Rastreio radiológico para tuberculose em uma penitenciária do sul do Brasil / Radiological screening for tuberculosis in a prison in the south of Brazil

Introdução: Conhecer o perfil da população privada de liberdade da Penitenciária Modulada de Osório (PMO), do ponto de vista radiológico e estimar a prevalência da tuberculose ativa no presídio.Métodos: Foi realizada análise retrospectiva de 677 radiografias de tórax obtidas para rastreio de tuberculose e de dados da ficha de atendimento do setor de Radiologia no período de julho a outubro de 2019.Resultados: Foram detectadas 150 radiografias alteradas, o que representa 22% dos 677 exames. Dos 150 exames alterados, 109 (16% do total e 72% dos alterados) apresentavam lesões com características de doença granulomatosa. Dos 677 pacientes, 11,5% referiram tratamento atual ou prévio para tuberculose e estes representam 38% dos casos com radiografias alteradas. Foram detectados 50 pacientes sem história prévia de tuberculose com lesões de aspecto muito provavelmente devido a tuberculose com características de doença ativa (7,3% do total), os quais foram encaminhados para investigação como casos novos. Em relação ao questionário aplicado, não foi observada diferença significativa entre os pacientes que referiam ou negavam tosse entre os com exames normais e alterados.Conclusões: Os indivíduos privados de liberdade apresentaram alta prevalência de alterações radiológicas com aspecto sugestivo de doença granulomatosa. Estes achados permitem inferir que na Penitenciária Modulada de Osório há elevada prevalência de tuberculose, provavelmente em níveis semelhantes a outras casas prisionais do Brasil.

Introduction: To determine the radiologic profile of 'the prisoners at Osório Modular Prison and estimate the prevalence of active tuberculosis in the institution.Methods: We retrospectively analyzed 677 chest radiographs obtained for tuberculosis screening and data from the medical records of prisoners seen at the Radiology Department from July to October 2019.Results: Of 677 radiographs, 150 (22%) showed abnormalities. Of these, 109 (16% of total or 72% of abnormal radiographs) showed lesions characteristic of granulomatous disease. Of all 677 patients, 11.5% reported current or previous treatment of tuberculosis, accounting for 38% of all abnormal radiographs. Fifty patients with no previous history of tuberculosis had lesions that were most likely due to active tuberculosis (7.3% of total), and were referred for further investigation as new cases. The responses to the questionnaire revealed no significant difference between patients who reported or denied coughing when comparing those with normal vs abnormal radiographs.Conclusions: Individuals deprived of liberty had a high prevalence of radiologic abnormalities suggestive of granulomatous disease. These findings allow us to infer that there is a high prevalence of tuberculosis at Osório Modular Prison, probably at levels comparable to those of other prison facilities in Brazil.

Radiografía de tórax de control en pacientes con neumotórax postraumático asintomático / Follow-up chest x-ray in patients with asymptomatic post-traumatic pneumothorax

Introducción. El trauma de tórax tiene alta incidencia y el neumotórax es el hallazgo más frecuente. La literatura es escasa sobre qué hacer con los pacientes asintomáticos y con neumotórax por trauma de tórax penetrante. El objetivo de este estudio fue evaluar cuáles son los hallazgos de la radiografía de control de los pacientes con trauma de tórax penetrante que no son llevados inicialmente a cirugía, y su utilidad para determinar la necesidad de un tratamiento adicional. Métodos. Se realizó un estudio retrospectivo de cohorte, incluyendo pacientes mayores de 15 años que ingresaron por trauma de tórax penetrante entre enero de 2015 y diciembre de 2017 y que no requirieron manejo quirúrgico inicial. Se analizaron los resultados de la radiografía de tórax, el tiempo de su toma y la conducta decidida según los hallazgos en los pacientes dejados inicialmente bajo observación. Resultados. Se incluyeron 1.554 pacientes, cuya edad promedio fue de 30 años, 92,5 % del sexo masculino y 97% con herida por arma cortopunzante. Se dejaron 361 pacientes bajo observación con radiografía de control, de los cuales 186 (51,5 %) no presentaban alteraciones en su radiografía inicial, 142 tenían neumotórax menor del 30 % y 33 tenían neumotórax mayor del 30 %, hemoneumotórax o hemotórax. Se requirió toracostomía cerrada como conducta final en 78 casos, esternotomía o toracotomía en 2 casos y 281 se dieron de alta. Conclusión. En pacientes asintomáticos con neumotórax pequeño o moderado y sin otras lesiones significativas, podrían ser innecesarios los largos tiempos de observación, las radiografías y la toracostomía cerrada

Introduction: Chest trauma has a high incidence, and pneumothorax is the most frequent finding. The literature is limited about what to do with asymptomatic patients with pneumothorax due to penetrating chest trauma. The objective of this study was to evaluate the findings of control follow-up chest x-ray in patients with penetrating chest trauma who are not initially taken to surgery and its usefulness in determining the need for additional management.Methods: A retrospective cohort study was conducted, including patients older than 15 years who were admitted for penetrating chest trauma between January 2015 and December 2017 and who did not require initial surgical management. The results of the chest x-ray, the timing of it and the management according to the findings in the patients initially left under observation were analyzed.Results: 1,554 patients were included; whose average age was 30 years, 92.5% were males and 97% sustained a gunshot wound; 361 patients were left under observation with control x-ray, of which 186 (51,5%) had no findings on their initial radiograph, 142 had pneumothorax less than 30% and 33 had pneumothorax greater than 30%, hemoneumotorax or hemothorax. Closed thoracostomy was required as final management in 78 cases, sternotomy or thoracotomy in 2 cases and discharge in 281.Conclusion: In asymptomatic patients with small or moderate pneumothorax and without other significant injuries, longer observation times, x-rays and closed thoracostomy may be unnecessary

Radiographic Measurements Related With the Cardiac Size in Apparently Healthy Goats (Capra hircus)

Present study was conducted on twelve apparently healthy goats free from cardiothoracic diseases. The animals were divided into two groups each containing 6 animals to evaluate various the cardiothoracic parameters. Mean ± SE values of body weight and age were measured 11.83 ± 0.70 (range 10 - 15) kg, 3.75 ± 0.31 (range 3 - 5) month and 25.67 ± 1.73 (range 16-30) kg, 8.58 ± 0.95 (range 6.5 - 12) month in animals of the group-I and II, respectively. In thoracic radiographic examination, routinely used in cases which cardiac evaluation is indicated, quantitative assessment of the heart is a useful role to be used in combination with subjective analysis. The purpose of this study was to establish the standard values (range) for radiographic parameters of the heart and thorax. Cardiophrenic contact (cm), Cardiac inclination angle (degree), Tracheal angle (degree), Tracheal diameter (cm), Cardiac height/thoracic height, Cardiac width/thoracic height, Cardiac width / T3-T5, Cardiac height / R3-R5, Cardiac width / R3-R5, Cardiophrenic contact /cardiac height, Cardiac height + cardiac width/R3-R5, cardiac height + cardiac width /thoracic height and Tracheal diameter/T4, except cardiosternal contact (No. of sternabae), cardiac height/T3-T5, and cardiac height + cardiac width /T3-T5, were found to be non-significantly different between animals of the group-I and group-II. The standardized values of cardiothoracic parameters and their correlation with age and weight would be helpful to diagnose various cardio-thoracic illnesses in goats

Costilla cervical en pediatría. Presentación de un caso clínico y revisión de la literatura / Cervical rib in pediatrics. Clinical case and literature review / Costela cervical em pediatria. Apresentação de caso clínico e revisão da literatura

Resumen: Introducción: la costilla cervical es una malformación rara que puede dar lugar a diagnósticos diferenciales y que tiene un manejo variable y controvertido. Objetivo: describir una observación clínica de costilla cervical, analizar su manejo y revisar la bibliografía relevante acerca del tema. Observación clínica: varón de 7 años, sano, en el cual, durante un control en salud, se halla una tumoración supraclavicular izquierda. Este fue estudiado, arribándose al diagnóstico de costilla cervical bilateral asintomática. Se tomó una conducta expectante y a diez meses de evolución el paciente ha permanecido asintomático. Discusión y revisión bibliográfica: se destacan los elementos clínicos que deben hacer pensar en el diagnóstico y el potencial de éstos para generar un curso de acción más rápido, con menores molestias para el paciente, menor ansiedad para la familia y menores costos para el sistema. Con base en la revisión bibliográfica, se destaca que la mayoría de los casos pueden manejarse en forma expectante tras informar al paciente y su familia de los elementos que deben motivar una rápida consulta y se mencionan las raras indicaciones de tratamiento activo y las opciones y controversias en torno a éste.

Summary: Introduction: a cervical rib is an uncommon malformation, that may lead to different diagnoses and to variable and controversial treatment procedures. Objectives: to describe a cervical rib case, to analyze how it was treated and to review the relevant bibliography. Clinical observation: healthy 7-year-old male, on whom a supraclavicular tumor was found during a check-up. He was studied until an asymptomatic bilateral cervical rib diagnosis was reached. We have followed-up the case closely and ten months after the finding the patient remains asymptomatic. Discussion and literature review: we have identified clinical elements that may lead to this diagnosis and may speed up the course of action to adopt as well as generate less patient discomfort, less family anxiety and lower system costs. Literature suggests that once the patient and his family have been warned about the symptoms that could require a rapid consultation, most cases can be treated as expected. We also described to them rare indications, available options and controversial issues that may arise.

Resumo: Introdução: costela cervical é uma malformação incomum, que pode levar a diagnósticos diferentes e a procedimentos de tratamento variáveis e controversos. Objetivos: descrever um caso de costela cervical, analisar o tratamento e revisar a bibliografia relevante. Observação clínica: menino saudável de 7 anos de idade, no qual encontramos um tumor supraclavicular durante um check-up. Ele foi estudado até alcançar o diagnóstico de costela cervical bilateral assintomática. Monitoramos o caso e dez meses após o paciente ainda permanecia assintomático. Discussão e revisão de literatura: identificamos elementos clínicos que podem levar a esse diagnóstico e podem acelerar as ações a serem realizadas, bem como gerar menos desconforto ao paciente, menor ansiedade familiar e menor custo do sistema. A literatura sugere que, uma vez que o paciente e sua família tivessem sido alertados sobre os sintomas que poderiam exigir uma consulta rápida, a maioria dos casos poderia ser tratada como esperado. Também descrevemos para eles indicações raras, opções disponíveis e questões controversas que podem surgir.

Classification of radiographic lung pattern based on texture analysis and machine learning

This study evaluated the feasibility of using texture analysis and machine learning to distinguish radiographic lung patterns. A total of 1200 regions of interest (ROIs) including four specific lung patterns (normal, alveolar, bronchial, and unstructured interstitial) were obtained from 512 thoracic radiographs of 252 dogs and 65 cats. Forty-four texture parameters based on eight methods of texture analysis (first-order statistics, spatial gray-level-dependence matrices, gray-level-difference statistics, gray-level run length image statistics, neighborhood gray-tone difference matrices, fractal dimension texture analysis, Fourier power spectrum, and Law's texture energy measures) were used to extract textural features from the ROIs. The texture parameters of each lung pattern were compared and used for training and testing of artificial neural networks. Classification performance was evaluated by calculating accuracy and the area under the receiver operating characteristic curve (AUC). Forty texture parameters showed significant differences between the lung patterns. The accuracy of lung pattern classification was 99.1% in the training dataset and 91.9% in the testing dataset. The AUCs were above 0.98 in the training set and above 0.92 in the testing dataset. Texture analysis and machine learning algorithms may potentially facilitate the evaluation of medical images.

Hernia paraesofágica: un reto diagnóstico / Paraesophageal hernia: a diagnostic challenge

Resumen Se presenta un caso de hernia paraesofágica en una mujer con diagnóstico inicial de enfermedad ácidopéptica. El diagnóstico preciso requirió radiografía de tórax, radiografía de vías digestivas altas y tomografia axial computarizada. Fue tratada mediante abordaje por videolaparascopía; seis meses después estaba asintomática y sin complicaciones. El médico general debe considerar la probabilidad de hernia paraesofágica en pacientes añosos con síntomas del tracto digestivo superior inexplicados, especialmente cuando los síntomas son crónicos y sin respuesta adecuada al tratamiento con inhibidores de la bomba de protones.

Abstract A case of paraesophageal hernia in a woman with an initial diagnosis of peptic acid disorders. Precise diagnosis required chest radiography, upper gastrointestinal tract x-ray and computed tomography. She was treated by videolaparoscopic approach; six months later she was asymptomatic and suffered no complications. The General Practitioner should consider the likelihood of paraesophageal hernia in elderly patients with unexplained upper digestive tract symptoms, especially when the symptoms are chronic and unresponsive to treatment with proton pump inhibitors.

Influence of bronchoalveolar lavage on thoracic radiography in the horse

Bronchoalveolar lavage (BAL) and thoracic radiography are routinely performed diagnostic procedures. We hypothesized that BAL increases the interstitial opacity of caudoventral and caudodorsal thoracic radiographs. Fifty-three horses, including 8 clinic owned and 45 from a referral hospital population, were classified as healthy controls (n = 12), severe equine asthma (recurrent airway obstruction, n = 12) or mild-to-moderate equine asthma (inflammatory airway disease, n = 21) based on the results of a clinical scoring system. Eight were excluded due to different diagnoses and poor image quality. Four randomized thoracic radiographs of each horse were scored by two blinded observers, who were also asked to identify the image as obtained before or after a BAL procedure. In severe equine asthma, the chance (adjusted odds) of misinterpretation of the correct imaging time was approximately 5 times higher than in controls (odds ratio [OR] = 5.373, p = 0.028). The chance of misinterpretation was approximately 4 times lower in caudodorsal images than in caudoventral projections (OR = 0.241, p = 0.004). Identification of the correct imaging time was highly correlated with an increase in interstitial opacity (OR = 9.976, p < 0.0001). In conclusion, we recommend performing BAL after thoracic radiography to avoid possible misinterpretation.

Modificaciones en el tratamiento de pacientes con bronquiolitis luego de la radiografía de tórax / Treatment modifications in patients with bronchiolitis after chest X-rays

Resumen: Introducción: las pautas nacionales vigentes sobre bronquiolitis recomiendan la realización de radiografía de tórax a todos los pacientes admitidos en áreas de internación. Estudios recientes sugieren que esta conducta tiene bajo rendimiento para diagnosticar complicaciones y determina una mayor prescripción de antibióticos. Objetivos: analizar las características de la radiografía de tórax en pacientes con bronquiolitis que requieren hospitalización y comprobar si se modificó la conducta terapéutica a partir de la realización de la misma. Material y métodos: estudio observacional prospectivo durante el invierno de 2015 en dos centros de asistencia pediátrica. Las radiografías fueron interpretadas por médicos clínicos y un imagenólogo siguiendo un protocolo único en forma independiente. Resultados: se incluyeron 82 pacientes en el estudio. Se observó una escasa coincidencia entre las lecturas radiográficas del médico clínico y el médico imagenólogo. El médico clínico informó neumonía en la radiografía con mayor frecuencia que el imagenólogo (26% vs 6%), Se observó indicación de antibióticos por parte del MC en pacientes con radiografías informadas por el MI como típicas de bronquiolitis. Conclusiones: la radiografía de tórax en lactantes hospitalizados por bronquiolitis fue normal o típica en un 93%. Hubo escasa coincidencia entre el informe del médico clínico y el médico imagenólogo. Se constató una mayor prescripción de antibióticos basado en la interpretación radiográfica realizada por el médico clínico, y no confirmadas por el MI.

Summary: Introduction: current national guidelines recommend routine chest x-rays to patients admitted with bronchiolitis. Recent publications suggest that performing chest x-rays to all admitted infants results in low performance rates in the diagnosis of complications and leads to higher rates of antibiotic prescription. Objectives: to analyze chest x-ray findings in admitted patients with bronchiolitis, and to evaluate whether x-rays findings determine modifications in medical treatment. Compare the interpretation of the x-rays between clinicians and radiologists. Method: observational study conducted in winter 2015, in the pediatric units of two different hospitals. X-rays were independently interpreted by clinicians and by one radiologist, following a single protocol. Results: 82 patients were included in the study. According to the radiologist, 6 % showed complications or non-consistent findings with broncholitis in the chest x-ray (atypical). Clinicians and radiologists interpretation of chest x-rays were barely coincident. Clinicians diagnosed pneumonia more frequently than imagenologists (26% vs 6%), leading to higher antibiotic prescription. Clinicians diagnosed anitbiotics in x-rays informed as typical bronchiolitis by imagenologists. Conclusions: chest x-ray in admitted infants with bronchiolitis were either normal or typical in 93 % of normal or typical findings. Clinicians´ and radiologists´ interpretations differed significantly. Clinicians overdiagnosed pneumonia, and thus antibiotic prescription was higher based on their x-ray interpretation.

Clinical and Laboratory Factors Associated with Pneumonic Infiltrations on Chest Radiography Among Influenza A (H1N1) Infected Patients

PURPOSE: Pulmonary complications are the leading cause of death among patients with influenza A (H1N1) infection. Knowledge of factors associated with development of pneumonia among patients infected with influenza A (H1N1) is limited. We conducted a comparative analysis of clinical features and laboratory findings between patients with influenza A (H1N1) infection with and without infiltrations on chest radiography. METHODS: Among adults patients with influenza A (H1N1) infection confirmed by real time reverse transcriptase polymerase chain reaction (rRT-PCR), those who underwent blood tests and chest radiograph at the same time from August to December of 2009 were included in the study. A total of 141 confirmed adult patients with influenza A (H1N1) infection were finally included and were allocated to either the positive infiltration group or the negative infiltration group, as shown on chest radiography. RESULTS: Regarding clinical features, significant differences in pulse rate, respiration rate, and presence of dyspnea were observed between patients with infiltrations on chest radiography and those without infiltrations on chest radiography. According to laboratory findings, differences in leukocytosis, as well as levels of blood urea nitrogen (BUN), alanine amino transferase (ALT), actate dehydrogenase (LDH), and C-reactive protein (CRP) were observed between the two groups. As a result of multivariable analysis, dyspnea and CRP were found to be significant independent factors in association with infiltrations on chest radiography. Best cut-off value of CRP was 2.53 mg/dL with a sensitivity of 78.6% and a specificity of 73.9% (AUC: 0.830, p 2.53 mg/dL with infiltrations suggestive of pneumonia on chest radiography was observed in adult patients with influenza A (H1N1) infection.

Avaliação radiográfica da silhueta cardíaca pelo método vertebral heart size em cães da raça Yorkshire Terrier clinicamente normais / Radiographic evaluation of the cardiac silhouette in clinically normal Yorkshire Terrier dogs through the vertebral heart size method

Determinou-se valor médio do vertebral heart size (VHS) em cães da raça Yorkshire Terrier. Foram selecionados 30 cães clinicamente normais, com média de peso de 2,42±0,64kg e idades entre um e seis anos. Os animais foram submetidos ao exame radiográfico do tórax nas projeções lateral direita, ventrodorsal e dorsoventral. Foram feitas mensurações para avaliação cardíaca e da profundidade e largura torácicas. O valor médio de VHS foi de 9,9±0,6 vértebras na projeção lateral, 10,1±0,6 vértebras na projeção ventrodorsal e 10,0±0,6 vértebras na projeção dorsoventral. Não houve diferença entre esses valores. Cinco animais (16,7 por cento) apresentaram VHS acima de 10,5 vértebras, valor sugerido como limite superior para a maioria das raças, em projeção lateral. Os valores de VHS correlacionaram-se com peso corporal nas projeções lateral e ventrodorsal. A razão profundidade:largura torácica apresentou valor médio de 0,75±0,06. Não foi observada correlação entre a qualidade do tórax e o VHS.

The mean vertebral heart size (VHS) was established for Yorkshire Terrier dogs. Thirty clinically normal dogs with mean weight of 2.42±0.64kg and ages varying from one to six years of age, were studied. The animals were submitted to right lateral, ventrodorsal and dorsoventral thoracic radiographs. The Buchanan e Bücheler method was applied to the cardiac silhouette and thoracic depth and width. The VHS was 9.9±0.6 vertebrae on lateral, 10.1±0.6 on ventrodorsal and 10.0±0.6 on dorsoventral radiographs. There was no difference among these values. Five animals (16.7 percent) presented VHS values exceeding 10.5, the value suggested as upper limit for most breeds in lateral view. However, 95 percent of the animals in this study provide VHS values below the upper limit, and this should be equal to 11 vertebrae. The VHS values had significant correlation with body weight on lateral and VD radiographs. The mean depth:width ratio was 0.75±0.06. There was no correlation among VHS and depth:width ratios.

Chest Radiographic Findings in Primary Pulmonary Tuberculosis: Observations from High School Outbreaks

OBJECTIVE: To describe the radiographic findings of primary pulmonary tuberculosis (TB) in previously healthy adolescent patients. MATERIALS AND METHODS: The Institutional Review Board approved this retrospective study, with a waiver of informed consent from the patients. TB outbreaks occurred in 15 senior high schools and chest radiographs from 58 students with identical strains of TB were analyzed by restriction fragment length polymorphism analysis by two independent observers. Lesions of nodule(s), consolidation, or cavitation in the upper lung zones were classified as typical TB. Mediastinal lymph node enlargement; lesions of nodule(s), consolidation, or cavitation in lower lung zones; or pleural effusion were classified as atypical TB. Inter-observer agreement for the presence of each radiographic finding was examined by kappa statistics. RESULTS: Of 58 patients, three (5%) had normal chest radiographs. Cavitary lesions were present in 25 (45%) of 55 students. Lesions with upper lung zone predominance were observed in 27 (49%) patients, whereas lower lung zone predominance was noted in 18 (33%) patients. The remaining 10 (18%) patients had lesions in both upper and lower lung zones. Pleural effusion was not observed in any patient, nor was the mediastinal lymph node enlargement. Hilar lymph node enlargement was seen in only one (2%) patient. Overall, 37 (67%) students had the typical form of TB, whereas 18 (33%) had TB lesions of the atypical form. CONCLUSION: The most common radiographic findings in primary pulmonary TB by recent infection in previously healthy adolescents are upper lung lesions, which were thought to be radiographic findings of reactivation pulmonary TB by remote infection.

Prevalence and Positive Predictive Value of Poor R-Wave Progression and Impact of the Cardiothoracic Ratio

BACKGROUND AND OBJECTIVES: Poor R-wave progression (PRWP) is a common electrocardiographic diagnosis. However, the diagnostic usefulness of PRWP for coronary artery disease (CAD) and the plausible explanation for subjects with normal heart function are unclear. SUBJECTS AND METHODS: We included 20,739 subjects who had routine medical examinations and applied the commonly used criteria (R-waves in V3 or V4 < or =2 mm) and the Marquette criteria in the current study. Subjects with PRWP by the Marquette criteria, but with no evidence of specific causes, were identified. Healthy age- and gender-matched controls were selected randomly for comparing cardiothoracic ratios. RESULTS: The commonly used criteria in practice were met by 372 of the 20,739 subjects (1.8%). The Marquette criteria were met by 96 subjects (0.5%), and 82 of who agreed to medical evaluation. Five subjects had known CAD and only one subject was shown to have a silent myocardial infarction by additional testing. Therefore, the positive predictive value of PRWP for CAD was 7.3% (6/82) based on the Marquette criteria. As compared with the control group, the subjects with PRWP had a significantly low cardiothoracic ratio (0.425 vs. 0.445, p<0.05), especially among the male group (0.454 vs. 0.407, p=0.02). CONCLUSION: The positive predictive value of PRWP for CAD in the general population is so low that additional tests for diagnosis may be unreasonable. In addition, a low cardiothoracic ratio could be a plausible explanation of PRWP in subjects without any identifiable cause.

Clinical and radiographic features of HIV-related pulmonary tuberculosis according to the level of immunosuppression

Medical charts and radiographs from 38 HIV-infected patients with positive cultures for Mycobacterium tuberculosis from sputum or bronchoalveolar lavage were reviewed in order to compare the clinical, radiographic, and sputum bacilloscopy characteristics of HIV-infected patients with pulmonary tuberculosis according to CD4+ lymphocyte count (CD4). The mean age of the patients was 32 years and 76 percent were male. The median CD4 was 106 cells/mm³ and 71 percent had CD4 < 200 cells/mm³. Sputum bacilloscopy was positive in 45 percent of the patients. Patients with CD4 < 200 cells/mm³ showed significantly less post-primary pattern (7 percent vs. 63 percent; p = 0.02) and more frequently reported weight loss (p = 0.04). Although not statistically significant, patients with lower CD4 showed lower positivity of sputum bacilloscopy (37 percent vs. 64 percent; p = 0.18). HIV-infected patients with culture-confirmed pulmonary tuberculosis had a high proportion of non-post-primary pattern in thoracic radiographs. Patients with CD4 lower than 200 cells/mm³ showed post-primary patterns less frequently and reported weight loss more frequently.

Foram revisados prontuários e radiografias de 38 pacientes infectados pelo HIV com culturas de escarro ou lavado broncoalveolar positivas para Mycobacterium tuberculosis no intuito de comparar características clínicas, radiológicas e baciloscópicas de pacientes HIV-positivos com tuberculose pulmonar de acordo com a contagem de linfócitos CD4. A idade média dos pacientes foi 32 anos e 76 por cento eram homens. Mediana de CD4 foi 106 cells/mm³ e 71 por cento tinham CD4 <200cel/mm³. Baciloscopia de escarro foi positiva em 45 por cento. Pacientes com CD4 <200 cel/mm³ apresentaram significativamente menos padrão pós-primário (p=0,02) e relataram emagrecimento mais freqüentemente (p=0,04). Embora sem significância estatística, pacientes com contagem mais baixa de CD4 apresentaram menor positividade na baciloscopia de escarro (p=0,18). Pacientes HIV-positivos com tuberculose pulmonar confirmada por cultura apresentam alta proporção de padrão diferentes do pós-primário na radiografia torácica. Pacientes com CD4 abaixo de 200 cells/mm³ apresentaram menos freqüentemente padrão pós-primário e maior proporção relatou perda de peso.

Inter-observer agreement in interpreting chest X-rays on children with acute lower respiratory tract infections and concurrent wheezing

CONTEXT AND OBJECTIVE: Many children with acute lower respiratory tract infections (ALRI) present to the emergency ward with concurrent wheezing. A chest x-ray is often requested to rule out pneumonia. We assessed inter-observer agreement in interpreting x-rays on such children. DESIGNS AND SETTING: Prospective consecutive case study at Instituto de Salud del Niño, Lima, Peru. METHODS: Chest x-rays were obtained from eligible children younger than two years old with ALRI and concurrent wheezing who were seen in the emergency ward of a nationwide pediatric referral hospital. The x-rays were read independently by three different pediatric residents who were aware only that the children had a respiratory infection. All the children had received inhaled beta-adrenergic agonists before undergoing chest x-rays. Lobar and complicated pneumonia cases were excluded from the study. RESULTS: Two hundred x-rays were read. The overall kappa index was 0.2. The highest individual kappa values for specific x-ray findings ranged from 0.26 to 0.34 for rib horizontalization and from 0.14 to 0.31 for alveolar infiltrate. Inter-observer variation was intermediate for alveolar infiltrate (kappa 0.14 to 0.21) and for air bronchogram (kappa 0.13 to 0.23). Reinforcement of the bronchovascular network (kappa 0.10 to 0.16) and air trapping (kappa 0.05 to 0.20) had the lowest agreement. CONCLUSIONS: There was poor inter-observer agreement for chest x-ray interpretation on children with ALRI and concurrent wheezing seen at the emergency ward. This may preclude reliable diagnosing of pneumonia in settings where residents make management decisions regarding sick children. The effects of training on inter-observer variation need further studies.

CONTEXTO Y OBJETIVO: Muchos niños con infecciones respiratorias agudas (IRA) bajas que se presentan a las unidades de emergencia tienen sibilancias concurrentes. En tales niños se solicita a menudo una radiografía de tórax para descartar neumonía. Realizamos un estudio para evaluar la variación inter-observador en la interpretación de las radiografías en niños con IRA baja y sibilancias concurrentes. TIPO DE ESTUDIO Y LUGAR: Estudio prospectivo de casos consecutivos realizado en el Instituto de Salud del Niño, Lima, Perú. METODOS: Se leyeron las radiografías de tórax de niños consecutivos elegibles menores de 2 años de edad con IRA baja y sibilancias concurrentes que acudieron a la emergencia de un hospital garbed de referencia en Lima, Perú. Las radiografías fueron leídas independientemente por 3 residentes de pediatría diferentes que habían recibido información clínica limitada sobre la presencia de una infección respiratoria. Todos los niños habían recibido agonistas beta-adrenérgicos inhalados antes de que se les tomara las radiografías de tórax. Las neumonías lobares y complicadas fueron excluídas del studio. RESULTADOS: Se leyeron 200 radiografías de tórax. El índice kappa global fue 0.2. Los valores kappa individuales más altos para hallazgos radiológicos específicos oscilaron entre 0.26 a 0.34 para horizontali zación de costillas y de 0.14 a 0.31 para infiltrado alveolar. La variación inter-observador fue intermedia para infiltrado alveolar (kappa 0.14 a 0.21) y para broncograma aéreo (kappa 0.13 a 0.23). l reforzamiento de la trama broncovascular (kappa 0.10 a 0.16) y el atrapamiento de aire (kappa 0.05 a 0.20) tuvieron la concordancia más baja. CONCLUSIONES: Hubo pobre concordancia inter-observador en la interpretación de las radiografías de tórax en niños con IRA baja y sibilancias concurrentes atendidos en la unidad de emergencia. Esto puede impedir un diagnóstico confiable de neumonía en lugares en los que los residents toman...

The actual condition of drug-resistant tuberculosis and treatment outcomes at a tuberculosis specialized hospital / 대한내과학회지

BACKGROUND: During the last decade, the reports of drug-resistant tuberculosis in Korea were not common. Therefore, we investigated the anti-tuberculosis drug resistance rate according to medical history and radiological findings, as well as the relationship between the drug resistance and treatment outcomes to provide guidelines for selection of drug regimen before drug sensitivity test. METHODS: The study population was composed of 745 hospitalized patients who received drug susceptibility test for M. tuberculosis and anti-tuberculosis chemotherapy for the last 5 years. RESULTS: The majority had resistance to at least one drug (91.3%; 3.8+/-2.6 drugs). Drug resistance rate of first line drugs was 25~55%; especially higher in retreatment cases and those with the cavity on chest X-ray. Drug resistance was not correlated with radiographic finding. The success rate for treatment was higher in new cases, patients with less severe disease status and those without cavity on chest X-ray. When new cases had no resistance to all of EHR (84.1%), the negative conversion rate by first line drugs was above 70~90%. For retreatment patients, the negative conversion rate was above 70% only when they were susceptible to all of EHR (31%). The relapse rate was 4~13%. CONCLUSIONS: Probably the prevalence of drug-resistant tuberculosis in Korea will be considerably high. The drug resistance and treatment outcome was affected more by history of previous medical treatment than radiological findings. The previous EHRZ regimen is very effective as the initial treatment in new case, but revised retreatment regimen composed of at least 4 drugs is needed in the previously treated patients.