Broadening Perspectives of Artificial Intelligence in Echocardiography.

Echocardiography frequently serves as the first-line treatment of diagnostic imaging for several pathological entities in cardiology. Artificial intelligence (AI) has been growing substantially in information technology and various commercial industries. Machine learning (ML), a branch of AI, has been shown to expand the capabilities and potential of echocardiography. ML algorithms expand the field of echocardiography by automated assessment of the ejection fraction and left ventricular function, integrating novel approaches such as speckle tracking or tissue Doppler echocardiography or vector flow mapping, improved phenotyping, distinguishing between cardiac conditions, and incorporating information from mobile health and genomics. In this review article, we assess the impact of AI and ML in echocardiography.

Echocardiography is the most common test in cardiovascular imaging and helps diagnose multiple different diseases. Machine learning, a branch of artificial intelligence (AI), will reduce the workload for medical professionals and help improve clinical workflows. It can rapidly calculate a lot of important cardiac parameters such as the ejection fraction or important metrics during different phases of the cardiac cycle. Machine learning algorithms can include new technology in echocardiography such as speckle tracking, tissue Doppler echocardiography, vector flow mapping, and other approaches in a user-friendly manner. Furthermore, it can help find new subtypes of existing diseases in cardiology. In this review article, we look at the current role of machine learning and AI in the field of echocardiography.

Lung Metastasis From Uterine Leiomyosarcoma: An Asymptomatic Presentation for a Rare Tumor.

Uterine leiomyosarcoma (ULC) is an uncommon neoplasm characterized by poor prognosis, it can predispose to distant metastasis, causing various symptomatic presentations. We present a unique case of a large heterogeneous mass in the lung cavity arising from a ULC, with complete absence of pulmonary symptoms and with concurrent coronavirus disease 2019 (COVID-19) infection. A high degree of clinical suspicion is required for ULC with accompanying metastasis.

Evolution of Stress Echocardiogram in the Era of CT Angiography.

The ideal diagnostic modality for acute chest pain is a highly debated topic in the cardiovascular community. With the rapid rise of coronary computed tomography angiography (CTA) and the fall of functional testing, stress echocardiography (SE) is at a delicate crossroads. Though there are many advantages of coronary CTA, it is not without its flaws. The exact realm of SE needs to be clearly defined, as well as which patients need diagnostic testing. The emergence of additional parameters will propel the evolution of modern SE. In this review article, we explore the role of SE, guidelines, comparison of SE versus CTA, and additional parameters in the coronary CTA era.

Tracheal Diverticulum Mimicking Pneumomediastinum: A Case Report Emphasizing the Importance of Differential Diagnosis in Chest Imaging Evaluation.

A tracheal diverticulum (TD) is a generally benign medical condition, where there is an outpouching of the tracheal wall. Additionally, it is generally asymptomatic but there have been reported cases of adverse outcomes linked to TD. Here we present a case of a tracheal diverticulum that was incidentally found during the workup for stroke in a patient. Moreover, due to its radiologic appearance, there was concern for pneumomediastinum. We highlight the presentation and clinical importance of TD owing to the complications one is predisposed to from having this condition.

Application of the RE-AIM framework to evaluate the implementation of telehealth pulmonary rehabilitation in a randomized controlled trial among African-American and Hispanic patients with advanced stage Chronic Obstructive Pulmonary Disease.

BACKGROUND: Pulmonary rehabilitation (PR) decreases rehospitalization for people with COPD. However, less than 2% receive PR, partly due to lack of referral and sparsity of PR facilities. This disparity is particularly pronounced in African American and Hispanic persons with COPD. Telehealth-provided PR could increase access and improve health outcomes. METHODS: We applied the RE-AIM framework in a post-hoc analysis of our mixed methods RCT comparing referral to Telehealth-delivered PR (TelePR) versus standard PR (SPR) for African American and Hispanic COPD patients hospitalized for COPD exacerbation. Both arms received a referral to PR for 8 weeks, social worker follow-up, and surveys administered at baseline, 8 weeks, 6, and 12 months. PR sessions were conducted twice a week for 90 min each (16 sessions total). Quantitative data were analyzed using 2-sample t tests or nonparametric Wilcoxon tests for continuous data and χ2/Fisher exact tests for categorical data. Logistic regression-estimated odds ratios (ORs) were used for the intention-to-treat primary outcome. Qualitative interviews were conducted at the end of the study to assess adherence and satisfaction and were analyzed using inductive and deductive methods. The goal was to understand Reach (whether the target population was able to be enrolled), Effectiveness (primary outcome was a composite of 6-month COPD rehospitalization and death), Adoption (proportion of people willing to initiate the program), Implementation (whether the program was able to be executed as intended, and Maintenance (whether the program was continued). RESULTS: Two hundred nine people enrolled out of a 276-recruitment goal. Only 85 completed at least one PR session 57/111 (51%) TelePR; 28/98 (28%) SPR. Referral to TelePR compared to SPR did not decrease the composite outcome of 6-month COPD-readmission rate/death (OR1.35;95%CI 0.69,2.66). There was significant reduction in fatigue (PROMIS® scale) from baseline to 8-weeks in TelePR compared to SPR (MD-1.34; ± SD4.22; p = 0.02). Participants who received TelePR experienced improvements from baseline in several outcomes (ie, before and after 8 weeks of PR) in the following: COPD symptoms, knowledge about COPD management, fatigue, and functional capacity. Among the patients who had 1 initial visit, adherence rates were similar (TelePR arm, 59% of sessions; SPR arm, 63%). No intervention-related adverse events occurred. Barriers to PR adoption included difficulty or reluctance to complete medical clearances and beliefs about PR efficacy. Notably, only 9 participants sustained exercise after program completion. Maintenance of the program was not possible due to low insurance reimbursement and sparsity of Respiratory Therapists. CONCLUSIONS: TelePR can reach COPD patients with health disparities and can be successfully implemented. The small sample size and large confidence intervals prevent conclusion about the relative effectiveness of participating in TelePR compared to SPR. However, improved outcomes were seen for those in TelePR as well as in SPR. Increasing adoption of PR and TelePR requires consideration of comorbidity burden, and perception of PR utility, and must facilitate medical clearances. Given the sparsity of SPR locations, TelePR can overcome at least the barrier of access. However, given the challenges to the uptake and completion of PR - many of the additional barriers in PR (both in TelePR and SPR) need to be addressed. Awareness of these real-world challenges will not only inform implementation of TelePR for clinicians seeking to adopt this platform but will also inform study designers and reviewers regarding the feasibility of approaches to patient recruitment and retention.

Community-Acquired Pneumonia Progressing to Necrotizing Pneumonia Due to Congenital Anatomical Abnormalities in the Lung.

Pneumonia is generally a treatable disease but there are instances when physicians are faced with rare circumstances such as congenital structural abnormalities. Structural abnormalities in the lungs may predispose to pneumonia and other complications. We present a patient with pneumonia, which progressed to necrotizing pneumonia. A diagnostic bronchoscopy was performed and identified multiple accessory lobes in the right lung. Multiple accessory lobes are not easily identifiable by diagnostic imaging such as X-rays or computed tomography scans. As a result, treating pneumonia in patients with such structural anomalies can further complicate management. Currently, there is limited information that correlates pneumonia and accessory lobes with necrotizing pneumonia.

Applications of Machine Learning in Cardiology.

In this digital era, artificial intelligence (AI) is establishing a strong foothold in commercial industry and the field of technology. These effects are trickling into the healthcare industry, especially in the clinical arena of cardiology. Machine learning (ML) algorithms are making substantial progress in various subspecialties of cardiology. This will have a positive impact on patient care and move the field towards precision medicine. In this review article, we explore the progress of ML in cardiovascular imaging, electrophysiology, heart failure, and interventional cardiology.

Septic Shock Secondary to Severe Gastroenteritis Resulting From Sapovirus Infection.

Sapovirus causes acute gastroenteritis (AGE) which manifests as severe diarrhea and vomiting. It is most often seen in, but not limited to, children and toddlers but can occur in people of all ages. It is typically more prevalent in low to middle-income countries but has also been reported in progressive countries such as the United States. Due to the universal use of reverse transcriptase-polymerase chain reaction (RT-PCR) testing, the reported incidence of sapovirus has continued to grow as the culprit agent in both AGE outbreaks and isolated cases. Its symptoms resemble what is seen with rotavirus but with a milder clinical course. This discussion explores the dire implications of a relatively understated pathogen. Here, we present a rare case of a 20-year-old woman who presented with septic shock secondary to severe gastroenteritis as a result of sapovirus infection.

Hemoptysis in a previously healthy elderly patient with an unrecognized tracheal bronchus: A case report.

A 83-year-old healthy female with no past medical history presented with persistent hemoptysis and respiratory failure. She was found to have a tracheal bronchus on bronchoscopy. Patient underwent pulmonary lavage and sterile irrigation. Patient was stable, but developed excessive hemoptysis which prompted a repeat, emergent, bronchoscopy was performed to advance the ET tube to isolate the left lung from the bleeding right lung. Despite the effort taken, the patient became pulseless from the hypoxia caused by blood spillover into the entire tracheobronchial field. ACLS protocol initiated without successful ROSC. Tracheal bronchus is uncommon but when present patients usually develop recurrent pulmonary symptoms at a younger age which require extensive workup which can lead to discovery of pulmonary anomalies. In our patient, she has no recurrent pulmonary symptoms as a child nor as an adult. We suspect the reason to this is the normal size diameter of the bronchus that connects the accessary lobe to the trachea. There are a few Medical conditions that may present with hemoptysis. When there is persistent, new onset hemoptysis in an otherwise healthy individual there should be no hesitation in performing the necessary procedural studies to reach a diagnosis.

Right Heart Transvalvular Embolus with High Risk Pulmonary Embolism in a Recently Hospitalized Patient: A Case Report of a Therapeutic Challenge.

Thrombus-in-transit is not uncommon in pulmonary embolism but Right Heart Transvalvular Embolus (RHTVE) complicating this is rare. A 54-year-old obese male with recent hospitalization presented with severe dyspnea and collapse. Initial investigations revealed elevated d-dimer and troponin. CTA showed saddle pulmonary embolus and bedside echocardiogram revealed right ventricular (RV) pressure overload and dilatation (RV > 41 mm), McConnell's sign, and mobile echodensity attached to tricuspid valve. Patient was immediately resuscitated and promptly transferred for surgical embolectomy under cardiopulmonary bypass. A long segment of embolus traversing through the tricuspid valve and extensive bilateral pulmonary artery embolus were removed. IVC filter was placed for a persistent right lower extremity DVT. Hypercoagulable work-up was negative. Patient continued to do well after discharge on Coumadin. Open embolectomy offers great promises where there is no consensus in optimal management approach in such patients. Bedside echocardiogram is vital in risk stratification and deciding choice of advanced PE treatment.

Sphincter-saving surgeries for rectal cancer: A single center study from Kashmir.

SUMMARY AND BACKGROUND DATA: The goals in the treatment of rectal cancer are cure, local control, and preservation of sphincter, bladder and sexual function. Surgical resection using sharp mesorectal dissection is important for achieving these goals. OBJECTIVES: The current treatment of choice for carcinoma rectum is sphincter saving procedures, which have practically replaced the previously done abdominoperineal resection. We performed a study in our institute to evaluate the surgical outcome and complications of rectal cancer. MATERIALS AND METHODS: This prospectivestudy included 117 patients, treated for primary rectal cancer by low anterior resection (LAR) from May 2007 to December 2010. All patients underwent standard total mesorectal excision (TME) followed by restoration of continuity. RESULTS: The peri-operative mortality rate was 2.5% (3/117). Post-operative complications occurred in 32% of the patients. After a median follow up of 42 months, local recurrences developed in 6 (5%) patients and distant metastasis in 5 (4.2%). The survival rate was 93%. CONCLUSION: The concept of total mesorectal excision (TME), advances in stapling technology and neoadjuvant therapy have made it possible to preserve the anal sphincter in most of the patients. Rectal cancer needs to be managed especially in a specialized unit for better results.