The Reading Hospital is a 738-bed non-profit teaching hospital located in the borough of West Reading, in the US state of Pennsylvania. The hospital was established in 1867 and is a part of Tower Health System. The hospital is a certified stroke center, and the emergency department includes a level I trauma center. The hospital operates several residency training programs for newly graduated physicians (MD, DO), podiatrists (DPM), and pharmacists (PharmD) which are accredited by the Accreditation Council for Graduate Medical Education. The internal medicine residency is also accredited by the American Osteopathic Association.
Asymptomatic aortic regurgitation (AR) has traditionally been managed conservatively until symptom onset or overt left ventricular systolic dysfunction. However, adverse myocardial remodeling-detected by myocardial strain, volumetric cardiac magnetic resonance, and fibrosis imaging-often precedes current guideline thresholds for interventions and may be irreversible. Advances in multimodal imaging now enable earlier risk stratification beyond conventional metrics. In parallel, intervention strategies are evolving, including valve repair, valve-sparing root replacement, Ross procedure, and transcatheter aortic valve replacement in selected high-risk patients. This narrative review summarizes contemporary advances in imaging and intervention for asymptomatic AR, while critically appraising current evidentiary and technical limitations that constrain earlier intervention. The review is based on a narrative synthesis of the contemporary literature, drawing from recent clinical studies, imaging advances, and guideline documents rather than a systematic evidence search.
Background High-quality bystander CPR is a key element in successful resuscitation from OHCA. However, less than 40% of adults receive bystander-initiated CPR.1 Objectives To investigate the relationship between socioeconomic variables and initiation of bystander cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrests (OHCA). Methods 504 adults were treated at one of three Emergency Departments between January 1, 2020, and December 31, 2022, for nontraumatic OHCA. Bystander CPR administration was the grouping variable while socioeconomic variables included Area Deprivation Index (ADI), population density, income, primary language, and poverty level. Chi-squared and group t-tests were performed. Results 4.9% of all OHCA survived to hospital discharge. Survival for bystander CPR patients was 8.4% compared to 2.7% with no bystander CPR (p<0.004). OHCA without bystander CPR occurred in places with higher state and national decile ADI (mean 6.63 vs 4.87, p<0.001 and 70.25 vs 55.39, p<0.001 respectively), a higher percentage of families below the poverty level (mean 14.17 vs 9.58, p<0.001), and a lower median household income (mean $63,116 vs $75,539, p<0.001) than cases with bystander CPR. Cases without bystander CPR happened in locales with higher population density (mean 4,428 vs 3,017 persons/square mile, p<0.001), and a higher percentage of the population speaking a language other than English (mean 27.42% vs 19.64%, p<0.001). Conclusions Bystander CPR improves OHCA survivability. Lower socioeconomic status, higher population density, and higher percentage of non-English-speaking population have lower rates of bystander CPR use. Community engagement should target these areas to improve CPR training, bystander CPR initiation, and OHCA survivability.
Abstract Introduction Congenital tracheobronchial anomalies are identified in approximately 1% of the population, with displaced or supernumerary bronchi being particularly uncommon in adults. These anomalies are often asymptomatic but may predispose to recurrent respiratory infections, chronic cough, or airway obstruction, especially in individuals with underlying pulmonary or genetic conditions. We present a case of bilateral eparterial displaced bronchi with accessory lobation discovered during evaluation of persistent cough in a patient with Wolff-Parkinson-White (WPW) syndrome and heterozygous alpha-1 antitrypsin (A1AT) deficiency. Case Presentation A 63-year-old male with WPW and heterozygous A1AT deficiency presented with a persistent non-productive cough and dyspnea for one week. He was initially treated at an urgent care center for presumed community-acquired pneumonia with doxycycline, albuterol, benzonatate, and prednisone without improvement. Subsequent evaluation by his primary care physician led to sequential courses of levofloxacin and moxifloxacin for five days each, with continued cough and wheezing despite frequent use of inhaled bronchodilators. He denied fever, chills, or recent hospital exposure. He was a lifelong non-smoker. Due to persistent symptoms despite three antibiotic regimens, bronchoscopy with bronchoalveolar lavage (BAL) was performed to evaluate for atypical infection. Bronchoscopy revealed a displaced eparterial bronchus arising from the left mainstem bronchus, bifurcating separately from the lingular division, resulting in three distinct left-sided lobes with an accessory fissure. A similar, though less pronounced, displaced eparterial bronchus was visualized on the right. BAL cultures were negative. Symptoms improved with supportive therapy, including benzonatate, without antimicrobial escalation. Discussion Congenital tracheobronchial anomalies such as tracheal bronchus (∼1%) and accessory cardiac bronchus (∼0.1%) are rare, while accessory lobes occur in only 0.3-1.2% of the population. Displaced or supernumerary bronchi represent an even smaller subset, and the coexistence of multiple anomalies in a single patient, as seen here, is exceedingly uncommon. These variants may alter airway anatomy, impair mucociliary clearance, and predispose to persistent cough or infection. In this case, underlying A1AT deficiency may have compounded respiratory symptoms and susceptibility to airway irritation. Recognition of such anomalies is important to avoid misdiagnosis as recurrent pneumonia and for procedural planning, as variant anatomy may increase complexity of airway interventions. Conclusion This case highlights the importance of thorough bronchoscopic and imaging evaluation in patients with persistent respiratory symptoms unresponsive to standard therapy. Early identification of rare congenital airway anomalies can guide appropriate management and prevent unnecessary antimicrobial use. This abstract is funded by: None
