Study of Pulmonary Function and Chest Radiographic Abnormalities in Patients with Rheumatoid Arthritis

Background: Interstitial lung disease (ILD) is one of the important contributors for morbidity and mortality in rheumatoid arthritis (RA) patients. There is paucity of reliable published data on burden of lung disease in RA patients from Andhra Pradesh, India. Materials and methods: This was an observational study in which 88 patients were evaluated. History and clinical features, including disease-severity score, imaging, and pulmonary function tests were recorded. The data were subjected to statistical analysis. Results: The mean age was 49.4 � 10.3 years. Females outnumbered males. Disease duration was less than 2 years in 60.2% of subjects. Respiratory complaints were noted in 12 patients. Seropositivity was noted in 59% of patients. Based on Disease Activity Score 28, high disease activity was seen in 70.5%, moderate activity in 25%, remission in 3.4%, and low activity in 1.1%. Chest radiography showed abnormalities in 4.5%. Pulmonary function tests revealed abnormalities in 23.9% of patients. High disease activity, duration of disease, and seropositivity were not significantly associated with respiratory abnormalities in our study. Conclusion: Patients with RA should be evaluated for pulmonary involvement during their routine follow-up, which can be helpful in early detection and intervention of ILD and therefore reducing morbidity and mortality.

Caracterización clínica y radiológica de pacientes positivos a la COVID-19 / Clinical and radiological characterization of COVID-19 positive patients

Introducción: Desde el surgimiento de los primeros casos en la pandemia de la COVID-19, se ha desarrollado una carrera vertiginosa en crear un espacio de investigación para el diagnóstico, tratamiento y control de la enfermedad. Objetivo: Describir las características clínicas y radiológicas de los pacientes con la COVID-19. Métodos: Se realizó un estudio descriptivo, en el período comprendido de marzo a octubre del año 2020, se estudiaron 404 pacientes de todas las edades, ingresados, con diagnóstico confirmado con PCR en tiempo real. Las variables utilizadas fueron: edad, sexo, síntomas y radiografía del tórax. Resultados: El 54,5 por ciento de los pacientes fueron del sexo femenino y entre ellos asintomáticos el 55,9 por ciento; el 36,9 por ciento tenía entre 40 a 59 años de edad, en los menores de 20 años, el 64,9 por ciento no presentó síntomas de la enfermedad al ingreso. Estuvieron asintomáticos el 53,5 por ciento; el 76,6 por ciento de las radiografías positivas correspondieron a los sintomáticos, la tos fue el síntoma más frecuente. La mayor positividad en la radiografía del tórax se encontró en los pacientes mayores de 60 años, se observó como patrón más frecuente, la opacidad en velo, de distribución periférica. Conclusiones: Predominan los pacientes asintomáticos, la positividad de las radiografías es mayor en los ancianos(AU)

Introduction: Since the emergence of the first cases of COVID-19 pandemic, a dizzying race has developed in creating a research space for the diagnosis, treatment and control of the disease. Objective: To describe the clinical and radiological characteristics of patients with COVID-19. Methods: A descriptive study was carried out, in the period from March to October 2020, 404 patients of all ages, admitted, with confirmed diagnosis with real-time PCR, were studied. The variables used were: age, sex, symptoms and chest X-ray. Results: 54.5 percent of the patients were female and 55,9 percent of them were asymptomatic, 36,9 percent were between 40 and 59 years old, in those under 20 years 64,9 percent were not. They presented symptoms of the disease upon admission 53,5 percent were asymptomatic, 76,6 percent of the positive radiographs corresponded to the symptomatic ones, coughing was the most frequent symptom. The greatest positivity in the chest X-ray was found in patients older than 60 years, the most frequent pattern was the opacity in the peripheral distribution veil. Conclusions: Asymptomatic patients predominate, the positivity of radiographs is higher in the elderly(AU)

Obstructive Spirometeric Patterns and Its reversibility against Short acting ß-2 Agonist in Patients with Bronchiectasis

Objectives: To determine the frequency of obstructive pattern of spirometry in bronchiectasis patients. Material and methods: This case series study was conducted at Department of Pulmonology, Jinnah Hospital Lahore. Total 143 patients with bronchiectasis having age 30-60 years either male or female and having duration of symptoms ?1 years were selected for this study. Results: Total 143 patients with Bronchiectasis were selected for this study. Mean age of the patients was 47.56 ± 9.11 years, mean weight, mean height and mean BMI was 68.01 12.22, 59.63 ± 4.21 and 29.84 5.71 respectively. Out of 143 patients of Bronchiectasis, Positive obstructive pattern was noted in 80 (55.9%) patients and reversibility was noted in 45 (56.25%) patients. Conclusion:Results of this study showed a higher number of positive obstructive pattern in patients of bronchiectasis and percentage reversibility is also very high. Reversibility was significantly associated with age of the patients and duration of disease.

Does shifting to professional emergency department staffing affect the decision for chest radiography? / 世界急诊医学杂志（英文）

@#BACKGROUND: The study aims to determine whether shifting to professional emergency department (ED) teams leads to a higher rate of radiologic workup. METHODS: We retrospectively analyzed a total of 2,000 patients presenting to the ED of a tertiary teaching hospital in two time periods: group 1 (G1) comprised 1,000 consecutive patients enrolled from December 21, 2012 to January 5, 2013 (all patients were examined by an internal medicine specialist); group 2 (G2) comprised 1,000 consecutive patients enrolled from December 21, 2018 to January 3, 2019 (all patients were examined by an emergency physician). RESULTS: The chest X-ray (CXR) was performed in 40.6% of all patients. There was no difference in the frequency of CXR (38.9% in G1 vs. 42.3% in G2, P=0.152). More CXRs were performed in G2 patients older than 65 years, in female patients older than 65 years, in patients presenting during the evening and night shifts or off-hours, in patients with a history of malignancy, in patients with gastrointestinal bleeding, and in patients with bradycardia, but fewer in patients presenting with arrhythmia. No difference in the rates of pathological CXR was found (47.3% in G1 vs. 52.2% in G2, P=0.186). Compared with G2, higher sensitivity and specificity were obtained for the binary logistic regression model predicting pathological findings in G1. CONCLUSIONS: Shifting to professional ED teams does not increase radiologic workup. By implementing deliberate usage of ultrasound, some self-governing procedures, case-oriented investigations, and center-specific recommendations, unnecessary radiologic workup can be avoided. Professional ED teams could lead to a higher standard of emergency care.

Analysis on active surveillance results of occupational pneumoconiosis in Beijing in 2019 / 中国职业医学

OBJECTIVE: To analyze the active surveillance results of occupational pneumoconiosis(hereinafter referred to as “pneumoconiosis”) in Beijing in 2019. METHODS: A total of 2 634 dust exposed workers were recruited as the active surveillance subjects by judgment sampling method. The abnormalities and influencing factors of High kV or digital photography of posterior-anterior chest radiography(hereinafter referred to as “chest radiography”) and lung function were analyzed. RESULTS: The detection rate of abnormal chest radiograph and pulmonary dysfunction were 14.0%(368/2 634) and 6.6%(175/2 634), respectively. The multivariate logistic regression analysis showed that the risk of abnormal chest radiograph in dust-exposed workers increased with age(P<0.01). Mining and construction workers had higher risk of abnormal chest radiograph than manufacturers(all P<0.05). The risk of abnormal chest radiograph of dusk-exposed workers in state-owned and foreign enterprises was higher than that of workers in private enterprises(P<0.05). The risk of pulmonary dysfunction was increased with age and length of dust exposure(all P<0.05). Workers exposed to silica dust and aluminum dust had higher risks than those exposed to welding dust(all P<0.01). The risk of pulmonary dysfunction of workers in small and micro enterprises was higher than that of workers in large enterprises(all P<0.01). Mining workers had higher risks of pulmonary dysfunction than manufacturing workers(P<0.05). CONCLUSION: Age, length of dust exposure, dust type, industry type, enterprise scale and economic type were the influencing factors of lung injury of dust exposed workers. Therefore, the supervision of key population and industries should be strengthened to reduce the occurrence of pneumoconiosis.

Utilidad de la radiografía de tórax en el contexto de la pandemia por SARS-CoV-2 / Usefulness Of Chest Radiography In The Context Of The SARS-CoV-2 Pandemic

En la actual pandemia por SARS-COV-2 la elección de una modalidad de imagen que ayude al basa en las condiciones clínicas del paciente, las pruebas de laboratorio y la disponibilidad de equipos de imágenes en los establecimientos de salud. La Tomografía (TC) y la radiografía de tórax (RxT) son las modalidades de imágenes más usadas; la RxT, con menor sensibilidad que la TC, es un método accesible, menos costoso y de menor exposición al personal de salud, se recomienda su uso en las emergencias y en los servicios de hospitalización. El objetivo del artículo es orientar en la toma de decisiones para elegir una modalidad de imagen de acuerdo a escenarios, teniendo en cuenta sus potenciales beneficios y profundizando en la descripción de las características radiográficas de sospecha de infección por SARS-COV-2 que pueden servir en las emergencias y que permiten evaluar la progresión de la enfermedad usando un sistema de puntuación.

In the current SARS-COV-2 pandemic, the choice of an imaging modality to aid diagnosis is based on the patient's clinical conditions, laboratory tests, and the availability of imaging equipment in health facilities. Tomography (CT) and chest radiography (CXR) are the most widely used imaging modalities; CXR, with less sensitivity than CT, is an accessible method, less expensive and less exposure to health personnel, its use is recommended in emergencies and in hospital services. The objective of the article is to guide decision-making to choose an imaging modality according to scenarios, taking into account its potential benefits and deepening in the description of the radiographic characteristics of suspected SARS-COV-2 infection that may serve in emergencies and we assess disease progression using a scoring system.

Hallazgos imagenológicos de la hemosiderosis pulmonar idiopática en el adulto: una revisión de la literatura de los últimos 20 años / Imaging findings of idiopathic pulmonary hemosiderosis in adults: Literature review of the last 20 years

Resumen La hemosiderosis pulmonar idiopática es una entidad rara caracterizada por hemorragia alveolar capilar. Su tríada clásica es hemoptisis crónica o recurrente, anemia por deficiencia de hierro y opacidades en las imágenes pulmonares. El objetivo de esta revisión fue determinar la frecuencia en radiografía y tomografía de tórax, de los hallazgos de hemosiderosis pulmonar idiopática en adultos, reportados en la literatura durante los últimos 20 años, de acuerdo con los hallazgos semiológicos en imagen, localización y distribución. Se hizo una búsqueda de publicaciones en bases de datos. Se seleccionaron 42 estudios, se estratificaron variables y se recopilaron los hallazgos. La consolidación y las opacidades reticulonodulares fueron el hallazgo más frecuente en radiografía. En tomografía el hallazgo principal fue el vidrio deslustrado en la región basal. No hubo diferencias en los hallazgos semiológicos de imagen en cuanto al compromiso de acuerdo con el género, aunque las mujeres tendieron a presentar una distribución difusa. MÉD.UIS.2020;33(2):55-64.

Abstract Idiopathic pulmonary hemosiderosis is a rare entity characterized by capillary alveolar hemorrhage. Its classic triad is chronic or recurrent hemoptysis, iron deficiency anemia, and opacities in lung images. The objective of this review was to determine the frequency in chest radiography and chest tomography of the findings of idiopathic pulmonary hemosiderosis in adults, reported in the literature during the last 20 years, according to the semiological imaging findings, location and distribution. A search of publications in databases was made. Forty-two studies were collected, variables were stratified in different categories and the findings were compiled. The most frequent finding in chest radiography were consolidation and reticulonodular opacities. On the other hand, the main finding in tomography was ground glass opacities in the basal region. There were no differences in the pattern of compromise by gender, although women tended to have a more diffuse distribution. MÉD.UIS.2020;33(2):55-64.

Evaluation on diaphragmatic motion in chronic obstructive pulmonary disease patients with dynamic X-ray chest radiography under calm breathing / 中国医学影像技术

Objective: To explore the value of evaluation of the diaphragmatic motion in chronic obstructive pulmonary disease (COPD) patients with dynamic X-ray chest radiography under calm breathing. Methods: Dynamic X-ray chest radiographs were performed in 96 COPD patients (COPD group) and 50 healthy controls (control group) under calm breathing. The range, speed and time of the diaphragmtic motion were obtained and analyzed. Results of lung function tests of 2 groups were recorded. Dynamic X-ray chest radiographs and pulmonary function parameters were compared between 2 groups, and the correlations of diaphragmatic motion parameters and lung function parameters were analyzed, respectively. Results: The left and right side diaphragmatic motion amplitude in COPD group ([18.63±7.45]mm, [15.64±5.98]mm) were larger than those in control group ([14.69±5.40]mm, [13.13±4.84]mm, both P0.05). Conclusion: Using dynamic X-ray chest radiograph could quantitatively analyze the diaphragmatic movement of COPD patients, providing a new examination method for accurate clinical evaluation of COPD.

Modelo predictivo clínico-radiológico para diagnosticar tuberculosis pulmonar activa / Predictive clinical-radiological model for diagnosing active pulmonary tuberculosis

Resumen: Introducción: El objetivo de este estudio fue desarrollar un modelo predictivo sobre la presencia de tuberculosis pulmonar activa utilizando datos clínico-epidemiológicos y hallazgos de radiografía simple (Rx) y tomografía computadorizada (TC) de tórax. Material y métodos: Se realizó un estudio observacional, retrospectivo, descriptivo y analítico, que recopiló 22 variables clínico-epidemiológicas, 11 hallazgos radiológicos en Rx de tórax y 23 en la TC, que se realizaron en pacientes con sospecha clínica de tuberculosis pulmonar durante un período de 10 años. Se aplicó un modelo de regresión logística multivariado a los predictores potenciales de cultivo positivo, obteniendo un modelo predictivo. Resultados: Se recogieron 1.540 pacientes con sospecha clínica de tuberculosis a los que se les realizó Rx y TC torácico. El cultivo fue positivo en 101 casos. Se utilizó un proceso de eliminación hacia atrás para obtener el mejor conjunto de variables predictivas. Se obtuvieron 24 variables que fueron significativas (6 clínicas, 5 de Rx y 13 de TC) y se les asignó una puntuación. A la suma de estas puntuaciones se restó la edad en años multiplicada por 0,03. El modelo sugiere el diagnóstico de tuberculosis pulmonar activa en pacientes con una puntuación superior a 1,845. Obtuvo una sensibilidad de 85,1%, especificidad de 83,6%, valor predictivo positivo de 26,6%, y valor predictivo negativo de 98,7%. El área bajo la curva ROC fue de 0,9163. Conclusión: Este sistema de puntuación basado en criterios clínico-epidemiológicos y hallazgos radiológicos puede ayudar a diagnosticar tuberculosis pulmonar activa en casos de sospecha diagnóstica.

Abstract:Introduction: The objective of this study was to develop a predictive model on the presence of active pulmonary tuberculosis using clinical-epidemiological data and findings of chest radiography and thoracic computed tomography (CT). Material and methods: An observational, retrospective, descriptive and analytical study was conducted, which collected 22 clinical and epidemiological variables, 11 radiological findings on chest x-ray and 23 on CT that were performed in patients with clinical suspicion of pulmonary tuberculosis during a period of 10 years. A multivariate logistic regression model was applied to the potential predictors of positive culture, obtaining a predictive model. Results: We collected 1,540 patients with clinical suspicion of tuberculosis who underwent radiography and thoracic CT. The culture was positive in 101 cases. A backward elimination process was used to obtain the best set of predictive variables. We obtained 24 variables that were significant (6 clinical, 5 of chest plain films and 13 of CT) and were assigned a score. The sum of these scores was subtracted from the age in years and multiplied by 0.03. The model suggests the diagnosis of active pulmonary tuberculosis in patients with a score higher than 1.845. The model obtained a sensitivity of 85.1%, specificity of 83.6%, positive predictive value of 26.6, and negative predictive value of 98.7%. The area under the ROC curve was 0.9163. Conclusion: This scoring system based on clinical-epidemiological criteria and radiological findings can help rule out active pulmonary tuberculosis in cases of diagnostic suspicion.

The clinical significance of aortic calcification in chest radiography in community-dwelling, healthy adults: The PRESENT project

@#Background: Aortic calcification (AC), a predictor of generalized atherosclerosis, may precedes cerebral white matter lesions. Cerebral white matter changes (WMCs) are associated with cognitive decline and future dementia. The aim of study was to evaluate the usefulness of aortic calcification (AC) detection by chest radiograph for cueing early intervention in possible WMCs to prevent stroke and dementia in community-dwelling healthy people. Methods: We assessed the relationship between AC in chest radiography and vascular risk factors and severity of WMCs in 543 middle-aged and elderly individuals with no history of stroke or dementia. Results: The mean age of the subjects was 61.6 ± 7.4 years. Of these, AC was observed in 39 (7.2%) subjects. AC combined with grade 1 WMC (mild), 2 (moderate), and 3 (severe) were seen in 8 (25.8%), 7 (23.3%) subjects, and 3 (30.0%) subjects, respectively. After adjustment for age and vascular risk factors, diabetes (odds ratio [OR], 1.92, 95% confidence interval (CI) 1.01–3.65, p<0.05) and hypertension (OR, 1.86, 95% CI, 1.03-3.35, p<0.05), aortic knob width (OR, 1.07, 95% CI, 1.01–1.13, p<0.05) and aortic calcification (OR, 2.93, 95% CI, 1.36-6.33, p<0.05) were significantly associated with the severity of WMCs. Conclusion: There is an association between the presence of AC in chest radiography and WMC. It may be useful in providing important information about development of WMCs for prevention of future vascular-related cognitive impairments or ischemic stroke

The Potential Role of Grid-Like Software in Bedside Chest Radiography in Improving Image Quality and Dose Reduction: An Observer Preference Study

OBJECTIVE: To compare the observer preference of image quality and radiation dose between non-grid, grid-like, and grid images. MATERIALS AND METHODS: Each of the 38 patients underwent bedside chest radiography with and without a grid. A grid-like image was generated from a non-grid image using SimGrid software (Samsung Electronics Co. Ltd.) employing deep-learning-based scatter correction technology. Two readers recorded the preference for 10 anatomic landmarks and the overall appearance on a five-point scale for a pair of non-grid and grid-like images, and a pair of grid-like and grid images, respectively, which were randomly presented. The dose area product (DAP) was also recorded. Wilcoxon's rank sum test was used to assess the significance of preference. RESULTS: Both readers preferred grid-like images to non-grid images significantly (p < 0.001); with a significant difference in terms of the preference for grid images to grid-like images (p = 0.317, 0.034, respectively). In terms of anatomic landmarks, both readers preferred grid-like images to non-grid images (p < 0.05). No significant differences existed between grid-like and grid images except for the preference for grid images in proximal airways by two readers, and in retrocardiac lung and thoracic spine by one reader. The median DAP were 1.48 (range, 1.37–2.17) dGy*cm2 in grid images and 1.22 (range, 1.11–1.78) dGy*cm2 in grid-like images with a significant difference (p < 0.001). CONCLUSION: The SimGrid software significantly improved the image quality of non-grid images to a level comparable to that of grid images with a relatively lower level of radiation exposure.

Application of Deconvolution Algorithm of Point Spread Function in Improving Image Quality: An Observer Preference Study on Chest Radiography

OBJECTIVE: To evaluate the preference of observers for image quality of chest radiography using the deconvolution algorithm of point spread function (PSF) (TRUVIEW ART algorithm, DRTECH Corp.) compared with that of original chest radiography for visualization of anatomic regions of the chest. MATERIALS AND METHODS: Prospectively enrolled 50 pairs of posteroanterior chest radiographs collected with standard protocol and with additional TRUVIEW ART algorithm were compared by four chest radiologists. This algorithm corrects scattered signals generated by a scintillator. Readers independently evaluated the visibility of 10 anatomical regions and overall image quality with a 5-point scale of preference. The significance of the differences in reader's preference was tested with a Wilcoxon's signed rank test. RESULTS: All four readers preferred the images applied with the algorithm to those without algorithm for all 10 anatomical regions (mean, 3.6; range, 3.2–4.0; p < 0.001) and for the overall image quality (mean, 3.8; range, 3.3–4.0; p < 0.001). The most preferred anatomical regions were the azygoesophageal recess, thoracic spine, and unobscured lung. CONCLUSION: The visibility of chest anatomical structures applied with the deconvolution algorithm of PSF was superior to the original chest radiography.

The Relationship between Aortic Knob Width and Metabolic Syndrome / 가정의학회지

BACKGROUND: Both aortic knob width and metabolic syndrome are suggested to be related to atherosclerosis and cardiovascular diseases. However, the association between aortic knob width and metabolic syndrome is unknown. This study aimed to explore this relationship. METHODS: Participants were 3,705 Korean adults aged 18–79 years who visited the health promotion center of a general hospital. Data on chest radiography, physical measurements, medical and social history, and blood tests were collected. We defined metabolic syndrome according to the National Cholesterol Education Program Adult Treatment Panel III criteria. A single reviewer measured aortic knob width on chest radiography. RESULTS: Aortic knob width was significantly correlated with age; body mass index; waist circumference; systolic and diastolic blood pressures; total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting glucose, glycated hemoglobin, insulin, and uric acid levels; and homeostatic model assessment of insulin resistance values. Aortic knob width significantly increased as the number of metabolic syndrome components increased. Moreover, metabolic syndrome component values tended to increase across the quartile groups of aortic knob width after adjusting for age, exercise, smoking status, and alcohol use. Through receiver operating characteristic curve analysis, we determined the clinically useful cutoff value for aortic knob width to be 30.47 mm in premenopausal women. CONCLUSION: Aortic knob width was found to be significantly related to metabolic syndrome and its individual components.

Percepções de médicos sobre diagnóstico clínico de pneumonias comunitárias na infância / Perceptions of physicians on clinical and radiological diagnosis of comunity-acquired pneumonias in children

Identificar diferentes linhas de raciocínio clínico e condutas de médicos num hospital pediátrico acerca de um caso hipotético de PAC não complicada. Estudo qualitativo, descritivo e transversal. Amostra intencional, não probabilística, composta por doze profissionais. Coleta de dados pela apresentação de hipotético caso clínico pediátrico sob a forma de entrevista semi-estruturada. Análise dos dados utilizando-se as diretrizes britânica e americanas vigentes como bases conceituais. Estudo aprovado pelo Comitê de Ética em Pesquisa do hospital pediátrico abordado. Entre os dados obtidos, a maioria dos entrevistados solicitou a radiografia de tórax e não mudou sua conduta, independente do laudo radiográfico. No geral, os profissionais valorizaram anamnese e exame físico bem feitos, e que uma radiografia de tórax dificilmente alteraria uma conduta quando PAC não complicada e ambulatorial. Deficiente relação médico-paciente na emergência, local da consulta, preocupação com defesa médica e verificação de complicações foram algumas justificativas dadas. A solicitação de exames complementares raramente altera a conduta terapêutica. Devido à grande importância epidemiológica, é imperativo novos estudos visando compreender condutas discrepantes às diretrizes vigentes.

To identify the different lines of clinical thought and medical practice in a pediatric hospital concerning a hypothetical case of non-complicated CAP. A qualitative, descriptive and transversal study. Intentional and non-probability sampling, and twelve physicians were included. Data collection was derived from a hypothetical pediatric clinical case organized as a semi-structured interview. Data analysis conceptually based on the current British and American guidelines. This research was approved by the Research Ethics Committee of the respective hospital. Among the data obtained, most of the interviewed subjects did request a chest radiography and did not change their decision making, regardless of radiological report. Overall, the physicians emphasized history and a good physical examination, and that a chest radiography hardly would change the decision making when PAC is non-complicated. A deficient doctor-patient relationship, an inadequate ambient, legal concerns and the assessment of possible complications were some of the reasons given. The request of complementary exams rarely changes the clinical decision making. Due to a great epidemiological importance, it is imperative that future research attempts to outline the discrepancies between practice and current guidelines.

Surgical Repair of Scimitar Syndrome

Scimitar syndrome (SS) is a form of partial anomalous pulmonary venous drainage that is dramatically visible on plain chest radiography (CXR). In these individuals, the entire venous drainage from the right lung enters a single anomalous large vein that descends to the inferior vena cava. This descending vein is visible on CXR as a curvilinear density along the right heart border and resembles the curved Turkish sword that gives the condition its name. SS forms part of the large spectrum of associated conditions known as venolobar syndrome. These include right lung hypoplasia or sequestered segments of right lung, congenital heart disease and various others. We report, along with our other five cases, a special case of a young woman who presented incidentally, with a murmur, at 16 years of age. Full investigation including angiography showed a large atrial septal defect (ASD) with right heart dilation and SS. She underwent surgical correction with uneventful and complete correction by baffling of the scimitar vein from its entry into the inferior vena to the left atrium through the enlarged ASD.

Accuracy of chest radiography for positioning of the umbilical venous catheter / Acurácia da radiografia de tórax para o posicionamento do cateter venoso umbilical

Abstract Objectives: To evaluate the accuracy of the simultaneous analysis of three radiographic anatomical landmarks - diaphragm, cardiac silhouette, and vertebral bodies - in determining the position of the umbilical venous catheter distal end using echocardiography as a reference standard. Methods: This was a cross-sectional, observational study, with the prospective inclusion of data from all neonates born in a public reference hospital, between April 2012 and September 2013, submitted to umbilical venous catheter insertion as part of their medical care. The position of the catheter distal end, determined by the simultaneous analysis of three radiographic anatomical landmarks, was compared with the anatomical position obtained by echocardiography; sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: Of the 162 newborns assessed by echocardiography, only 44 (27.16%) had the catheter in optimal position, in the thoracic portion of the inferior vena cava or at the junction of the inferior vena cava with the right atrium. The catheters were located in the left atrium and interatrial septum in 54 (33.33%) newborns, in the right atrium in 26 (16.05%), intra-hepatic in 37 (22.84%), and intra-aortic in-one newborn (0.62%). The sensitivity, specificity and accuracy of the radiography to detect the catheter in the target area were 56%, 71%, and 67.28%, respectively. Conclusion: Anteroposterior radiography of the chest alone is not able to safely define the umbilical venous catheter position. Echocardiography allows direct visualization of the catheter tip in relation to vascular structures and, whenever possible, should be considered to identify the location of the umbilical venous catheter.

Resumo Objetivos: Avaliar a acurácia da análise simultânea dos três marcos anatômicos radiográficos - diafragma, silhueta cardíaca e corpos vertebrais - na determinação da posição da extremidade distal do cateter venoso umbilical com a ecocardiografia como padrão de referência. Métodos: Estudo transversal, observacional, com inclusão prospectiva de dados de todos os neonatos nascidos em uma maternidade pública de referência, entre abril de 2012 e setembro de 2013, submetidos à inserção de cateter venoso umbilical como parte do atendimento clínico. A posição da extremidade distal do cateter, determinada pela análise simultânea dos três marcos anatômicos radiográficos, foi comparada com a posição anatômica obtida pela ecocardiografia. Sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia foram calculados. Resultados: Dos 162 recém-nascidos avaliados por ecocardiografia, somente 44 (27,16%) estavam com o cateter em posição ótima, na porção torácica da veia cava inferior ou na junção da veia cava inferior com o átrio direito. Os cateteres foram localizados no átrio esquerdo e no septo interatrial em 54 (33,33%), no átrio direito em 26 (16,05%), no intra-hepático em 37 (22,84%) e na aorta em um recém-nascido (0,62%). A sensibilidade, especificidade e acurácia da radiografia para detectar cateter na zona-alvo foram de 56%, 71% e 67,28%, respectivamente. Conclusão: A radiografia anteroposterior de tórax isolada não é capaz de definir com segurança a posição do cateter venoso umbilical. A ecocardiografia permite a visibilização direta da ponta do cateter em relação às estruturas vasculares e, sempre que possível, deve ser considerada para localização do cateter venoso umbilical.

Radiological findings of pulmonary tuberculosis in adolescents in a teaching hospital, Sangareddy

Background: Tuberculosis (TB) accounts for 1.7 million deaths, according to the recent WHO report. India alone accounts for one fifth (21%) of all the TB cases globally. Objectives: Radiologic findings of pulmonary tuberculosis (TB) in adolescents. Materials and methods: A cross-sectional, observational study of 170 patients with TB aged 10 to 19 years. Data were collected from the TB notification and medical records during the period of 2014- 2017. Data were shown in tables and analyzed using the chi-square test, with a 5% significance level. Results: Mean age was 15.6 years; 97 (57%) patients were males. The most common radiologic lesion was the upper pulmonary lobe infiltrates (43.33%), and isolated cavitation was found in 20.7% of the patients. Both lungs were affected in 32.2% of the patients. The finding of bilateral radiologic lesions was significantly associated with longer disease duration (p = 0.0005). Conclusion: Pulmonary TB in adolescents has similar characteristics to TB in adults, evidencing the important role played by adolescents to transmit the disease in community.

A preliminary investigation on pulmonary subsolid nodule detection using deep learning methods from chest X-rays / 中华放射学杂志

Objective To evaluate the effectiveness of deep learning methods to detect subsolid nodules from chest X-ray images.Methods The building,training,and testing of the deep learning model were performed using the research platform developed by Infervision,China.The training dataset consisted of 1 965 chest X-ray images, which contained 85 labeled subsolid nodules and 1 880 solid nodules. Eighty-five subsolid nodules were confirmed by corresponding CT exams. We labeled each X-ray image using the corresponding reconstructed coronal slice from the CT exam as the gold standard,and trained the deep learning model using alternate training.After the training,the model was tested on a different dataset containing 56 subsolid nodules,which were also confirmed by corresponding coronal slices from CT exams. The model results were compared with an experienced radiologist in terms of sensitivity,specificity,and test time. Results Out of the testing dataset that contained 56 subsolid nodules, the deep learning model marked 72 nodules,which consisted of 39 true positives(TP)and 33 false positives(FP).The model took 17 seconds.The human radiologist marked 39 nodules,with 31 TP and 8 FP.The radiologist took 50 minutes and 24 seconds. Conclusions Subsolid nodules are prone to mis-diagnosis by human radiologists. The proposed deep learning model was able to effectively identify subsolid nodules from X-ray images.

Quality assurance and quality control in chest radiography based on X-ray digital radiography / 中国医学装备

Objective:To study and analyze the quality assurance(QA) and quality control(QC) in chest radiography based on X-ray digital radiography (DR).Methods:600 cases ( 320 male cases, 280 female cases, age range from 2 to 68 years old, with an average 48.2 years old) chest radiography based on DR were random sampling from database during the period from Oct., 2015 to Dec., 2015. In accordance with chest imaging criteria, these images were graded, and calculated the share rate. After analyzing the causes that produced the bad images, a number of measures were provided to improve the quality of image.Results:The patients can be examined in short time, and there are a large number of information with high resolution and rich layers. The qualified rate was 100% (Grade A with 525, accounting for 87.5%,Grade B with 63, accounting for 10.5%; Grade C with 12 , accounting for 2%), and the rate of waste film was zero.Conclusion: DR produced by computer digital image processing technology combined with X-ray radiation technology has powerful post-processing function. This function can combine a series of quality control measures to improve image quality as reducing radiation dosage, and finally, to realize the target of QA and QC.

Características clínicas y epidemiológicas de los pacientes hospitalizados con derrame pleural / Clinical and epidemiological characteristics of patients hospitalized with pleural effusion

El derrame pleural tiene una prevalencia mundial de aproximadamente 400 de cada 100.000 habitantes y Venezuela tiene cifras similares. Se relaciona con múltiples patologías, por lo que determinar sus características podría ayudar a obtener un mejor diagnóstico y tratamiento. Métodos: Se realizó un estudio de casos, retrospectivo y descriptivo, obteniendo información de las historias de pacientes hospitalizados con derrame pleural en el servicio de Medicina Interna del Hospital Dr. Domingo Luciani en el período Enero 2010- Abril 2015. Resultados: La edad promedio fue de 49±19 años, género masculino (53%). Motivo de consulta: disnea (81%), dolor torácico (44%) y tos (37%). Los síntomas: disnea (92%), dolor pleurítico (58%) y fiebre (54%). Antecedentes personales: HTA (32%), DM (22%) e IC (20%). Radiografía de tórax: (60%) derrame pleural derecho y (26%) izquierdo. Tomografía de tórax realizada en (77%). Citoquímicos: (85%) exudado (53% mononuclear y 32% polimorfonucleares). La prueba de ADA positiva en 25%, cultivo para bacterias realizado en 89 casos, positivos 18%. Bloque celular con resultado inflamatorio (80%). Biopsia pleural realizada (22%): inflamatorio (36,4%), seguido por ADC metástasico (31,8%). Estancia hospitalaria > 15 días (76%) y el diagnóstico final fue infeccioso (51%). Conclusión: Contando con estos datos clínicos- epidemiológicos se puede caracterizar el comportamiento del derrame pleural en nuestro centro para el rápido y acertado diagnóstico, igualmente proponer una investigación prospectiva donde se analice el comportamiento de dicha enfermedad, y crear protocolos de actuación(AU)

Pleural effusion has a worldwide prevalence of approximately 400 per 100,000 inhabitants and Venezuela has similar statistics. It is related to multiple pathologies, which determine their characteristics which could help for better diagnosis and treatment. Methods: A retrospective descriptive case study was conducted, obtaining information from the charts of hospitalized patients with pleural effusion in Internal Medicine Dr. Domingo Luciani Hospital Venezuela in the period January 2010-April 2015. Results: Mean age 49 ± 19 years, male genre (53%). Complaints: dyspnea (81%), chest pain (44%) and cough (37%). Symptoms: dyspnea (92%), pleuritic pain (58%) and fever (54%). Personal history: hypertension (32%), DM (22%) and HF (20%). Chest x-ray: right pleural effusion (60%), left (26%). Chest tomography performed on (77%). Cytochemical: exudate: 85% (53% mononuclear and polymorphonuclear 32%). ADA testing positive in 25%. For bacteria culture: performed in 89 cases, 18% positive. Cell block inflammatory (80%). Pleural followed by metastatic ADC (31.8%). Hospital stay> 15 days (76%) and final diagnosis was infection (51%). Cause of discharge from hospital: improvement (80%). Conclusion: Having these clinical and epidemiological data can characterize the behavior of pleural effusion for quick and accurate diagnosis(AU)