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For the acutely dyspneic patient, discerning bedside between acute decompensated heart failure (ADHF) and COVID-19 is crucial. A lung ultrasound (LUS) is sensitive for detecting these conditions, but not in distinguishing between them; both have bilateral B-lines. The Blue protocol uses pleural sliding to differentiate decreased pneumonia; however, this is not the case in ADHF. Nonetheless, this pleural sliding has never been quantified. Speckled tracking is a technology utilized in the echocardiography field that quantifies the motion of tissues by examining the movement of ultrasound speckles. We conducted a retrospective study of LUS performed in emergency room patients during the COVID-19 pandemic. Speckled tracking of the pleura by applying software to the B-mode of pleura was compared between COVID-19 patients, ADHF patients, and patients with no respiratory complaints. A significant difference was found between the patient groups on speckled tracking both in respect of displacement and velocity. ADHF had the highest displacement, followed by COVID-19, and then non-respiratory patients: 1.63 ± 1.89, 0.59 ± 0.71, and 0.24 ± 0.45, respectively (p < 0.01). A similar trend was seen in velocity with ADHF having the highest velocity 0.34 ± 0.37, followed by COVID-19 0.14 ± 0.71, and non-respiratory patients 0.02 ± 0.09 (p <0.01). Speckled tracking of the pleura is a potential tool for discerning between different causes of dyspnea. [ABSTRACT FROM AUTHOR]

Patients previously infected with acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may experience post-acute adverse health outcomes, known as long COVID. The most reported symptoms are fatigue, headache and attention/concentration issues, dyspnea and myalgia. In addition, reduced aerobic capacity has been demonstrated in both mild and moderate COVID-19 patients. It is unknown whether COVID-19 vaccination mitigates against reduced aerobic capacity. Our aim was to compare the aerobic capacity of vaccinated and unvaccinated individuals previously infected with SARS-CoV-2. Methods: Individuals aged 18 to 65 years with laboratory-confirmed mild to moderate COVID-19 disease were invited to Ziv Medical Centre, Israel, three months after SARS-CoV-2 infection. We compared individuals unvaccinated at the time of infection to those vaccinated in terms of aerobic capacity, measured using symptom-limited cardiopulmonary exercise test (CPET). Results: We recruited 28 unvaccinated and 22 vaccinated patients. There were no differences in baseline demographic and pulmonary function testing (PFT) parameters. Compared with unvaccinated individuals, those vaccinated had higher V'O2/kg at peak exercise and at the anaerobic threshold. The V'O2/kg peak in the unvaccinated group was 83% of predicted vs. 100% in the vaccinated (p < 0.002). At the anaerobic threshold (AT), vaccinated individuals had a higher V'O2/kg than those unvaccinated. Conclusions: Vaccinated individuals had significantly better exercise performance. Compared with vaccinated individuals, a higher proportion of those unvaccinated performed substantially worse than expected on CPET. These results suggest that vaccination at the time of infection is associated with better aerobic capacity following SARS-CoV-2 infection. [ABSTRACT FROM AUTHOR]

Summary: The goal of this study is to quantify the assumptions associated with the Wasserman‐Hansen (WH) and Fitness Registry and the Importance of Exercise: A National Database (FRIEND) predictive peak oxygen consumption (pVO2) equations across body mass index (BMI). Assumptions in pVO2 for both equations were first determined using a simulation and then evaluated using exercise data from the Stanford Exercise Testing registry. We calculated percent‐predicted VO2 (ppVO2) values for both equations and compared them using the Bland–Altman method. Assumptions associated with pVO2 across BMI categories were quantified by comparing the slopes of age‐adjusted VO2 ratios (pVO2/pre‐exercise VO2) and ppVO2 values for different BMI categories. The simulation revealed lower predicted fitness among adults with obesity using the FRIEND equation compared to the WH equations. In the clinical cohort, we evaluated 2471 patients (56.9% male, 22% with BMI >30 kg/m2, pVO2 26.8 mlO2/kg/min). The Bland–Altman plot revealed an average relative difference of −1.7% (95% CI: −2.1 to −1.2%) between WH and FRIEND ppVO2 values with greater differences among those with obesity. Analysis of the VO2 ratio to ppVO2 slopes across the BMI spectrum confirmed the assumption of lower fitness in those with obesity, and this trend was more pronounced using the FRIEND equation. Peak VO2 estimations between the WH and FRIEND equations differed significantly among individuals with obesity. The FRIEND equation resulted in a greater attributable reduction in pVO2 associated with obesity relative to the WH equations. The outlined relationships between BMI and predicted VO2 may better inform the clinical interpretation of ppVO2 values during cardiopulmonary exercise test evaluations. [ABSTRACT FROM AUTHOR]

The cardiopulmonary exercise test (CPX) has expansive clinical utility. Currently, the strongest diagnostic and prognostic metrics from CPX are assessed within the exercise phase. Patients with heart failure (HF) also demonstrate a slower recovery from max exercise, including heart rate and oxygen consumption (VO2) compared to healthy individuals. PURPOSE: To comprehensively investigate the behavior of respiratory gases during recovery from maximal exercise in a diverse cohort of patients with HF. METHODS: Individuals with HF who performed CPX at Stanford University Hospital were eligible. Healthy controls were recruited from the local community. Respiratory gases were collected on a breath-by-breath basis and analyzed after applying a 30-second-rolling-average filter. Primary metrics were analyzed as absolute values, percentage change from peak and the half-time of recovery (T 1/2; i.e. the duration until a metric had returned to ½ of its value at peak). Data were analyzed per subject over time and between groups using parametric statistical methods. In accordance with previous studies, the amount of change after exercise is presented as the magnitude-of-overshoot. RESULTS: 32 patients with HF (11 Female, 47±13 yrs) and 30 healthy subjects (14 Female, 43±12 yrs) were included. A comparison of ventilatory metrics during recovery between HF and controls is depicted in Figure 1. Peak VO2 was 13.5±3.8 mL/kg/min vs 32.5±9.0 mL/kg/min; P <0.01. A significant difference between patients with HF and healthy subjects was found in T 1/2 of VO2 (111.3±51.0s vs 58.0±13.2s, p<0.01) and VCO2 (132.0±38.8s vs 74.3±21.1s, p<0.01). The magnitude of the overshoot was also found to be significantly reduced in patients with HF for VE/VO2, RQ and PETO2. CONCLUSIONS: We observed that ventilatory kinetics measured in early recovery after CPX differ significantly between healthy subjects and patients with HF. [ABSTRACT FROM AUTHOR]

R5113 --> 474.35 --> Opening a new medical school and introducing an anatomy course is a rare opportunity for medical anatomy educators. Here we sum our experience in an ongoing 10‐year anatomy program, emphasizing the challenges we endured, the hardships and successes in the hope that others can learn from our experience. In February 2010, Bar Ilan University was chosen by the Israeli Council for Higher Education to open a new, fifth, medical faculty. A mere eight months later, the school opened its gates to a class of 70 students in the northern city of Safed. This new faculty, dedicated to establishing connections to the local community, enabled us to develop and implement a new anatomy curriculum. The basic course incorporated frontal lectures, dissection labs, basic systematic physiology, clinical correlation lectures and imaging labs. The initial curriculum included trunk and Head & neck regions spanning 5 weeks. After the first couple of years, the length and contents of the course started to change and adapt according to the needs of our faculty, and by input from physicians as well as students. Over the years student number rose to 100, and the course expanded to 10 weeks to incorporate the entire body aside from neuroanatomy, which is taught in a separate course. Histology and embryology were included; ultrasound hands‐on labs were added; and virtual anatomy sessions were integrated to the program. Clinical and physiological correlate lectures were cut down, with the understating, backed by students' evaluations, that this was too early for them, and focus should remain on basic normal anatomy. On the other hand, more time was added to imaging sessions and lectures, as most modern physicians use these techniques in their everyday clinical practice. While originally relaying on retired physicians to serve as dissection instructors, we initialed a near‐peer students dissection instructors' program that was met with great success. In the last couple of years our program and indeed the entire medical school was heavily impacted by the ongoing Covid‐19 pandemic. While lectures were taken to virtual platform, we decided to continue dissection sessions as normally as possible, with strict mandatory regulations including personal protective gear and keeping students' number within the lab to a minimum of 15, 7‐8 students per cadaver. Students were highly appreciative of our efforts, and course scoring was exceptionally high. The last 10 years has shown us that anatomy, a basic and important tradition, could be taught in many exceptional ways, and we should always strive to improve. But perhaps even more important is the understating that we are educators to whom our students look up to, and endurance, perseverance, resourcefulness, and professionalism are just as important as scholastic knowledge. [ABSTRACT FROM AUTHOR]