Wearable Lung Patch Uses Deep Learning to Detect Asthma and COPD: Study

Wheezing, a high-pitched whistling sound, is a common indicator of chronic respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), due to inflammation and swelling of the airways.

In 2023, nearly nine percent of all adults in the United States had asthma, and COPD remains a leading cause of death in the U.S.

Early detection and management of asthma and COPD is critical. Globally, asthma and COPD are under-diagnosed (20-70% for asthma and up to 81% for COPD). In addition, the U.S. Centers for Disease Control and Prevention estimate that asthma is uncontrolled in 50% of children and 62% of adults, resulting in frequent and intense episodes that can lead to increased emergency department visits and missed school days and workdays.

While digital stethoscopes are an improvement over traditional stethoscopes, they pick up airborne noise, which interferes with wheeze detection.

An advanced technological solution is needed that could be used as a screening tool in the clinic and for remote patient monitoring, which would enable physicians to intervene early.

Researchers at the Georgia Institute of Technology have developed a deep learning (DL) model that they paired with a wearable patch equipped with a highly sensitive sensor that can automatically detect wheezing sounds. The deep learning model has the potential to classify respiratory diseases, which could speed up their diagnosis and treatment. The results of the pilot patient study were published in BioSensors.

What physicians do now

Physicians typically use digital stethoscopes (the gold standard) to listen to and record abnormal lung sounds like wheezing and crackles, which are clicking and rattling sounds that can accompany wheezing. They listen to each recording to determine whether the sounds are a wheeze, crackle, or normal breath sounds.

The standard method of labeling data as a wheeze involves a computerized time-frequency analysis that uses a checklist (i.e. an algorithm) to determine whether a wheeze meets certain requirements. However, the algorithm is not comprehensive, leading to some cases being missed, according to the researchers.

A new wearable patch

BioSensorsThe researchers designed a new wearable device to address these shortcomings. The patch has a microchip sensor, which unlike traditional microphones in digital stethoscopes, can detect tiny vibrations at a high sensitivity with minimal distortion.

“Our sensitive patch has many advantages over traditional wheeze detection, which struggles to detect all variations of wheezes and crackles, which can lead to misdiagnosis,” said Farrokh Ayazi, Ph.D., senior study author and a professor in electrical and computer engineering at Georgia Institute of Technology.

“By incorporating data from these wheeze variations into a deep learning model, and by taking advantage of the sensor’s ability to eliminate ambient sounds, our detection method led to higher accuracy, sensitivity [it correctly identified the presence of a wheeze], and specificity [it correctly identified absence of a wheeze] compared to the standard time-frequency approach,” he said.

Developing a deep learning model

Lung sound recordings were taken from 52 patients in an outpatient asthma clinic or a hospital setting. Twenty-five of the 52 patients were obese, which can interfere with the quality of traditional lung recordings.

To obtain the recordings, patients wore the miniature patch on up to nine different sites on their chest. Data was recorded from each location while the patient took deep breaths for 30 seconds at a time. For comparison, physicians also obtained lung recordings using digital stethoscopes on the same chest sites.

Physicians listened to the recordings from both sources and labeled whether they heard wheezing or not in a blinded experiment and later provided a diagnosis after the clinical evaluation. The labeled wheezes were highly aligned between the digital stethoscope and the wearable patch, even for obese patients. The clinician-labeled data were incorporated into the deep learning model so it could distinguish wheezing sounds from normal breath sounds.

Comparing the DL model to standard methods

The researchers compared the deep learning model to the standard time-frequency method for wheeze detection when paired with the patch or the digital stethoscope.

The deep learning model paired with the patch consistently had the highest average accuracy, sensitivity, and specificity rates for wheeze detection: 95%, 96%, and 93% respectively. This combination outperformed the time-frequency method paired with the patch or the digital stethoscope, and the deep learning method paired with the digital stethoscope.

The study had a few limitations: The only automated component is the deep learning model, which limited its application to clinical settings, and the findings need to be further validated in a larger and more diverse patient sample.

Looking Ahead

The researchers envision two potential uses for the wearable patch framework. One is for short-term screening in a clinic and the other is for long-term home monitoring. The researchers are developing a wireless version of the patch for remote monitoring that could transmit data to a patient’s physician to facilitate treatment.

“This noninvasive and rapid analysis of a patient’s respiratory and lung status could improve early detection of respiratory conditions, especially in patients with obesity who are at higher risk of asthma and COPD,” said Tiffani Lash, Ph.D., program director in NIBIB’s Division of Health Informatics Technologies (Informatics).

“Technology solutions such as this have the potential to improve health outcomes and lessen the burden on people with these chronic diseases,” she said. 

Reference:

Sang B, Wen H, Junek G, Neveu W, Di Francesco L, Ayazi F. An Accelerometer-Based Wearable Patch for Robust Respiratory Rate and Wheeze Detection Using Deep Learning. Biosensors (Basel). 2024 Feb 22;14(3):118. doi: 10.3390/bios14030118.. 

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Denosumab Linked to Higher Risk of Severe Hypocalcemia in Older Female Dialysis-Dependent Patients: JAMA

USA: A target trial emulation study revealed that denosumab significantly increased the risk of hypocalcemia requiring emergency treatment compared to bisphosphonates in women with osteoporosis and chronic kidney disease (CKD). The risk of emergently treated hypocalcemia with denosumab was found to rise with the progression of CKD, especially in patients with CKD-mineral and bone disorders.

“Treatment with denosumab in older female dialysis-dependent patients was linked to a statistically and clinically significant higher risk of severe hypocalcemia compared to oral bisphosphonates,” the researchers wrote in the Journal of the American Medical Association (JAMA). 

The researchers note that dialysis-dependent patients face high morbidity rates from fractures, yet there is limited evidence on the best treatment strategies. Chronic kidney disease–mineral and bone disorder is almost ubiquitous in these patients, making the diagnosis and management of skeletal fragility more challenging. Considering this, Steven T. Bird, US Food and Drug Administration, Silver Spring, Maryland, and colleagues aimed to assess the incidence and relative risk of severe hypocalcemia in dialysis-dependent patients treated for osteoporosis with denosumab compared to oral bisphosphonates.

For this purpose, the researchers conducted a retrospective cohort study of female dialysis-dependent Medicare patients aged 65 or older who began treatment with denosumab or oral bisphosphonates between 2013 and 2020. Clinical data, including monthly serum calcium levels, were obtained through the Consolidated Renal Operations in a Web-Enabled Network database.

Severe hypocalcemia was defined as serum calcium below 7.5 mg/dL or emergent care for hypocalcemia. Very severe hypocalcemia was also assessed. The study calculated cumulative incidence and risk differences during the first 12 weeks of treatment.

Based on the study, the researchers reported the following findings:

  • In the unweighted cohorts, 607 of 1523 denosumab-treated patients and 23 of 1281 oral bisphosphonate-treated patients developed severe hypocalcemia.
  • The 12-week weighted cumulative incidence of severe hypocalcemia was 41.1% for denosumab versus 2.0% for oral bisphosphonates (weighted risk difference, 39.1%; weighted risk ratio, 20.7).
  • The 12-week weighted cumulative incidence of very severe hypocalcemia was higher with denosumab (10.9%) versus oral bisphosphonates (0.4%) (weighted risk difference, 10.5%; weighted risk ratio, 26.4)

This study found a higher incidence of severe and very severe hypocalcemia following denosumab initiation compared to oral bisphosphonates in dialysis-dependent patients treated for osteoporosis. The risk was particularly elevated in patients with mild to moderate hypocalcemia at baseline.

“Due to the challenges of diagnosing underlying bone pathophysiology in this population, the high risk associated with denosumab, and the complex monitoring and treatment strategies required for severe hypocalcemia, denosumab should be used cautiously, with careful patient selection and frequent monitoring,” the researchers concluded.

Reference:

Bird ST, Smith ER, Gelperin K, et al. Severe Hypocalcemia With Denosumab Among Older Female Dialysis-Dependent Patients. JAMA. 2024;331(6):491–499. doi:10.1001/jama.2023.28239

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Two-medication combo pills successfully lowers blood pressure among adults in India: Study

Medication variations that combined two of three different blood pressure-lowering medications into a single pill worked equally well in reducing blood pressure and were safe among adults in India, according to late-breaking science presented today at the American Heart Association’s Scientific Sessions 2024. 

High blood pressure is a significant global health burden, affecting 300 million people in India and nearly half of all U.S. adults. Current international hypertension guidelines suggest combining various blood pressure-lowering medications; however, existing research has not determined which combinations offer the best outcomes in South Asian people.

“South Asians account for one-fourth of the world’s population, and India, in particular, has an enormous burden of hypertension, leading to high stroke and cardiovascular disease risk,” said lead TOPSPIN study author Dorairaj Prabhakaran, M.D., D.M., M.Sc., a cardiologist and executive director of the Centre for Chronic Disease Control in New Delhi, India. “Optimal blood pressure management is essential to lower the cardiovascular complications of high blood pressure.”

This clinical trial, called TOPSPIN, was initiated to specifically address high blood pressure among people of South Asian descent. In the multicenter trial in India, almost 2,000 adults were randomly assigned to one of three treatment groups-to receive a single pill, often called a polypill, that included a combination of two commonly recommended medications to lower blood pressure.

Each of the three participant groups was prescribed a pill combining two of these medications: a renin-angiotensin enzyme inhibitor (perindopril), which prevent the arteries from narrowing; calcium channel blockers (amlodipine), which prevent calcium from entering the heart muscle and arteries; and/or diuretics (indapamide), which help the body excrete excess salt and water. The primary outcome measured 24-hour ambulatory systolic blood pressure after taking the combo pill daily for six months.

After six months, the analysis found:

  • All three combinations of the medications lowered blood pressure equally, with about 70% of the study participants achieving blood pressure below 140/90 mm Hg.
  • More than 40% of participants achieved the stricter blood pressure target of less than 130/80 mm Hg.
  • The absolute reduction in blood pressure for participants in all groups was approximately 30/14 mm Hg lower when measured in a physician’s office and 14/8 mm Hg lower when measured using 24-hour ambulatory blood pressure monitors.
  • Each of the three combination pills had an excellent safety profile: less than 3% of all study participants reported ending treatment due to adverse effects from the medications. This confirms a high level of tolerability for the medications examined in the trial.
  • The participants in the amlodipine-perindopril combination group also experienced a decrease in fasting blood sugar levels after six months.

“It was reassuring to find that all three dual combinations of commonly recommended blood pressure medications were equally effective,” Prabhakaran said. “This is contrary to the findings observed in the CREOLE study that examined the impact of a similar group of three high blood pressure combination pills in Black adults with hypertension in Sub-Saharan Africa and found amlodipine-based combinations to be superior.”

He noted that this study’s strength was that it included participants across India, a wide age range (30-79 years), both men and women, people with and without Type 2 diabetes, and those previously diagnosed and newly diagnosed with hypertension.

Among the study’s limitations is that about 17% of participants did not complete the six-month study.

While this study was conducted in India, it has significant meaning for South Asian adults in the U.S. “More than five million South Asian people live in the U.S., so these findings have huge relevance for them,” Prabhakaran said.

The October 2021 American Heart Association scientific statement, Medication Adherence and Blood Pressure Control, urges health care professionals to evaluate ways to simplify the medication regimen for people with hypertension, such as through prescribing a polypill or a fixed-dose combination pill-one tablet that contains multiple medications.

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Delay in registration with Medical Council not Negligence! NCDRC relief to gynaecologist

New Delhi: While exonerating a doctor accused of medical negligence while providing treatment to a pregnant woman, the National Consumer Disputes Redressal Commission (NCDRC) ruled that mere delay in registration with the State Medical Council, while being adequately qualified and having registration in the Indian Medical Register with the privilege to practice anywhere in India, does not amount to medical negligence or deficiency in service.

The history of the case goes back to 1994 when the complainant was in the early stages of her second pregnancy and sought consultation and treatment from the treating doctor- a gynaecologist. At that time, the doctor assured her that a normal delivery was expected. However, due to a delay beyond the expected delivery date, she was admitted to the treating hospital where the doctor was practising.

As the patient did not experience labour pain, the doctor instructed the use of cervix-prime and Pitocin drip to induce labour. However, after Pitocin was administered, the patient developed severe allergic reactions, leading to feeble pulses. Subsequently, the doctor performed a forceps-assisted delivery, after which her condition deteriorated, with a sudden drop in BP and massive bleeding, necessitating a hysterectomy.

The complainant alleged that during the administration of Pitocin, neither the doctor nor any medical personnel were present, and forceps delivery was conducted recklessly, causing a uterine rupture leading to a hysterectomy. The complications arising from her delivery and premature removal of her uterus were due to deficiencies in quality, nature, and performance of services provided by the treating doctor and hospital, amounting to medical negligence.

Also Read: No Medical Negligence! Doctor only performed Excisional Biopsy to confirm cancer: NCDRC grants Rs 75 lakh relief to doctor

Additionally, there was a serious contradiction regarding her blood group. Initially, it was stated to be O+ and when the complications arose from the Pitocin allergy and forceps delivery, her husband arranged for O+ blood donors. However, it was later revealed that her blood group was AB-. Since AB- donors were unavailable, the treating doctor administered both AB- and B_ blood to her and she had to undergo the removal of her uterus, which she attributed to be the lack of proper care and it also resulted in the infant suffering from asphyxia, neonatal convulsion and birth palsy, requiring immediate treatment at Medical College Hospital, Calicut. Allegedly, the infant was hospitalized for four days and required follow-up visits three months. 

Alleging medical negligence against the treating doctor and hospital complications that arose from forceps delivery and subsequent hysterectomy, filed a complaint seeking a compensation of Rs 3,00,250.

On the other hand, the treating doctor and hospital filed separate versions but raised identical defences, denying all material allegations made against them. They asserted that, as the complainant did not experience labour pains well beyond the anticipated delivery date, labour induction was recommended to prevent foetal distress due to the delay.

Accordingly, after the patient was admitted, cerviprime was applied and Pitocin was administered after this. Despite this, she did not develop labour pain and foetal distress was noted, necessitating a forceps-assisted delivery. After about half an hour after the child’s delivery, she was reported to be experiencing bleeding, and steps were taken to manage it. In her best interest, and to avoid further life-threatening complications, hysterectomy was performed, submitted the doctor and the hospital, while refuting the allegations regarding mismatched blood transfusion, claiming that her husband had initially provided an incorrect blood group. 

However, they asserted that cross-matching was conducted before taking any action and it was discovered that her complainant’s blood group was AB-. Since AB-donors were unavailable, compatible negative blood groups that could be safely transfused were administered. They further claimed that there were no lapses in the complainant’s treatment or the blood transfusion.

The District Commission dismissed the complaint. However, when an appeal was made before the State Commission, the State Consumer Court held that there was negligence in identifying the patient’s blood group and informing different groups at different points of time found to be having some substance in examining the materials produced in the case.

“There is every reason to hold that her blood group was wrongly identified as AB+ve and accordingly informed to the complaint’s husband to arrange blood for transfusion and just before such transfusion when the complainant was in a Critical condition, on matching the blood was identified as AB -ve. Donors of such blood groups not being immediately available other negative blood groups were transfused to complainant. Though we do not have anything to show that transfusion of other negative blood groups when ABve blood is not available is detrimental, still, the circumstances presented clearly reveal deficiency of service on the part of the hospital,” the State Commission had held.

Accordingly, it had directed the hospital and doctor to pay the complainant a compensation of Rs 2 lakhs with 8% interest p.a. on such sum from the date of filing of the complaint till realization, along with Rs 50,000 as the cost of litigation.

When the matter was challenged before the Apex Consumer Court, apart from submitting the previous contentions, the complainant’s counsel also argued that the treating gynaecologist was ineligible to practice modern medicine in Kerala as she failed to obtain requisite statutory registration with the State Medical Council at the time of treating and performing surgery on the complainant. Therefore, the treating hospital, which employed and permitted her to practice as a gynaecologist without such registration was equally liable.

On the other hand, the counsel for the treating doctor and hospital asserted that the doctor’s failure to register within the State where the treatment was conducted could not be considered within the legal definitions of “medical negligence” or “deficiency in service”. It was contended that at most, such omission would subject the practitioner to regulatory action by the relevant State Medical Council, which could impose disciplinary measures as per applicable statutory provisions. Therefore, they concluded that the State Commission’s finding of medical negligence and deficiency in service was unjustified and prayed for the dismissal of the complaint.

While considering the matter, the NCDRC bench noted that all allegations were dismissed by both the District and State Commission, except for the issue of incorrect blood transfusion.

At this outset, the Commission noted,

“Upon reviewing the evidence on record and considering the limited scope of this Commission’s revisional jurisdiction, I find no reason to interfere with the detailed evaluation of evidence and reasoned finding arrived at by the learned District Forum and the learned State Commission, except the conflicting views between the said fora with respect to blood transfusion. Thus, the main question is whether the OPs were negligent or deficient in service with respect to transfusion of wrong blood group to the complainant, as alleged. In this regard the contention of OPs is that the complainant’s blood group was incorrectly recorded as AB+ in both the case sheet and requisition slip, based on information provided at the time of admission by the complainant’s husband. While the complainant denied this, there is no evidence on record to support her stand.”

“It is undisputed that the OPs have in fact conducted an independent blood matching test prior to the transfusion, which revealed that her actual blood group was AB-ve, making it inappropriate to transfuse AB+ blood. It is further undisputed that B- blood was arranged and administered to the complainant during and after the hysterectomy. According to accepted medical practice, Bblood can be safely transfused to a patient with AB- blood. Regardless of the fact whether her husband provided incorrect input about her blood group, the critical fact remains that the OPs have specifically verified the correct blood group before administering blood, and a medically acceptable blood group was transfused. Therefore, I find no negligence or deficiency in service in this regard,” it further observed.

Regarding the issue of the treating doctor’s disqualification and registration with the Medical Council, the Commission referred to the relevant provisions of the Indian Medical Council, Act, 1956 stating “Subject to the conditions and restrictions laid down in this Act regarding medical practice by persons possessing certain recognised medical qualifications, every person whose name is for the time being; borne on the Indian Medical Register shall be entitled according to his qualifications to practice as a medical practitioner in any part of India and to recover in due course of law in respect of such practice any expenses, charges in respect of medicaments or other appliances, or any fees to which he may be entitled.”

The NCDRC bench also noted that the issue of non-registration with the State Medical Council was not originally raised in the complaint. It also observed that there was no dispute regarding the fact that the treating doctor was a qualified medical doctor (gynaecologist) and there are no questions regarding her educational and professional qualifications as well as experience. 

“Her admission to the Indian Medical Register which grants privilege to practice her field of medicine in any part of India is also undisputed. The contention at this stage is, she was not registered with Kerala Medical Council for practice in Kerala as on the date of she administering treatment to the complainant and that it constitutes negligence and deficiency in service. However, it is also undisputed that subsequently the registration of OP-1 was accepted by the Travancore Cochin Medical Council,” note the Apex Consumer Court.

“Mere delay in registration with Travancore Cochin Medical Council, while being adequately qualified and held on the rolls of Indian Medical Register with privilege to practice anywhere in India, does not amount to medical negligence or deficiency in service by OP-1 with respect to the complainant. It is for the Travancore Cochin Medical Council or Kerala State Medical Council to take cognizance of this deviation, if any, as per rules,” it further noted.

Therefore, after due consideration of the entire facts and circumstances of the case, NCDRC concluded, “…no medical negligence or deficiency in service of OPs is established. Therefore, the order of the learned State commission dated 28.02.2019 in FA No. 371 of 2010 is set aside and the complaint is dismissed.”

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/ncdrc–261487.pdf

Also Read:No medical negligence in administering anaesthesia: Consumer Court exonerates UP hospital, Doctors

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Clinical microbiologist explains why you should never kiss a baby

There is a cognitive bias called “the curse of knowledge” (sometimes also called “the curse of expertise”). It happens when you incorrectly assume that everyone knows as much as you do on a given topic. As a clinical microbiologist, I assumed everyone knew that it was a terrible idea to kiss a newborn baby anywhere on its head.

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Risk perception and antibiotic resistance: Bridging knowledge and action

Antibiotic resistance is one of the greatest health threats of our time. With microbes increasingly evading the effects of the drugs designed to combat them, we risk losing the ability to treat even common infections effectively. While the urgency of this issue is clear, addressing it requires innovative and targeted approaches, particularly in education.

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Yes, you still need to use sunscreen, despite what you’ve heard on TikTok

Summer is nearly here. But rather than getting out the sunscreen, some TikTokers are urging followers to chuck it out and go sunscreen-free.

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Psychosis symptoms found to precede adolescent cannabis use

Washington University in St. Louis researchers have found that adolescents who use cannabis report more psychosis spectrum symptoms and greater distress from these symptoms, suggesting that shared vulnerability and self-medication contribute to the association between cannabis use and psychosis risk.

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New combo treatment cuts subdural hematoma recurrence

A novel combination of surgery and embolization used to treat subdural hematomas, bleeding between the brain and its protective membrane due to trauma, reduces the risk of follow-up surgeries, according to researchers at Weill Cornell Medicine and University at Buffalo. Embolization is a minimally invasive procedure that blocks specific blood vessels to stop abnormal bleeding.

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Infant abducted from Niloufer Hospital rescued, 3 accused arrested

Hyderabad: A one-month-old baby boy, who was allegedly kidnapped from Niloufer Hospital in Telangana’s Hyderabad by a woman on Saturday evening, was traced by the police near Kurnool, Andhra Pradesh.

Three people were arrested for allegedly abducting a newborn from a hospital at Nampally in Telangana’s Hyderabad, police said. The infant was safely returned to his parents on Sunday.

According to officials, the complainant, Haseena Begum, gave birth to a baby boy named Sauqlain on October 25 this year. The baby was undergoing treatment for jaundice at Niloufer Children’s Hospital, news agency ANI reported.

On November 23, a woman wearing a black burkha reportedly kidnapped the baby from the hospital.

The police launched an investigation and formed five teams to apprehend the suspects. After analyzing CCTV footage, the police tracked down the accused and intercepted their vehicle at Pullur Toll Plaza.

Also Read:Newborn abducted from Tirupur Government Hospital rescued, woman arrested

As per a media report in the TOI, During the investigation, police learned that Abdullah and Reshma, married in 2009, already had three daughters and feared their fourth child might also be a girl. It was Reshma’s sister, Shaheen who proposed the idea of kidnapping a boy.

The arrested accused have been identified as Shaheen Begum, Abdulla alias Venkatesh, and Reshma alias Renuka. They were taken into judicial custody, police said.

Officials said that the accused were desperate for a male child and had planned the abduction to steal a baby boy.

The police were further looking into the case.

Medical Dialogues team had earlier reported that a newborn girl was abducted after her father was deceived under the pretence of vaccination by five people, including a woman. The Chitrakoot Police have rescued a kidnapped girl from a hospital in Uttar Pradesh’s Kaushambi district and arrested five accused in connection with the case.

Also Read:Guwahati: 2 women booked for abducting newborns from GMCH

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