Chest x-ray findings of paediatric patients seen at a Teaching Hospital in North-western Nigeria

Introduction: Plain radiography is the first line of radiological examination used for the evaluation of paediatric chest, and also a rapid imaging technique that allows lung abnormality to be identified. X-ray is used to diagnose conditions of the thoracic cavity, including airways, ribs, lungs, heart, and diaphragm. Chest x-ray has a high sensitivity for pulmonary tuberculosis and thus is a valuable tool to identify a differential diagnosis for a patient. Methodology: Two hundred and eleven paediatrics chest x-ray reports were studied between February 2017 to September 2018. Data were collected retrospectively from the hospital archives using a data capture sheet. Results: Two hundred and eleven radiographs were assessed and the age of patients whose radiographs participated in the study ranged from 0-15 years. Also, a greater number of male patients 133(63.03%) participated in the study than female patients 78(36.97%). Among all the radiographs used in this study, the most common age group for this study ranged from 0-3 years. Results from the study also revealed that bronchopneumonia was the most common finding totaling 105(49.76%) followed by radiographs which are normal findings 77(36.49), pulmonary tuberculosis, 19(9.00%), congestive heart failure 4(1.90%), pleural effusion 3(1.42%), enlarged adenoid 2(0.95%) and dextrocardia 1(0.47%). Conclusion: This study report bronchopneumonia was the most common paediatrics radiographic finding in a chest x-ray. Plain radiography is an effective tool to examine various respiratory and cardiac pathologies and is the first line of investigation for chest pathologies.

The Brixia Chest X Ray Severity Score in adult patients with symptomatic Covid-19 Infection : A useful guide to management

@#COVID-19 is a highly contagious viral illness with a wide spectrum of clinical manifestations ranging from asymptomatic or mild cold like symptoms to a devastating and often fatal respiratory illness. The elderly and those with underlying morbidity are the groups most often, but certainly not exclusively, associated with death from respiratory pathology. COVID-19 respiratory illness usually manifests clinically as pneumonia with predominant imaging findings of an atypical or organized pneumonia. Chest radiography (CXR) helps to assess the progress of the disease. The BRIXIA score based on radiological appearance may be used to determine the severity and clinical outcome of a patient with COVID-19. The aim of this study was to assess the relationship between the BRIXIA score and the clinical outcome of positive COVID-19 patients at Port Moresby General Hospital (PMGH) in Papua New Guinea (PNG). In this descriptive retrospective study conducted at the Radiology Department of the PMGH the records of 129 Polymerise Chain Reaction (PCR) confirmed patients admitted to PMGH between September and December 2021 were examined. The patients were grouped into mild, moderate or severe categories depending on clinical features at the time of diagnosis. There were 89 (69%) males and 40 (31%) females. The mean (SD) age was 52 (12) years, and the median (IQR) was 53 (44-60). Their admission CXRs were given a Brixia score. Mean (SD) Brixia scores for mild (n=24), moderate (n=67) and severe (n=38) were 4.5 (2.5), 8.9 (2.7) and 12.5 (3.5) respectively. The Brixia score was significantly related to the clinical severity, F 55.49, p <0.001. Twenty seven (77%) of the 35 patients who died had comorbidities of whom 21 (78%) were in the clinically severe group. A Brixia score of 9 or more was closely associated with death, p = 0.001, Odds Ratio with 95% Confidence interval (0R) of 3.9 (1.7-9.6). The Brixia CXR severity score is a useful tool in assessing clinical severity and prognosis in patients with COVID 19.

Correlation of biomarkers and radiological findings among COVID-19 patients: a retrospective study

Introduction: The severity of COVID-19 is classified based on clinical, laboratory, and radiology characteristics. Although chest X-ray (CXR) is not sensitive in early stage disease, it can be useful in assessing the rapid progression of lung abnormalities in COVID-19. While CXR findings correlate with the severity of the disease, computed tomography (CT) scans of the chest are widely and repeatedly done. As it exposes the patient to a large dose of radiation and risks the spread of infection to other patients, it is worthwhile to explore the utility of CXR to overcome the above problem, especially in resource-poor settings. Materials and Methods: Inpatients with reverse transcriptase–polymerase chain reaction (RT-PCR)-positive COVID-19 irrespective of severity, admitted in the COVID wards from June to September 2020, were included in a retrospective study. CXR done at admission was scored for radiological severity of COVID-19 by an independent radiologist, unaware of the clinical/laboratory parameters of patients. It was then co-related with clinical severity and standard biomarkers at admission. Results: We studied 400 patients, the mean age (SD) was 53.69 (15.43) years, 268 (67%) were males, the majority of them were symptomatic (95%), 192 (48%) had severe disease, and 238 (59.5%) patients had co-morbidities. Receiver-operating curve (ROC) for CXR severity score showed a threshold of 3.5 to predict severe COVID, which had a positive predictive value of 71% and a negative predictive value of 73%. Using Pearson’s correlation coefficient, CXR severity scores significantly correlated with the clinical severity and standard biomarkers. Conclusion: With the overwhelming number of COVID-19 patients burdening the healthcare system, monitoring of the severity of the disease can be achieved with regular clinical assessment and laboratory parameters with limited radiation exposure, avoiding repeated CT scans, especially in resource-poor settings.

Correlation of Vitamin D deficiency with chest X-rays severity scores and different inflammatory markers in severe and critical COVID-19 patients

Objective: To determine the relationship between Vitamin D deficiency with Chest X-Rays severity score and Different Inflammatory Markers in Severe and Critical COVID-19 Patients. Design: A cross-sectional study Setting: The study was conducted in COVID-19 isolation units at Mardan Medical Complex Teaching Hospital (MMCTH) and Bacha Khan Medical College, Pakistan Participants: 206 patients who tested positive for COVID-19 by PCR were included in the final analysis.Data Collection/Intervention: We collected demographic, comorbidity, laboratory, and clinical outcome data from the electronic records of admitted, deceased, or discharged patients.Main outcome measure: Frequency of symptoms, comorbidities, mortality and morbidity, chest x-ray severity scores, different inflammatory markers in Vitamin D deficient Covid-19 patients Results: 128(62.14%) were severe and 78(37.5%) were critical COVID-19 patients. The whole cohort had 82(39.80%) males and 124(60.20%) females, with a median age of 55 IQR (50-73). Study participants' median Vitamin D level was 14.01ng/ml, with a minimum of 7.5ng/ml and a maximum of 70.8ng/ml. 67/206 patients died, with a fatality ratio of 32.5%. 54/67(80.59%) suffered from one or more comorbid conditions. Conclusion: Low Vitamin D levels were linked to a higher risk of death, higher x-ray severity scores, and different inflammatory markers. Vitamin D levels greater than 30ng/ml for older patients and greater than 40ng/ml in older patients with comorbidities were associated with reduced severity and mortality in patients with COVID-19

The predictive value of chest x-ray and plain chest CT scan as adjunct screening tools for COVID-19 patients in a national tertiary infectious disease hospital from March 1 to November 30, 2020

Background@#COVID-19 is diagnosed via Real Time Reverse Transcription Polymerase Chain Reaction (RT-PCR), with plain chest CT and chest x-ray as adjuncts. In the Philippines, chest x-ray is used as initial screening in assessing potential COVID-19 cases, with plain chest CT scan not routinely used due to higher cost and decreased availability.@*Objective@#This study determined the validity of chest x-ray and plain chest CT as initial screening tools for admitted COVID-19 patients from March 1 to November 30, 2020, at San Lazaro Hospital, comparing these with RT-PCR testing for COVID-19 as initial basis for considering a patient as a possible case of COVID-19.@*Methods@#This was a cross-sectional study of radiographic literature of admitted COVID-19 patients from March 1 to November 30, 2020, at San Lazaro Hospital, all with confirmatory RT-PCR, chest X-rays, and plain chest CTs. Baseline chest x-rays, with initial plain chest CT results, were compared with RT-PCR results. A tally was made, noting radiographic findings on both Chest X-ray and Plain Chest CT most frequently seen among patients with corresponding positive real time RT-PCR results.@*Results@#Chest X-rays done < 2 days from admission revealed involvement of both lungs, with infiltrates located centrally and peripherally, with major predilection for both lower lobes. Plain chest CT was similar, with ground glass opacities as the most common finding, consolidation second. Chest x-ray had a sensitivity of 88.11%, plain chest CT 94.71%. Sensitivity of combined chest x-ray and plain chest CT was 86.78%. Specificity and predictive value were not computed due to non-inclusion of admitted patients with COVID negative RT-PCR swab.@*Conclusion@#Chest X-ray and plain chest CT are useful modalities with high sensitivity in screening patients with fever, cough, and colds on admission. However, initial chest x-ray and plain chest CT scan results do not translate into a prognosis without context of initial diagnostics and management done during confinement.

The utility of a chest radiograph in screening COVID-19 patients in a pediatric tertiary government hospital

@#<p><strong>Background:</strong> Coronavirus disease 2019 (COVID-19) continues to be a pandemic to this time, and chest radiography has been used as a first-line triage tool, due to long turnaround times for real-time reverse transcription polymerase chain reaction (RT-PCR), which remains to be the gold standard in COVID-19 diagnosis. Chest x-ray alone has poor sensitivity to diagnosing COVID-19 and pediatric studies on this are scarce.</p><p><strong>Objectives:</strong> The main objective is to evaluate the usefulness of a routine chest radiograph as an adjunct to diagnosing suspected pediatric COVID-19, along with its sensitivity, specificity, accuracy, and correlation with the most common pediatric signs and symptoms. In line with this, the radiographic characteristics seen in pediatric COVID-19 patients are presented.</p><p><strong>Methods:</strong> A cross-sectional study involving a retrospective chart review of 259 pediatric patients admitted in a tertiary hospital with COVID-19 signs and symptoms, with baseline chest x-ray and SARS-CoV2 RT-PCR tests. Correlation of signs and symptoms with chest x-ray findings to RT-PCR positivity was determined using univariate and multivariate logistic regression analysis.</p><p><strong>Results:</strong> The study was composed of 259 pediatric patients (ages 0-18 years old). Of these, 35 had positive findings with RT-PCR (15%). Sensitivity of a chest radiograph with pneumonia is at 62.9%, while specificity is at 39.3%. Overall accuracy of CXR findings leading to RT-PCR positivity is at 42.5%. Ground glass or hazy opacities was the most common radiographic finding (45.5%), followed by reticular opacities (31.8%). Abnormalities were mostly distributed in the inner lung zone distribution with bilateral lung involvement (90%). Those with difficulty of breathing were more likely to have pneumonia on their CXR, though a finding of pneumonia on CXR did not significantly correlate to a positive RT-PCR.</p><p><strong>Conclusions & Recommendations:</strong> Findings of pneumonia on a pediatric CXR may not necessarily lead to a positive SARS-CoV2 RT-PCR, but correlating this with the patient's clinical course and symptoms may be beneficial in effective triaging of patients. Reassessment by another radiologist may provide additional strength to this study.</p>

Changes of X-ray examination mode for ophthalmic inpatients and impact on radiation dose level from 2019 to 2020 / 中华放射医学与防护杂志

Objective:To analyze and compare the X-ray procedures and radiation dose composition of ophthalmic inpatients, and to explore the changes of the X-ray examination mode in recent years and the effect of optimization in imaging technology on the radiation dose level of the patients.Methods:The simple random sampling method was used to retrospectively select the imaging data of the ophthalmic inpatients in the Second Affiliated Hospital of Zhejiang University School of Medicine from July 1st to November 31st in 2019 and from July 1st to November 31st in 2020. A total of 516 cases were selected according to the imaging time, including 258 cases in 2019 and 258 cases in 2020. Based on our previous research and the related documents of low-dose CT screening, a series of optimizations on CT scanning parameters and process were carried out in 2020, including the frequency of DR and CT scanning, the number of examinations per capita, the composition ratio of CT and DR, and X-ray dose per capita.Results:In 2020, the average effective doses of chest CT and orbital CT for ophthalmic inpatients were (2.587±1.586) mSv and (0.877±0.733) mSv, significantly lower than those in 2019 ( F=0.52, 0.72, P<0.05), and decreased by 34.82% and 37.13%, respectively. There was no significant difference in the average effective dose of chest DR and head CT between 2020 and 2019 ( F=6.01, 1.81, P>0.05). The number of X-ray examination per capita increased by 0.15 times, and the effective dose increased by 1.44 times (1.589 mSv). Chest DR was the main type of X-ray examination, accounting for 68.79% of all examinations in 2019, while chest CT was the main type, accounting for 71.05% in 2020. The composition of chest CT in 2020 increased by 63.17% compared with 2019, and the compositions of chest DR, orbital CT and cranial CT were decreased by 53.88%, 5.79% and 2.89%, respectively. Conclusions:With dose optimization measures, the single CT dose of ophthalmic inpatients in 2020 was lower than that in 2019. Chest CT increased significantly in frequency, and became main X-ray examination instead of chest DR which made the effective dose of ophthalmic inpatients increasing significantly.

Factores asociados a hallazgos anormales en radiografías digitales de tórax en trabajadores asintomáticos en Lima, Perú / Factors associated with abnormal findings on digital chest radiographs in asymptomatic workers in Lima, Peru

RESUMEN Introducción : La radiografía posteroanterior (PA) de tórax es utilizada rutinariamente como examen complementario en la evaluación de trabajadores. Sin embargo, existe la controversia sobre su indicación y utilidad en todos los trabajadores. El presente estudio tuvo como objetivo describir los factores asociados a hallazgos anormales en radiografías digitales de tórax en trabajadores sin síntomas respiratorios. Materiales y métodos : Se realizó un estudio observacional transversal analítico, utilizando registros de placas radiografías digitales de tórax PA de 24 069 trabajadores asintomáticos respiratorios, evaluados en un establecimiento de salud acreditado para la realización de exámenes médicos ocupacionales en el Perú, entre los años 2016 - 2019. Resultados : De los 24 069 trabajadores asintomáticos, 1166 (4,84 % IC 95 % [4,58 - 5,12]) presentaron radiografía anormal. Los principales hallazgos se encontraron en el parénquima pulmonar y de estas, las imágenes secuelares de tuberculosis fueron las más frecuentes. Se observó que los trabajadores mayores de 50 años (RP(a) = 6,34 IC 95 % [1,68 - 2,01]), los que presentaron bajo peso (RP(a) = 2,71 IC 95 % [1,88 - 3,91]) y los que tuvieron antecedentes patológicos pulmonares (RP(a) = 6,19 IC 95 % [5,54 - 6,91]) presentaron mayor probabilidad de presentar anormalidades en la radiografía pulmonar. Conclusiones : Debido a la baja frecuencia de radiografías digitales anormales de tórax, creemos que no resulta de utilidad como detección precoz de patología respiratoria en la población estudiada y que debería considerarse en trabajadores mayores de 50 años, con antecedente de enfermedad respiratoria y/o con bajo peso. Es importante realizar mayor cantidad de estudios que confirmen nuestros resultados.

ABSTRACT Introduction : Posteroanterior Chest X-Ray (CXR) is usually performed as a routine exam for workers' health surveillance, but their benefits are discussed and controversial. Our investigation described the associated factors with abnormal digital CXR in workers without respiratory symptoms. Materials and methods : An analytical cross-sectional observational study was performed, including 24 069 digital CXR obtained from workers without respiratory symptoms who performed their workers' health surveillance at an accredited occupational health center in Lima, Perú, from 2016 to 2019. Results : Of the 24 069 asymptomatic workers, 1166 (4.84 %, 95 % CI [4.58-5.12]) had abnormal radiography. The main findings were found in the lung parenchyma and of these, sequential images of tuberculosis were the most frequent. It was observed that workers older than 50 years (RP(a) = 6.34, 95 % CI [1.68 - 2.01]), those with low weight (RP(a) = 2.71 95 % CI [1.88 - 3.91]) and those with a history of pulmonary pathology (RP(a) = 6.19 95 % CI [5.54 - 6.91]) were more likely to have abnormalities on pulmonary radiography. Conclusions : Due to the low frequency of abnormal digital Chest X-Ray (CXR), it is not useful as an early detection of respiratory pathology in the population studied, however it should be considered in those over 50 years with a history of respiratory disease and/or low weight. It is important to carry out more studies that confirm our results.

Prevalence of pneumonia by chest x-ray, associated demographic characteristics and health risk factors among COVID-19 patients in Ghana

Objective: The study was conducted to determine the prevalence of radiologically diagnosed pneumonia among COVID-19 patients and associated factors. Design, setting, and participants: A retrospective manual data extraction of 275 medical records of COVID-19 patients was conducted at two COVID-19 national treatment centres in Accra from March to May 2020. All patients had a chest x-ray done. Main outcome and analysis: The main outcome was the presence of pneumonia. Descriptive statistics and Chi-square test of independence were employed to determine the associations between independent variables and the presence of pneumonia. All analysis was performed using Stata 16, and a p-value ≤ 0.05 was deemed significant Results: The prevalence of pneumonia was 44%(95%CI) =38.2-50.0). Chi-square independent test indicated that pneumonia in the COVID-19 patients was associated with educational level, history of domestic and international travel, mass gathering in the past 14 days before diagnosis, and discharge plan (p-value< 0.05). Patients classified as secondary cases (61.5%) and those discharged as fully recovered from the health facility (61.2%) had a higher prevalence of pneumonia. In addition, COVID-19 patients with hypertension (32.1%) and asthma (5.2%) had a significantly higher prevalence of pneumonia. Conclusion: Overall, the prevalence of pneumonia was 44% and was associated with the demographic and personal characteristics of the patients. Early detection through contact tracing and community surveillance should be intensified to pick up more asymptomatic cases. The role of the chest x-ray for triaging patients and for clinical management of symptomatic patients remains key

Current status and prospect of imaging examination methods for rejection after lung transplantation / 器官移植

Lung transplantation is the only effective therapeutic option for end-stage lung diseases, and postoperative rejection is the main factor affecting clinical prognosis of the recipients. Imaging examination can be utilized as a noninvasive tool to assist other examinations in monitoring rejection after lung transplantation. At present, multiple imaging examination methods have been reported. The advantages and disadvantages of various imaging examinations have been clarified, which may promote early diagnosis of rejection, deliver timely treatment for lung transplant recipients and improve the quality of life and clinical prognosis. In this article, the advantages, disadvantages and research progress upon different imaging examinations for rejection after lung transplantation were reviewed, aiming to provide reference for identifying the optimal noninvasive examination approach for rejection after lung transplantation and enhance the long-term survival of the recipients.

Relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a ventilación mecánica en pacientes COVID-19: un análisis preliminar / Relations of ventilatory mechanical and radiographic measures with the connection time to mechanical ventilation in patients COVID-19: a preliminary analysis

RESUMEN: Los pulmones son el sitio predominante en la infección por COVID-19. Esta puede conducir al síndrome distrés respiratorio agudo (SDRA). Frente a su sintomatología severa, la ventilación mecánica (VM), y sus valores de mecánica ventilatoria aparecen como una herramienta fundamental. Un complemento, para analizar el estado de avance de esta patología es la radiografía de tórax (RT), aunque en ocasiones esta depende de la experiencia del equipo de salud. Así el objetivo de esta investigación fue explorar la relación de las medidas de mecánica ventilatoria y radiográficas con el tiempo de conexión a VM en pacientes COVID-19. Estudio retrospectivo, que incluyó a 23 pacientes en VM. Se recolectó información de variables de mecánica ventilatoria; PEEP, presión plateau, presión de distensión y compliance estática. Desde la RT se midió, altura y ancho pulmonar, ángulo costodiafragmático y espacio intercostal. Los resultados indicaron que las variables de mecánica ventilatoria tales como el PEEP y el plateau se relacionaron significativamente con el tiempo de conexión a VM (r=0,449; p=0,035 y r=0,472; p=0,026), mientras que las variables radiográficas construidas en base al ángulo costodiafragmático y el espacio intercostal presentaron similares comportamientos (r= 0,462; p=0,046 y r=-0,543; p=0,009). En conclusión, la presión resultante de la programación del ventilador mecánico junto a cambios estructurales observados en la RT, se relacionan con el tiempo de conexión a VM.

SUMMARY: The lungs are the predominant site of COVID-19 infection. This can lead to severe acute respiratory síndrome (ARDS). In view of its severe symptoms, mechanical ventilation (MV) and its ventilatory mechanics values appear as a fundamental tool. Chest radiography (CR) is a complement to analyze the state of progress of this pathology, although this sometimes depends on the experience of the health team. Thus, the aim of this research was to explore the relationship of ventilatory mechanics and radiographic measures with connection time to MV in COVID-19 patients. Retrospective study, which included 23 patients on MV. Information on ventilatory mechanics variables was collected; PEEP, plateau pressure, distension pressure and static compliance. And from CR, lung height and width, costodiaphragmatic angle and intercostal space were measured. The results indicated that ventilatory mechanics variables such as PEEP and plateau were significantly related to connection time to MV (r = 0.449; p = 0.035 and r = 0.472; p = 0.026), while the radiographic variables Constructed on the basis of the costodiaphragmatic angle and the intercostal space, they showed similar behaviors (r = 0.462; p = 0.046 and r = -0.543; p = 0.009). In conclusion, the pressure resulting from mechanical ventilator programming, together with the structural changes observed in CR, are related to the connection time to MV.

Can chest x-ray predict pneumonia severity and its outcome in children aged 2 months - 5 years?

Background: Worldwide 16% of death in children under the age 5 years is only due to pneumonia every year. Among the diagnostic modality x-ray chest is simple tool to diagnose the pneumonia especially in developing country like in India. Aims of study was to know the incidence of radiologically proven pneumonia and to see the correlation between x-rays findings and clinical severity of pneumonia, so as to predict the severity of pneumonia on the basis of x-ray chest done on first day of hospitalization.Methods: We did the study in department of pediatrics at tertiary care centre, total 150 patients of pneumonia (2 months to 5 years age) enrolled on clinical basis. X-ray chest done in all patients on first contact.Results: Out of 150 patients, 54% of patient having radiologically proven pneumonia while 46% were normal x-ray findings. We found that interstitial pneumonia were more common in younger children, but lobar pneumonia were more common in older children, but in severe and very severe pneumonia cases most common radiologically proven pneumonia were bronchopneumonia in all age group, which was statistically significant.Conclusions: So the basis of start of treatment should be on the clinical background and clinical severity, not only on the basis of x-ray chest findings. Late x-ray films give more chance of positive findings, multilobar infiltration or diffuse heterogeneous opacity in lungs positively correlated with clinical severity and gives idea about course and duration of hospitalization.

A Comparative Study of Chest X-ray and Chest High-resolution Computed Tomography in Blunt Trauma Chest Patients

Introduction: Computed tomography (CT) scan is an accurate tool for the detection of injuries in a trauma setting and is able to find the injuries that were occult in chest X-ray (CXR). In past years, the utility of CT scan was limited to severe trauma injuries but now is used in less severely injured trauma patients. The study aimed to compare the efficacy of CXR and chest CT scans in patients with chest trauma. Materials and Methods: The present study was conducted in the Department of Surgery of Medical Institute. For the study, we prospectively view the previous medical records of the patients who were admitted in our surgical ward for blunt chest trauma and received both CXR and high resolution CT chest scans. A total of 95 patients were included in the study. Data regarding the study were collected. Results: Out of 95 patients, 79 were males and 16 females. The mean age of the patients was 32.42 years ranging from 2 to 90 years. The most common cause for blunt trauma to the chest according to our results was a road traffic accident. We observed that CT scan is more accurate as compared to CXR in the detection of certain cases such as sternum fracture, rib fracture, scapula fracture, lung contusion, hemothorax, and pneumothorax. Conclusion: Chest CT scan is highly sensitive in the detection of thoracic injuries following blunt chest trauma. In day-to-day practice, CT scan is better in visualizing as sternum fracture, rib fracture, scapula fracture, lung contusion, hemothorax, and pneumothorax

Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea

OBJECTIVE: This study presents a preliminary report on the chest radiographic and computed tomography (CT) findings of the 2019 novel coronavirus disease (COVID-19) pneumonia in Korea.MATERIALS AND METHODS: As part of a multi-institutional collaboration coordinated by the Korean Society of Thoracic Radiology, we collected nine patients with COVID-19 infections who had undergone chest radiography and CT scans. We analyzed the radiographic and CT findings of COVID-19 pneumonia at baseline. Fisher's exact test was used to compare CT findings depending on the shape of pulmonary lesions.RESULTS: Three of the nine patients (33.3%) had parenchymal abnormalities detected by chest radiography, and most of the abnormalities were peripheral consolidations. Chest CT images showed bilateral involvement in eight of the nine patients, and a unilobar reversed halo sign in the other patient. In total, 77 pulmonary lesions were found, including patchy lesions (39%), large confluent lesions (13%), and small nodular lesions (48%). The peripheral and posterior lung fields were involved in 78% and 67% of the lesions, respectively. The lesions were typically ill-defined and were composed of mixed ground-glass opacities and consolidation or pure ground-glass opacities. Patchy to confluent lesions were primarily distributed in the lower lobes (p = 0.040) and along the pleura (p < 0.001), whereas nodular lesions were primarily distributed along the bronchovascular bundles (p = 0.006).CONCLUSION: COVID-19 pneumonia in Korea primarily manifested as pure to mixed ground-glass opacities with a patchy to confluent or nodular shape in the bilateral peripheral posterior lungs. A considerable proportion of patients with COVID-19 pneumonia had normal chest radiographs.

Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea

OBJECTIVE: This study presents a preliminary report on the chest radiographic and computed tomography (CT) findings of the 2019 novel coronavirus disease (COVID-19) pneumonia in Korea.MATERIALS AND METHODS: As part of a multi-institutional collaboration coordinated by the Korean Society of Thoracic Radiology, we collected nine patients with COVID-19 infections who had undergone chest radiography and CT scans. We analyzed the radiographic and CT findings of COVID-19 pneumonia at baseline. Fisher's exact test was used to compare CT findings depending on the shape of pulmonary lesions.RESULTS: Three of the nine patients (33.3%) had parenchymal abnormalities detected by chest radiography, and most of the abnormalities were peripheral consolidations. Chest CT images showed bilateral involvement in eight of the nine patients, and a unilobar reversed halo sign in the other patient. In total, 77 pulmonary lesions were found, including patchy lesions (39%), large confluent lesions (13%), and small nodular lesions (48%). The peripheral and posterior lung fields were involved in 78% and 67% of the lesions, respectively. The lesions were typically ill-defined and were composed of mixed ground-glass opacities and consolidation or pure ground-glass opacities. Patchy to confluent lesions were primarily distributed in the lower lobes (p = 0.040) and along the pleura (p < 0.001), whereas nodular lesions were primarily distributed along the bronchovascular bundles (p = 0.006).CONCLUSION: COVID-19 pneumonia in Korea primarily manifested as pure to mixed ground-glass opacities with a patchy to confluent or nodular shape in the bilateral peripheral posterior lungs. A considerable proportion of patients with COVID-19 pneumonia had normal chest radiographs.

Role of Sputum Induction in Sputum Smear Negative and Chest X-Ray Suggestive of Pulmonary Tuberculosis

Background: Sputum induction is a procedure used forpatients who have difficulty in spontaneously producingsputum. So we have planned to conduct a study to find out therole of sputum induction in TB patients to increase the yield ofsputum smear positivity in sputum smear negative pulmonarytuberculosis patients and the role of sputum induction intuberculosis suspected patients having cough withoutexpectoration.Materials & Methods: The present study was carried out in 50patients admitted with clinical & radiological featuressuggestive of pulmonary tuberculosis in the Department of TB& Respiratory diseases, R.N.T Medical College, Udaipur. Studyprotocol includes detailed history, clinical examination, routineblood investigations including ESR, chest x-ray, sputuminduction and smear study by Ziehl-Neelson staining was doneto all the patients included in the study.Results: Our study showed that the total numbers of caseswere 50, among which 40 (80%) cases were in the age groupof below 60 years. Males in the study are 31 (62%) andfemales are 19 (38%). ESR was elevated to more than 30mm/hr in 46 (92%) cases and less than 30mm/hr in 4 (8%)cases. Sputum production were absent in 40 (80%) cases.Maximum 30 (60%) cases had moderate disease, 14 (28%)cases had minimal disease and 6 (12%) cases hadfar advanced disease on chest x-ray. 30 (60%) cases had nocavity on chest x-ray and 20 (40%)cases had cavity.30(60%)cases had bilateral disease (B/L) and 20 (40%) caseshad unilateral disease (U/L) on chest x-ray.Conclusion: We concluded that the identification of smearpositivity through sputum induction method with 3%hypertonicsaline that allows sampling of the airways in a noninvasivefashion and is a less expensive approach than the techniquelike bronchial biopsy, bronchoalveolar lavage and gastriclavage.

Study of etiology of pleural effusion in Telangana population

Background: Among 86 patients aged between 18 to 65 of both sexes having pleural effusion due to various clinical etiologies were studied.Methods: Chest x-ray PA. was studied, 20 ml of pleural fluid was aspirated to study bio-chemically, microbiologically and pathological. Echo-cardiography, USG abdomen and biopsy of pleura was also done in same patients in whom diagnosis or etiology was unclear.Results: Among 59(68.6%) had fever, 68(79%) had cough, 40(46.5%) had breathlessness, 20(23.2%) had pedal edema, 42(48.8%) had chest pain, 5(5.8%) had abdominal distention. 52(60.4%) had tubercular pleural effusion 34(39.5%) had non- tubercular pleural types of non-tubercular PE effusion (PE) included 8(23.5%) synpneumonic, 5(14.7%) had CCF, 11(32.3%) had malignancy, 2(5.88%) had RA, 2(5.88%) had dengue fever, 2(5.88%) had pancreatitis, 4(11.7%) had Hypoproteinaemia.Conclusions: This pragmatic approach to pleural effusion for patients with different clinical manifestations as pleural fluid analysis is gold standard method in evaluation pleural effusion of different etiology.Background: Among 86 patients aged between 18 to 65 of both sexes having pleural effusion due to various clinical etiologies were studied.Methods: Chest x-ray PA. was studied, 20 ml of pleural fluid was aspirated to study bio-chemically, microbiologically and pathological. Echo-cardiography, USG abdomen and biopsy of pleura was also done in same patients in whom diagnosis or etiology was unclear.Results: Among 59(68.6%) had fever, 68(79%) had cough, 40(46.5%) had breathlessness, 20(23.2%) had pedal edema, 42(48.8%) had chest pain, 5(5.8%) had abdominal distention. 52(60.4%) had tubercular pleural effusion 34(39.5%) had non- tubercular pleural types of non-tubercular PE effusion (PE) included 8(23.5%) synpneumonic, 5(14.7%) had CCF, 11(32.3%) had malignancy, 2(5.88%) had RA, 2(5.88%) had dengue fever, 2(5.88%) had pancreatitis, 4(11.7%) had Hypoproteinaemia.Conclusions: This pragmatic approach to pleural effusion for patients with different clinical manifestations as pleural fluid analysis is gold standard method in evaluation pleural effusion of different etiology.

A study on clinical profile of tuberculosis in HIV children

Background: Children born to Human immunodeficiency virus (HIV) positive parents who are not infected with tuberculosis (TB) themselves, are also at higher risk of acquiring TB because of exposure. The source of transmission of TB to a child is usually an adult with sputum-smear positive PTB. To evaluate the clinical, bacteriological and radiological pattern of TB in HIV seropositive children in correlation with CD4 count.Methods: This study was conducted over a period of 12 months from May 2008- April 2009 at GMKMCH Salem. 100 children screened positive for HIV at voluntary counselling and testing centers (VCTC) in Antiretroviral therapy (ART) center and diagnosed to have TB infection as per Revised national tuberculosis control programme (RNTCP) guidelines.Results: Out of the 100 children with HIV and TB infection 62 were males and 38 were females. The ratio was 1.63:1. The sputum positivity in our study shows that only 9% of the children are sputum positive. Sputum culture for M. Tuberculosis remains the gold standard for the diagnosis of Pulmonary TB. In resource-poor countries, the diagnosis is heavily dependent on the sputum AFB smear. In our study CD4 cell count, less than 300 was observed in 33 children. In these children the predominant X-ray lesions were Hilar adenopathy, lower lobe infiltrations, diffuse infiltrates and miliary mottling. Upper lobe infiltrates was common with higher CD4 count mean 350.Conclusions: With the conventional sputum positivity and Tuberculin test not providing an adequate diagnostic help, familiarity with clinical radiological spectrum of TB and HIV co-infection will help in early diagnosis and improve survival among HIV seropositive children.

Association of Lung Function with Serum 25-Hydroxyvitamin D Level according to the Presence of Past Pulmonary Tuberculosis in Korean Adults / 가정의학회지

BACKGROUND: Vitamin D deficiency is associated with an increased risk of pulmonary tuberculosis (PTB) infection and the treatment outcome. The aim of this study was to examine the relationship between the serum 25-hydroxyvitamin D (25[OH]D) level and lung function in Korean adults according to whether or not there is a history of PTB. METHODS: The data for subjects aged 19 years or older from the Korea National Health and Nutrition Examination Survey 2008–2012 who underwent spirometry, chest radiography, and serum 25(OH)D level measurement were analyzed. RESULTS: Evidence of past PTB infection was found in 1,482 (9.6%) of 15,516 subjects. The serum 25(OH)D level was lower in the group with past PTB than in the non-PTB group (P=0.013). Respiratory dysfunction was more common in the past PTB group than in the non-PTB group (restrictive pattern, 14.0% vs. 9.6%; obstructive pattern, 29.6% vs. 8.2%; both P<0.001). After adjusting for age, sex, height, and season, the mean difference in forced expiratory volume in 1 second (FEV1) between the highest and lowest quartiles of 25(OH)D was 100.2 mL (standard error= 49.3 mL, P for trend=0.049) in the past PTB group and 34.7 mL (standard error=13.6 mL, P=0.009) in the non-PTB group. CONCLUSION: FEV1 tended to increase as the vitamin D quartile increased in both study groups. This relationship was more pronounced in subjects with a history of PTB. A higher serum 25(OH)D level might be beneficial in preserving lung function after PTB infection.

Three-year clinical application practice report of lung ultrasound in our NICU / 中国小儿急救医学

Objective To retrospectively analyze the application of lung ultrasound in neonatal de-partment of our hospital in the past three years,and summed up the clinical diagnosis and treatment changes brought by it. Methods The clinical data of infants accepted the bedside lung ultrasound examination from May to December 2016(early carry out stage),from January to December 2017(adaptation stage),from Jan-uary to August 2018(normal conduct stage) in our NICU of Jingzhou Central Hospital were collected. The clinical data of 878 infants with different stages of application were compared and analyzed. Results In 878 children,1 225 of lung ultrasound were performed,64. 1% of patients had pulmonary disease,and 35. 9% had no lung disease. There were 67 cases of neonatal respiratory distress syndrome,278 cases of wet lung,259 ca-ses of pneumonia,64 cases of meconium aspiration syndrome,72 cases of acute respiratory distress syn-drome,63 cases of atelectasis and 14 cases of pleural effusion. A total of 1 122 times of lung X-ray examina-tion were performed in 878 children. The number of X-ray examinations per capita decreased from 2. 48 times in 2016 to 1. 40 times in 2017 and 0. 84 times in 2018. A total of 32 times of pulmonary CT examination were performed. The number of lung CT inspection decreased from 0. 060 times in 2016 to 0. 038 times in 2017 and 0. 029 times in 2018. Lung ultrasound was convenient for dynamic observation,and could be used to de-termine the improvement,aggravation or new pulmonary lesions. Conclusion Lung ultrasound is accurate in the diagnosis of lung disease in NICU,especially for children with long hospital stay,repeated illness and dif-ficult to withdraw. It is easy to carry out in clinic,at the bedside,which can reduce the times of chest X-ray and CT per capita examination. Lung ultrasound is an effective and feasible method for NICU to diagnose lung diseases and it is worth promoting.