Lessons from the pandemic must be transformed into actions to prepare for future health emergencies, highlights PAHO director at opening of 17th National Health Conference, in Brazil

Cristina Mitchell

3 Jul 2023

cell-mediated killing of CD20-positive cells.The open-label, multicenter phase 1/2 EPCORE NHL-1 trial assessed the safety and preliminary efficacy of epcoritamab-bysp among patients with relapsed,

The procedure, done for the first time in Jamaica on June 16, 2023 at PICJ, is called transcatheter aortic valve replacement/implantation (TAVR/I).

The procedure was led by Miami-based Jamaican interventional and structural cardiologist Dr Shaun Smithson, with cardiothoracic surgeon Dr Roger Irvine as backup.

The TAVR is a minimally invasive procedure where the aortic heart valve is replaced, not by the conventional open-chest technique on a non-beating heart but introduced from a blood vessel in the groin via a long catheter, put in position and attached while the heart is still beating.

It is done using X-ray guidance, and except for the puncture wound in the groin for the introduction of the catheter necessary for the procedure, there are no other cuts on the skin.

It can be done with only sedation, versus a surgical aortic valve replacement which requires general anaesthesia. It is a procedure indicated best for a narrowed aortic valve (stenotic) in someone thought too frail to safely undergo surgical aortic valve replacement. Most patients go home in one to two days following the procedure.

In this case, the patient was an older gentleman with multiple risk factors for a poor outcome with the conventional surgical valve replacement. The TAVR allowed the patient to have a short length of stay at the hospital and a quicker return to his normal daily activities.

"TAVR is a minimally invasive procedure and is generally preferred for higher-risk or elderly patients, while SAVR (surgical aortic valve replacement) is considered for younger and lower-risk patients. SAVR is an open-heart surgery operation where the diseased valve is replaced with a prosthetic valve. This has a higher risk of periprocedural complications, including stroke, and longer length of stay in hospital for recovery," Dr Smithson told the Jamaica Observer.

Further, Dr Smithson said the procedure is "a complete game-changer not only for Jamaica but the Caribbean".

"Patients will now have the option of a minimally invasive procedure that is commonly offered in more developed countries. The procedure utilises significantly less hospital resources compared to SAVR, making it more easily accessible to more patients that need to be treated," he said.

Following the procedure, the patient was awake and arousable from anaesthesia in less than an hour after completion, and was in great spirits as he felt immediate improvement.

The TAVR improves the patient's lifestyle by relieving symptoms associated with aortic valve stenosis.

"These include shortness of breath, fatigue, and chest pain. By restoring proper blood flow TAVR enhances physical capacity and enables individuals to engage in activities they previously found challenging. The minimally invasive nature of TAVR also leads to faster recovery times, allowing for a quicker return to normal daily activities," Dr Smithson said.

In reference to the efficacy of the procedure, Dr Smithson added, "Prior to the commencement of the procedure I hosted a valve conference outlining the patient's risk factors and clinical data consistent with severe aortic stenosis. During this presentation we also discussed the case plan which involves the sizing of the new valve, approach to valve implantation, and any significant areas of potential complications. Given the complexity of procedure we also ensure each member of the team is familiar and comfortable with their role and responsibilities.

"During my training at Houston Methodist Debakey Heart & Vascular Institute, one of the most renowned cardiac facilities in the world, I was privileged to be a part of some of the pivotal trials for the approval of this device. This experience has since allowed me to successfully initiate three valve programmes at hospitals in South Florida. The procedure went smoothly because of my familiarity with TAVR, in addition to comprehensive planning and adequate preparation."

Moreover, Dr Smithson said it was a privilege for him to come back to his home country and share his expertise in this regard.

"It was a pleasure to work alongside colleagues in the local medical community and forge new relationships with international industry representatives in cardiology. I hope to continue to advance cardiac care in Jamaica and the Caribbean," he said.

In the meantime Dr Victor Elliot, interventional cardiologist and managing director at PICJ, said, "Being able to provide this level of cardiac care has always been our goal. To see a patient do a heart valve replacement without the need for days in ICU post-recovery, awake responsive, is truly remarkable. For us, this is just the beginning."

With advancements in machine learning, deep learning, and data analytics, AI has revolutionised health care by enhancing diagnosis, improving treatment outcomes, and facilitating efficient health-care delivery. In our column today we will explore the profound influence of AI in medicine, highlighting its potential, challenges, and prospects.

Early detection and diagnosis: AI algorithms have demonstrated exceptional capabilities in early detection and accurate diagnosis of various medical conditions. Machine learning models trained on vast amounts of medical data can analyse symptoms, medical history, and imaging scans with remarkable accuracy. This assists health-care professionals in identifying diseases at earlier stages, leading to timely interventions and improved patient outcomes. For example, AI-based systems have been developed to detect cancerous cells in mammograms and identify abnormalities in retinal scans, aiding in the early detection of breast cancer and diabetic retinopathy.

Personalised treatment: Another significant area wherein AI has made remarkable progress is personalised treatment. By leveraging patient-specific data — including genetic information, medical records, and treatment outcomes — AI algorithms can provide tailored treatment recommendations. This allows physicians to optimise therapies, predict drug responses, and minimise adverse effects. Additionally, AI-powered tools can assist in precision surgery by providing real time guidance and enhancing surgical accuracy, leading to better patient safety and improved surgical outcomes.

Health-care efficiency: AI technologies have the potential to streamline health-care operations, reducing costs and enhancing efficiency. Natural language processing (NLP) algorithms can analyse vast amounts of unstructured health-care data, such as clinical notes and research papers, to extract relevant information and generate insights. This aids in clinical decision-making, research, and drug discovery processes. Furthermore, AI-powered chat bots and virtual assistants can offer immediate responses to patient queries, schedule appointments, and provide basic medical advice, thus reducing the burden on health-care staff and enhancing patient satisfaction.

Predictive analytics and preventive medicine: AI's ability to analyse large datasets and identify patterns enables predictive analytics in medicine. By analysing patient data and identifying risk factors, AI algorithms can predict the likelihood of disease development or complications. This knowledge allows health-care providers to intervene early and implement preventive measures, reducing the overall burden on the health-care system. For example, AI models can predict the probability of readmission in patients with chronic conditions, enabling targeted interventions and reducing health-care costs. Recently, our colleagues at Yale University have shown that with AI analytics a large database of electrocardiograms can be used to predict patients with low-ejection fraction, which ordinarily would require echocardiogram study. Accurate prediction of low-ejection fraction with a low-cost, easy to perform technique like an electrocardiogram could be a potential game changer for low-resource economies like Jamaica.

Challenges and ethical considerations: While AI holds tremendous promise in medicine, several challenges must be addressed. First, the ethical implications of using AI in health care — such as data privacy, transparency, and bias — need careful consideration. Ensuring that AI algorithms are fair, inclusive, unbiased, and transparent is crucial for patient trust and equitable health-care delivery. Additionally, concerns regarding the potential displacement of health-care professionals and the need for continuous training and upskilling should be addressed.

Future prospects: The future of AI in medicine appears promising. Integration of AI with emerging technologies like the Internet of Medical Things (IoMT) and wearable devices will enable continuous remote monitoring, early detection of health issues, and proactive interventions. Additionally, AI can facilitate the development of personalised medicine by analysing genetic data and tailoring treatments based on individual variations. Furthermore, collaborations between medical professionals, researchers, and AI experts are essential to harness the full potential of AI in medicine. Our team at HIC is currently working with Yale University and Ultrasight, a leading AI pioneer from Israel, to use AI to deliver echocardiograms to rural communities and thus greatly expand access to cardiovascular care without the limitation of trained personnel and geography.

Artificial intelligence has brought transformative changes to the field of medicine, revolutionising diagnostics, treatment, and health-care delivery. The ability of AI to process vast amounts of data, identify patterns, and generate actionable insights has the potential to revolutionise healthcare systems worldwide. However, it is crucial to address the challenges associated with AI implementation and ensure ethical considerations are at the forefront. By embracing AI responsibly the medical community can leverage the immense potential of big data analytics to improve health-care delivery and efficiency.

In future columns we will address specific roles of AI in particular fields of medicine like cardiology, cancer care and women's health.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to info@caribbeanheart.com or call
876-906-2107.

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Under the name “Parade of Generations,” this event will take place this Sunday, July 2, at 4:00 in the afternoon within the framework of the VEST International, an outstanding exhibition on beauty, health, energy, and wellness, which will take place from June 30 to July 2 this year at the Catalonia Hotel & Resort, in Santo Domingo.

With the purchase of a 2,000 pesos ticket, attendees will be able to enjoy the parade, featuring the participation of families with children affected by Cystic Fibrosis. This will be an opportunity to raise awareness in the community about this disease and raise the necessary funds to improve the patient’s quality of life. Alexandra Tabar, president of the foundation, emphasized that they need resources to support their beneficiaries.

View the full post Canada provides funding to Grenadian organisations on NOW Grenada.