Abnormal Chest Radiograph Research Articles

Treatment Response in Pediatric Pulmonary Tuberculosis-A Prospective Longitudinal Study.

Data are limited on the resolution of symptoms and signs in children treated for pulmonary tuberculosis (PTB) and whether this resolution differs from children with other lower respiratory tract infections (LRTIs). A prospective study of children ≤ 15 years presenting with features suggestive of PTB was performed. Clinical, microbiological, and radiological investigations were done at enrollment. Symptoms and clinical features were measured 1, 3, and 6 months after enrollment. Participants were categorized into 3 groups based on National Institutes of Health consensus definitions: confirmed PTB, unconfirmed PTB, and unlikely PTB (children with other LRTIs). Univariable and multivariable logistic regression modeling was used to investigate predictors of persistence of symptoms or signs. Among 2019 participants, there were 427 (21%) confirmed, 810 (40%) unconfirmed, and 782 (39%) with unlikely PTB. Of 1693/2008 (84%) with cough and 1157/1997 (58%) with loss of appetite at baseline, persistence at 3 months was reported in 24/1222 (2%) and 23/886 (3%), respectively. Of 934/1884 (50%) with tachypnoea and 947/1999 (47%) with abnormal auscultatory findings at baseline, persistence at 3 months occurred in 410/723 (57%) and 216/778 (28%), respectively. HIV infection and abnormal baseline chest radiography were associated with persistence of symptoms or signs at month 3 (adjusted odds ration [aOR] 1.6; 95% confidence interval [CI]: [1.1, 2.3] and aOR 2.3; 95% CI: [1.5, 3.3], respectively]. The resolution of symptoms and signs was similar across categories. Symptoms resolved rapidly in most children with PTB, but signs resolved more slowly. The pattern and resolution of symptoms or signs did not distinguish children with PTB from those with other LRTIs.

Application of the advanced lung cancer inflammation index for patients with coronavirus disease 2019 pneumonia: Combined risk prediction model with advanced lung cancer inflammation index, computed tomography and chest radiograph.

The purpose of the present study was to evaluate the feasibility of applying the advanced lung cancer inflammation index (ALI) in patients with coronavirus disease 2019 (COVID-19) and to establish a combined ALI and radiologic risk prediction model for disease exacerbation. The present study included patients diagnosed with COVID-19 infection in our single institution from March to October 2020. Patients without clinical information and/or chest computed tomography (CT) upon admission were excluded. A radiologist assessed the CT severity score and abnormality on chest radiograph. The combined ALI and radiologic risk prediction model was developed via random forest classification. Among 79 patients (age, 43±19 years; male/female, 45:34), 72 experienced improvement and seven patients experienced exacerbation after admission. Significant differences were observed between the improved and exacerbated groups in the ALI (median, 47.6 vs. 13.2; P=0.011), frequency of chest radiograph abnormality (24.7 vs. 83.3%; P<0.001), and chest CT score (CCTS; median, 1 vs. 9; P<0.001). For the accuracy of predicting exacerbation, the receiver-operating characteristic curve analysis demonstrated an area under the curve of 0.79 and 0.92 for the ALI and CCTS, respectively. The combined ALI and radiologic risk prediction model had a sensitivity of 1.00 and a specificity of 0.81. Overall, ALI alone and CCTS alone modestly predicted the exacerbation of COVID-19, and the combined ALI and radiologic risk prediction model exhibited decent sensitivity and specificity.

Deep Learning Applied to Chest Radiograph Classification—A COVID-19 Pneumonia Experience

Due to the recent COVID-19 pandemic, a large number of reports present deep learning algorithms that support the detection of pneumonia caused by COVID-19 in chest radiographs. Few studies have provided the complete source code, limiting testing and reproducibility on different datasets. This work presents Cimatec_XCOV19, a novel deep learning system inspired by the Inception-V3 architecture that is able to (i) support the identification of abnormal chest radiographs and (ii) classify the abnormal radiographs as suggestive of COVID-19. The training dataset has 44,031 images with 2917 COVID-19 cases, one of the largest datasets in recent literature. We organized and published an external validation dataset of 1158 chest radiographs from a Brazilian hospital. Two experienced radiologists independently evaluated the radiographs. The Cimatec_XCOV19 algorithm obtained a sensitivity of 0.85, specificity of 0.82, and AUC ROC of 0.93. We compared the AUC ROC of our algorithm with a well-known public solution and did not find a statistically relevant difference between both performances. We provide full access to the code and the test dataset, enabling this work to be used as a tool for supporting the fast screening of COVID-19 on chest X-ray exams, serving as a reference for educators, and supporting further algorithm enhancements.

Clinical profile, risk factors and outcomes of pediatric COVID-19: a retrospective cohort multicentre study in Saudi Arabia

ObjectiveTo describe the risk factors, clinical profile and outcomes of COVID-19 in the paediatric population.DesignMulticentre, retrospective observational study.SettingFour tertiary hospitals in Saudi Arabia.PatientsWe recruited 390 paediatric patients aged 0–18 years...

Association of Chest Xray (CXR) findings with outcomes in COVID-19 Patients.

To investigate chest radiography findings in suspected coronavirus disease-2019 patients in a tertiary care setting. The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of coronavirus disease-2019 cases admitted to the tertiary care centre from March 1 to March 30, 2020. A predesigned proforma was used to gather data, including demographics, like age and gender, co-morbidities, presenting symptoms and chest radiography findings during the admission. Length of stay and mortality were the outcome measures. Data was analysed using SPSS 22. Of the 154 suspected cases, 46(29.8%) tested positive for coronavirus disease-2019; 29(63%) males and 17(37%) females with a mean age of 50.7±19.1 years. Abnormal chest radiography was noted in 25(54.3%) cases, with bilateral pulmonary infiltrates being the most common finding 19(41.3%). Mortality was the outcome in 7(28%) of these cases, and the mean length of hospital stay was 9.3±7.3 days. Abnormal chest radiography findings were associated with an increased risk of mortality (p=0.009) and a longer hospital stay (p=0.017). Abnormal chest radiography findings were frequently seen in coronavirus disease-2019 patients and were also associated with increased risk of mortality and prolonged hospital stay.

Comparative Study of Early Impacts of Post-COVID-19 Pneumonia on Clinical Manifestations, Pulmonary Function, and Chest Radiographs.

Background and Objectives: Scant data regarding early post-COVID-19 effects are available, especially in younger people. Therefore, the objective of this study was to explore the early clinical impacts of post-COVID-19 pneumonia, comparing severe and non-severe patients. Materials and Methods: A cross-sectional study was conducted in adult patients admitted with COVID-19 pneumonia from April to May 2021. Demographic data, symptoms and signs, quality of life, Hospital Anxiety and Depression Scale (HADS), chest radiograph (CXR), pulmonary function tests (spirometry, impulse oscillometry), fractional exhaled nitric oxide (FeNO), and exercise capacity were assessed one month after hospital discharge. Twenty-five healthy control subjects that were age- and gender-matched were recruited for comparisons. Results: One hundred and five patients, with a mean age of 35.6 ± 15.8 years and 54 (51.4%) males, participated and were categorized into the non-severe pneumonia (N = 68) and severe pneumonia groups (N = 37). At a one-month follow-up visit (the time from the onset of the disease symptoms = 45.4 ± 5.9 days), the severe group had more cough, fatigue, and skin rash with higher dyspnea scale, more residual CXR lesions, and lower quality of life scores. Forced vital capacity (FVC) was lower in the severe group (88.3% of predicted value) and non-severe group (94.6% of predicted value) than in the healthy controls (p = 0.001). The six-minute walk distance was significantly lower in the non-severe group, at 79.2 m, and in the severe group, at 103.8 m, than in the healthy control subjects (p < 0.001). Conclusions: Adult patients with COVID-19, especially those with clinically severe pneumonia, still had residual symptoms and chest radiographic abnormalities, together with poorer quality of life and lower exercise capacity, one month after hospital discharge.

Results of the Evaluation of the Respiratory Condition of Permanent Workers in an Oil Mill in Benin

Introduction: The process of extracting oil from cotton seeds can create dusty work atmospheres that can cause respiratory problems. The main objective of this study was to determine the prevalence of respiratory problems among permanent workers in an oil mill in Benin. Methods: This cross-sectional study of 52 workers in an oil mill took place in January 2017 as part of the annual medical check-ups of workers. A questionnaire was administered and spirometry using Spirobank II and chest radiography were performed. The spirometry results were interpreted by an occupational physician and a pulmonologist. Data were entered and analyzed using Epidata software. Results: The mean age was 42.7 ± 6.4 years, and 43 of the 52 workers were men. Of these, 58% were in technical production positions and 42% in administrative positions. Most of them had more than 10 years of seniority. The prevalence of respiratory symptoms among production workers was 4 (13%) versus 2 (9%) among administrative workers. A total of 8 (15.4%) abnormal spirometry was identified with 4 obstructive syndrome, 3 restrictive syndrome, 1 a mixed pattern. There were 5 (16.6%) workers in production versus 3 (13.6%) in administration who had abnormal spirometry. The means 25/75 forced expiratory flow (FEF) value of production workers was significantly lower than that of administration workers. Abnormal chest radiographs were 5 (17%) in production workers compared to 3 (14%) in administration workers. Conclusion: Oil mill workers had few respiratory symptoms. However, production workers had more ventilatory disorders than administrative workers. A spirometric follow-up of this group of workers is therefore necessary.

Comparison of Interferon Gamma Release Assay and Tuberculin Skin Test for Diagnosis of Latent Tuberculosis in Psoriasis Patients Planned for Systemic Therapy.

Background:Latent tuberculosis infection (LTBI) is a common yet difficult problem to diagnose in tuberculosis endemic countries. Both tuberculin skin test (TST) and interferon-gamma release assay (IGRA) are used for the diagnosis of LTBI.Aims:The aim of the study is to compare TST and IGRA in patients planned for systemic treatment of psoriasis.Methods:It was a diagnostic study conducted in a tertiary care centre during the study period from January 20 to December 20. Patients more than 18 years of age with chronic plaque psoriasis planned for systemic therapy were included. Psoriasis area severity index (PASI), history of tuberculosis in past or family and BCG vaccination were recorded. Complete blood count, radiograph of the chest, tuberculin skin test and interferon-gamma release assay were performed in all patients. Statistical analysis was performed using statistical package for social sciences (SPSS version 20, Chicago).Results:A total of 75 patients, including 48 males and 27 females, were included in the study. The mean age and mean duration of disease were 46.08 (±12.16) and 4.59 (±3.8) years, respectively. Seventy-one (94.6%) patients had BCG scar, and two (2.6%) had a history of tuberculosis in a family member. The TST and IGRA were positive (>10 mm) in 23 (30.6%) and 16 (21.3%) patients, respectively. Either TST or IGRA was positive in 28 (37.3%) patients. Out of these 28 patients, concordance was seen in 11 (39.2%) and discordance in 17 (60.7%). Discordance was TST+/IGRA − in 12 (42.8%) and TST−/IGRA + in five (17.8%) patients. Abnormality in radiograph of the chest and computed tomography (CT) scan of the chest were seen in five (6.6%) and nine (12%) patients, respectively. The patients with either TST or IGRA + were more likely to have abnormal chest radiographs than those who were TST−/IGRA− (OR: 11.3, 95% CI: 1.24–102.3, P = 0.03). The TST and IGRA showed fair agreement ( = 0.364, P = 0.003). ROC curve was plotted for the absolute value of TST in mm considering IGRA as the gold standard. The area under the curve was 0.805 (95%CI: 0.655–0.954). For the TST positivity cut-off of 10 and 15 mm, specificity was 77.3% and 95.5%, respectively; the sensitivity was 68.8% irrespective of the cut-off value.Limitation:Small sample size and lack of follow-up are the biggest limitations of the study. The lack of a gold standard in the diagnosis of LTBI is an inherent yet unavoidable flaw in the study.Conclusion:Reactivation of LTBI is a concern in a patient planned for immunosuppressive therapy. We suggest the use of both TST and IGRA rather than two-step testing (TST followed by IGRA) or IGRA alone for the diagnosis of LTBI, especially in patients with a high risk of reactivation. The positivity on either test should prompt further evaluation and treatment decisions should be taken considering the risk-benefit ratio of treatment rather than test results alone.

Markers for severe disease and long-term sequelae in pediatric patients with severe acute respiratory syndrome coronavirus 2 infection.

BackgroundCoronavirus disease 2019 (COVID‐19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and has resulted in substantial global morbidity and mortality since late 2019. Children can be infected but the disease predominantly affects adults, and research into the acute and chronic sequelae mostly pertains to this population. This study determines the clinical and demographic parameters associated with severe acute disease and chronic complications from COVID‐19 in the pediatric population.MethodsA retrospective chart review was undertaken of all patients between birth and 21 years of age who were positive for SARS‐CoV‐2 by polymerase chain reaction (PCR) and were admitted to two tertiary care hospitals between March 1, 2020, and January 21, 2021. Markers for severe disease were defined as supplemental oxygen requirement, positive pressure ventilation, and acute chest radiograph abnormality at presentation. Chronic disease was defined as symptoms persisting >4 weeks.ResultsReview of 101 patients with positive SARS‐CoV2 testing found 67 presentations consistent with acute symptomatic infection. Age distribution was bimodal, with predominance in infancy and adolescence. Most (75%) had an extrapulmonary comorbidity, and fewer patients (33%) had pre‐existing lung disease. A history of pulmonary comorbidity and obesity was significantly associated with markers for severe disease. Long‐term chronic complications were associated with history of underlying lung disease and acute severe COVID‐19.ConclusionsDemographic and clinical markers were associated with severe COVID‐19 in children. Moreover, both the presence of pulmonary comorbidity and severe acute COVID‐19 are associated with long‐term sequelae.

Clinical features of patients with Legionnaires disease showing initial clinical improvement but radiological deterioration: A retrospective single-center analysis.

Patients with Legionnaires disease occasionally experience initial clinical improvement but radiological progression. However, data on this issue are so far limited. The aim of this study was to investigate changes in chest radiograph findings in patients with Legionnaires disease who showed initial clinical improvement and to identify risk factors and outcomes in these patients.All patients diagnosed with Legionnaires disease at a tertiary hospital in South Korea between March 2011 and May 2020 were retrospectively enrolled. Legionnaires disease was defined as abnormal chest radiographs accompanied by a positive finding on at least one of the following tests: urinary antigen test, sputum Legionella polymerase chain reaction, and sputum Legionella culture. Clinical improvement was defined as defervescence and decreased C-reactive protein level. Clinical and radiological records were reviewed on treatment days 7 and 14 and at discharge. We describe the characteristics of patients with clinical improvement but radiological deterioration on treatment for Legionnaires disease and compared them with patients with initial clinical improvement and stable or resolving chest radiograph findings.Of 140 patients with Legionnaires disease, 33 (24%) showed initial clinical deterioration, while the remaining 107 (76%) showed initial clinical improvement on day 7. The latter 107 patients were analyzed in this study; 22 (21%) showed radiological progression despite the clinical improvement. Risk factors for these patients were a high pneumonia severity index score and the use of mechanical ventilation. Mortality did not significantly differ between those with initial clinical improvement but radiological deterioration and those with both initial clinical and radiological improvement (28% vs 12%, P = .49).About one-fifth of patients with Legionnaires disease, especially those who had a high pneumonia severity index score and underwent mechanical ventilation, showed radiological deterioration despite of clinical improvement 1 week after appropriate treatment, while outcomes were not significantly worse in these patients. Therefore, our findings support that close monitoring without modification of antibiotics use is warranted in those who have clinical improvement regardless of radiologic findings.

Early air transport after thoracic surgery might be safe: A retrospective observational study in the French Caribbean

ObjectiveThe objective of this study was to determine the incidence of early air transport (EAT) morbidity after transpleural surgery. We compared our cohort with our patients not requiring air transport. MethodsThis was a retrospective observational study, in the Thoracic and Cardiovascular Surgery Department of the University Hospital of Martinique over 40 months. We included all of the files (national and local database, and systematic postoperative consultation) of patients operated on for thoracic surgery or distinguished transpleural surgical intervention, whatever their geographical origin. Patients from another French department benefited from EAT. The complications were classified according to Clavien–Dindo before or after the EAT. Diagnostic criteria were chest pain, dyspnea, and abnormal chest radiograph. Continuous variables are presented as mean, median, and SDs. Discrete variables are presented as n (%). ResultsOf 491 patients operated on, 315 were transpleural surgeries, and 99 patients benefited from EAT. There were 55% resections, a percent predicted of forced expiratory volume in 1 second, and an average preoperative Tiffeneau ratio of respectively, 86% and 78. One complication was found: a pneumothorax in an emphysematous patient, 15 days after the flight, who had an index of prolonged air leak >10. The mean time between surgery and flight was 7.2 days (σ = 4.5), and 3.3 days (σ = 2.9) between removal of the last drain and flight. The morbidity of EAT after transpleural surgery was 1%. The 2 cohorts of “EAT” and “Locals” patients were statistically comparable, particularly in morbidity. ConclusionsEAT appears to be safe after transpleural surgery, following usual criteria for hospital discharge. It would be interesting to study, on a larger scale, the effect of IPAL as an independent risk factor (in case of high IPAL > 10) as well as pathologies that modify transpleural pressures restrictive ventilatory defect.

183. Decrease in Invasive Pneumococcal Disease in 7 United States Children’s Hospitals during the COVID-19 Pandemic

BackgroundDuring the 2020 SARS-CoV-2 pandemic, physical distancing and mask use guidelines were implemented resulting in a decline in the number of infections caused by influenza, respiratory syncytial virus and otitis media. A surveillance analysis from England and Taiwan showed a decline in invasive pneumococcal disease (IPD) (Clin Infect Dis. 2021;72: e65-75 and J Infect. 2021;82:296-297). We hypothesized that COVID mitigation efforts resulted in a decrease in incidence of pediatric IPD within the U.S. during 2020 compared to previous years.MethodsWe reviewed all cases of IPD among 7 children’s hospitals from the U.S. Pediatric Multicenter Pneumococcal Surveillance Group from 2017-2020. IPD was defined by the isolation of Streptococcus pneumoniae from normally sterile sites (eg. blood, cerebrospinal, pleural, synovial or peritoneal fluid). Pneumococcal pneumonia was defined as an abnormal chest radiograph in the presence of a positive blood, pleural fluid or lung culture. Mastoiditis was identified by positive middle ear, subperiosteal abscess or mastoid bone culture. Serotypes were determined by the capsular swelling method. Hospital admission numbers were obtained for incidence calculations. Statistical analyses were performed using STATA11. A p< 0.05 was considered significant.ResultsA total of 410 IPD cases were identified. The cumulative incidence of IPD (0-22 years of age) decreased from 99.2/100,000 admissions in 2017-2019 to 53.8/100,000 admissions in 2020 (risk ratio 0.54, CI: 0.40-0.72, p< 0.00001). Pneumococcal bacteremia and pneumonia decreased significantly in 2020 (p< 0.05), and although not statistically significant, there were fewer cases of meningitis and mastoiditis when compared to previous years (p=0.08) (Figure 1). Sex, race, age or presence of comorbidities were not significantly different between groups. Most common serotypes in 2020 were 35B, 3 and 15B/C (Figure 2). ConclusionThe observed decline in IPD cases during the first year of the SARS-CoV-2 pandemic is likely associated with mask use and physical distancing limiting transmission of S. pneumoniae via droplets and viral infections frequently preceding IPD. These precautions might be useful in the future to decrease IPD, especially in high-risk patients.Disclosures Sheldon L. Kaplan, MD, Pfizer (Research Grant or Support) Tina Q. Tan, MD, GSK (Individual(s) Involved: Self): Advisor or Review Panel member, Grant/Research Support; ILiAD (Individual(s) Involved: Self): Advisor or Review Panel member; Merck (Individual(s) Involved: Self): Advisor or Review Panel member, Grant/Research Support; Moderna (Individual(s) Involved: Self): Advisor or Review Panel member; Pfizer (Individual(s) Involved: Self): Advisor or Review Panel member Pia S. Pannaraj, MD, MPH, Pfizer (Grant/Research Support)Sanofi-Pasteur (Advisor or Review Panel member)Seqirus (Advisor or Review Panel member) Larry Givner, MD, AstraZeneca (Advisor or Review Panel member) Kristina G. Hulten, PhD, Pfizer (Research Grant or Support)

Profile and Outcome of Childhood Hydrocarbon Poisoning: An Observational Study.

Background: Accidental poisoning, though preventable, has continued to be one of the most prevalent medical emergencies among children in developing countries.Objective: To describe the clinico-demographic profile and outcome of children with hydrocarbon poisoning at a tertiary care teaching hospital from Eastern India.Methods: A retrospective analysis of the hospital case records of all children <15 years of age admitted with hydrocarbon poisoning from January 2015 to October 2018 was performed.Results: Out of 2658 total admissions, 21 children were admitted with hydrocarbon poisoning during the study period. The median age was 2.6 years (range, 1 to 14 years). Majorities (76%) were <5 years of age. The male/female ratio was 5:2. The majority belonged to rural areas (80.9%) and low socioeconomic status (71.4%). In all the cases, poisoning was accidental in nature. Kerosene (71.4%) and turpentine oil (24%) were the most common agents implicated. Majorities (95.3%) were symptomatic requiring hospitalization. Fever and vomiting were the most commonly observed symptoms (57%). Neutrophilic leucocytosis was observed in 62% of cases. Abnormal chest radiography was observed in 67% of cases. There was no mortality.Conclusions: The majority of the children with hydrocarbon poisoning are under five years of age with the accidental mode of poisoning in the current study. Kerosene was the most common agent. The outcome was excellent without any mortality.

Fever and Abdominal Pain in a 10-year-old with Autism.

Fever and Abdominal Pain in a 10-year-old with Autism.

Prevalence of Mycobacterium tuberculosis in Sputum and Reported Symptoms Among Clinic Attendees Compared With a Community Survey in Rural South Africa.

BackgroundTuberculosis (TB) case finding efforts typically target symptomatic people attending health facilities. We compared the prevalence of Mycobacterium tuberculosis (Mtb) sputum culture-positivity among adult clinic attendees in rural South Africa with a concurrent, community-based estimate from the surrounding demographic surveillance area (DSA).MethodsClinic: Randomly selected adults (≥18 years) attending 2 primary healthcare clinics were interviewed and requested to give sputum for mycobacterial culture. Human immunodeficiency virus (HIV) and antiretroviral therapy (ART) status were based on self-report and record review. Community: All adult (≥15 years) DSA residents were invited to a mobile clinic for health screening, including serological HIV testing; those with ≥1 TB symptom (cough, weight loss, night sweats, fever) or abnormal chest radiograph were asked for sputum.ResultsClinic: 2055 patients were enrolled (76.9% female; median age, 36 years); 1479 (72.0%) were classified HIV-positive (98.9% on ART) and 131 (6.4%) reported ≥1 TB symptom. Of 20/2055 (1.0% [95% CI, .6–1.5]) with Mtb culture-positive sputum, 14 (70%) reported no symptoms. Community: 10 320 residents were enrolled (68.3% female; median age, 38 years); 3105 (30.3%) tested HIV-positive (87.4% on ART) and 1091 (10.6%) reported ≥1 TB symptom. Of 58/10 320 (0.6% [95% CI, .4–.7]) with Mtb culture-positive sputum, 45 (77.6%) reported no symptoms. In both surveys, sputum culture positivity was associated with male sex and reporting >1 TB symptom.ConclusionsIn both clinic and community settings, most participants with Mtb culture-positive sputum were asymptomatic. TB screening based only on symptoms will miss many people with active disease in both settings.

Lung cancer risk following previous abnormal chest radiographs: A 27-year follow-up study of a Chinese lung screening cohort.

Background Chest radiograph (CXR) is still one of the most commonly used diagnostic tools for chest diseases. In this cohort study, we attempted to investigate the magnitude and temporal pattern of lung cancer risk following abnormal CXR findings.MethodsWe conducted an extended follow‐up of an occupational screening cohort in Yunnan, China. The associations between abnormal CXR results from baseline screening, the first four consecutive rounds of CXR screening, all previous rounds of screening and lung cancer risk were analyzed using time‐varying coefficient Cox regression model. The associations of lung cancer risk and previous CXR‐screening results according to histology were also considered. Sensitivity analyses were conducted to assess the robustness of the previous abnormal CXR findings on subsequent lung cancer risk.ResultsAbnormal CXR findings were associated with a significantly increased lung cancer risk. This relative hazard significantly decreased over time. Compared to negative screening results, the adjusted hazard ratios (HR) of baseline abnormal CXR results, and at least one abnormal result in the first four consecutive screening rounds during the first 5 years of follow‐up were 17.06 (95% CI: 11.74–24.79) and 13.77 (95%: 9.58–17.79), respectively. This significantly increased lung cancer risk continued over the next 5 years. These associations were stronger for persistent abnormal findings, and abnormal findings identified in recent screening rounds.ConclusionsThe increased risk was significant for both squamous cell carcinoma and adenocarcinoma. Although decreased over time, an increased lung cancer risk relative to abnormal CXR findings can continue for 10 years.

High rate of transmission in a pulmonary tuberculosis outbreak in a junior high school in China, 2020

BackgroundSchool tuberculosis outbreaks are common in China. This study aimed to introduce a new screening process to help control outbreaks. MethodsAn epidemiological investigation into a school-based tuberculosis outbreak was conducted in order to identify the origin of the infection, and how it was transmitted. ResultsIn total, 10 confirmed active tuberculosis cases were diagnosed among student contacts in the index case's class, giving an incidence rate of 19.2% (10/52). Three were found through a proactive visit and seven through screening. Of the nine secondary cases, two had purified protein derivation of tuberculin (PPD) ≥ 15 mm or blister (confirmed by computed tomography (CT) scan before preventive therapy), five had TST ≥ 10 mm and < 15 mm (two with abnormal chest radiography scan and three with positive T-SPOT tests, confirmed by CT) and two with PPD ≥ 5 mm and < 10 mm (confirmed by CT scan through proactive visit). ConclusionFurther to our results based on this school outbreak, a new screening process is recommended that involves conducting interferon gamma release assays on those students with PPD ≥ 5 mm and < 15 mm if there are three or more active tuberculosis patients in the class with an epidemiological link. Furthermore, a CT scan is recommended for students who have had a recent tuberculosis infection before they have preventive therapy.

A new scoring system and clinical algorithm for the management of suspected foreign body aspiration in children: a retrospective cohort study

BackgroundCases of foreign body aspiration in children may be encountered in emergency departments. A suggestive history is important in diagnosing aspirated foreign body owing to the difficulty in making a diagnosis on the basis of an abnormal physical examination or chest radiography alone. The aim of this study was to examine the sensitivity and specificity of the presenting symptoms, physical examination, and radiologic findings as predictors of foreign body aspiration in children. In addition, a feasible simple algorithm with a scoring system was generated to indicate bronchoscopic investigation.MethodsIn a retrospective cohort, medical records of patients aged less than 16 years with suspected foreign body aspiration who underwent flexible or rigid bronchoscopy were included. Data including age, sex, symptoms, physical examination findings, radiological features, nature and location of the foreign body, and outcome of the bronchoscopy were collected, and multivariable binary logistic regression analysis was employed for prediction of foreign body aspiration.ResultsA total of 203 children were included, and the model showed excellent discrimination power for positive foreign body aspiration (area under the curve = 0.911) with an accuracy, sensitivity, and specificity of 86.2, 90.6, and 76.6%, respectively. The total weighted risk score at a cut-off > 2 showed a significant good power of discrimination (area under the curve = 0.879), with a sensitivity of 79.9% and specificity of 84.4%. Accordingly, a clinical algorithm was recommended.ConclusionsThe proposed scoring system and clinical algorithm might help in decision making with regard to the need and type of bronchoscopy in children presenting with potential foreign body aspiration. However, further prospective multicenter studies should be conducted to validate this scoring system.

Pulmonary function and six-minute-walk test in patients after recovery from COVID-19: A prospective cohort study.

To study abnormality of spirometry, six-minute walk distance, and chest radiograph among patients recovered from Coronavirus Disease 2019 (COVID-19). A prospective cohort study was conducted in 87 COVID-19 confirmed cases who recovered and discharged from a medical school hospital in Thailand. At the follow-up visit on day 60 after onset of symptoms, patients underwent an evaluation by spirometry (FVC, FEV1, FEV1/FVC, FEF25-75, and PEF), a six-minute-walk test (6MWT), and a chest radiograph. There were 35 men and 52 women, with a mean age of 39.6±11.8 years and the mean body mass index (BMI) was 23.8±4.3 kg/m2. Of all, 45 cases had mild symptoms; 35 had non-severe pneumonia, and 7 had severe pneumonia. Abnormality in spirometry was observed in 15 cases (17.2%), with 8% of restrictive defect and 9.2% of obstructive defect. Among the patients with an abnormal spirometry, the majority of the cases were in the severe pneumonia group (71.4%), compared with 15.6% in the non-severe pneumonia group, and 10.2% in the mild symptom group (p = 0.001). The mean six-minute-walk distance (6MWD) in the mild symptom and non-severe pneumonia groups was 538±56.8 and 527.5±53.5 meters, respectively. Although the severe pneumonia group tended to have a shorter mean 6-min walking distance, but this was not statistically significant (p = 0.118). Twelve patients (13.8%) had abnormal chest radiographs that showed residual fibrosis. This abnormality was more common in the severe pneumonia group (85.7%) and in others (7.5%) (p<0.001). Abnormal spirometry was noted in 17.2% of COVID-19 survivors with both restrictive and obstructive defects. Severe COVID-19 pneumonia patients had higher prevalence rates of abnormal spirometry and residual fibrosis on the chest radiographs when compared to patients in the mild symptom and non-severe pneumonia groups.

Nosocomial Fever in General Medical Wards: A Prospective Cohort Study of Clinical Characteristics and Outcomes.

PurposeNosocomial fever (NF) is a common sign of healthcare-associated infection; however, infection is not always followed up. We studied the etiology, clinical characteristics, and outcomes of nosocomial fever in hospitalized patients.Patients and MethodsBetween October 2019 and December 2020, we enrolled subjects from general medical wards who developed fever ≥48 hours after hospital admission or who were admitted with fever, defervesced, and then developed a fever ≥7 days later that was unrelated to the cause for admission. Subjects with NF underwent a comprehensive clinical evaluation and laboratory investigations.ResultsEighty-six cases of NF were identified and completely followed, the mean age was 69.29 years, and 35 were male. Fifty-seven were from infectious etiologies, 28 from non-infectious etiologies, and one case was unable to be determined. Hospital-associated pneumonia (47.4%) and urinary tract infection (22.8%) were the most common infectious causes, and malignancy (17.8%) and large hematoma (14.3%) were the most common non-infectious causes. The median day of onset of NF following hospitalization was 12 (4.7–21.2) days. Acute physiology and chronic health evaluation II (APACHE II) score (14.70 vs 11.97, p = 0.02), sequential organ failure assessment (SOFA) scores (4 vs 2, p < 0.01), pertinent clinical findings (82.5% vs 42.9%, p < 0.01), blood urea nitrogen (BUN) (37.30 vs 21.10, p = 0.03) and creatinine (1.41 vs 0.97, p = 0.05) levels, and abnormal chest radiography (45.6% vs 3.6%, p < 0.01) had significant differences between infectious and non-infectious etiologies. Twenty-three subjects (26.7%) died. The presence of end-stage renal disease (ESRD) [OR 19.49 (1.77–214.18), p = 0.015], SOFA score >6 [OR 5.18 (1.04–25.90), p = 0.045], and abnormal chest radiography [OR 3.45 (1.16–10.29), p = 0.026] were significantly associated with mortality.ConclusionNosocomial infections, malignancy, and hematoma were the leading causes of NF. Severity scores, clinical findings, renal function tests, and chest radiography were distinguishing features between infectious and non-infectious etiologies. ESRD, high SOFA scores, and abnormal chest radiography were associated with mortality.