Coarctation of the Aorta in Adolescence: Significance of Detailed Cardiac Examination in Pediatric Hypertension

ABSTRACT

Although coarctation of the aorta (CoAo) is a congenital anomaly, it can pose a diagnostic challenge in those presenting beyond neonatal period, as some patients can remain asymptomatic until complications of hypertension develop later in life. Careful physical examination can play an important role in timely diagnosis and prevention of complications.We present 2 cases of adolescents with undiagnosed CoAo who both presented with nonspecific headaches and hypertension. Both were initially misdiagnosed as essential hypertension until careful detailed physical examination later detected weak/absent femoral pulses and discrepancy in upper and lower limb blood pressures. These findings raised the clinical suspicion of CoAo, which was confirmed on further investigations.Our cases highlight the importance of considering CoAo in the differential diagnosis of hypertension in adolescents. These cases also stress the significance of detailed cardiac examination including 4-limb blood pressure and femoral pulses in a patient presenting to the emergency department with high blood pressure irrespective of the primary complaint.

Paediatric hypertension for the primary care provider: What you need to know

The prevalence of hypertension has increased in the paediatric and adolescent populations, and is estimated between 1% and 2% in Canada. Paediatric and adolescent hypertension differs from adult hypertension in many ways, and primary care providers may not be up to date with current guidelines and recommendations. Recently, the American Academy of Pediatrics updated and published guidelines on the diagnosis, evaluation, and management of hypertension in children and adolescents. This paper summarizes these new guidelines in addition to the existing Canadian guidelines in a simple four-step approach, catered to a primary care setting, detailing the diagnosis, evaluation, workup, and management of hypertension in children and adolescents.

A novel computational method for assigning weights of importance to symptoms of COVID-19 patients

BACKGROUND AND OBJECTIVE

The novel coronavirus disease 2019 (COVID-19) is considered a pandemic by the World Health Organization (WHO). As of April 3, 2020, there were 1,009,625 reported confirmed cases, and 51,737 reported deaths. Doctors have been faced with a myriad of patients who present with many different symptoms. This raises two important questions. What are the common symptoms, and what are their relative importance?

METHODS

A non-structured and incomplete COVID-19 dataset of 14,251 confirmed cases was preprocessed. This produced a complete and organized COVID-19 dataset of 738 confirmed cases. Six different feature selection algorithms were then applied to this new dataset. Five of these algorithms have been proposed earlier in the literature. The sixth is a novel algorithm being proposed by the authors, called Variance Based Feature Weighting (VBFW), which not only ranks the symptoms (based on their importance) but also assigns a quantitative importance measure to each symptom.

RESULTS

For our COVID-19 dataset, the five different feature selection algorithms provided different rankings for the most important top-five symptoms. They even selected different symptoms for inclusion within the top five. This is because each of the five algorithms ranks the symptoms based on different data characteristics. Each of these algorithms has advantages and disadvantages. However, when all these five rankings were aggregated (using two different aggregating methods) they produced two identical rankings of the five most important COVID-19 symptoms. Starting from the most important to least important, they were: Fever/Cough, Fatigue, Sore Throat, and Shortness of Breath. (Fever and cough were ranked equally in both aggregations.) Meanwhile, the sixth novel Variance Based Feature Weighting algorithm, chose the same top five symptoms, but ranked fever much higher than cough, based on its quantitative importance measures for each of those symptoms (Fever - 75 %, Cough - 39.8 %, Fatigue - 16.5 %, Sore Throat - 10.8 %, and Shortness of Breath - 6.6 %). Moreover, the proposed VBFW method achieved an accuracy of 92.1 % when used to build a one-class SVM model, and an NDCG@5 of 100 %.

CONCLUSIONS

Based on the dataset, and the feature selection algorithms employed here, symptoms of Fever, Cough, Fatigue, Sore Throat and Shortness of Breath are important symptoms of COVID-19. The VBFW algorithm also indicates that Fever and Cough symptoms were especially indicative of COVID-19, for the confirmed cases that are documented in our database.

An IoT-based framework for early identification and monitoring of COVID-19 cases

The world has been facing the challenge of COVID-19 since the end of 2019. It is expected that the world will need to battle the COVID-19 pandemic with precautious measures, until an effective vaccine is developed. This paper proposes a real-time COVID-19 detection and monitoring system. The proposed system would employ an Internet of Things (IoTs) framework to collect real-time symptom data from users to early identify suspected coronaviruses cases, to monitor the treatment response of those who have already recovered from the virus, and to understand the nature of the virus by collecting and analyzing relevant data. The framework consists of five main components: Symptom Data Collection and Uploading (using wearable sensors), Quarantine/Isolation Center, Data Analysis Center (that uses machine learning algorithms), Health Physicians, and Cloud Infrastructure. To quickly identify potential coronaviruses cases from this real-time symptom data, this work proposes eight machine learning algorithms, namely Support Vector Machine (SVM), Neural Network, Naïve Bayes, K-Nearest Neighbor (K-NN), Decision Table, Decision Stump, OneR, and ZeroR. An experiment was conducted to test these eight algorithms on a real COVID-19 symptom dataset, after selecting the relevant symptoms. The results show that five of these eight algorithms achieved an accuracy of more than 90 %. Based on these results we believe that real-time symptom data would allow these five algorithms to provide effective and accurate identification of potential cases of COVID-19, and the framework would then document the treatment response for each patient who has contracted the virus.

Point-of-Care Ultrasound in Pediatric Diagnostic Dilemmas: Two Atypical Presentations of Intussusception

Diagnostic dilemmas are ubiquitous in pediatric emergency medicine because of the varied and often insidious presentations of many pediatric conditions. Point-of-care ultrasound (POCUS) in emergency departments is being used for some of these diagnostic challenges and can often provide rapid and valuable information to supplement a physician's clinical assessment. Intussusception is a pediatric condition that may be challenging to recognize because of its subtle and varied presenting symptoms. An unrecognized or delayed diagnosis of intussusception can be catastrophic, with complications including bowel obstruction, bowel perforation, and death. Here we present two challenging cases of intussusception, one due to its atypical age of presentation and the other due to its unique symptoms. These cases demonstrate the benefits of point-of-care ultrasound for diagnostically challenging cases in the emergency department.

Evaluation of children with heart murmurs

Cardiac murmurs can be a source of anxiety for both physicians and parents until serious cardiac disorders are excluded. The innocent cardiac murmur is still the most common finding in healthy children and can usually be diagnosed through obtaining a complete history and performing a complete physical examination. However, a cardiac murmur may be the first sign of a structural cardiac disease and should not be ignored. Referral to a pediatric cardiologist for further evaluation is required when murmur assessment is not clear and diagnostic uncertainty is present. Educating and reassuring parents remains an important aspect of this evaluation. This article discusses features of innocent and pathological murmurs and provides an approach to cardiac murmurs in children.