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Portable AI Technology As Accurate As Cardiologists in Detecting Rheumatic Heart Disease

By MedImaging International staff writers
Posted on 24 Jan 2024

Image: The novel AI platform matches cardiologists in detecting rheumatic heart disease (Photo courtesy of Children’s National Hospital)

Rheumatic heart disease (RHD), a result of the body's response to repeated Strep A bacterial infections, can lead to permanent heart damage. Early detection is crucial, as RHD is treatable with penicillin, a commonly available antibiotic. However, millions in low-income countries lack access to specialized care, and the standard method for RHD diagnosis requires a skilled cardiologist to interpret an echocardiogram—a widely used, non-invasive ultrasound imaging technology. The absence of a cardiologist often results in undetected RHD, leading to severe cardiac complications and even death. As a result, while almost eradicated in high-income countries, while RHD has been almost entirely eradicated in high-income nations, it still impacts the lives of 40 million people in low- and middle-income countries, causing nearly 400,000 deaths annually.

In new research, scientists at Children’s National Hospital (Washington, D.C., USA) have shown that artificial intelligence (AI) can detect RHD with equivalent accuracy to a cardiologist. This breakthrough in applying advanced deep learning technology to RHD, a disease of inequity, could help prevent hundreds of thousands of deaths globally each year. The innovative AI system combines advanced ultrasound probes with portable electronic devices equipped with algorithms that diagnose RHD from echocardiograms. Distributing these devices could enable healthcare workers, even without specialized medical training, to identify RHD in regions where it is still prevalent.

The AI system was developed through extensive testing of machine learning modalities, which emulate human intelligence, and deep learning, which surpasses human learning capabilities. This dual-approach optimization led to a novel algorithm trained to interpret ultrasound images for RHD detection. The AI algorithm has already identified 39 heart characteristics associated with RHD that are imperceptible to cardiologists with the naked eye. For instance, heart size is crucial in RHD diagnosis, with current guidelines using two weight categories—above or below 66 pounds—as indirect measures. However, heart size in children within these groups can vary significantly.

The research team faced the challenge of training the AI to manage clinical variations in ultrasound images and the intricacies of analyzing color Doppler echocardiograms, typically requiring specialized human skills. In trials, the AI algorithm successfully identified mitral regurgitation, a common RHD indicator, in up to 90% of affected children. This condition leads to improper closure of mitral valve flaps, causing reverse blood flow. A pilot program in Uganda will integrate AI into the echo screening process for children at risk of RHD. The researchers believe that a handheld ultrasound probe, a tablet, and a laptop equipped with this sophisticated algorithm could significantly improve early diagnosis and alter outcomes for these children.

“This technology has the potential to extend the reach of a cardiologist to anywhere in the world,” said Kelsey Brown, M.D., a cardiology fellow at Children’s National Hospital. “In one minute, anyone trained to use our system can screen a child to find out if their heart is demonstrating signs of RHD. This will lead them to more specialized care and a simple antibiotic to prevent this degenerative disease from critically damaging their hearts.”

“One of the most effective ways to prevent rheumatic heart disease is to find the patients that are affected in the very early stages, give them monthly penicillin for pennies a day and prevent them from becoming one of the 400,000 people a year who die from this disease,” added Craig Sable, M.D., interim division chief of Cardiology at Children’s National Hospital. “Once this technology is built and distributed at a scale to address the need, we are optimistic that it holds great promise to bring highly accurate care to economically disadvantaged countries and help eradicate RHD around the world.”

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64 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

65 (76.055526733398): select cover from jos_number where journalid in (5) and cover is not null order by left(issue,2)+right(issue,2)*12 desc limit 1

66 (488.9965057373): SELECT fid FROM jos_deeppockets WHERE id=294800001 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294800001 AND published='1' LIMIT 1

67 (365.01884460449): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

68 (44.822692871094): select jos_twitters.link from jos_twitters where cat=10

69 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

70 (29.087066650391): select jos_google_plus.link from jos_google_plus where cat=10

71 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

72 (34.093856811523): SELECT fid FROM jos_deeppockets WHERE id=294800001 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294800001 AND published='1' LIMIT 1

73 (31.948089599609): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=214 ORDER BY `ordering`

74 (241.99485778809): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800001 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

75 (204.80155944824): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800001 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

76 (40.054321289062): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

77 (82.015991210938): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (48.160552978516): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (41.961669921875): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (35.04753112793): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (39.815902709961): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (52.928924560547): SELECT show_live FROM jos_com_show_setting LIMIT 1

88 (43.153762817383): SELECT show_live FROM jos_com_show_setting LIMIT 1

89 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

90 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (67.949295043945): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800001 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

92 (41.007995605469): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800001 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

93 (44.822692871094): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

94 (54.121017456055): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (34.809112548828): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (58.889389038086): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

105 (36.001205444336): SELECT show_live FROM jos_com_show_setting LIMIT 1

106 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

107 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

108 (64.13459777832): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

109 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

110 (54.121017456055): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800001 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (48.160552978516): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800001 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (82.969665527344): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

113 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

114 (56.028366088867): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294800001 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

115 (550.98533630371): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294800001 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

116 (810.86158752441): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

117 (630.14030456543): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

118 (182.8670501709): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

119 (120.16296386719): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

120 (102.04315185547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

121 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

122 (92.029571533203): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

123 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

124 (446.08116149902): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

125 (!!!!! 22695.779800415): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

126 (90.122222900391): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

127 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

128 (513.07678222656): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800001 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800001 AND type='deeppockets_item' AND published='1' LIMIT 1

129 (!!!!! 471999.168396): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

130 (117.06352233887): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

131 (488.0428314209): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

132 (70.095062255859): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800513 LIMIT 1

133 (424.86190795898): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

134 (58.889389038086): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800359 LIMIT 1

135 (325.20294189453): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

136 (56.028366088867): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294800361 LIMIT 1

137 (448.94218444824): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

138 (311.13624572754): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

139 (188.11225891113): SELECT name FROM jos_deeppockets WHERE id=214

140 (31.948089599609): SELECT name FROM jos_deeppockets WHERE id=214

141 (576.97296142578): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

142 (488.0428314209): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))214((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

143 (103.95050048828): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

144 (68.902969360352): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

145 (!!!!! 9106.8744659424): TRUNCATE TABLE jos_trademed_module

146 (112.05673217773): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800001 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

147 (56.982040405273): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294800001 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

148 (819.20623779297): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

149 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

150 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

151 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

152 (!!!!! 1057.1479797363): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

153 (54.121017456055): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

154 (41.007995605469): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

155 (33.140182495117): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294800001 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294800001 AND type='deeppockets_item' AND published='1' LIMIT 1

156 (29.087066650391): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

157 (26.941299438477): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=214 or channel_id is null)

158 (29.087066650391): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

159 (108.95729064941): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

160 (51.021575927734): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294800001 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294800001 AND published='1' LIMIT 1

161 (102.99682617188): select jos_twitters.link from jos_twitters where cat=10

162 (36.001205444336): select jos_facebook.link from jos_facebook where cat=10

163 (27.894973754883): select jos_google_plus.link from jos_google_plus where cat=10

164 (27.894973754883): select jos_linkedin.link from jos_linkedin where cat=10

165 (261.78359985352): update jos_bannersmanager_banner set impmade=impmade+1 where id in(14615,14202,14203)

166 (!!!!! 1191.8544769287): insert into jos_banners_delta values (14615,'2025-04-29 19:59:37','3.135.64.92','view'),(14202,'2025-04-29 19:59:37','3.135.64.92','view'),(14203,'2025-04-29 19:59:37','3.135.64.92','view')

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