and strokes. This review primarily focusses on the presentation, diagnosis and treatment. The last 10 years have brought dramatic improvements in the imaging and medical therapies for this condition. After the American College of Rheumatology suggested criteria for the diagnosis of giant cell arteritis, many studies have been performed to find alternatives to a temporal artery biopsy. There is growing evidence that a biopsy may not be needed when one can make a convincing clinical and radiological diagnosis. Although glucocorticoids are the mainstay of treatment and their role has not changed, various biological and non-biological therapies are being used to reduce relapses and prolong remission of symptoms.

Gender Differences in Radiation Dose From Nuclear Cardiology Studies Across the World: Findings From the INCAPS Registry.

OBJECTIVES: The aim of this study was to investigate gender-based differences in nuclear cardiology practice globally, with a particular focus on laboratory volume, radiation dose, protocols, and best practices. BACKGROUND: It is unclear whether gender-based differences exist in radiation exposure for nuclear cardiology procedures. METHODS: In a large, multicenter, observational, cross-sectional study encompassing 7,911 patients in 65 countries, radiation effective dose was estimated for each examination. Patient-level best practices relating to radiation exposure were compared between genders. Analysis of covariance was used to determine any difference in radiation exposure according to gender, region, and the interaction between gender and region. Linear, logistic, and hierarchical regression models were developed to evaluate gender-based differences in radiation exposure and laboratory adherence to best practices. The study also included the United Nations Gender Inequality Index and Human Development Index as covariates in multivariable models. RESULTS: The proportion of myocardial perfusion imaging studies performed in women varied among countries; however, there was no significant correlation with the Gender Inequality Index. Globally, mean effective dose for nuclear cardiology procedures was only slightly lower in women (9.6 ± 4.5 mSv) than in men (10.3 ± 4.5 mSv; p < 0.001), with a difference of only 0.3 mSv in a multivariable model adjusting for patients' age and weight. Stress-only imaging was performed more frequently in women (12.5% vs. 8.4%; p < 0.001); however, camera-based dose reduction strategies were used less frequently in women (58.6% vs. 65.5%; p < 0.001). CONCLUSIONS: Despite significant worldwide variation in best practice use and radiation doses from nuclear cardiology procedures, only small differences were observed between genders worldwide. Regional variations noted in myocardial perfusion imaging use and radiation dose offer potential opportunities to address gender-related differences in delivery of nuclear cardiology care.