Author: medicalviseAdmin

Oct 14

Should You Start Wearing Hearing Aids? Experts Note the Benefits

Hearing loss, a condition often associated with aging, is undergoing a significant transformation in both perception and management. Traditionally, hearing aids were considered the remedy for those already afflicted by hearing impairment. However, recent developments in hearing aid technology and a growing awareness of hearing health have prompted a paradigm shift. It is now increasingly recognized that hearing aids, when used as a preventative measure, can benefit individuals of all ages. In this comprehensive exploration, we delve into the changing landscape of hearing loss, emphasizing the importance of early intervention and hearing protection. The Rising Prevalence of Hearing Loss Hearing loss is no longer confined to the elderly. Recent statistics from the Centers for Disease Control and Prevention (CDC) reveal that approximately 13% of adults over the age of 18 experience some degree of hearing loss. This shift in demographics has ignited discussions about the necessity of early intervention and prevention strategies. The historical stereotype of hearing aids being reserved for seniors is giving way to a more inclusive approach. Shannon M. Van Hyfte, AuD, CCC-A, a clinical associate professor at Purdue University, notes a rising trend of people in their 40s, 50s, and 60s seeking hearing aids. Traditionally, her patients seeking hearing aids were primarily in their 70s. This shift underscores a fundamental change in the perception of hearing health, as younger generations increasingly recognize the importance of proactive hearing care. Normalizing Hearing Aids: A Trifecta of Factors The growing acceptance of hearing aids can be attributed to a convergence of several factors that have come together over the past five years. Firstly, there has been a noticeable increase in awareness regarding hearing loss, driven by extensive educational campaigns and heightened media coverage. This heightened awareness has made people more conscious of the prevalence and impact of hearing impairment. Secondly, there has been a significant shift in people’s attitudes towards proactive hearing protection. Many individuals now recognize the importance of safeguarding their hearing from the very beginning, understanding that hearing is a crucial sensory function that enhances their quality of life. Thirdly, the introduction of over-the-counter (OTC) hearing aids has marked a significant milestone in improving accessibility and reducing the stigma associated with hearing assistance. OTC hearing aids have made it easier for individuals to take control of their hearing health. Moreover, the COVID-19 pandemic has played a unique role in raising awareness about hearing loss. The widespread use of masks during the pandemic has heightened people’s sensitivity to hearing difficulties, as they realized the significant role visual cues play in effective communication. This newfound awareness has contributed to a broader acceptance of hearing aids as essential tools for maintaining clear and effective communication in various situations. As a result, the perception of hearing aids has evolved, and they are now seen as valuable devices that can enhance one’s overall quality of life. Using Hearing Aids as a Preventative Measure A prevalent misconception that needs addressing is the belief that early use of hearing aids might contribute to a decline in natural hearing abilities. This notion has been debunked by experts such as Timothy Hullar, MD, who holds the position of Professor of Otolaryngology at the Oregon Health and Science University School of Medicine. Dr. Hullar emphasizes that wearing hearing aids at an earlier stage in life does not harm one’s hearing; instead, it assists the brain in processing auditory information more effectively. It’s important to recognize that hearing damage primarily results from exposure to excessive noise that reaches the delicate ear drum. Modern hearing aids come equipped with sophisticated noise-limiting mechanisms that prevent harmful levels of noise from being amplified, thereby acting as a protective barrier for your hearing health. Moreover, many of these hearing aids are Bluetooth-enabled, allowing users to seamlessly connect them to various devices like TVs and phones. This integration enhances the clarity of audio content, potentially reducing the need for higher volume levels and, consequently, lowering the risk of further hearing damage. While the introduction of over-the-counter (OTC) hearing aids provides a more accessible option for those beginning to experience hearing difficulties, Van Hyfte stresses the importance of seeking personalized hearing solutions following a professional hearing assessment. The one-size-fits-all approach of OTC hearing aids may not adequately address an individual’s unique hearing needs, and consulting with a hearing healthcare professional remains crucial for achieving the best hearing outcomes. Protection is Paramount Whether one chooses to use hearing aids or not, prioritizing hearing protection remains fundamental to maintaining optimal hearing health. Dr. Hullar underscores the vital importance of recognizing situations that could potentially jeopardize one’s hearing. Prolonged exposure to noisy environments, often indicated by ringing in the ears afterward, can lead to irreversible hearing damage. Fortunately, there are effective preventive measures such as noise-canceling earmuffs and earplugs that can significantly safeguard hearing in these loud settings. It’s essential not to underestimate the cumulative damage that can occur from everyday noise exposure, like listening to music through non-noise-canceling headphones. Noise-canceling headphones offer a safer alternative by reducing the need for higher volume levels. A practical guideline, as suggested by Van Hyfte, is to assess whether you need to raise your voice to be heard when conversing with someone at arm’s length. If you do, the environment is likely too loud, and protective measures become essential. In conclusion, the perception of hearing aids is evolving, and their utility is no longer confined to older adults. Early intervention with hearing aids can be a proactive step to enhance communication and preserve hearing health. Nevertheless, it’s crucial to emphasize that hearing protection should always be a top priority in preventing hearing loss. This underscores the age-old wisdom that prevention is invariably more effective than seeking a cure when it comes to safeguarding our precious sense of hearing.

Oct 14

What Is Parosmia?

The human sense of smell, often underappreciated, plays a pivotal role in our daily lives. From savoring delicious meals to detecting potential hazards, our olfactory system enriches our experiences and keeps us safe. However, there are times when this intricate sensory mechanism goes awry, leading to a perplexing condition known as parosmia. In this comprehensive exploration, we will delve into the intriguing world of parosmia, shedding light on its causes, manifestations, diagnosis, and potential treatments. Parosmia, an unusual term, denotes a profound alteration in the perception of smell. For those afflicted, scents once familiar and comforting may undergo a dramatic transformation, becoming oddly distorted. What was once pleasing may now elicit aversion, and what was once repulsive may suddenly appear appealing. The olfactory landscape becomes a realm of uncertainty and peculiarity. The impact of parosmia can extend beyond the realm of mere discomfort; it may culminate in nausea and even vomiting, rendering the experience profoundly distressing. The Curious Case of Distorted Food Scents Certain scents have emerged as frequent protagonists in the parosmic narrative. Among these, the aromas of coffee, meat, and onions have taken center stage. Previously beloved, these scents now adopt disconcerting personas. Coffee, once a fragrant morning ritual, may be tainted by the perception of a “burnt” aroma. Similarly, the wholesome scent of meat and the pungent allure of onions may undergo a nightmarish transformation, resembling the unpleasant descriptor of “rotten.” However, the paradox of parosmia extends to scents traditionally associated with repulsion. Fecal odors, universally regarded as foul, may now be bereft of their noxious qualities, even evoking a peculiar positivity or going entirely undetected. Beyond the realm of distorted scent perception, parosmia often introduces a disconcerting companion: a profound alteration in taste perception. Food, once a source of delight, may lose its luster as flavors become muted, contributing to a shift in dietary preferences. Unraveling the Origins: What Causes Parosmia? The olfactory journey begins within the intricate nerve tissues nestled within our nasal passages. As we inhale, scent molecules embark on a voyage, brushing past specialized receptors in the nose. This interaction triggers a signal to the brain, manifesting as a recognizable or unfamiliar scent. Parosmia, however, emerges when these olfactory nerves suffer damage due to various underlying factors. While the origins of parosmia are not always apparent, several common culprits have been identified: 1. Viral or Bacterial Infections: Infections represent a prevalent trigger for parosmia. Pathogens such as viruses and bacteria can inflict damage on the olfactory system, leaving an altered sense of smell in their wake. 2. Smoking: A habit with multifaceted health implications, smoking can impact the olfactory senses, leading to the development of parosmia. 3. Head Injury: Traumatic incidents that result in head injuries may disrupt the olfactory system, subsequently giving rise to parosmia. 4. Chemical Exposure: Exposure to various chemicals, including ammonia, solvents, or nickel, can inflict damage on olfactory nerves and foster parosmia. 5. Medications: Certain medications, encompassing antihistamines, antibiotics, and selective serotonin reuptake inhibitors (SSRIs), have been associated with parosmia development. 6. Chemotherapy and Radiation: Cancer treatments, such as chemotherapy and radiation, may inadvertently impact the olfactory system, leading to parosmia. 7. Neurological Conditions: Underlying neurological conditions, including Alzheimer’s and Parkinson’s diseases, can influence the sense of smell and contribute to parosmia. 8. Nasal Growths: The presence of growths or obstructions within the nasal cavity can interfere with olfactory function and result in parosmia. COVID-19, a contemporary example, has garnered attention for its potential to induce parosmia. In the context of COVID-19, parosmia may manifest either independently or subsequent to a complete loss of smell. Paradoxically, parosmia, though unsettling, can signify a positive step in recovery, suggesting the gradual return of the sense of smell, particularly in individuals who initially experienced a complete anosmia (loss of smell). Navigating the Temporal Landscape: How Long Does Parosmia Last? The duration of a parosmic episode is an enigmatic aspect of this condition. The timeline of recovery hinges on the intricate process of nerve repair within the olfactory system. This duration varies substantially among individuals, influenced by the underlying cause of parosmia. While parosmia is typically not a permanent condition, it can endure for varying periods, spanning from weeks to years. For instance, parosmia stemming from COVID-19 has exhibited durations of 14 to 16 months. Deciphering the Diagnosis of Parosmia The task of diagnosing parosmia falls within the domain of otolaryngologists, specialists renowned for their expertise in the ear, nose, and throat. These medical professionals, often referred to as ENTs, are equipped to navigate the labyrinthine intricacies of parosmia. The diagnostic journey commences with a meticulous evaluation encompassing examinations of the ears, nose, and throat, coupled with a comprehensive review of the patient’s medical history. This review may encompass inquiries into potential exposure to toxic chemicals or histories of injuries to unveil the root cause. Crucially, an ENT administers a smell test, a pivotal component of the diagnostic process. Such assessments may entail the utilization of a specialized scratch-and-sniff booklet, enabling patients to identify various scents featured within its pages. An inability to accurately identify scents may serve as a diagnostic indicator of parosmia. Unveiling the Path to Recovery: How Can Parosmia be Treated? The trajectory of parosmia may entail spontaneous recovery, while in other cases, intervention becomes a necessity. Various treatment modalities exist to potentially restore normal scent perception, contingent on the underlying cause of parosmia. These include: 1. Removal of Environmental Triggers: Identifying and eliminating environmental triggers, such as ceasing smoking or minimizing exposure to specific chemicals, represents a crucial step in parosmia management. 2. Surgical Interventions: Surgical procedures may be recommended to address obstructions within the nasal passages that impair olfactory nerve function. Polyps or tumors that impede scent perception can be surgically removed, facilitating recovery. 3. Medications: Medications may play a pivotal role in parosmia management, particularly when infections or other health conditions contribute to scent distortion. Treatment options may encompass corticosteroids, antibiotics, or nerve medications like gabapentin. In some instances, modifying the medication type or dosage

Oct 14

What Is Dysphagia?

Dysphagia, a medical term signifying difficulty in swallowing, is a condition that can significantly impact an individual’s daily life. This condition manifests as a struggle to swallow various substances, including food, liquids, and saliva, which can lead to inadequate calorie and fluid intake, potentially affecting overall health. Although dysphagia can affect individuals of all ages, it is most prevalent among older adults, with as many as one in six reporting difficulty swallowing. The root causes of dysphagia are diverse, ranging from neurological and muscular disorders to injuries of the brain and spinal cord, adverse effects of medications, and structural abnormalities in the mouth or esophagus. Depending on the underlying cause and its severity, treatment options may include dietary adjustments, swallowing therapy, medication, or even surgical interventions. Dysphagia can be categorized into two primary types, each stemming from different locations and causes: 1. Oropharyngeal Dysphagia: 2. Esophageal Dysphagia: Symptoms of dysphagia encompass more than just difficulty swallowing; they include: Dysphagia’s complexity arises from the intricacy of swallowing, which involves the coordinated efforts of approximately 50 muscles and nerves. Disruptions in any of these elements or structures within the mouth and throat can contribute to the onset of dysphagia. Causes of Oropharyngeal Dysphagia Causes of Esophageal Dysphagia Several risk factors are associated with an increased likelihood of developing dysphagia, including aging, underlying health conditions (GERD, neurological or muscular disorders), and the use of specific medications like calcium channel blockers, antidepressants, antispasmodics, and narcotic pain relievers. Diagnosing dysphagia typically involves a comprehensive assessment. Healthcare providers review medical histories, inquire about symptoms, and conduct physical examinations, focusing on the mouth and throat for signs of swelling or structural issues. Additional diagnostic tests may be ordered, such as: Treatment strategies for dysphagia vary based on the underlying cause: 1. Lifestyle and Dietary Modifications: 2. Swallowing Therapy: 3. Medications: 4. Surgery: Preventing dysphagia is challenging since it often results from underlying conditions. However, adopting a few habits can minimize occasional swallowing difficulties and reduce complications: Left untreated, dysphagia can lead to various complications, including malnutrition, aspiration pneumonia, unintended weight loss, food impaction, and social and emotional impacts like depression and anxiety. To mitigate these risks, individuals with dysphagia should adhere to their treatment plans and make necessary lifestyle and dietary adjustments. Seeking support from healthcare providers, speech therapists, and loved ones can aid in managing the physical and emotional challenges that often accompany dysphagia.

Oct 14

Study reveals molecular mechanism behind new DOT1L-related disorder

A study from the laboratory of Dr. Hugo J. Bellen, a distinguished service professor at Baylor College of Medicine and a principal investigator at the Jan and Dan Duncan Neurological Research Institute (Duncan NRI) at Texas Children’s Hospital, has discovered that gain-of-function variants in the DOT1L gene cause a new disorder. Further studies revealed that the majority of the symptoms in the patients were surprisingly due to an increase in the enzymatic activity of a histone methylase encoded by this gene. This study was published in the American Journal of Human Genetics. This project originated when the Undiagnosed Diseases Network, SickKids Complex Care Genomics project in Canada headed by Dr. Gregory Costain, and a search of the GeneMatcher database identified nine unrelated individuals with intellectual disability, developmental delays, distinctive facial features, and other overlapping features carried variants in DOT1L gene. We found this intriguing because this gene had not been previously associated with a genetic or neurological disorder.” Dr. Hugo J. Bellen, distinguished service professor at Baylor College of Medicine DOT1L is an evolutionarily conserved gene found in a broad range of species from yeast to man. It encodes an enzyme – lysine methyltransferase (KMT) – that adds methyl groups to a specific amino acid (lysine 79 aka K79) present on a particular histone (H3). Methylation of specific lysine residues within histones acts as a switch to turn ‘on’ or ‘off’ the expression of target genes. So far, only partial loss-of-function DOT1L variants in around half of KMT-encoding genes (16 of 34) have been shown to cause dominant human developmental disorders. “We found the variants in DOT1L cause a dominant disorder through a gain-of-function mechanism, which is different from other KMTs,” said Dr. Bellen. Although DOT1L is involved in several fundamental cellular processes, and its misregulation has been implicated in cancer, prior to this study it was not clear how variants in the DOT1L gene cause a congenital disorder. So, Dr. Zelha Nil, the first author and postdoctoral associate in the Bellen lab, turned to fruit flies to address that question. DOT1L and its fruit fly version, grappa (gpp) have similar protein sequences and are also likely to have overlapping functions. Most disease-causing human variants in DOT1L are located in its enzymatic domain. Furthermore, gpp is expressed in a large subset of neurons and some glial cells. The team generated a fly gpp mutant, which grew slowly and died in larval stages. Using these mutant flies and flies in which gpp RNA was knocked down, they found compelling evidence that gpp is essential for the survival of the flies and required for proper development as well as the development and function of the fly nervous system, and for H3K79 methylation. Related Stories “We attempted to suppress the lethality of gpp mutant flies by expressing the human DOT1L gene in flies,” Dr. Zelha Nil said. “To our surprise, expressing normal or variant versions of the human DOT1L gene in tissues where it occurs naturally in flies was not sufficient for gpp mutants who had lost both copies of the gene to survive. Surprisingly, flies with a partial loss of gpp that expressed the human DOT1L variants were less viable and had more profound morphological defects than the normal DOT1L expressing flies, suggesting the human DOT1L expression in flies was toxic.” Consistent with this observation, gpp mutant flies and cultured cells expressing variant versions of human DOT1L exhibited significantly higher levels of H3K79 methylation than normal DOT1L, suggesting that elevated levels of methylation are the likely molecular cause of the symptoms seen in the patients. “Based on our studies in flies, it appears that the variants result in excess enzymatic activity of DOT1Lin these patients,” Dr. Bellen said. “While additional studies are needed to unravel the exact mechanism of disease pathogenesis, our study suggests that reducing DOT1L activity is a viable therapeutic strategy that can be developed in the future to treat this new genetic condition.” Others involved in the study were Ashish R. Deshwar, Yan Huang, Scott Barish, Xi Zhang, Sanaa Choufani, Polona Le Quesne Stabej, Ian Hayes, Patrick Yap, Chad Haldeman-Englert, Carolyn Wilson, Trine Prescott, Kristian Tveten, Arve Vøllo, Devon Haynes, Patricia G. Wheeler, Jessica Zon, Cheryl Cytrynbaum, Rebekah Jobling, Moira Blyth, Siddharth Banka, Alexandra Afenjar, Cyril Mignot, Florence Robin-Renaldo, Boris Keren, Oguz Kanca, Xiao Mao, Daniel J. Wegner, Kathleen Sisco, Marwan Shinawi, Undiagnosed Disease Network, Michael F. Wangler, Rosanna Weksberg, Shinya Yamamoto, and Gregory Costain. Their institutional affiliations can be found here. The study was funded by a grant from the NIH Commonfund to the Model Organisms Screening Center of the UDN, the Office of Research Infrastructure Programs of the NIH, the Huffington Foundation, the Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital to H.J.B, the Baylor College of Medicine IDDRC, through a grant from the Eunice Kennedy Shriver National Institute of Child Health and Human Development for use of the Microscopy Core facilities, NIHR Manchester Biomedical Research Centre and Canadian Institutes of Health Research (CIHR) grants. Texas Children’s Hospital Journal reference: Nil, Z., et al. (2023). Rare de novo gain-of-function missense variants in DOT1L are associated with developmental delay and congenital anomalies. American Journal of Human Genetics. doi.org/10.1016/j.ajhg.2023.09.009.

Oct 14

What Is Lymphatic Drainage Massage—And How Do You Do It?

Lymphatic drainage massage, also known as manual lymphatic drainage (MLD), is a gentle yet powerful technique designed to facilitate the movement of lymph, a vital fluid that plays a crucial role in our body’s immune system. This therapeutic approach employs manual pressure to stimulate lymphatic vessels, encouraging the natural flow of lymph and addressing conditions like lymphedema, a swelling of the limbs caused by lymphatic system dysfunction. In this comprehensive guide, we will delve into the workings of the lymphatic system, the techniques involved in lymphatic drainage massage, its potential benefits, and the associated risks. Understanding the Lymphatic System The lymphatic system is a complex network of thin tubes, known as lymph vessels, which intricately connect to hundreds of lymph nodes throughout the body. Lymph, or lymphatic fluid, is the clear fluid left behind once blood has circulated through our tissues and organs. This lymph travels through the lymph vessels, ultimately reaching lymph nodes. These lymph nodes act as filters, capturing harmful bacteria, abnormal cells, and waste. Excess lymph is then reabsorbed into the bloodstream via lymph vessels. However, when conditions such as lymphedema or lymph node damage disrupt the normal functioning of the lymphatic system, lymph fluid accumulates, leading to swelling, most commonly in the arms and legs. If left untreated, lymphedema can result in severe, potentially life-threatening infections. Performing a Lymphatic Drainage Massage Certified lymphedema therapists (CLTs) are typically trained professionals who perform lymphatic drainage massage. This category of specialists includes physical therapists, occupational therapists, nurses, and massage therapists. When diagnosed with lymphedema, healthcare providers often refer patients to CLTs for manual lymphatic drainage sessions. Additionally, CLTs can teach individuals how to conduct lymphatic massages at home. A lymphatic drainage massage, whether performed by a professional or at home, comprises two primary phases: 1. Clearing: Involves the movement of lymph through the body’s tissues. 2. Reabsorption: Focuses on directing lymph toward lymph nodes for processing. The process of a lymphatic drainage massage session typically follows these steps: Lymphatic drainage massage often constitutes a part of complete decongestive therapy (CDT), a comprehensive approach to reducing lymphedema and associated swelling. CDT encompasses several elements, including wearing compression bandages or sleeves, performing specific exercises to promote lymphatic drainage, and addressing skin conditions caused by swelling. Benefits of Lymphatic Drainage Massage Lymphatic drainage massage offers a range of potential benefits, including: Risks Associated with Lymphatic Drainage Massage Lymphatic drainage massage is generally considered safe and low-risk. However, certain health conditions may contraindicate this therapy. Individuals with the following conditions should avoid lymphatic drainage massage: Lymphatic drainage massage should not cause pain or bruising, as it employs extremely gentle pressure and is distinct from deep tissue massage. If any discomfort arises during the massage, it is crucial to promptly inform the CLT or healthcare provider for appropriate adjustments. Conclusion Lymphatic drainage massage, a therapeutic technique rooted in gentle and precise movements, has emerged as a valuable approach to addressing a range of health concerns, notably the management of lymphedema-related swelling. Ongoing research endeavors are shedding light on its potential benefits for an array of conditions, underscoring its versatility within the realm of complementary and alternative therapies. One of the key strengths of lymphatic drainage massage lies in its safety and non-invasiveness, rendering it a suitable choice for individuals seeking relief from various health issues. However, it’s essential to note that specific contraindications exist, and individuals with certain medical conditions should exercise caution when considering this therapy. As our knowledge of the lymphatic system’s intricacies continues to deepen, lymphatic drainage massage may very well evolve further as a valuable tool in holistic healthcare. The potential applications of this therapy extend beyond mere relaxation, positioning it as an increasingly promising avenue for enhancing overall health and well-being. As research advances, we can anticipate more precise guidelines and a broader spectrum of therapeutic possibilities associated with lymphatic drainage massage.

Oct 14

Woman finds front porch, door covered in blood after North Nashville murder

NASHVILLE, Tenn. (WSMV) – A man is dead after a shooting in North Nashville on Thursday night. Metro Nashville Police said 44-year-old Terran Frazier was shot twice and ran up to homes along Phillips Street and 14th Avenue North trying to get help as he was bleeding out. Danielle was home alone when she heard Frazier breathing heavily on her front porch and then he started banging on her door. Her dog started barking and she thought the man was trying to break into her house. Instead of looking out the peephole, she called 911 and hid inside her home. “Scared and worried, and just not really knowing what was going on,” Danielle said. “Being alone, I just really didn’t want to be by the door in case it wasn’t someone who was hurt, and it was someone trying to break into the house. I had two thoughts. If this person is hurt, they need help. If they are not hurt and are trying to break in, I need help.” After about five minutes of knocking, Danielle said it went quiet and police showed up a short time later. When she opened the door, she found a giant pool of blood on her porch and across her door. “It just broke my heart opening the door and seeing the handprints and just not being able to help,” Danielle said. “Feeling guilty for not being able to help in the moment.” Officers found Frazier a short distance away collapsed on the sidewalk in front of another house. He was taken to the hospital where he died. READ MORE: Police identify victim in fatal North Nashville shooting Sean Heggem had just gotten into town on a weekend trip from California with his wife and friends after the shooting happened. Their rideshare driver pulled up to their vacation rental along Phillips Street when they saw what they thought was a homeless man stumbling down the road. Heggem said Frazier came over to their car and started banging on the window asking for help. They quickly noticed he was shot and called 911 too. “Kind of shocking to see that,” Heggem said. “Having another human being affectively bleeding out. You show up and it’s like, It’s a heck of a welcoming to Nashville.’” There was a trail of blood down the sidewalk in front of their vacation rental. Police blocked off the entire area and searched for evidence. Danielle hired a cleaning crew to take care of the blood that covered her front porch as she tried to figure out why Frazier spent so much time at her house. She thinks he came there because it was very close to where the shooting happened. “I don’t know if it’s because we leave the porch light on or because the house is yellow,” Danielle said. Metro Nashville Police said detectives are working active leads searching for who shot Frazier. Copyright 2023 WSMV. All rights reserved.

Oct 14

VIDEO: A call to action to improve health for all

October 14, 2023 2 min watch Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio BOSTON — During the Edward H. Kass Lecture at IDWeek, Louise Ivers, MD, MPH, FIDSA, FASTMH, addressed the crowd about infections, inequalities and the hope that everyone can contribute to improving health for all. “My talk was really focused on how there are massive inequities in the world as it relates to infectious diseases but also many other diseases, too,” Ivers, faculty director of the Center for Global Health at the Harvard Global Health Institute, told Healio. “The chief cause of deaths — six out of the top 10 causes of deaths — in low-income countries are due to infectious diseases. Even though we have the diagnostics and therapeutics and the vaccines to prevent many of those diseases, we still see these huge disparities.” Ivers called on everyone in the infectious disease field to “stand up and take bold action to change the status quo.” Published by: Read more about Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio IDWeek

Oct 14

Lumped-parameter model as a non-invasive tool to assess coronary blood flow in AAOCA patients

Abstract Anomalous aortic origin of the coronary artery (AAOCA) is a rare disease associated with sudden cardiac death, usually related to physical effort in young people. Clinical routine tests fail to assess the ischemic risk, calling for novel diagnostic approaches. To this aim, some recent studies propose to assess the coronary blood flow (CBF) in AAOCA by computational simulations but they are limited by the use of data from literature retrieved from normal subjects. To overcome this limitation and obtain a reliable assessment of CBF, we developed a fully patient-specific lumped parameter model based on clinical imaging and in-vivo data retrieved during invasive coronary functional assessment of subjects with AAOCA. In such a way, we can estimate the CBF replicating the two hemodynamic conditions in-vivo analyzed. The model can mimic the effective coronary behavior with high accuracy and could be a valuable tool to quantify CBF in AAOCA. It represents the first step required to move toward a future clinical application with the aim of improving patient care. The study was registered at Clinicaltrial.gov with (ID: NCT05159791, date 2021-12-16). Introduction Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital disease with several anatomical variants, such as the origin from the opposite sinus of Valsalva1. In some cases, an intramural tract may also be present in the most proximal zone, whereby part of the coronary artery (CA) is enclosed within the aortic wall2. Although AAOCA is often asymptomatic3, it is related to sudden cardiac death (SCD) or ischemic events, usually associated with high-intensity physical activity, especially in young athletes4,5. Risk estimation based on pre-operative tests is critical to AAOCA diagnosis and management because traditional clinical exams, such as stress tests, usually fail to recognize adverse events related to ischemia and SCD6. Moreover, the mechanisms linking the anatomical abnormality with the risk of SCD are still unclear. In this context, computational simulations have contributed to clarifying some mechanical and physiological aspects linked to ischemia since they can simulate extreme stress conditions, which are not traditionally evaluated in diagnostic tests. Previous biomechanical studies using structural finite element analysis7 have shown a limited expansion of the anomalous CA under increasing pressure, particularly within the intramural tract8. Furthermore, 3D computational fluid dynamics (CFD)9,10,11, and 3D fluid-structure interaction (FSI) simulations12,13,14were performed to assess coronary blood flow (CBF) and coronary perfusion in AAOCA. However, it is worth noting that these hemodynamic investigations were based on the analytically computed coronary resistance based on physiological hypotheses for healthy subjects, probably poorly reliable in AAOCA patients. In addition, the results were not validated due to the lack of in-vivo CBF measurements. Finally, the available patient-specific simulations deal with a small cohort of patients, not attaining general conclusions for the AAOCA population. Therefore we aimed to develop a patient-specific lumped-parameter model (LPM) fed by anatomical, hemodynamic, and functional data retrieved from AAOCA patients that could accurately estimate CBF at two different conditions. We validate the model accuracy in replicating in-vivo conditions by comparing the results with in-vivo measurements. Methods This study was approved by the IRCCS Policlinico San Raffaele ethical committee (record number 19/int/2021, approved 09/06/2021). All patients enrolled in the study at IRCCS Policlinico San Donato gave written informed consent. All methods were carried out in accordance with relevant guidelines and regulations. In particular, the present work includes data retrieved from 19 AAOCA patients, recruited for the NECESSARY study (GR-2019-12369116, Italian Ministry of Health) between November 2021 and May 2023 (ClinicalTrials.gov Identifier: NCT05159791). The study population consists of patients with AAOCA, subjects with other congenital cardiac abnormalities or contraindications to performing the required diagnostic tests were excluded. All patients recruited did not present atherosclerotic plaque and calcification or diagnosis of severe stenosis. The study involved the collection of clinical data and coronary anomaly classification. Details regarding the acquisition, post-processing, and use of such data are described in the following sections, and a schematic representation is also shown in Fig. 1. Figure 1 Schematic representation of the lumped-parameter model and input data used to calibrate it. On the top, IVUS registration was illustrated in the yellow rectangle: a slice was selected to extract the geometrical measurements related to the more proximal tract (OSTIUM) of a right CA. In the green rectangle, the points selected along the centerline of the 3D model of the aortic root were shown; they were used to measure aortic geometrical parameters. The 3D model was reconstructed through the segmentation of CT. In the middle, signals recorded during the coronary functional assessment were shown in the blue rectangle. For both rest and hyperemic conditions CBF (Q) and CA resistance (R) were assessed. Aortic pressure wave signal was used to extract patient values to rescale both aortic and left ventricular pressure waves taken from literature14. On the bottom, the purple rectangle enclosed a schematic representation of the lumped-parameter model. Each arterial segment was represented by the circuit highlighted in gray, aortic BCs were defined by the Windkessel circuit colored in orange, and the BC of the CAs were defined in the blue dashed rectangle. Full size image Clinical data acquisition Computed tomography (CT) scans were performed on a dual-source CT system (Somatom Flash; Siemens Medical Solutions, Forchheim, Germany). CT parameters were 0.6 mm slice thickness, 0.3 mm increment, kernel Bv38, and Admire with strength 2. For patients that had performed the CT in other centers (n(=)16), a maximum slice thickness of 0.6 mm was required. Cardiac magnetic resonance imaging (MRI) examinations were performed with a 1.5 T unit (Magnetom AERA, Siemens Medical Solutions, Forchheim, Germany) with 45 mT/m gradient power, using twelve channel surface phased-array coil placed over the thorax and with the patient in supine position. Image acquisition was gated by the electrocardiogram (ECG) signal and respiration control (breath-holding) to produce a CINE sequence throughout all the systole and diastole and to avoid cardiac and respiratory artifacts. An MRI study included a complete set of short-axis (from base to apex) CINE images, using an ECG-triggered steady-state free precession pulse sequence acquired with the following