StethAid: A Digital Auscultation Platform for Pediatrics.

(1) Background: Mastery of auscultation can be challenging for many healthcare providers. Artificial intelligence (AI)-powered digital support is emerging as an aid to assist with the interpretation of auscultated sounds. A few AI-augmented digital stethoscopes exist but none are dedicated to pediatrics. Our goal was to develop a digital auscultation platform for pediatric medicine. (2) Methods: We developed StethAid-a digital platform for artificial intelligence-assisted auscultation and telehealth in pediatrics-that consists of a wireless digital stethoscope, mobile applications, customized patient-provider portals, and deep learning algorithms. To validate the StethAid platform, we characterized our stethoscope and used the platform in two clinical applications: (1) Still's murmur identification and (2) wheeze detection. The platform has been deployed in four children's medical centers to build the first and largest pediatric cardiopulmonary datasets, to our knowledge. We have trained and tested deep-learning models using these datasets. (3) Results: The frequency response of the StethAid stethoscope was comparable to those of the commercially available Eko Core, Thinklabs One, and Littman 3200 stethoscopes. The labels provided by our expert physician offline were in concordance with the labels of providers at the bedside using their acoustic stethoscopes for 79.3% of lungs cases and 98.3% of heart cases. Our deep learning algorithms achieved high sensitivity and specificity for both Still's murmur identification (sensitivity of 91.9% and specificity of 92.6%) and wheeze detection (sensitivity of 83.7% and specificity of 84.4%). (4) Conclusions: Our team has created a technically and clinically validated pediatric digital AI-enabled auscultation platform. Use of our platform could improve efficacy and efficiency of clinical care for pediatric patients, reduce parental anxiety, and result in cost savings.

Multisystem Inflammatory Syndrome in Children during the COVID-19 Pandemic: A Case Report on Managing the Hyperinflammation.

The novel human coronavirus of 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has quickly swept throughout the entire world. As the ongoing pandemic has spread, recent studies have described children presenting with a multisystem inflammatory disorder sharing the features of Kawasaki disease (KD) and toxic shock syndrome, now named Multisystem Inflammatory Syndrome in Children (MIS-C). These cases report a similar phenotype of prolonged fever, multisystem involvement, and biomarkers demonstrating marked hyperinflammation that occurs temporally in association with local community spread of SARS-CoV-2. Herein, we describe the presentation, clinical characteristics, and management of an 11-year-old boy with prolonged fever, strikingly elevated inflammatory markers, and profound, early coronary artery aneurysm consistent with a hyperinflammatory, multisystem disease temporally associated with coronavirus disease 2019. We highlight our multidisciplinary team's management with intravenous immunoglobulin, methylprednisolone, and an interleukin-1 receptor antagonist, anakinra, as a strategy to manage this multisystem, hyperinflammatory disease process.

Multisystem Inflammatory Syndrome in Children (MIS-C), a Post-viral Myocarditis and Systemic Vasculitis-A Critical Review of Its Pathogenesis and Treatment.

MIS-C is a newly defined post-viral myocarditis and inflammatory vasculopathy of children following COVID-19 infection. This review summarizes the literature on diagnosis, parameters of disease severity, and current treatment regimens. The clinical perspective was analyzed in light of potential immunopathogenesis and compared to other post-infectious and inflammatory illnesses of children affecting the heart. In this paradigm, the evidence supports the importance of endothelial injury and activation of the IL-1 pathway as a common determinant among MIS-C, Kawasaki disease, and Acute Rheumatic fever.

Clinical impact of a novel ambulatory rhythm monitor in children.

Traditional ambulatory rhythm monitoring in children can have limitations, including cumbersome leads and limited monitoring duration. The ZioTM patch ambulatory monitor is a small, adhesive, single-channel rhythm monitor that can be worn up to 2 weeks. In this study, we present a retrospective cross-sectional analysis of the ZioTM monitor's impact in clinical practice. Patients aged 0-18 years were included in the study. A total of 373 studies were reviewed in 332 patients. In all, 28.4% had structural heart disease, and 16.9% had a prior surgical, catheterisation, or electrophysiology procedure. The most common indication for monitoring was tachypalpitations (41%); 93.5% of these patients had their symptoms captured during the study window. The median duration of monitoring was 5 days. Overall, 5.1% of ZioTM monitoring identified arrhythmias requiring new intervention or increased medical management; 4.0% identified arrhythmias requiring increased clinical surveillance. The remainder had either normal-variant rhythm or minor rhythm findings requiring no change in management. For patients with tachypalpitations and no structural heart disease, 13.2% had pathological arrhythmias, but 72.9% had normal-variant rhythm during symptoms, allowing discharge from cardiology care. Notably, for patients with findings requiring intervention or increased surveillance, 56% had findings first identified beyond 24 hours, and only 62% were patient-triggered findings. Seven studies (1.9%) were associated with complications or patient intolerance. The ZioTM is a well-tolerated device that may improve what traditional Holter and event monitoring would detect in paediatric cardiology patients. This study shows a positive clinical impact on the management of patients within a paediatric cardiology practice.

Preoperative right ventricle voltage mapping in Ebstein's anomaly: can we make the late arrhythmogenic mortality following the cone procedure zero?

A young woman with Epstein's anomaly had a large endocardial scar in the atrialised ventricular myocardium. In patients with significant preoperative ventricular scarring, more information is needed to help appropriately manage the risk of ventricular arrhythmias and sudden death.

Managing a "New" Murmur in Healthy Children and Teens.

An asymptomatic child with a murmur can be challenging practice management conundrum. Some providers refer all patients with a "new" murmur to a cardiologist, likely resulting in excessive resource utilization and parental anxiety. This study examines whether the prevalence of significant cardiac pathology differs in asymptomatic patients aged 2 to 18 years who were referred for a murmur that was "new" versus those referred for a murmur that was known to exist and followed conservatively during the previous 2 years. Of 473 patients meeting inclusion criteria, 33/473 (7.0%) were diagnosed with cardiac pathology, with 21/357 (5.9%) occurring among "new" murmur referrals and 12/116 (10.3%) occurring among "known" murmur referrals. Notably, 34/357 (9.5%) patients referred for a "new" murmur had no murmur present when assessed by the cardiologist. This study suggests that asymptomatic children with a "new" murmur may be conservatively managed. This may lessen health care resource utilization rates and overall parental anxiety.

Non-adiabatic molecular dynamics investigation of photoionization state formation and lifetime in Mn²âº-doped ZnO quantum dots.

The unique electronic structure of Mn(2+)-doped ZnO quantum dots gives rise to photoionization states that can be used to manipulate the magnetic state of the material and to generate zero-reabsorption luminescence. Fast formation and long non-radiative decay of this photoionization state is a necessary requirement for these important applications. In this work, surface hopping based non-adiabatic molecular dynamics are used to demonstrate the fast formation of a metal-to-ligand charge transfer state in a Mn(2+)-doped ZnO quantum dot. The formation occurs on an ultrafast timescale and is aided by the large density of states and significant mixing of the dopant Mn(2+) 3dt2 levels with the valence-band levels of the ZnO lattice. The non-radiative lifetime of the photoionization states is also investigated.

Ferromagnetism in p-Type Manganese-Doped Zinc Oxide Quantum Dots.

The magnetic exchange interactions between paramagnetic Mn(2+) dopants in the presence of a N(2-) p-type defect in zinc oxide quantum dots are studied using density functional theory. Spin-dependent delocalization of the N(2-) 2p acceptor level among the nearest-neighbor Mn(2+) dopants is observed. The calculations show that parallel Mn(2+) spin alignment is favored upon the formation of a nitrogen-bridged Mn-Mn dimer. Although the effect is short-ranged, the observed magnitude of stabilization of the ferromagnetic alignment of nearest-neighbor Mn(2+) spins arises from p-d exchange and suggests p-type Mn(2+)-doped ZnO quantum dots as excellent candidates for exhibiting room-temperature ferromagnetism. Analytical expressions are derived and supported by density functional theory calculations that show that the N(2-) concentration has a stronger influence on the magnetic splitting compared with that of the Mn(2+) concentration.

Transition State Search Using a Guided Direct Inversion in the Iterative Subspace Method.

A transition state optimization method using a guided energy-represented direct inversion in the iterative subspace (gEn-DIIS) algorithm is introduced and compared with the quasi-Newton rational function optimization (RFO) method. A hybrid technique that employs a combination of RFO and guided DIIS methods at various stages of convergence is presented. A set of test molecules is optimized for comparison using the hybrid method with gEn-DIIS and the traditional RFO methods. The gEn-DIIS method presented here exhibits fast optimization and is shown to be advantageous for difficult optimizations where the reaction path is flat.

Migration of an abandoned pacemaker generator into the pouch of Douglas in a child with complex congenital heart disease.

A young girl with complex congenital heart disease underwent Fontan procedure and multiple pacemaker revisions, including abandonment of an intraabdominal pacemaker generator at age eight. She presented two years later with constipation and abdominal twitching. Radiographs, pacemaker interrogation, and laparoscopy confirmed dislocation of the abandoned generator and intraperitoneal migration into the pouch of Douglas. The device was removed surgically without incident.

Nicotine replacement therapy use among a cohort of smokers.

BACKGROUND: Nicotine replacement therapy (NRT) has been shown to assist smokers to stop smoking in randomized trials, but little is known about its use in the general population. METHODS: As part of ongoing follow-up of a cohort established in 1989 in Washington County, Maryland, a questionnaire mailed in 1998 included a question about ever use of the two NRT products then available over-the-counter: nicotine gum and nicotine patch. This study reports on ever use of NRT among the 1,954 respondents who were current smokers in 1989 and subsequently provided data on NRT use and smoking habits in 1998. RESULTS: Overall, 36% of the smokers in 1989 had ever used NRT in some form by 1998; 10% used gum only, 16% used patch only, and 10% used both gum and patch. Number of cigarettes smoked per day at baseline was the strongest predictor of ever use of NRT (ptrend < 0.001). Compared to nonusers, ever users of NRT were more likely to have more than 12 years of education (p < 0.01) and be 25-54 years old at baseline (p < 0.001). When NRT use was assessed in relation to smoking status in 1998, 30% of NRT ever users compared to 39% of nonusers had quit smoking (p < 0.01). Among persistent smokers, the likelihood of reducing the number of cigarettes smoked per day was similar between NRT ever users (40%) and nonusers (41%). CONCLUSIONS: Ever use of NRT was common among this cohort of smokers, particularly among heavy smokers. Compared to nonusers, ever users of NRT were less likely to have stopped smoking and equally likely to cut down the frequency of smoking. This may reflect a tendency to turn to NRT for help after failing to quit by other means.