Improved Fracture Recognition with AI assistance

 A retrospective study published in Radiology that included 489 patients with fractures that were interpreted by 24 readers showed a 10% improvement of fracture detection (75% vs 65%, superiority P<.001) when Artificial intelligence (AI) assistance was used.  AI also decreases the reading time by 6.3 seconds.  

The authors concluded that AI assistance improved the sensitivity and specificity of fracture detection for radiologists and non-radiologists alike  and shortened slightly their interpretation time. 

AI of Coronary Calcium Accurately Predicts Adverse Cardiovascular Events

 A study published in the Journal of the American College of Cardiology (JACC) Cardiovascular Imaging reports that researchers found that AI algorithms can more rapidly and objectively determine coronary calcium score (CAC) in CT and PET images than physicians.  The model was trained using 9,543 CT scans from a cohort of 4,331 patients with major adverse cardiac events (MACEs) who underwent PET/CT imaging.  MACE risk stratification in four CAC score categories (0, 1-100, 101-400 and over 400).  The AI also performed well when studies were obtained from very-low-attenuation scans.  The authors concluded that AI CT scores predict risk similarly to CAC scores obtained by experienced operators from ECG gated CAC scans. 

Additional Cancers Linked to Breast Implants

 The FDA issued a safety communication that cancer cases, including squamous cell carcinomas (SCC) and other lymphomas, have been linked to scar tissue around breast implants.

The pathology of these cases differs than that of anaplastic large lymphomas linked to breast implants a decade ago.

A preliminary review of published literature found fewer than 20 cases of SCC and fewer than 30 cases of various lymphomas in the scar tissue around the implant.

Women who have had implants should be aware of symptoms of cancer, which include swelling, pain, lumps or skin changes, the FDA said, noting that some cases emerged years after women received their implants. The SCC cases were linked to both textured and smooth implants, and saline and silicone implants.

Transplenic Portal Catheterization

The use of percutaneous trans-splenic access (TSA) of the portal system has grown for the treatment of chronic portal vein occlusion, placement of stents in cases of portal vein stenosis, portal vein embolisation of the liver, embolisation of gastric varices, placement of porto-systemic shunts, and interventions after liver transplants.  

The authors conclude that the use of percutaneous TSA access could be used for the treatment of many portal system abnormalities with high success and low complication rates.  

Brain Activity Immediately Before and After Death

A case report published in Frontiers in Aging Neuroscience describes EEG findings on an 87-year old man with epilepsy who died while an electroencephalogram was in process.  The patient's brain waves 30 seconds before and after death occurred were the same as those when we dream or recalling past memories.  This accidental finding suggests that a final "recall of life" may occur in a person's last moments.

Chest CT findings in patients with Omicron versus Delta variants in SARS-CoV-2 infection

The SARS-CoV-2 omicron variant shows fewer and less severe changes on chest CT than the delta variant, according to a paper published in Radiology.  However, it does have at least one distinct manifestation that of bronchial thickening.  More of the patients who contracted the omicron variant had normal results on computed tomography.  The SARS-CoV-2 omicron variant spreads rapidly but has lower rates of hospital admission and disease severity.

CT Contrast Shortage is Affecting Radiology

 A paper published in Radiology discusses the current shortage of CT contrast which is prompting Radiology departments to make dramatic changes in imaging protocols and patient triage.

Long-term Sequelae in Covid-19 patients; CT Findings

A study of 118 patients with Covid-19 had both baseline and six months follow-up computed tomograms.  At follow-up chest CT 72% of the patients showed fibrotic-like changes while 42% showed ground glass opacifications.  The researchers concluded that blending clinical data with baseline chest CT findings can effectively anticipate which Covid-19 patients are a higher risk of long-term sequelae. 

Preoperative CT-guided Localisation of Lung Nodules

A paper published in Radiology reported on a series of 198 preoperative CT-guided fiducial marker placement procedures that were performed on 190 patients to localise 205 nodules.  The technical success rate was 98.5%.  There were no major complications.  A total of 202 nodules were resected.  Of the resected nodules, 146 were lung cancers, 26 nodules were metastases, 2 were carcinoid tumors, and 28 were benign.

The authors concluded that CT-guided marker placement was an effective and resulted in a low localisation failure rate. 

Ultra-low Field MRI

 An Ultra low field (ULF)  prototype magnetic resonance imaging (MRI) scanner that does not require heavy shielding and is much quieter than commercially available MRI scanners was developed by Wu et al in the University of Hong Kong.  The prototype system described in Physics World has 0.055 Tesla permanent samarium-cobalt (SmCo) magnet with a 29x70 cm gantry for patient access. Costing an estimated $20,000 to build, it would be significantly less expensive that the MRI scanners in use today which cost between $1 and $3 million.  The researchers hope that the ULF scanner, which can be plugged in a typical wall outlet, although it generates a magnetic field of a much lower strength than those produced by clinical MRI machines in use today might one day bring this valuable clinical tool to 70% of the world's population that does not have access to MRI imaging and thus improve global access to neuroimaging.

Risk Factors Associated with long Covid

Three new studies published in Cell, Nature and Gut found several risk factors that make patients prone in developing post acute sequelae Covid-19 (PASC) or long Covid.  

Those are Asthma, the presence of antibodies associated with autoimmune conditions and unhealthy gut bacteria.  Other risk factors were Type 2 diabetes and the detection of genetic material from SARS-CoV-2 in the blood, which means the virus escaped from the lungs and spread to other parts of the body.  Another risk factor was reactivated Epstein-Barr, the virus that causes infectious mononucleosis and infects about 90% of the people but normally remains dormant afterward.

Detectability of the PASC factors with tests early in the disease will assist in the understanding of emergent chronic conditions and more important will suggest specific long Covid treatment strategies.  

Covid-19 Pandemic; four countries - four tales

United States

A country of 330 million reports nearly 55 million cases during the last two years and 825,000 deaths or 2485 deaths per million due to Covid-19.  Sixty two percent of its population has been completely vaccinated and 21% has received a 3rd dose.  Although the U.S. is the leader in the development of vaccines their acceptance by the population has been mixed mostly due to political and cultural reasons.  In the past week the average daily cases per 100,000 people was 116 with the 14-day trend increasing.

Greece

A country of 10 million reports 1.1 million cases and 21,800 deaths or 2080 deaths per million.  The country had very few cases and deaths in the first wave of the pandemic.  This success story was due to a very strict lockdown.  Its vaccination program with 65% of its population completely vaccinated and 30% having had their 3rd dose is above average in Europe.  In the past week the average daily cases per 100,000 people was 195 with the 14-day trend increasing.

Taiwan

A country of 23 million instituted very good epidemiological measures since the beginning of the pandemic and reports only 17,000 cases that caused 848 deaths or 37 deaths per million.  In Taiwan 68% of its people are completely vaccinated and 1% had the 3rd dose.  The average daily cases per 100,000 people of the past week was 0.1 case with the 14-day trend increasing. 

New Zealand

A country of 5 million had 13,000 cases and 44 deaths or 9 deaths per million.  New Zealand enacted a very strong lockdown early in the pandemic and recently enacted a successful vaccination campaign with 78% of its people being fully vaccinated and with 7% having the 3rd dose.  The average daily cases per 100,000 people in past week was 1.2 with the 14-day trend increasing.

Discussion

Since Covid-19 was first diagnosed in China approximately 2 years ago it has infected 290 million people worldwide and has caused 5.5 million deaths according to JHU.  A total of nearly 9 billion doses of vaccines have been administered worldwide.  Although we now know that vaccines are not totally effective in the prevention of the disease, vaccinated individuals are not as sick as the non-vaccinated ones and definitely save lives especially among elderly individuals.  According to a recent study by WHO/ECDC nearly half a million lives have been saved in Europe alone in less than a year.  

The country with the worst death toll is Peru with 6,000 deaths per million and the country that has fared the best is China with 3 deaths per million.  The average daily cases in China per 100,000 people in past week was zero.

On Jan 1, 2021 the daily count of cases worldwide was 580,000 while on the first day of 2022 the number has surpassed the 1 million due to the latest mutation of the virus "omicron" which very transmissible.

In the last two years we learned that lockdowns work but they adversely economies therefore cannot continue for a long time.  Social isolation is also effective but it affects adversely people's psychology.  In spite of the worldwide upheaval the pandemic caused there were success stories such as the speedy development of vaccines.  The development of mRNA vaccines especially is noteworthy as they will likely be used not only in the prevention of viral diseases but the treatment of other diseases such as cancer. Also several antiviral medications have been developed and approved for use in the treatment of patients with Covid.

Conclusion   

The above mentioned advancements will be used in the prevention and control of diseases and will benefit the health of humans for many decades into the future. In closing, I will make a prediction from lessons learned from prior pandemics which usually last 3 years; thus 2022 will be the last year that Covid-19 will be classified as a pandemic becoming from an endemic disease instead one of several viral disease that afflict humans.