Breath Sounds Research Articles

C18 A FISTULA BETWEEN LVOT AND LEFT ATRIUM: AN UNKNOWN ORIGIN

Abstract History of presentation A 76–year–old woman presented to our EchoLab for worsening exertional dyspnea. Few weeks prior the patient underwent cardiological examination that showed heart failure with preserved ejection fraction (HFpEF) with bilateral pleuric effusion, severe mitralic regurgitation (MR), moderate tricuspid regurgitation (TR) with an estimated systolic pulmonary artery pressure (sPAP) of 50 mmHg and a mildly increased mean gradient on bioprothesic aortic valve (26 mmHg). Past medical history The patient had a medical history significant for arterial hypertension, hyperlipidemia, diabetes mellitus, permanent atrial fibrillation and HCV–related liver disease. She received double surgical aortic valve replacement in 2015 and 2019, the second procedure was complicated by intraoperatory stretching of mitral anterior leaflet and atrioventricular block treated with implantation of bicameral PMK. In the following weeks, the patient was admitted to hospital for exposure of the PMK generator pocket associated to catether cultures positivity for S. Aureus oxacilline–resistant, thus undergoing to device removal and positioning of a new PMK. Investigations The cardio–thoracic auscultation revealed a bilateral basal reduction of vesicular breath sounds, an apical sweet systolic murmur (suggestive of MR) and a systolic small aortic murmur best heard at the second intercostal space. The transthoracic echocardiography showed a blood flow apparently originating from interatrial septum heading towards the free left atrial wall. The Transoesophageal Echocardiography (TEE) with bubble test ruled out any interatrial communication. The 3D TEE acquisitions clarified that the shunt arose from the left ventricular outflow tract (LVOT), thus allowing the diagnosis of fistula between the LVOT and the left atrium. Follow–up and conclusions The patient underwent a procedure of percutaneous closure of the fistula. One month after this intervention, the patient presented to our department for the cardiological follow–up. We noticed that the closure had been successful with no left residual shunts and a reduction of the transprothesic mean aortic gradient (18 mmHg). This case report highlights the importance of the 3D echocardiography in order to settle uncertain diagnostics whereas the 2D echocardiography alone is not sufficient. Nevertheless, the diagnostic challenge that remains open is to understand whether the etiology of the fistula is iatrogenic or post–infectious.

Acoustic-Based Deep Learning Architectures for Lung Disease Diagnosis: A Comprehensive Overview.

Lung auscultation has long been used as a valuable medical tool to assess respiratory health and has gotten a lot of attention in recent years, notably following the coronavirus epidemic. Lung auscultation is used to assess a patient's respiratory role. Modern technological progress has guided the growth of computer-based respiratory speech investigation, a valuable tool for detecting lung abnormalities and diseases. Several recent studies have reviewed this important area, but none are specific to lung sound-based analysis with deep-learning architectures from one side and the provided information was not sufficient for a good understanding of these techniques. This paper gives a complete review of prior deep-learning-based architecture lung sound analysis. Deep-learning-based respiratory sound analysis articles are found in different databases including the Plos, ACM Digital Libraries, Elsevier, PubMed, MDPI, Springer, and IEEE. More than 160 publications were extracted and submitted for assessment. This paper discusses different trends in pathology/lung sound, the common features for classifying lung sounds, several considered datasets, classification methods, signal processing techniques, and some statistical information based on previous study findings. Finally, the assessment concludes with a discussion of potential future improvements and recommendations.

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

Accumulated bispectral image-based respiratory sound signal classification using deep learning.

The COVID-19 virus is increasingly crucial to human health since new variants appear frequently. Detection of COVID-19 through respiratory sound has been an important area of research. This study analyzes respiratory sounds using novel accumulated bi-spectral features. The principal domain bispectrum is used for computing accumulated bispectrum. The resulting magnitude bispectrum is used in forming the bispectral image. In this work, a convolutional neural network (CNN) and ResNet-50 algorithms are designed to classify respiratory sounds as either COVID-19 or healthy. The performance of the proposed method is compared with the state-of-the-art methods. The proposed CNN-based method achieves the highest accuracy of 87.68% for shallow breath sounds, and ResNet-50 achieves the highest accuracy of 87.62% for deep breath sounds. Similarly, proposed methods gives the improved performance for other respiratory sounds.

Diagnostic clues for the identification of pediatric foreign body aspirations and consideration of novel imaging techniques

ObjectiveTo better understand the diagnosis of foreign body aspiration by elucidating key components of its clinical presentation. MethodsThis is a retrospective cohort study of pediatric patients with suspected foreign body aspiration. We collected information regarding demographics, history, symptoms, physical exam, imaging, and operative findings for rigid bronchoscopies. An evaluation of these findings for an association with foreign body aspiration and the overall diagnostic algorithm was performed. Results518 pediatric patients presented with 75.2 % presenting within one day of the inciting event. Identified history findings included wheeze (OR: 5.83, p < 0.0001) and multiple encounters (OR: 5.46, p < 0.0001). Oxygen saturation was lower in patients with foreign body aspiration (97.3 %, p < 0.001). Identified physical exam findings included wheeze (OR: 7.38, p < 0.001) and asymmetric breath sounds (OR: 5.48, p < 0.0001). The sensitivity and specificity of history findings was 86.7 % and 23.1 %, physical exam was 60.8 % and 88.4 %, and chest radiographs was 45.3 % and 88.0 %. 25 CT scans were performed with a sensitivity and specificity of 100 % and 85.7 %. Combining two components of the diagnostic algorithm yielded a high sensitivity and moderate specificity; the best combination was the history and physical exam. 186 rigid bronchoscopies were performed with 65.6 % positive for foreign body aspiration. ConclusionAccurate diagnosis of foreign body aspiration requires careful history taking and examination. Low-dose CT should be included in the diagnostic algorithm. The combination of any two components of the diagnostic algorithm is the most accurate for foreign body aspiration.

Fish bone associated pneumomediastinum in a 15-year-old adolescent male.

A 15-year-old boy who had been experiencing chest tightness and odynophagia for 6 h came to the emergency department. He swallowed a salmon bone 12 h earlier. The vital signs at triage did not indicate tachypnea or desaturation. The patient appeared well on physical examination. He had a patent oropharynx and crepitus felt over his right supraclavicular area. His respiratory pattern was smooth, and his breath sounds were symmetric and clear bilaterally. A chest radiograph revealed lucent streaks of gas outlining mediastinal structures with an extension of subcutaneous emphysema and pneumopericardium (Fig. 1a).

Electrocardiographic Waveform Abnormalities in Patients With Structural Heart Disease

Scenario: This 12-lead electrocardiogram (ECG) was obtained in a 72-year-old man arriving in the emergency department with shortness of breath and dizziness. Prior medical history includes myocardial infarction (MI), heart failure (HF), chronic obstructive pulmonary disease (COPD), diabetes (type 2), and paroxysmal atrial fibrillation. Current prescribed medications include a β-blocker, aspirin, angiotensin-converting enzyme inhibitor, furosemide, and diltiazem. His blood pressure was 98/50 mm Hg, respiratory rate 24/min, and oxygen saturation as measured by pulse oximetry (Spo2) was 92% on 3 L of oxygen. He was most comfortable sitting up with his arms on the bedside table, and said he felt better after 40 mg of furosemide was administered intravenously.Sinus rhythm with premature atrial complexes (PACs), possible right and left atrial enlargement, prior inferior wall MI (q waves in leads III and aVF), incomplete left intraventricular conduction defect (fQRS waves), left ventricular hypertrophy, and ST-segment and T-wave abnormalities may suggest anterolateral ischemia.Although the underlying rhythm is irregular, suggesting atrial fibrillation, P waves are visible before every QRS complex; thus, this is sinus rhythm with frequent PACs. PACs are not uncommon in patients with structural heart disease and COPD, like this one. The pause after the PACs is a normal physiologic response and represents a compensatory pause associated with PACs. The ECG criterion for right atrial enlargement is a P-wave amplitude greater than 2.5 mm in leads II, III, and aVF (so-called P pulmonale) and can be seen with COPD. Left atrial enlargement is due to pressure or volume overload of the left atrium and can be assessed in V1 (biphasic P waves with negative terminal portion >40 ms long and >1 mm deep). Biatrial enlargement is consistent with this patient’s medical history (MI, HF, and left ventricular hypertrophy); however, ECG is not the reference standard method, so the diagnosis should be confirmed by echocardiography. The T-wave inversion and ST-segment depression most likely represent a “strain” pattern seen with left ventricular hypertrophy, but acute myocardial ischemia should be ruled out given the patient’s prior MI.Immediate management includes addressing the acute respiratory distress and low blood pressure, with HF exacerbation a likely source. This patient’s symptoms were somewhat relieved after the intravenous furosemide, which supports this diagnosis. Checking a venous blood sample for brain natriuretic peptide (BNP) to assess for HF, troponin to rule out myocardial ischemia, and electrolyte levels would help. A chest radiograph would be useful, as might arterial blood gas analysis, given his elevated rate of breathing and the 92% Spo2 with 3 L of oxygen. Findings on physical examination, especially lung and heart sounds, peripheral edema, and daily weight should be evaluated. Ultimately, this patient’s BNP level was 3400 ng/mL, which corroborates HF, and his troponin was negative for myocardial ischemia. He was discharged home 3 days later.

Sleep Apnea Detection by Tracheal Motion and Sound, and Oximetry via Application of Deep Neural Networks.

Sleep apnea (SA) is highly prevalent, but under diagnosed due to inaccessibility of sleep testing. To address this issue, portable devices for home sleep testing have been developed to provide convenience with reasonable accuracy in diagnosing SA. The objective of this study was to test the validity a novel portable sleep apnea testing device, BresoDX1, in SA diagnosis, via recording of trachea-sternal motion, tracheal sound and oximetry. Adults with a suspected sleep disorder were recruited to undergo in-laboratory polysomnography (PSG) and a simultaneous BresoDX1 recording. Data from BresoDX1 were collected and features related to breathing sounds, body motions and oximetry were extracted. A deep neural network (DNN) model was trained with 61-second epochs of the extracted features to detect apneas and hypopneas from which an apnea-hypopnea index (AHI) was calculated. The AHI estimated by BresoDX1 (AHIbreso) was compared to the AHI determined from PSG (AHIPSG) and the sensitivity and specificity of SA diagnosis were assessed at an AHIPSG ≥ 15. Two-hundred thirty-three participants (mean ± SD) 50 ± 16 years of age, with BMI of 29.8 ± 6.6 and AHI of 19.5 ± 22.7, were included. There was a strong relationship between AHIbreso and AHIPSG (r = 0.91, p < 0.001). SA detection for an AHIPSG ≥ 15 was highly sensitive (90.0%) and specific (85.9%). We conclude that the DNN model we developed via recording and analyses of trachea-sternal motion and sound along with oximetry provides an accurate estimate of the AHIPSG with high sensitivity and specificity. Therefore, BresoDX1 is a simple, convenient and accurate portable SA monitoring device that could be employed for home SA testing in the future.

Inborn Error of Immunity Presenting with Salmonella Pericarditis and Pericardial Effusion

Salmonella infections typically occur in disorders of innate immunity with impairment in phagocyte function and/or impaired signaling in the IL-12/interferon (IFN)-gamma axis. Pericarditis/pericardial effusion has previously been reported as a rare complication of Salmonella infection.An 8-year-old, previously healthy, fully immunized Hispanic female presented with 4 days of fever and 5 days of pain in her chest, abdomen, and left shoulder. Her medical and family history was unremarkable. Chest radiograph revealed cardiomegaly, and a transthoracic echocardiogram identified a large pericardial effusion. Labs showed leukocytosis (15 K/uL), neutrophilia (ANC 12.77 K/uL), elevated CRP (287 mg/dL), and elevated BNP (607 pg/mL). Exam showed mild distress, gallop on cardiac auscultation, diminished left breath sounds, cool extremities, and 1+ peripheral pulses. She underwent pericardiocentesis, and the fluid culture was positive for Salmonella alachua. She was treated with IV ceftriaxone for 8 days, then transitioned to trimethoprim/sulfamethoxazole (TMP/SMX) to complete a 30-day total antibiotic course.Inpatient immunologic evaluation revealed T cell lymphopenia (TCL) with decreased naïve CD4+ and CD8+ T cells. Increased CD4+ and CD8+ effector memory T cells (Tem) were also observed, along with increased CD8+ TEMRA, and certain subsets of CD4+/CD8+ central memory T cells lacking CD62L. HIV testing and neutrophil oxidative burst were negative. Given her significant T cell lymphopenia, TMP/SMX prophylaxis was continued after the treatment course, and fluconazole prophylaxis was initiated due to endemic coccidiomycosis.A targeted 429-gene panel for inborn errors of immunity revealed a heterozygous missense variant of uncertain significance in PIK3CD, = c.1013G>A, p.Arg338Gln. This variant is not in gnomAD for Hispanics and is present in 0.0009% of non-Finnish Europeans. Gain-of-function (GoF) PIK3CD mutations cause a combined immunodeficiency, with increased risk of infection from encapsulated organisms, such as salmonella. However, the patient’s immunophenotype is not consistent with GoF PIK3CD mutation. She had normal transitional B cells, lack of increased senescent T cells, and absence of lymphoproliferation.TCL is likely an immunologic risk factor for Salmonella pericarditis with pericardial effusion. Though the PI3CKD variant does not appear to be pathogenic, additional functional testing for this variant is in progress.

Abstract #1412763: Hustle for The Muscle: A Rare Case of Non-traumatic Rhabdomyolysis Secondary to Thyrotoxicosis

Rhabdomyolysis (RM) is a rare potentially life-threatening condition characterized by breakdown of striated muscle which can lead to progressive acute kidney injury. Common etiologies include trauma, infection, drugs, or surgery. Rarely, endocrinopathies including thyrotoxicosis have been associated with RM. Here, we present a case of non-traumatic and non-exertional RM secondary to thyrotoxicosis. A 50-year-old man recently diagnosed with Graves’ disease a month ago presented to the hospital with fever for 3 days. A week prior to presentation, thyroid function tests (TFT) showed normalizing FT4 (1.13ng/dL) and T3 (112ng/dL) levels with low TSH (<0.005ulU/m) which prompted his endocrinologist to decrease the methimazole dose from 20mg thrice daily to 10mg once daily. His fever was associated with nausea, vomiting, chills, and non-bloody diarrhea. On admission, the following vital signs were obtained: temperature 101.6F, blood pressure 140/85 mmHg, pulse rate 108 bpm, respiratory rate 16 bpm, and oxygen saturation 99% on room air. He was found to be alert, conscious, and coherent. Physical examination was notable for exophthalmos, absence of jugular vein distention, diffusely enlarged non-tender thyroid, clear breath sounds, no jaundice, and no peripheral edema. His calculated Burch-Wartofsky score was 40. Laboratory evaluation showed leukocytosis, elevated FT4 (4.01ng/dL), elevated FT3 (5.87pg/mL), and low TSH (<0.015uIU/mL) levels. He was also found to have acute kidney injury with creatinine of 1.33 mg/dL associated with hemoglobinuria. Further testing revealed a significantly elevated creatinine kinase (CK) at 98,760 U/L. On imaging, chest x-ray and CT scan were consistent with left lower lobe pneumonia. During the hospital stay, the patient was treated with methimazole 20mg daily together with antibiotics, aggressive hydration, and propranolol. His kidney function initially rapidly worsened but eventually improved as the CK levels normalized. FT4 levels were monitored and it gradually trended back to normal after 5 days. He was discharged stable and advised to follow up with his endocrinologist after a week. This is a case of a thyrotoxicosis complicated by rapidly worsening renal function. With a markedly elevated CK level accompanied by hemoglobinuria, absence of trauma or physical exertion, patient developed a concomitant non-traumatic RM. Non-traumatic RM is a rare complication of thyrotoxicosis and/or hyperthyroidism. Due to increased metabolic rate and energy consumption, rapid depletion of myocyte energy storage and substrates escalates, ultimately leading to necrosis. Based on literatures, only four cases were reported regarding the similar condition. In these cases, CK levels reported was less than 10 times the normal range. Our patient is unique that without history of trauma or exertion, a non-traumatic, non-drug-induced rhabdomyolysis transpired in the setting of acute thyrotoxicosis, with CK levels almost 580 times the upper normal limit. Management wise, aggressive hydration remains the treatment of choice to provide adequate renal perfusion and prevent renal damage.

Performance evaluation of the smartphone-based AI cough monitoring app - Hyfe Cough Tracker against solicited respiratory sounds

Performance evaluation of the smartphone-based AI cough monitoring app - Hyfe Cough Tracker against solicited respiratory sounds

Simultaneous Bilateral Spontaneous Pneumothorax in an HIV Positive Tuberculosis Patient

Background: Even though tuberculosis has been linked to pneumothorax for a long time and has caused significant morbidity and mortality in some patients, it has been the topic of few publications and analyses, thus very little study has been done to evaluate and review on this matter.Case: In this article, we reported a 39-year-old male, presented to the ER with breathlessness for the last 3 days accompanied by increased sputum productivity. The patient had an active pulmonary tuberculosis taht was under treatment, as well as HIV. Physical examination showed low chest expansion, weakened breathing sounds on both lungs, and the use of accessory breathing muscles. The chest X-ray showed bilateral pneumothorax. The patient underwent emergency chest decompression with a 16-gauge needle on both sides, followed by the insertion of an IPC and chest tube. The patient's breathlessness got significantly better, and after 35 days, the IPC was removed.Discussion: Pneumothorax is a frequent complication in Tuberculosis with HIV, with a prevalence of 6.8% compared to 0.95-1.4% in Tuberculosis without HIV. The progression of breathlessness in bilateral pneumothorax on HIV positive Tuberculosis patient is slower, up to 3 days since onset, compared to pneumothorax occured in other etiologies. Secondary pneumothorax usually occurs after extensive destruction of the lungs, leaving a little functionality and lower cardiopulmonary reserve, thus requiring prompt evaluation and more aggresive lifesaving treatment.Conclusion: Based on this case, bilateral pneumothorax found in HIV-associated TB patients comes with an insidious onset but warrants immediate evaluation and aggressive treatment or surgery if necessary.

Preventing unrecognized esophageal intubation in the emergency department.

Tracheal intubation is a commonly performed procedure on critically ill patients in the emergency department. It is associated with many serious complications, one of the most dangerous being unrecognized esophageal intubation, which can result in anoxic brain injury, cardiac arrest, or death. It is the responsibility of the emergency physician to do everything possible to avoid this devastating complication. Preventing unrecognized esophageal intubation requires a two-pronged approach. First, the inadvertent placement of intended tracheal tubes into the esophagus must be reduced as much as is humanly possible. This can be achieved with the routine use of video laryngoscopes for emergency department intubations. Numerous studies have demonstrated that use of video laryngoscopes can significantly reduce the occurrence of esophageal intubation, presumablyby providing an improved view of the larynx. Second, if an esophageal intubation inadvertently occurs, it must be rapidly identified and appropriately addressed. The cornerstone of rapid identification is the use of continuous waveform capnography to detect exhaled carbon dioxide. Capnography has been shown to be the most accurate method to determine tube placement after intubation. Standard clinical examinations, for example, auscultation of breath sounds, visualization of chest excursion, and observation of condensation in the tube, have all been demonstrated in studies to be unreliable and thus should not be used to exclude esophageal intubation. Recently, the Project for Universal Management of Airways, an international collaborative of airway experts from anesthesiology, critical care and emergency medicine, published evidence-based guidelines to specifically address the issue of preventing unrecognized esophageal intubation. These guidelines, which have received endorsement from several prominent airway societies, including the Society for Airway Management, the Difficult Airway Society, and the European Airway Management Society, will be briefly discussed in this review.

Scalable serial hardware architecture of multilayer perceptron neural network for automatic wheezing detection

This paper proposes a serial hardware architecture of a multilayer perceptron (MLP) neural network for real-time wheezing detection in respiratory sounds. As an established classification tool, the MLP has proven its ability to identify complex patterns within respiratory sounds. The proposed fully serial architecture uses a single calculation unit, independently of the number of neurons in the MLP network. It is also a fully scalable architecture that permits to implement MLP networks, of any size, easily and efficiently without modifying the design or wiring. The proposed serial architecture has been implemented on a low-cost and power-efficient field programmable gate array (FPGA) chip using a high-level programming tool. The respiratory sounds classification rates are evaluated in terms of sensitivity, specificity, performance, and accuracy. The proposed serial architecture reaches the same classification performances as the parallel one, but it presents the main advantage of using much fewer hardware resources.

Review on the Advancements of Stethoscope Types in Chest Auscultation.

Stethoscopes were originally designed for the auscultation of a patient's chest for the purpose of listening to lung and heart sounds. These aid medical professionals in their evaluation of the cardiovascular and respiratory systems, as well as in other applications, such as listening to bowel sounds in the gastrointestinal system or assessing for vascular bruits. Listening to internal sounds during chest auscultation aids healthcare professionals in their diagnosis of a patient's illness. We performed an extensive literature review on the currently available stethoscopes specifically for use in chest auscultation. By understanding the specificities of the different stethoscopes available, healthcare professionals can capitalize on their beneficial features, to serve both clinical and educational purposes. Additionally, the ongoing COVID-19 pandemic has also highlighted the unique application of digital stethoscopes for telemedicine. Thus, the advantages and limitations of digital stethoscopes are reviewed. Lastly, to determine the best available stethoscopes in the healthcare industry, this literature review explored various benchmarking methods that can be used to identify areas of improvement for existing stethoscopes, as well as to serve as a standard for the general comparison of stethoscope quality. The potential use of digital stethoscopes for telemedicine amidst ongoing technological advancements in wearable sensors and modern communication facilities such as 5G are also discussed. Based on the ongoing trend in advancements in wearable technology, telemedicine, and smart hospitals, understanding the benefits and limitations of the digital stethoscope is an essential consideration for potential equipment deployment, especially during the height of the current COVID-19 pandemic and, more importantly, for future healthcare crises when human and resource mobility is restricted.

A low power respiratory sound diagnosis processing unit based on LSTM for wearable health monitoring.

Early prevention and detection of respiratory disease have attracted extensive attention due to the significant increase in people with respiratory issues. Restraining the spread and relieving the symptom of this disease is essential. However, the traditional auscultation technique demands a high-level medical skill, and computational respiratory sound analysis approaches have limits in constrained locations. A wearable auscultation device is required to real-time monitor respiratory system health and provides consumers with ease. In this work, we developed a Respiratory Sound Diagnosis Processor Unit (RSDPU) based on Long Short-Term Memory (LSTM). The experiments and analyses were conducted on feature extraction and abnormality diagnosis algorithm of respiratory sound, and Dynamic Normalization Mapping (DNM) was proposed to better utilize quantization bits and lessen overfitting. Furthermore, we developed the hardware implementation of RSDPU including a corrector to filter diagnosis noise. We presented the FPGA prototyping verification and layout of the RSDPU for power and area evaluation. Experimental results demonstrated that RSDPU achieved an abnormality diagnosis accuracy of 81.4 %, an area of 1.57×1.76 mm under the SMIC 130 nm process, and power consumption of 381.8 μW, which met the requirements of high accuracy, low power consumption, and small area.

Classification of pulmonary sounds through deep learning for the diagnosis of interstitial lung diseases secondary to connective tissue diseases

Early diagnosis of interstitial lung diseases secondary to connective tissue diseases is critical for the treatment and survival of patients. The symptoms, like dry cough and dyspnea, appear late in the clinical history and are not specific, moreover, the current approach to confirm the diagnosis of interstitial lung disease is based on high resolution computer tomography. However, computer tomography involves x-ray exposure for patients and high costs for the Health System, therefore preventing its use for a massive screening campaign in elder people.In this work we investigate the use of deep learning techniques for the classification of pulmonary sounds acquired from patients affected by connective tissue diseases. The novelty of the work consists of a suitably developed pre-processing pipeline for de-noising and data augmentation. The proposed approach is combined with a clinical study where the ground truth is represented by high resolution computer tomography. Various convolutional neural networks have provided an overall accuracy as high as 91% in the classification of lung sounds and have led to an overwhelming diagnostic accuracy in the range 91%−93%. Modern high performance hardware for edge computing can easily support our algorithms. This solution paves the way for a vast screening campaign of interstitial lung diseases in elder people on the basis of a non-invasive and cheap thoracic auscultation.

Late-Onset Pneumothorax and Bullous Disease in Post-COVID-19 Pneumonia with Severe ARDS

Background: Patients with COVID-19 pneumonia may develop bullae that can rupture into spontaneous pneumothorax (SP) during the diagnosis and treatment, which can be a predictor of a poor prognosis. However, late-onset bullous disease and SP after recovering from COVID-19 are unusual.Case: A 48-year-old male presented with sudden shortness of breath accompanied by chest pain. Three weeks earlier, the patient had finished treatment in the COVID-19 isolation room for 20 days with a diagnosis of COVID-19 pneumonia with severe ARDS. Physical examination demonstrates tachypnea, desaturation, decreased vesicular breath sounds, and hyperresonance percussion on the right hemithorax; without rhonchi or wheezing. Chest X-ray and CT scan showed a right pneumothorax with infected subpleural giant bullae in right perihilar, right lung collapse, minimal right-to-left lung herniation and post-covid pulmonary fibrosis. Culture and sensitivity examination of the pleural fluid showed the growth of Providencia stuartile. A chest tube was placed for the management of the pneumothorax. Subsequently, according to the results of culture and antibiotic sensitivity test, the patient was treated using piperacilin/tazobactam and amikacin. The patient showed clinical and radiological improvement following 41 days of treatment and could be managed as an outpatient.Conclusion: Our patient had infected giant bullae and pneumothorax post COVID-19 pneumonia and severe ARDS. The patient did not undergo a bullectomy in consideration of the post-COVID-19 condition and was managed conservatively using adequate chest tube and antibiotics. Patient responded well to therapy, showed clinical improvement and could be discharged.

Utilizing CNN-LSTM techniques for the enhancement of medical systems

COVID-19 is one of the most chronic and serious infections of recent years due to its worldwide spread. Determining who was genuinely affected when the disease spreads more widely is challenging. More than 60% of affected individuals report having a dry cough. In many recent studies, diagnostic models were developed using coughing and other breathing sounds. With the development of technology, body sounds are now collected using digital techniques for respiratory and cardiovascular tests. Early research on identifying COVID-19 utilizing speech and diagnosing signs yielded encouraging findings. The gathering of extensive, multi-group, airborne acoustical sound data is used in the developed framework to conduct an efficient assessment to test for COVID-19. An effective classification model is created to assess COVID-19 utilizing deep learning methods. The MIT-Covid-19 dataset is used as the input, and the Weiner filter is used for pre-processing. Following feature extraction done by Mel-frequency cepstral coefficients, the classification is performed using the CNN-LSTM approach. The study compared the performance of the developed framework with other techniques such as CNN, GRU, and LSTM. Study results revealed that CNN-LSTM outperformed other existing approaches by 97.7%.

Delayed Bochdalek Diaphragmatic Hernia Appearance and Coincidence with Pneumonia in One-Year-Old Baby: A Case Report

Background: Congenital diaphragmatic hernia (CDH) is a developmental defect in the diaphragm leading to protrusion of abdominal contents into the thoracic cavity. The incidence rates showed that this disease happened to one in 2,200-3,000 births. This study aimed to describe a case of delayed Boschdalek diaphragmatic hernia and coincidence with pneumonia in a one-year-old baby. &#x0D; Case Presentation: A 12-month-old girl came to the emergency room of Dr. M. Djamil General Hospital with a chief complaint of breathlessness for 2 days before admission to the hospital. She had difficulty gaining weight, only about 200 grams per month. The symptoms are breathlessness, cyanosis, asymmetry of lung sounds, change in the position of the heart sound, and scaphoid abdomen. The chest X-ray showed the opacity loops, which are fluid-filled, suggestive left diaphragmatic hernia. &#x0D; Conclusion: Pneumonia-like symptoms and signs could be an initial or coincidence with delayed presentation of Bochdalek hernia diaphragmatic.