Asymptomatic Presentation Research Articles

Abstract 4135311: Cryptogenic stroke associated with a double interatrial septum treated with surgical closure

Introduction: A double atrium septum is a rare congenital anomaly characterized by a double-walled atrial septum with persistent interatrial space. This could be an asymptomatic presentation but also serve as a nidus of thromboembolic complications. We hereby present a case of a 57-year-old female with a cryptogenic stroke found to have a patent foramen ovale and double atrial septum. Case Description: A 57 year-old-female with a past medical history of hypertension presented with acute complaints of word-finding difficulty, left-sided neck pain and lightheadedness after a head strike while swimming. She was found to have a right-sided cerebellar stroke. A carotid artery ultrasound showed no evidence of atherosclerotic disease. Her lipid profile was normal. A transthoracic echocardiogram showed a patent foramen ovale with a positive bubble study revealing a large right to left shunt with Valsalva. A transesophageal echocardiogram confirmed a patent foramen ovale with an incidental finding of a double atrial septum with extreme redundancy of septal issue. The patient had a surgical closure of the interatrial septum and resection of the accessory interatrial septum tissue. She developed chronic post-sternotomy pain and subsequently had sternal wire removal. Discussion: A double atrial septum is a rare congenital anomaly seen as two parallel interatrial septa accompanied by a distinct echo-lucent midline space that expands during systole and contracts during diastole. It can happen embryologically by either the abnormal development of the septum secundum, resorption failure of the superior portion of the septum primum, or the persistence of the left venous valve of the sinus venosus. Typically, individuals with double atrial septum are asymptomatic, but they may encounter cardioembolic events due to the potential thrombi formation in the interatrial space. Communication between the septa increases the likelihood of such events. Unlike atrial fibrillation/flutter, there are currently no established criteria for initiating anticoagulation therapy for double atrial septum, primarily due to its rarity. Some options include antiplatelet agents, oral anticoagulation therapy, and percutaneous or surgical PFO closure. Surgical closure provides a permanent closure of the defect, thereby preventing future paradoxical emboli without the potential risks associated with long-term anticoagulation.

Abstract 4134747: Trends and Disparities in Mortality Due to Thoracic Aortic Aneurysm in Patients in the United States from 1999 to 2020

Background: Thoracic aortic aneurysms (TAA) impact approximately 6 to 10 individuals per 100,000 people, though the actual prevalence is likely higher due to frequent asymptomatic presentations, posing a challenge for early diagnosis. The rupture of these aneurysms presents a significant risk, resulting in an estimated 30,000 deaths annually in the United States alone. This emphasizes the urgent need for enhanced detection and treatment strategies. An understanding of trends in TAA mortality is imperative for assessing the efficacy of current approaches, pinpointing vulnerable populations, and ultimately, advancing treatment equity. Methods: This study utilized death certificates from 1999 to 2020 sourced from the CDC WONDER Database. Deaths among individuals aged 25 years and older attributed to TAA were identified using the International Classification of Diseases, Tenth Revision (ICD-10) codes I71.1 and I71.2. Age-adjusted mortality rates (AAMRs) per 1,000,000 individuals and annual percent change (APC) were computed and stratified based on year, gender, race/ethnicity, and urbanization status. Results: Between 1999 and 2020, 47,136 deaths were reported in patients with TAA. Overall, AAMR decreased from 16.2 to 8.2 per 1,000,000 population between 1999 and 2020, with a significant decline from 1999 to 2013 (APC: -5.00; 95% CI: -5.54 to -4.5), followed by a slight increase from 2013 to 2020 (APC: 0.47; 95% CI: -1.02 to 3.06). Gender-based analysis revealed that men had consistently higher AAMRs than women (men: 11.2; 95% CI: 11 to 11.3; vs. women: 9; 95% CI: 8.9 to 9.1). Moreover, we found that AAMRs were the highest among non-Hispanic African Americans (11; 95% CI: 10.7 to 11.3) followed by non-Hispanic Whites (10.3; 95% CI: 10.2 to 10.4), non-Hispanic Asian or Pacific Islanders (9.5; 95% CI: 9 to 9.9), non-Hispanic American Indian or Alaska Native (7.8; 95% CI: 6.6 to 9), and Hispanic populations (5.2; 95% CI 5 to 5.5). In addition, non-metropolitan areas had higher AAMRs than metropolitan areas (non-metropolitan areas: 11; 95% CI: 10.8 to 11.2; vs. metropolitan: 9.8; 95% CI: 9.7 to 9.9) (Figure 1). Conclusions: This analysis revealed a significant decline in mortality since 1999 from TAA, with a slight upward trend in recent years. However, disparities persist, with higher AAMRs observed among men, non-Hispanic African Americans, and residents of non-metropolitan areas.

Asymptomatic presentation of giant liver abscess: simultaneous Klebsiella pneumoniae and amoebic infection in an immunocompetent comorbid patient

Liver abscess is a rare clinical entity, giant abscess is also rare and asymptomatic presentation in immune competency is even rare. Simultaneous Klebsiella pneumoniae and amoebic liver abscess is rarely reported in immunocompetent patients, just few articles. Our case, a 69-year-old man was discovered to have hypoechoic liver mass during a scan of the abdomen for evaluation of dysuria. He was hospitalized through ER for advanced assessment. Systemic inquiries of the patient revealed generalized fatigue, constipation, but no fever, chills, abdominal pain or hypotension. Physical examination revealed normal liver span and no right upper quadrant tenderness. Tumor markers were not strikingly high and an enhanced abdominal computed tomography showed a large area of low attenuation with some liquefaction in the liver. Echo-guided aspiration revealed 220 ml of pus, which grew Klebsiella pneumoniae, and the same organism was isolated from the blood. Cytology examination of the pus showed scattered amoeba. The patient gradually improved over 3 weeks on treatment with meropenem and metronidazole, along with sustained drainage of the abscess cavity. No parasite ova or amoeba were found in the stool. He had no evidence of immunocompromise. Parasitic diseases may be a predisposing factor for bacterial infections, including pyogenic liver abscess. Giant size, possible coexistence of amoebae and bacteria in a liver abscess and asymptomatic presentation should not be discounted.

Asymptomatic presentation of diffuse large B-cell lymphoma as isolated submental lymphadenopathy

Non-Hodgkin lymphoma (NHL) is the most common type of lymphoma, Diffuse larger B-cell lymphoma (DLBCL) being most common type of NHL. Patients usually present at later stage with b-symptoms, lymphadenopathy and organomegaly. Isolated asymptomatic lymphadenopathy is a rare presentation. A 50-year-old female presented with complaints of swelling in the sub mental region. It increased in size over 1month without any associated local or systemic symptoms. On examination a firm, non-tender, mobile swelling of around 2×1.5 cm was present at sub mental region. Abdominal examination revealed no organomegaly. Blood picture- HB- 9.7 gm/dl, TLC- 5200/mm3, neutrophils/ lymphocytes/ eosinophil/ basophils-43.4/44.4/5.1/0.4 and Platelets-2.41 lakhs/mm3. Ultrasonography study was suggestive of necrotic lymph node. Fine needle aspiration cytology demonstrated nonspecific reactive lymphadenitis. After routine pre-operative workup patient was taken up for lymph node excision in elective OR under general anesthesia and the excised lymph node was sent for biopsy. A histopathological diagnosis of diffuse large B-cell lymphoma was made and confirmed with Immunohistochemistry (IHC), (CD20-diffuse positive; CD3-focal positive; Cyclin D-negative; BCL6-positive; CD10- focally positive). Post-operative hospital stay was uneventful. Our case was atypical with asymptomatic presentation with isolated lymphadenopathy with suspicious lymphocytosis. Diagnosis was only possible by histopathology.

Robotic assisted excision of a mesenteric cyst of Müllerian origin in a 29-year-old woman

Mesenteric cysts are rare, benign tumors of uncertain etiology that require management. The Müllerian subtype of one of the rarer types of mesenteric cysts. Diagnosis of a mesenteric cyst typically involves nonspecific symptoms or an asymptomatic presentation. Treatment involves resection to prevent life-threatening complications. Resection through laparotomy surgery is the most common approach. The laparoscopic approach is gaining traction. We present a case in which a large mesenteric cyst was resected using a robotic assisted laparoscopic approach.

6666 Asymptomatic Fasting Hypoglycemia After Sleeve Gastrectomy

Abstract Disclosure: K. Mitrollari: None. H.K. Deveaux: None. A. Gundeti: None. A.P. Calimag: None. T. Yasmeen: None. Introduction: Post-bariatric surgery hypoglycemia (PBSH), though previously considered rare, is increasingly recognized, occurring not only after Roux-en-Y gastric bypass (RYGB,) but also following various bariatric procedures. PBSH can manifest as postprandial or fasting hypoglycemia, requiring thorough investigation and prevention due to potential asymptomatic presentations that may lead to severe consequences, including coma and death. Case Report A 45-year-old female with a history of type 2 DM, ESRD on HD, gastric sleeve surgery, bilateral trans-metatarsal amputations, coronary artery disease, and congestive heart failure presented with bilateral lower extremity wounds. On admission her venous blood glucose was 71 mg/dL. Glycohemoglobin was 3.9% and fructosamine was 225 (205-285 umol/L). Her glycohemoglobin levels consistently remained below 6.4% status post sleeve gastrectomy off diabetes medications. Throughout admission, she experienced almost daily episodes of fasting asymptomatic hypoglycemia correlated with venous sample with lowest blood glucose reading 38 mg/dL. Initially, these episodes were attributed to NPO status for procedures or decreased PO intake. Her diet consisted of fast food brought by her family, which she reported was similar to her diet at home. Workup during a hypoglycemic episode (glucose 51 mg/dL,) revealed insulin 4 mUnits/L, proinsulin 7.1 pmol/L (<=7.2 pmol/L), C-peptide 25.7 ng/mL (0.8-3.9 ng/mL), and beta-hydroxybutyrate 0.5 mmol/L (0.0-0.3 mmol/L). Negative insulin antibodies and sulfonylurea panel, normal cortisol, and ACTH levels were noted. The patient was placed on a 10% dextrose infusion to avoid further episodes of hypoglycemia. However, she continued to experience hypoglycemia and was started on oral diazoxide. A CT pancreas with and without contrast was unremarkable, and endoscopic ultrasonography only revealed a 10 mm accessory spleen. The patient was discharged with counseling on glucose monitoring, dietary changes, and follow-up with endocrinology. Conclusion: PBSH should be considered as a differential diagnosis in patients with unexplained hypoglycemia and a history of bariatric surgery. PBSH mimics insulinoma or non-insulinoma pancreatogenous hypoglycemia syndrome (NIPHS) with elevated insulin, proinsulin, C-peptide, and low beta-hydroxybutyrate during hypoglycemia, however NIPHS is exclusive to non-bariatric patients. Imaging is crucial to rule out insulinoma, and invasive tests such as endoscopic ultrasound aid diagnosis. PBSH is a diagnosis of exclusion; therefore, workup involves ruling out other causes of hypoglycemia. First-line treatment involves diet modification, with medications like diazoxide or acarbose considered if dietary changes prove insufficient. This case underscores the complexity of hypoglycemia, implicating bariatric surgery as a contributing factor. Presentation: 6/3/2024

A Case Report on Odontogenic Keratocyst of Right Mandible

Odontogenic keratocysts (OKCs) are rare, aggressive cystic lesions originating from the dental lamina remnants and basal cells of the oral epithelium. Despite their typically asymptomatic presentation, OKCs may be incidentally discovered on dental radiographs or present with symptoms such as pain or swelling due to infection or bone expansion. This case report describes a 21-year-old male who presented with pain in the lower right molar region, This case highlights the diagnostic challenge of OKCs, which can mimic other odontogenic pathologies and underscores the importance of radiographic assessment for early identification and management of such lesions.

Early Identification and Management of Chronic Kidney Disease: A Narrative Review of the Crucial Role of Primary Care Practitioners.

Early-stage (stage1-3) chronic kidney disease (CKD) has an asymptomatic presentation such that most people with CKD are unaware of their disease status and remain undiagnosed. CKD is associated with multiple long-term conditions (MLTC), or multimorbidity, the most common of these being cardiovascular disease, hypertension, and type2 diabetes. Primary care practitioners (PCPs) are crucial in the early identification and management of patients with CKD. For individuals at high risk of CKD, measurements of estimated glomerular filtration rate, urine albumin-creatinine ratio, and blood pressure should be obtained regularly and recorded in a timely manner. The importance of lifestyle changes in the prevention and management of CKD should also be highlighted. A recent addition to the treatment of CKD in people with and without type2 diabetes has been the recommendation by clinical practice guidelines of a sodium-glucose co-transporter2 (SGLT2) inhibitor alongside a renin-angiotensin-aldosterone system inhibitor as foundational therapy. SGLT2 inhibitors prevent CKD progression and reduce fatal and non-fatal kidney and cardiovascular events, hospitalization for heart failure, and all-cause mortality, and they have a favorable safety and tolerability profile. However, uptake has been slow, particularly in people with CKD without type2 diabetes. A multifaceted approach is required to ensure that people with CKD receive optimal kidney protection. Measures to raise awareness of the importance of early identification and intervention include local/national campaigns via social media and practice-based education; clinical education programs; integration of clinical decision support tools into electronic health records; detection programs built around electronic health records; and good interdisciplinary communication. PCPs at the forefront of multidisciplinary care are best placed to implement the evidence-based clinical practice CKD guidelines for lifestyle modification and guideline-directed medical therapy.

Newborn screening algorithm distinguishing potential symptomatic isovaleric acidemia from asymptomatic newborns.

Newborn screening (NBS) for isovaleric acidemia (IVA) reduces mortality and morbidity; however, it has also resulted in the detection of individuals with an asymptomatic or mild presentation for which early detection via newborn screening has not been proven to alter neurological outcome. We reevaluated biochemical and molecular data for newborns flagged positive for IVA in aim of developing a new screening algorithm to exclude the latter from positive screening. Among 2 794 365 newborns underwent routine newborn screening in Israel, 412 flagged positive for IVA, of which, 371 were false positives on recall sample testing and 41 positive newborns were referred to the clinic. 38/41 have biochemical and molecular confirmation in keeping with IVA. Among the 38 patients, 32% (12/38) were classified as symptomatic while, 68% (26/38) were classified as asymptomatic. 69% of the latter group harbor the known variant associated with mild potentially asymptomatic phenotype, c.932C>T; p. Ala311Val. Among asymptomatic patients, only 46% (12/26) are currently treated. Two novel variants have been detected in the IVD gene: c.487G>A; p. Ala163Thr and c.985A>G; p. Met329Val. Cut-off recalculation, of referred newborns' initial biochemical results, after classifying the referred patients to two binary groups of symptomatic and asymptomatic, resulted in an improved NBS algorithm comprising of C5 >5 μM and C5/C2>0.2 and C5/C3>4 flagging only those likely to have the classic symptomatic phenotype.

Asymptomatic pediatric presentation of S-adenosylhomocysteine hydrolase deficiency.

S-adenosylhomocysteine hydrolase deficiency is an autosomal recessive inborn error of metabolism affecting methylation by disrupting the methionine cycle. Its clinical spectrum spans from severe perinatal encephalomyopathy and liver failure to asymptomatic course in patients with isolated hypermethioninemia. We present two new cases of S-adenosylhomocysteine hydrolase deficiency from Pakistani origin clinically asymptomatic at presentation. Both siblings showed mild chronic liver failure and elevation of creatine kinase. The older patient presented at 6 years of age with isolated verbal processing difficulty and mild diffuse leukodystrophy, reversible 12 months after introduction of methionine dietary restriction. The patient showed subtle atrophy in the muscle MRI at the age of 7 years. S-adenosylhomocysteine hydrolase deficiency was confirmed with homozygous missense variant c.146G>A (p.Arg49His) in the AHCY gene, a genotype previously reported in Pakistani patients with mild presentation. Dietary methionine restriction decreased plasma methionine but not plasma S-adenosylhomocysteine and S-adenosylmethionine. This work expands the mild spectrum of S-adenosylhomocysteine hydrolase deficiency with no noticeable clinical symptoms in children, highlighting a specific hotspot variant from South Asia. This mild form of the disease is likely underdiagnosed and raises the question of therapeutic management to prevent long-term complications documented in the literature, such as hepatocellular carcinoma and myopathy in early adulthood.

CA-ViT: Contour-Guided and Augmented Vision Transformers to Enhance Glaucoma Classification Using Fundus Images.

Glaucoma, a predominant cause of visual impairment on a global scale, poses notable challenges in diagnosis owing to its initially asymptomatic presentation. Early identification is vital to prevent irreversible vision impairment. Cutting-edge deep learning techniques, such as vision transformers (ViTs), have been employed to tackle the challenge of early glaucoma detection. Nevertheless, limited approaches have been suggested to improve glaucoma classification due to issues like inadequate training data, variations in feature distribution, and the overall quality of samples. Furthermore, fundus images display significant similarities and slight discrepancies in lesion sizes, complicating glaucoma classification when utilizing ViTs. To address these obstacles, we introduce the contour-guided and augmented vision transformer (CA-ViT) for enhanced glaucoma classification using fundus images. We employ a Conditional Variational Generative Adversarial Network (CVGAN) to enhance and diversify the training dataset by incorporating conditional sample generation and reconstruction. Subsequently, a contour-guided approach is integrated to offer crucial insights into the disease, particularly concerning the optic disc and optic cup regions. Both the original images and extracted contours are given to the ViT backbone; then, feature alignment is performed with a weighted cross-entropy loss. Finally, in the inference phase, the ViT backbone, trained on the original fundus images and augmented data, is used for multi-class glaucoma categorization. By utilizing the Standardized Multi-Channel Dataset for Glaucoma (SMDG), which encompasses various datasets (e.g., EYEPACS, DRISHTI-GS, RIM-ONE, REFUGE), we conducted thorough testing. The results indicate that the proposed CA-ViT model significantly outperforms current methods, achieving a precision of 93.0%, a recall of 93.08%, an F1 score of 92.9%, and an accuracy of 93.0%. Therefore, the integration of augmentation with the CVGAN and contour guidance can effectively enhance glaucoma classification tasks.

Anesthetic management and anesthesia-related complications in dogs with a dilated cardiomyopathy phenotype: a retrospective study of 30 dogs (2010-2024).

To describe perioperative anesthetic management in canines with a dilated cardiomyopathy (DCM) phenotype and to compare the frequency of general anesthesia-related complications with a control group of dogs without heart disease. 30 dogs with DCM phenotype (cases) and 30 dogs without heart disease (controls). Dogs presented to a teaching hospital between 2010 and 2024 that were diagnosed with a DCM phenotype via echocardiography were included in this study. Controls were dogs that presented during the same time period and were matched with cases based on their age, breed, and type of procedure; however, no standardization of treatment between the groups was performed. Medical records were reviewed to evaluate the occurrence of anesthetic complications. Of dogs with a DCM phenotype, 2 had overt DCM, 22 had occult DCM, and 6 had equivocal DCM. Dogs with DCM exhibited a lower likelihood of being premedicated with dexmedetomidine or induced with propofol. Conversely, DCM dogs were more likely to be induced with etomidate or midazolam compared to their counterparts without DCM. Dogs with DCM demonstrated an increased likelihood of experiencing cardiac arrhythmias during anesthesia, received comparatively lower volumes of IV fluids, and were more likely to be administered dobutamine during anesthesia. No significant differences were identified in terms of postanesthesia complications or survival rates to discharge. Dogs with a DCM phenotype, primarily characterized by asymptomatic presentation, demonstrated comparable perioperative outcomes under general anesthesia when compared to matched controls, though the lack of standardization in anesthetic management limits definitive conclusions.

A Case Report on the Asymptomatic First Presentation of a Pencil-Piercing Neck Injury in a 22-Year-Old Boy

A Case Report on the Asymptomatic First Presentation of a Pencil-Piercing Neck Injury in a 22-Year-Old Boy

Extensive asymptomatic violaceous plaques on the upper body of a middle-aged male.

We describe an extensive, asymptomatic presentation of a rare condition in a 59-year-old male patient presenting with nonpruritic, nonpainful, hyperpigmented plaques on the upper body. Multiple treatments had failed to resolve the lesions, but with an added JAK inhibitor the patient developed no new lesions. We hope this description contributes to our limited understanding of this rarely reported clinical entity.

Highlights of ophthalmological manifestations in newly diagnosed acute leukemia: a correlation with hematological parameters

Acute leukemia is a hematological malignancy affecting different organ systems including the eye and orbit through direct infiltration of tissues or secondary to hematological abnormalities. Ophthalmological manifestations in acute leukemia are variable ranging from asymptomatic presentation to serious manifestations that can alter the disease course and treatment. The purpose of this study is to detect the incidence of different ophthalmological manifestations in newly diagnosed acute leukemia patients and to assess the relationship between ocular findings and hematological characteristics and the sequel of these neoplasms. A cross-sectional study with analytical components was conducted on 222 newly diagnosed acute myeloid and acute lymphoblastic leukemia patients who presented at Oncology Center Mansoura University (OCMU) between January 2022 and February 2023. All patients underwent a complete ophthalmic evaluation at Mansoura Ophthalmology Center (MOC). The mean age was 43.45 ± 17.35 years (range, 17–85), and M/F was 137 (61.7%)/85 (38.3%). One-hundred and forty-four (64.9%) had acute myeloid leukemia (AML), and 78 (35.1%) had acute lymphoblastic leukemia (ALL). Ophthalmic manifestations were detected in 96 patients (43.2%). Among them, 4 (1.8%) had poor visual acuity. Retinal hemorrhage (19.8%) and Roth spots (17.1%) were the most common ocular manifestations. Other ophthalmological manifestations observed were orbital involvement (3.2%), ocular motility issues (1.4%), subconjunctival hemorrhage (5.9%), conjunctival chemosis (0.9%),lid swelling (4.1%), lid ecchymosis (3.2%), lagophthalmos (0.5%), lid ptosis (1.8%), retinal venous congestion & tortuosity (4.1%), preretinal hemorrhage (3.2%), vitreous hemorrhage (3.2%), macular affection (2.3%), retinal infiltration (1.8%), exudative retinal detachment (ERD) (1.8%), cotton-wool spots (0.9%), retinal vein occlusion (0.5%), papilledema (2.8%), optic disc infiltration (1.8%), disc pallor (1.8%).AML patients were significantly associated with a higher frequency of ocular affection, retinal hemorrhages, and Roth spots (P 0.028, 0.003, and 0.046, respectively) compared to ALL patients. Retinal hemorrhage was statistically significantly associated with anemia (P 0.021). Ophthalmological manifestations of acute leukemia are heterogeneous; they can be detected at initial presentations or relapse. Some manifestations are asymptomatic, others can affect visual acuity or even alter the disease course. Cooperation between ophthalmologists and haemato-oncologists is crucial for recognizing ocular involvement and disease management.

A rare case of an aggressive polymorphous adenocarcinoma of minor salivary gland in the retro-maxilla

Abstract Polymorphous adenocarcinoma (PAC) is a low-grade malignant tumour of minor salivary glands of the oral cavity, which rarely presents with invasive features. Low metastatic and excellent survival rates are some of its favorable features. A 36-year-old woman reported with swelling, pain, and mobility of teeth in the left upper inner cheek region. Contrast enhanced computed tomography (CECT) revealed a large, lobulated, heterogenous mass in the left retro-maxillary region with a few enlarged left cervical lymph nodes (levels IB and II). After surgery, the final histopathology report gave a definitive diagnosis of PAC with certain invasive characteristics – perineural invasion, infiltration into skeletal muscle, and depth of invasion of 10 mm, which recurred in a different location 1.5 years later. A few predictable features of PAC include incidence in elderly women, asymptomatic presentation, occurrence in the posterior hard of soft palate, very low incidence of nodal or distant metastases, perineural spread, skeletal muscle infiltration, and low rates of recurrence with good survival outcomes. However, in our case, the patient appeared to present with a relatively aggressive form of PAC, considering her young age, symptomatic presentation, uncommon anatomic location in the retro-maxilla, cervical nodal metastasis, perineural and skeletal muscle infiltration, and local recurrence within a short period. Although PAC is a low-grade tumour with excellent prognosis, it may occasionally present with invasive characteristics, and early diagnosis and prompt management with strict adherence to post-operative regimens and follow-up is of prime importance to prevent any untoward outcomes.

An Occult Laryngeal Foreign Body in A 2-Year-Old Child: A Case Report

Lodgment of foreign bodies in the larynx is a relatively infrequent incident, given that aspirated foreign bodies generally traverse the respiratory tract and often get stuck in the lower airways. The diagnosis of a laryngeal foreign body poses significant challenges, particularly when the object in question is small, radiolucent, and induces partial airway obstruction. Foreign body aspiration (FBA) is commonly identified in pediatric cases, characterized by a sudden onset of symptoms such as cough, dyspnea, and wheezing. This manifestation becomes especially conspicuous when there are no underlying lung conditions like asthma or chronic pulmonary infections. The differential diagnosis hinges on a comprehensive scoring system that evaluates both clinical and radiological aspects. Presented here is a case involving a 4-year-old child with a laryngeal foreign body, initially misdiagnosed due to the patient's asymptomatic presentation. This case underscores the nuances of clinical manifestation, the investigative process, and subsequent management strategies.

Osteoporotic Precise Screening Using Chest Radiography and Artificial Neural Network: The OPSCAN Randomized Controlled Trial.

Background Diagnosing osteoporosis is challenging due to its often asymptomatic presentation, which highlights the importance of providing screening for high-risk populations. Purpose To evaluate the effectiveness of dual-energy x-ray absorptiometry (DXA) screening in high-risk patients with osteoporosis identified by an artificial intelligence (AI) model using chest radiographs. Materials and Methods This randomized controlled trial conducted at an academic medical center included participants 40 years of age or older who had undergone chest radiography between January and December 2022 without a history of DXA examination. High-risk participants identified with the AI-enabled chest radiographs were randomly allocated to either a screening group, which was offered fully reimbursed DXA examinations between January and June 2023, or a control group, which received usual care, defined as DXA examination by a physician or patient on their own initiative without AI intervention. A logistic regression was used to test the difference in the primary outcome, new-onset osteoporosis, between the screening and control groups. Results Of the 40 658 enrolled participants, 4912 (12.1%) were identified by the AI model as high risk, with 2456 assigned to the screening group (mean age, 71.8 years ± 11.5 [SD]; 1909 female) and 2456 assigned to the control group (mean age, 72.1 years ± 11.8; 1872 female). A total of 315 of 2456 (12.8%) participants in the screening group underwent fully reimbursed DXA, and 237 of 315 (75.2%) were identified with new-onset osteoporosis. After including DXA results by means of usual care in both screening and control groups, the screening group exhibited higher rates of osteoporosis detection (272 of 2456 [11.1%] vs 27 of 2456 [1.1%]; odds ratio [OR], 11.2 [95% CI: 7.5, 16.7]; P < .001) compared with the control group. The ORs of osteoporosis diagnosis were increased in screening group participants who did not meet formalized criteria for DXA compared with those who did (OR, 23.2 [95% CI: 10.2, 53.1] vs OR, 8.0 [95% CI: 5.0, 12.6]; interactive P = .03). Conclusion Providing DXA screening to a high-risk group identified with AI-enabled chest radiographs can effectively diagnose more patients with osteoporosis. Clinical trial registration no. NCT05721157 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Smith and Rothenberg in this issue.

Exploring the Epidemiological Surveillance of Hepatitis A in South Africa: A 2023 Perspective.

Hepatitis A (HAV) presents a significant global health concern with diverse clinical manifestations primarily transmitted through fecal-oral routes, emphasizing the critical role of sanitation and water cleanliness in transmission dynamics. Age-related variations, notably asymptomatic presentation in children, add complexity. The World Health Organization's (WHO) endemicity classification aids in understanding prevalence and control strategies. This study examines 2023 South African epidemiological data on HAV cases, evaluating age distribution, incidence rates, and provincial disparities. Data from the national surveillance system and weather services were analyzed. Findings reveal distinct age-related trends, with the highest seroprevalence observed in the 5-9 age group with the most burdened areas located in the Western Cape, KwaZulu-Natal, and Gauteng provinces. Furthermore, seasonal rainfall variations correlate with increased incidence in Western Cape and KZN. The amalgamation of results suggest a potential epidemiological shift, emphasizing the need for updated immunization strategies. Noteworthy patterns, like the rise in 5-9-year-olds, may be influenced by factors such as school clustering and migration. Provincial disparities and the impact of climatic events underscore the necessity for dynamic vaccination strategies and surveillance network enhancements. This study highlights the urgency for improved understanding and response to HAV in South Africa.

Non-invasive detection of cardiac arrhythmias using photoplethysmography signals

Abstract Cardiac arrhythmias (CAs) are associated with critical heart-related complications such as stroke or heart failure. Because of the intermittent and asymptomatic presentation of some CAs in their early stages, the screening remains limited using traditional methods based on ECG. Recent advances in photoplethysmography (PPG) have revealed substantial potential for wearable devices to detect CAs within large populations. Although PPG has demonstrated efficiency in discriminating atrial fibrillation (AF) from normal sinus rhythm, it remains unclear whether AF detection methods remains effective in the presence of CAs other than AF. In this study, we applied a recurrent neural network on a dataset containing eight different types of CAs (Table 1). The classifier processes sequences of interbeat intervals (IBIs) as input and discriminates between normal and abnormal rhythms. The algorithm was evaluated on 64 patients (45 males and 19 females , with a mean age of 55.9 ± 16.0) undergoing a diagnostic or therapeutic electrophysiological procedure. This dataset includes simultaneous recordings of PPG signals from a wrist-bracelet and 12-lead ECG, with the latter used as the gold-standard for annotating cardiac rhythms. The classifier achieved 84% accuracy, 77% sensitivity and 88% specificity in detecting abnormal rhythms. Table 1 shows that AF (99.6%), atrial tachycardia (100%) and AVRT (96.4%) were well classified as abnormal rhythm, whereas the reliability of the detection decreased for atrial flutter (65.4%), atrial or ventricular bigeminy (72.4%) and ventricular tachycardia (80.2%). Undetected abnormal rhythms were often characterized by a rather regular rhythm (illustrated by VT in Figure 1) and CAs for which PPG heartbeat detection was initially not optimal (Bigeminy in Figure 1). In conclusion, this study shows the capability of PPG-based technology to detect various CAs extending beyond AF. It highlights the merits and limitations of IBI-based detection of abnormal rhythms, highlighting the need for a better comprehension of the peripheral hemodynamic signature of CAs.