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The article presents a case study of a 72-year-old woman who was evaluated for dysarthria and respiratory failure, following a history of exertional dyspnea, edema, and neurological symptoms such as slurred speech and facial asymmetry. Topics include respiratory failure, neurological symptoms, and differential diagnosis.

Background: Patients who undergo cardiac surgery for drug useassociated infective endocarditis (DUA-IE) have high rates of readmissions for recurrent endocarditis, substance use disorder (SUD), and septicemia. Our primary objectivewas to assesswhether exposure to an addiction consult team (ACT) was associated with reduced readmissions in this population. Methods: This single-center retrospective analysis identified patients who underwent cardiac surgery for DUA-IE between 1/2012-9/2022 using the Society for Thoracic Surgeons database, and compared the cumulative incidence of readmissions at 1, 3, 6, and 12 months among those cared for before and after the implementation of an ACT in 9/2017, accounting for competing risk of mortality and adjusted for measured confounders using inverse probability of treatment weighting. Results: The 58 patients (35 pre-ACT and 23 post-ACT) were young (36.4 +/- 7.7 years) and predominantly White (53.4%) and male (70.7%). The post-ACT cohort had a significantly lower risk of readmission at 1 month (adjusted risk difference [RD] -23.8% [95% CI -94.4%, -8.3%], P = 0.005) and 3 months (RD -34.1% [-55.1%, -13.1%], P = 0.005), but not at 6 or 12months. In a sensitivity analysis, the post-ACT cohort also had significantly lower risk of readmissions for SUD complications at 3 months. Discussion and Conclusion: ACTexposure was associated with a lower risk of short-term readmission among patients with surgically managed DUA-IE, possibly due to a reduction in SUD-related complications. Additional studies are needed to replicate these findings and to identify ways to sustain the potential benefits of ACTs over the longer term. [ABSTRACT FROM AUTHOR]

Competing Interests: Funding Support and Author Disclosures Dr Marinacci has received research support from grant T32-HL160522 from the National Institutes of Health. Dr Wadhera has received research support from the National Heart, Lung, and Blood Institute at the National Institutes of Health (R01HL164561, R01HL174549), the National Institute for Nursing Research at the National Institutes of Health (R01NR021686), the American Heart Association Established Investigator Award, and the Donaghue Foundation (West Hartford, CT); and has served as a consultant for Abbott, CVS Health, and Chambercardio, outside of the submitted work. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Background : Chest imaging, including chest X-ray (CXR) and computed tomography (CT), can be a helpful adjunct to nucleic acid test (NAT) in the diagnosis and management of Coronavirus Disease 2019 (COVID-19). Lung point of care ultrasound (POCUS), particularly with handheld devices, is an imaging alternative that is rapid, highly portable, and more accessible in low-resource settings. A standardized POCUS scanning protocol has been proposed to assess the severity of COVID-19 pneumonia, but it has not been sufficiently validated to assess diagnostic accuracy for COVID-19 pneumonia. Purpose : To assess the diagnostic performance of a standardized lung POCUS protocol using a handheld POCUS device to detect patients with either a positive NAT or a COVID-19-typical pattern on CT scan. Methods: Adult inpatients with confirmed or suspected COVID-19 and a recent CT were recruited from April to July 2020. Twelve lung zones were scanned with a handheld POCUS machine. Images were reviewed independently by blinded experts and scored according to the proposed protocol. Patients were divided into low, intermediate, and high suspicion based on their POCUS score. Results : Of 79 subjects, 26.6% had a positive NAT and 31.6% had a typical CT pattern. The receiver operator curve for POCUS had an area under the curve (AUC) of 0.787 for positive NAT and 0.820 for a typical CT. Using a two-point cutoff system, POCUS had a sensitivity of 0.90 and 1.00 compared to NAT and typical CT pattern, respectively, at the lower cutoff; it had a specificity of 0.90 and 0.89 compared to NAT and typical CT pattern at the higher cutoff, respectively. Conclusions : The proposed lung POCUS protocol with a handheld device showed reasonable diagnostic performance to detect inpatients with a positive NAT or typical CT pattern for COVID-19. Particularly in low-resource settings, POCUS with handheld devices may serve as a helpful adjunct for persons under investigation for COVID-19 pneumonia., Competing Interests: The authors declare that they have no competing interests., (Copyright (c) 2023 Thomas Heyne, Kay Negishi, Daniel Choi, Ahad Al Saud, Lucas Marinacci, Patrick Smithedajkul, Lily Devaraj, Brent Little, Dexter Mendoza, Efren Flores, Milena Petranovic, Steven Toal, Hamid Shokoohi, Andrew Liteplo, Benjamin Geisler.)