Interobserver Variability in the Computed Tomography Assessment of Pulmonary Injury and Tumor Recurrence After Stereotactic Body Radiotherapy.

PURPOSE: To evaluate the interobserver agreement of chest computed tomography (CT) findings in the diagnosis of expected changes and local recurrence after stereotactic body radiation therapy (SBRT) in patients with early-stage lung cancer or a single pulmonary metastasis. MATERIALS AND METHODS: A total of 54 patients with early-stage lung cancer or pulmonary metastasis who were treated with SBRT from 2007 to 2015 were included. The exclusion criteria were patients who presented with pulmonary infection during follow-up and patients who underwent a single CT during follow-up. The imaging features on CT were assessed by 3 blinded radiologists at the following 2 time points after SBRT: (a) early follow-up and (b) late follow-up (≥6 mo). The radiologists classified the findings as expected changes after SBRT or recurrence. Interobserver agreement was assessed by kappa and Wilcoxon statistics. RESULTS: A total of 13 women and 41 men with a mean age of 75.3 (±8.9) years were selected. The total and per fraction SBRT doses were 54 Gy (interquartile range: 45 to 54) and 18 Gy (interquartile range: 15 to 18), respectively. All expected changes and findings suggestive of recurrence had an almost perfect agreement (κ>0.85) among readers, except for diffuse consolidation in the early period (κ=0.65). CONCLUSION: CT findings demonstrate high interobserver agreement for expected changes and for findings indicating recurrence after SBRT.

Spectrum of clinical and radiographic findings in patients with diagnosis of H1N1 and correlation with clinical severity.

BACKGROUND: The aim of this study was to evaluate the correlation between clinical and imaging findings with a worse clinical outcome in patients with a confirmed diagnosis of H1N1 influenza A virus. METHODS: Patients with a positive viral test for influenza A H1N1 in 2016 and chest radiography (CR) and/or computed tomography (CT) results had clinical and imaging data reviewed. Hospitalization, admission to the intensive care unit or death were defined as worse clinical outcomes. The association between clinical and imaging features and the worse outcome was calculated in a logistical regression model. RESULTS: Eighty of 160 (50%) patients were men, with a mean age of 43 ± 19 years. The most common symptoms were as follows: flu-like symptoms 141/160 (88%), dyspnea (25/160, 17%), and thoracic pain (7/160, 5%). Abnormalities on CR were detected in 8/110 (7%) patients, and 43/59 (73%) patients had an abnormal CT. The following variables were associated with worse clinical outcomes: the presence of diabetes mellitus (DM), hypertension, dyspnea, thoracic pain, abnormal CR or CT regardless of the type of finding, CT with consolidation or ground glass opacity. CONCLUSIONS: The presence of DM, hypertension, dyspnea, thoracic pain, or an abnormal CR or CT on admission were associated with worse clinical outcomes in patients with H1N1 influenza A virus infection. Thus, the use of readily accessible clinical and imaging features on admission may have a role in the evaluation of patients with H1N1 infection.

Prevalence, antimicrobial resistance profile and comparison of selective plating media for the isolation of Salmonella spp. in free-ranging waterfowl from Entre Rios, Argentina.

The present study was conducted to estimate the apparent prevalence of Salmonella spp. in free-ranging waterfowl that inhabitant Entre Ríos, Argentina, determine the antimicrobial resistance of the isolated, and compare the performance of two selective plating media used for Salmonella isolation. Five hundred ninety nine free-living waterfowl were sampled one time by cloacal swab from April 2014 to July 2016. Only 6 samples from waterfowl belonged to all counties sampled were positive to Salmonella spp., so the apparent prevalence was 1%. Four serovars were isolated (Salmonella ser. Typhimurium, S. ser. Schwarzengrund, S. enterica subsp. I [4,12: i: -], S. enterica subsp. IIIb [60: r: e, n, x, z15]), which were susceptible to 15 antibiotics tested and resistant to erythromycin. Furthermore, some strains showed an intermediate resistant to neomycin, ciprofloxacin and/or streptomycin. The multiple antibiotic resistances index was 0.05. For Hektoen enteric agar and Salmonella Shigella agar, the relative accuracy, sensitivity, specificity, positive predictive value, and negative predictive value did not show any difference between them. The agreement was good between these two plating-media and the difference between these plating-media was not statistically significant. The low prevalence of Salmonella spp. in waterfowl in Entre Rios should not be discounted, since Salmonella ser. Typhimurium was the most prevalent serovar and some free-ranging waterfowl species studied can migrate from/to different countries, increasing the possibility to cross-contaminated Salmonella to resident or other migrant birds.