-
Journal of Cardiovascular Development... May 2024The congenital Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium. This review aimed to summarize existing evidence,... (Review)
Review
The congenital Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium. This review aimed to summarize existing evidence, shed light on the clinical implications, and identify knowledge gaps. The systematic literature search was conducted in the PubMed and Google Scholar medical databases using specifically selected keywords. The inclusion of each publication was assessed according to predefined eligibility criteria based on the PICOM (Population, Phenomenon of Interest, Context, Methodology) schema. Titles and abstracts were screened independently by two authors. Available full-text versions of included publications were reviewed and relevant information was extracted. A total of 78 reports were included. The compilation of all congenital Gerbode defect cases described in the literature revealed a variety of clinical presentations comprising dyspnea, palpitations, growth retardation, and asymptomatology. A suitable multimodal diagnostic approach for newborns consists of auscultation, TTE, and optionally TEE and MRI. Because of its rarity, diversity of findings, unknown pathophysiology, and similarity to more common cardiac diseases, the diagnostic challenge remains significant. To prevent untreated long-term sequelae, early individualized treatment is recommended. Surgical defect closure is preferred to device closure for evidence reasons, although major developments are currently taking place. In conclusion, the congenital Gerbode defect provides a diagnostic challenge for pediatricians to allow early diagnosis and intervention in order to improve patients' quality of life.
PubMed: 38921666
DOI: 10.3390/jcdd11060166 -
Resuscitation Plus Sep 2024To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth. (Review)
Review
AIM
To examine speed and accuracy of newborn heart rate measurement by various assessment methods employed at birth.
METHODS
A search of Medline, SCOPUS, CINAHL and Cochrane was conducted between January 1, 1946, to until August 16, 2023. (CRD 42021283364) Study selection was based on predetermined criteria. Reviewers independently extracted data, appraised risk of bias and assessed certainty of evidence.
RESULTS
Pulse oximetry is slower and less precise than ECG for heart rate assessment. Both auscultation and palpation are imprecise for heart rate assessment. Other devices such as digital stethoscope, Doppler ultrasound, an ECG device using dry electrodes incorporated in a belt, photoplethysmography and electromyography are studied in small numbers of newborns and data are not available for extremely preterm or bradycardic newborns receiving resuscitation. Digital stethoscope is fast and accurate. Doppler ultrasound and dry electrode ECG in a belt are fast, accurate and precise when compared to conventional ECG with gel adhesive electrodes.
LIMITATIONS
Certainty of evidence was low or very low for most comparisons.
CONCLUSION
If resources permit, ECG should be used for fast and accurate heart rate assessment at birth. Pulse oximetry and auscultation may be reasonable alternatives but have limitations. Digital stethoscope, doppler ultrasound and dry electrode ECG show promise but need further study.
PubMed: 38912532
DOI: 10.1016/j.resplu.2024.100668 -
Medicina 2024Takotsubo syndrome, was described in Japan in 1990, it is a stress cardiomyopathy, predominantly in women, usually postmenopausal. Cardiac hypokinesia occurs, with...
Takotsubo syndrome, was described in Japan in 1990, it is a stress cardiomyopathy, predominantly in women, usually postmenopausal. Cardiac hypokinesia occurs, with involvement of multiple coronary territories. In intensive care unit (ICU), it is considered underdiagnosed. Manifestations of severe dengue fever include cardiovascular involvement, mainly arrhythmias and systolic dysfunction. A case of a 72-year-old man is presented, who was hospitalized in ICU for dengue fever, with plateletopenia (15000 cells/mm3) and dehydration. After fluid management the patient reported respiratory discomfort, auscultating crackling rales. A pulmonary ultrasound was made where bilateral B lines were found with B7 pattern compatible with interstitial syndrome and pulmonary edema. Basal hyperkinesia, medial and apical hypokinesia with an image consistent with apical ballooning were observed in the transthoracic echocardiogram. The electrocardiogram showed complete right bundle branch block. Chagas serology was negative and quantitative troponin I was increased. In the context of severe dengue, a Takotsubo syndrome was diagnosed. The patient evolved favorably. After discharge, a normalization of the cardiac function was stated in ultrasound images. The case is of clinical importance due to the low association of these two diseases and the need to screen for cardiac involvement in severe dengue.
Topics: Humans; Takotsubo Cardiomyopathy; Aged; Male; Dengue; Electrocardiography; Severe Dengue; Echocardiography
PubMed: 38907979
DOI: No ID Found -
American Family Physician Jun 2024Pregnancy dating is determined by the patient's last menstrual period or an ultrasound measurement. A full-term pregnancy is considered 37 weeks' gestation or more.... (Review)
Review
Pregnancy dating is determined by the patient's last menstrual period or an ultrasound measurement. A full-term pregnancy is considered 37 weeks' gestation or more. Spontaneous labor begins when regular painful uterine contractions result in a cervical change. Active labor begins at 6 cm dilation and is marked by more predictable, accelerated cervical change. In the absence of pregnancy complications, intermittent fetal auscultation may be considered as an alternative to continuous electronic fetal monitoring, which is associated with a high false-positive rate. Intravenous antibiotic prophylaxis is indicated in patients with group B streptococcus colonization or those at high risk to prevent newborn early-onset group B streptococcus. The likelihood of vaginal delivery is increased by providing continuous nonmedical support during labor, encouraging mobility, and using a peanut ball with epidural analgesia. Neuraxial analgesia is more effective for pain control than systemic opioids and is associated with fewer adverse effects. Delayed pushing during the second stage of labor has risks but does not affect the mode of delivery. Routine oropharyngeal suctioning of the newborn is not recommended, even with meconium-stained amniotic fluid. Delayed cord clamping reduces newborn anemia. Prevention of postpartum hemorrhage in patients at risk includes prophylactic uterotonic administration and controlled cord traction. Perineal lacerations that alter anatomy or are not hemostatic should be repaired. (Am Fam Physician. 2024;109(6):525-532.
Topics: Humans; Female; Pregnancy; Delivery, Obstetric; Infant, Newborn; Labor, Obstetric
PubMed: 38905550
DOI: No ID Found -
IEEE Open Journal of Engineering in... 2024Auscultation for neonates is a simple and non-invasive method of diagnosing cardiovascular and respiratory disease. However, obtaining high-quality chest sounds...
Auscultation for neonates is a simple and non-invasive method of diagnosing cardiovascular and respiratory disease. However, obtaining high-quality chest sounds containing only heart or lung sounds is non-trivial. Hence, this study introduces a new deep-learning model named NeoSSNet and evaluates its performance in neonatal chest sound separation with previous methods. We propose a masked-based architecture similar to Conv-TasNet. The encoder and decoder consist of 1D convolution and 1D transposed convolution, while the mask generator consists of a convolution and transformer architecture. The input chest sounds were first encoded as a sequence of tokens using 1D convolution. The tokens were then passed to the mask generator to generate two masks, one for heart sounds and one for lung sounds. Each mask is then applied to the input token sequence. Lastly, the tokens are converted back to waveforms using 1D transposed convolution. Our proposed model showed superior results compared to the previous methods based on objective distortion measures, ranging from a 2.01 dB improvement to a 5.06 dB improvement. The proposed model is also significantly faster than the previous methods, with at least a 17-time improvement. The proposed model could be a suitable preprocessing step for any health monitoring system where only the heart sound or lung sound is desired.
PubMed: 38899018
DOI: 10.1109/OJEMB.2024.3401571 -
IEEE Open Journal of Engineering in... 2024In light of the COVID-19 pandemic, the early diagnosis of respiratory diseases has become increasingly crucial. Traditional diagnostic methods such as computed...
In light of the COVID-19 pandemic, the early diagnosis of respiratory diseases has become increasingly crucial. Traditional diagnostic methods such as computed tomography (CT) and magnetic resonance imaging (MRI), while accurate, often face accessibility challenges. Lung auscultation, a simpler alternative, is subjective and highly dependent on the clinician's expertise. The pandemic has further exacerbated these challenges by restricting face-to-face consultations. This study aims to overcome these limitations by developing an automated respiratory sound classification system using deep learning, facilitating remote and accurate diagnoses. We developed a deep convolutional neural network (CNN) model that utilizes spectrographic representations of respiratory sounds within an image classification framework. Our model is enhanced with attention feature fusion of low-to-high-level information based on a knowledge propagation mechanism to increase classification effectiveness. This novel approach was evaluated using the ICBHI benchmark dataset and a larger, self-collected Pediatric dataset comprising outpatient children aged 1 to 6 years. The proposed CNN model with knowledge propagation demonstrated superior performance compared to existing state-of-the-art models. Specifically, our model showed higher sensitivity in detecting abnormalities in the Pediatric dataset, indicating its potential for improving the accuracy of respiratory disease diagnosis. The integration of a knowledge propagation mechanism into a CNN model marks a significant advancement in the field of automated diagnosis of respiratory disease. This study paves the way for more accessible and precise healthcare solutions, which is especially crucial in pandemic scenarios.
PubMed: 38899013
DOI: 10.1109/OJEMB.2024.3402139 -
Nurse Education in Practice Jun 2024This study evaluated the effect of simulation on auscultation skills, self-confidence and anxiety levels.
AIM
This study evaluated the effect of simulation on auscultation skills, self-confidence and anxiety levels.
BACKGROUND
Auscultation is an essential topic in nursing education and patient care. Simulation is efficacious in improving auscultation skills and self-confidence and reducing anxiety levels. It is a valuable educational approach whose effects should be evaluated and disseminated in the context of auscultation.
DESIGN
This study had a randomised controlled trial design.
METHODS
The study was conducted with second-year nursing students enrolled at a university in Turkey. One group of students studied auscultation of heart, lung and bowel sounds with a simulated patient (n = 28), the second group with a high fidelity simulator (n = 30) and the third group with traditional education (n = 28). Data were collected using a demographic information form, auscultation control list and Nursing Anxiety and Self-Confidence with Clinical Decision Making Scale. The students' psychomotor auscultation skills, self-confidence and anxiety levels were evaluated. Data on auscultation skills were assessed after the intervention, while data on self-confidence and anxiety levels were collected at baseline, after the intervention and after clinical practices throughout the academic year.
RESULTS
Anxiety and self-confidence levels showed statistically significant differences in intragroup evaluation. The self-confidence levels of the groups working with simulation did not change much in the follow-up test conducted after the end of clinical practices. The mean skill scores in the auscultation control list showed a statistically significant difference between the groups.
CONCLUSIONS
Simulation and traditional approaches are effective in learning auscultation skills. However, the positive effects of simulation, particularly in enhancing students' self-confidence and reducing anxiety levels, appear to be more permanent and impactful than traditional education. Therefore, it is recommended that simulation be prioritized for teaching auscultation skills.
PubMed: 38889525
DOI: 10.1016/j.nepr.2024.104016 -
The Journal of the Acoustical Society... Jun 2024This study proposes the use of vocal resonators to enhance cardiac auscultation signals and evaluates their performance for voice-noise suppression. Data were collected...
This study proposes the use of vocal resonators to enhance cardiac auscultation signals and evaluates their performance for voice-noise suppression. Data were collected using two electronic stethoscopes while each study subject was talking. One collected auscultation signal from the chest while the other collected voice signals from one of the three voice resonators (cheek, back of the neck, and shoulder). The spectral subtraction method was applied to the signals. Both objective and subjective metrics were used to evaluate the quality of enhanced signals and to investigate the most effective vocal resonator for noise suppression. Our preliminary findings showed a significant improvement after enhancement and demonstrated the efficacy of vocal resonators. A listening survey was conducted with thirteen physicians to evaluate the quality of enhanced signals, and they have received significantly better scores regarding the sound quality than their original signals. The shoulder resonator group demonstrated significantly better sound quality than the cheek group when reducing voice sound in cardiac auscultation signals. The suggested method has the potential to be used for the development of an electronic stethoscope with a robust noise removal function. Significant clinical benefits are expected from the expedited preliminary diagnostic procedure.
Topics: Humans; Heart Auscultation; Stethoscopes; Signal Processing, Computer-Assisted; Male; Female; Adult; Heart Sounds; Sound Spectrography; Equipment Design; Voice; Middle Aged; Voice Quality; Vibration; Noise
PubMed: 38874464
DOI: 10.1121/10.0026237 -
Indian Pediatrics Jun 2024Conventional stethoscope is a useful clinical examination tool to aid evaluation of the underlying clinical condition, especially respiratory and cardiac illnesses, even...
Conventional stethoscope is a useful clinical examination tool to aid evaluation of the underlying clinical condition, especially respiratory and cardiac illnesses, even before definitive imaging studies are performed. Auscultation with a stethoscope becomes highly challenging when wearing personal protective equipment (PPE) because the hood of the PPE covers both the ears. Herein, we describe an innovation that involves refashioning of the head cover device of the PPE suit to facilitate conventional auscultation using a stethoscope. In resource-limited settings where advanced gadgets such as wireless stethoscopes may be lacking, redesigning the head cover of the PPE suit can allow the use of manual stethoscopes without increasing the risk of exposure to the pathogen of concern.
Topics: Humans; Personal Protective Equipment; Stethoscopes; Auscultation; Equipment Design
PubMed: 38872294
DOI: No ID Found -
The American Journal of Medicine Jun 2024Validated syncope risk scores were aimed to predict a cardiac etiology and are mainly used in the decision of hospital admission. Whether these scores could also predict...
INTRODUCTION
Validated syncope risk scores were aimed to predict a cardiac etiology and are mainly used in the decision of hospital admission. Whether these scores could also predict the outcomes of inpatient cardiac evaluation is unknown and was the aim of our study.
METHODS
An observational study including consecutive patients admitted for syncope evaluation. All patients completed prolonged ECG monitoring and an echocardiography before discharge. The area under the receiver operating curve (AUC) was used to evaluate the ability of validated risk scores to predict positive inpatient findings. Subsequently, a multivariate regression was performed to identify independent predictors for positive cardiac evaluation, which were then incorporated into the best predictive risk scores.
RESULTS
397 patients were included, 56 (14%) with a positive inpatient cardiac evaluation. The Osservatorio Epidemiologico sulla Sincope Lazio (OESIL) and Canadian Syncope Risk Score (CSRS) achieved the largest AUC (0.701, 95% CI 0.63-0.77 and 0.694, 95% CI 0.62-0.77, respectively). Yet, all scores provided relatively high sensitivity with low specificity. Multivariate regression revealed age ≥75 (adjusted OR 3.50, 95% CI 1.5-7.9) and abnormal cardiac auscultation (AOR 4.79, 95% CI 2.5-9.1) to be independent predictors. Incorporating these factors led to a significantly higher prediction ability of the OESIL (AUC of 0.787, p<0.01) and CSRS (AUC 0.778, p<0.01) modified scores.
CONCLUSION
Current syncope risk scores provide limited prediction ability for the outcomes of inpatient cardiac syncope work-up. One should specifically consider at age > 75 and either cardiac murmur of irregular heart rate on examination very significant in implying a cardiac etiology for syncope. While these factors may be obvious, current risk scores can be interpreted in such a fashion that ignores the importance of findings extracted from a good history and physical examination.
PubMed: 38871205
DOI: 10.1016/j.amjmed.2024.05.035