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Tierarztliche Praxis. Ausgabe K,... Apr 2024The objective of this study was to evaluate the signalement, clinical features, and echocardiographic findings of cats diagnosed with patent ductus arteriosus (PDA) as...
OBJECTIVE
The objective of this study was to evaluate the signalement, clinical features, and echocardiographic findings of cats diagnosed with patent ductus arteriosus (PDA) as well as short- and medium-term outcome after successful ligation of the PDA.
MATERIAL AND METHODS
Over a 10-year period 17 cats were diagnosed with PDA by transthoracic echocardiography. Thirteen cats were surgically treated by thoracotomy and ligation of the PDA.
RESULTS
In all cats, a heart murmur was detected. In 88.2% of the cases, this presented as grade 4 out of 6 murmur (15/17 cats). A continuous murmur was more common (10/17 cats; 58.9%) than a systolic murmur (7/17 cats; 41.1%). Echocardiography showed that left ventricular internal diameter end diastole (LVIDd) and left ventricular internal diameter end systole (LVIDs) were significantly above reference values in the majority of cats. Mean diameter of the PDA measured at the widest point of the vessel was 3.4 mm (± 1.08 mm) and mean maximum flow velocity amounted to 5,06 m/sec (2,6m/sec-6,4m/sec). Surgery was successfully performed in all cats treated by surgical ligation and all of these patients were discharged after postoperative inpatient therapy. One cat experienced perioperative bleeding from the PDA, which was stopped efficaciously. This cat exhibited a residual shunt directly postoperatively; this could no longer be visualized in a re-check echocardiography 3 months later. Six cats were followed over a longer period of time.
CONCLUSIONS
The surgical prognosis in this case study is very good with a postoperative survival rate of 100%.
CLINICAL RELEVANCE
Surgical treatment of PDA is curative in animals not displaying advanced cardiac lesions. The auscultation of a heart murmur can provide initial findings indicative of PDA. Therefore, cardiac auscultation is warranted at every first presentation of a kitten. It must however be taken into consideration that not every cat with PDA necessarily has a continuous murmur but may display a systolic heart murmur. Therefore, it is important give utmost attention to the patients' clinical signs.
Topics: Animals; Cats; Ductus Arteriosus, Patent; Cat Diseases; Retrospective Studies; Echocardiography; Ligation; Heart Murmurs; Female; Male
PubMed: 38701804
DOI: 10.1055/a-2290-2441 -
IEEE Transactions on Bio-medical... May 2024Early diagnosis of cardiovascular diseases is a crucial task in medical practice. With the application of computer audition in the healthcare field, artificial...
OBJECTIVE
Early diagnosis of cardiovascular diseases is a crucial task in medical practice. With the application of computer audition in the healthcare field, artificial intelligence (AI) has been applied to clinical non-invasive intelligent auscultation of heart sounds to provide rapid and effective pre-screening. However, AI models generally require large amounts of data which may cause privacy issues. Unfortunately, it is difficult to collect large amounts of healthcare data from a single centre.
METHODS
In this study, we propose federated learning (FL) optimisation strategies for the practical application in multi-centre institutional heart sound databases. The horizontal FL is mainly employed to tackle the privacy problem by aligning the feature spaces of FL participating institutions without information leakage. In addition, techniques based on deep learning have poor interpretability due to their "black-box" property, which limits the feasibility of AI in real medical data. To this end, vertical FL is utilised to address the issues of model interpretability and data scarcity.
CONCLUSION
Experimental results demonstrate that, the proposed FL framework can achieve good performance for heart sound abnormality detection by taking the personal privacy protection into account. Moreover, using the federated feature space is beneficial to balance the interpretability of the vertical FL and the privacy of the data.
SIGNIFICANCE
This work realises the potential of FL from research to clinical practice, and is expected to have extensive application in the federated smart medical system.
PubMed: 38700959
DOI: 10.1109/TBME.2024.3393557 -
Cureus Dec 2023Hospital-acquired pneumonia (HAP) is a life-threatening hospital-acquired infection contributing to poor outcomes and mortality. Though the prevalence is...
BACKGROUND AND OBJECTIVES
Hospital-acquired pneumonia (HAP) is a life-threatening hospital-acquired infection contributing to poor outcomes and mortality. Though the prevalence is comparable, the burden of comorbidities and malnutrition further worsens the scenario in developing countries. Infective agents responsible for these infections vary between regions due to the variables involved. There is a dearth of data on clinico-microbiological correlates of HAP from Northern India. With this study, we aim to explore the same and add more evidence to fill the gap.
METHODOLOGY
A hospital-based cohort study was done on ICU patients of the tertiary care center in Northern India including the cohort of patients obeying a strict inclusion criterion. The clinical and microbiological correlates were estimated following an appraisal of quality of study samples.
RESULTS
We found that the most common clinical feature in patients with HAP was fever (82%) followed by purulent respiratory secretions (72%), tachycardia (52%), and crepitations on auscultation (38%). Approximately 86% of cases were found to be culture-positive while others were bacteriologically sterile. Gram-negative bacilli were more commonly isolated (83% Gram-negative vs 17% Gram-positive). The most common organisms isolated were Klebsiella pneumoniae, Citrobacter freundii, Escherichia coli, Acinetobacter, and Pseudomonas aeruginosa. Staphylococcus aureus was isolated from eight specimens and all isolates were susceptible to vancomycin, linezolid, teicoplanin, and tigecycline. Seven isolates were resistant to clindamycin and all 8 were resistant to macrolides and quinolones. Five strains had methicillin resistance indicating a rising burden of 'superbugs'. The most common side involved was the right side and the right middle zone was the most common zone involved. Forty-four percent of cases had a poor outcome and succumbed to the infection.
CONCLUSIONS
HAP places patients at a heightened risk of mortality and manifests a distinctive clinical-microbiological profile. It is advisable to adopt a proactive stance in averting HAI by adhering to robust prophylaxis and management protocols in alignment with regional data and hospital guidelines. Despite the study's constrained sample size, it contributes significant insights specific to the region. This underscores the necessity for further exploration through analogous studies and audits in the northern part of India. Such endeavors have the potential to tailor treatment approaches for patients, ultimately enhancing overall outcomes.
PubMed: 38694727
DOI: 10.7759/cureus.50707 -
Journal of the American Veterinary... Apr 2024To report a ventral diaphragmatic advancement technique to repair a large congenital peritoneopericardial diaphragmatic hernia in a dog.
OBJECTIVE
To report a ventral diaphragmatic advancement technique to repair a large congenital peritoneopericardial diaphragmatic hernia in a dog.
ANIMAL
A 5-month-old 15-kg entire male Labrador Retriever.
CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES
The dog presented with a history of diarrhea for a week and acute-onset lethargy and vomiting for 3 days. Clinical examination revealed borborygmi on auscultation of the chest, and subsequent imaging showed a congenital peritoneopericardial diaphragmatic hernia.
TREATMENT AND OUTCOME
The ventro-central diaphragmatic defect was repaired with a pericardial flap, which subsequently failed 7 months later. The revision surgery was performed with a novel surgical technique. The defect was closed by means of incising the ventral attachments of the diaphragm either side of the defect and sliding it medially to allow a tension-free closure. The ventral aspect of the incised diaphragm was reattached with circumcostal sutures and the central defect closed. The dog recovered rapidly and without complication. An excellent outcome was reported after surgery.
CLINICAL RELEVANCE
This novel technique was a simple method to repair a peritoneopericardial diaphragmatic hernia and had good clinical results in this case.
PubMed: 38688312
DOI: 10.2460/javma.24.02.0098 -
QJM : Monthly Journal of the... Apr 2024
PubMed: 38684175
DOI: 10.1093/qjmed/hcae063 -
Microorganisms Mar 2024Human metapneumovirus (hMPV) is an important pathogen that causes both upper (URTIs) and lower respiratory tract infections (LRTIs) in children. The virus can be...
Human metapneumovirus (hMPV) is an important pathogen that causes both upper (URTIs) and lower respiratory tract infections (LRTIs) in children. The virus can be implicated in severe bronchiolitis and pneumonia, necessitating hospitalization, with certain cases requiring intensive care unit intervention. As part of a retrospective observational study, we aimed to identify indicators of severe hMPV respiratory tract infections in children referred to the University Children's Hospital Ljubljana and the Department of Infectious Diseases Ljubljana, Slovenia, during a recent outbreak. We analyzed clinical data from November 2022 to January 2023 and compared the characteristics of children presenting with URTIs and LRTIs. We also examined the characteristics of children with hMPV LRTIs, distinguishing between children with and without LRTI-associated hypoxemia. Of 78 hMPV-PCR-positive pediatric patients (mean age 3.1 years; 60.3% boys), 36% had a URTI, and 64% had an LRTI. Hospitalization was required in 64% (50/78), with 42% (21/50) requiring oxygen therapy. LRTI-associated hypoxemia was more common in patients with atopy who showed dyspnea, tachypnea, crackles, and wheezing on lung auscultation. In a multivariable logistic regression analysis, wheezing detected on lung auscultation was a significant predictive factor for hypoxemic hMPV-LRTI. Specifically, children presenting with wheezing were found to be ten times more likely to experience hypoxemia. Prematurity and chronic conditions did not influence the presentation or severity of hMPV infection. This study highlights wheezing and atopy as crucial indicators of severe hMPV LRTI in children, emphasizing the importance of early recognition and intervention.
PubMed: 38674586
DOI: 10.3390/microorganisms12040641 -
Tomography (Ann Arbor, Mich.) Apr 2024Interstitial lung disease (ILD) is a complication in patients with systemic sclerosis (SSc). Accurate strategies to identify its presence in early phases are essential....
BACKGROUND
Interstitial lung disease (ILD) is a complication in patients with systemic sclerosis (SSc). Accurate strategies to identify its presence in early phases are essential. We conducted the study aiming to determine the validity of ultrasound (US) in detecting subclinical ILD in SSc, and to ascertain its potential in determining the disease progression.
METHODS
133 patients without respiratory symptoms and 133 healthy controls were included. Borg scale, Rodnan skin score (RSS), auscultation, chest radiographs, and respiratory function tests (RFT) were performed. A rheumatologist performed the lung US. High-resolution CT (HRCT) was also performed. The patients were followed every 12 weeks for 48 weeks.
RESULTS
A total of 79 of 133 patients (59.4%) showed US signs of ILD in contrast to healthy controls (4.8%) ( = 0.0001). Anti-centromere antibodies ( = 0.005) and RSS ( = 0.004) showed an association with ILD. A positive correlation was demonstrated between the US and HRCT findings ( = 0.001). The sensitivity and specificity of US in detecting ILD were 91.2% and 88.6%, respectively. In the follow-up, a total of 30 patients out of 79 (37.9%) who demonstrated US signs of ILD at baseline, showed changes in the ILD score by US.
CONCLUSIONS
US showed a high prevalence of subclinical ILD in SSc patients. It proved to be a valid, reliable, and feasible tool to detect ILD in SSc and to monitor disease progression.
Topics: Humans; Lung Diseases, Interstitial; Scleroderma, Systemic; Female; Male; Middle Aged; Ultrasonography; Adult; Tomography, X-Ray Computed; Disease Progression; Sensitivity and Specificity; Lung; Aged; Reproducibility of Results; Respiratory Function Tests
PubMed: 38668398
DOI: 10.3390/tomography10040041 -
Respiratory Medicine Case Reports 2024A 59-year-old previously healthy woman presented with a six-month history of fever, nonproductive cough, and weight loss. The cause of these symptoms remained obscure...
A 59-year-old previously healthy woman presented with a six-month history of fever, nonproductive cough, and weight loss. The cause of these symptoms remained obscure despite a thorough, month-long hospitalization. On presentation, she was normotensive with a pulse of 98 beats/minute, respiratory rate of 20 breaths/minute, and a temperature of 39.4C. She was emaciated. Physical examination was notable for faint bibasilar crackles on lung auscultation. Initial laboratory testing revealed pancytopenia. Peripheral smear demonstrated normocytic, normochromic anemia without immature cells or schistocytes. Other notable laboratory findings included elevated levels of lactate dehydrogenase, elevated ferritin, and elevated levels of fasting serum triglycerides. A comprehensive laboratory evaluation for connective tissue disease was negative. Plain chest radiography was normal while computed tomography (CT) of the chest demonstrated sub-centimeter nodules in a branching centrilobular pattern as well as in a peri-lymphatic distribution without associated lymphadenopathy or organomegaly. The above constellation of laboratory abnormalities raised concern for hemophagocytic lymphohistiocytosis (HLH). Soluble IL-2 (CD25) receptor levels were markedly elevated. Bronchoscopy with transbronchial biopsies of the right lower lobe was performed, revealing intravascular lymphoma associated with HLH. Our case emphasizes the need for clinicians to consider vascular causes of tree - in-bud nodules in addition to the conventional bronchiolar causes. The case also is a reminder of the need to conduct an exhaustive search for malignancy, in patients with HLH.
PubMed: 38659648
DOI: 10.1016/j.rmcr.2024.102020 -
Anatomical Sciences Education Apr 2024Fidelity between teaching activities and assessment methods is an important goal of knowledge and performance evaluations in medical education. Ideally, assessment...
Fidelity between teaching activities and assessment methods is an important goal of knowledge and performance evaluations in medical education. Ideally, assessment methods provide evidence of learning that reflects the types of knowledge described in the learning objectives of the course. The most reliable assessments involve the same or similar tasks as those used during the instructional components of the course. Our preclinical human anatomy course includes, in addition to traditional lecture and cadaver-based laboratory learning activities, a series of applied human anatomy learning activities intended to emphasize human anatomy as it is encountered in living human individuals. The learning activities involve psychomotor behaviors including inspection, palpation, and auscultation, techniques used in the physical examination, as well as other activities designed to emphasize anatomical structures and tissues as they may be found in patient populations. We describe here our method for measuring student success in learning human anatomy in this manner, highlighting the direct linkage between the learning activities and the assessment tasks. We describe our performance scoring method and how we include this data in the calculation of an anatomy examination grade. As an indicator of our success with this approach, we include performance scores for the applied anatomy questions included on the laboratory component of our unit examinations for two successive academic years. We conclude with summary comments from students regarding the applied anatomy learning activities and assessment approach and offer suggestions for addressing specific challenges associated with the use of these types of assessment methods.
PubMed: 38659288
DOI: 10.1002/ase.2429