Abnormal CXR Research Articles

Survey on Findings and Utilization of Preoperative Chest Radiography in Ophthalmic Surgery.

Objective: The objective of this paper is to reconsider the significance of preoperative chest radiography (CXR) before ophthalmic surgery through investigation of imaging findings and usage status. Methods: This retrospective observational clinical study involved 1616 patients who underwent ophthalmic surgery at Saga University Hospital from 1 January 2019 to 31 December 2020. The patients' radiology reports were obtained from the electronic medical records, and their CXR findings, therapeutic interventions, and progress were investigated. Results: Among all patients, 539 (33.4%) had abnormal preoperative CXR findings. Of these patients, 74 (4.6%) had newly identified abnormal findings. In both patient groups, approximately 70% of patients with abnormal findings were aged ≥70 years, and interstitial shadows were the most common finding. Among all patients with abnormal findings, three (0.19%) received preoperative therapeutic interventions, and all surgeries were performed safely. Forty-three patients with abnormal findings were referred to our hospital or other hospitals for further investigation and treatment postoperatively. Among those patients, eight (0.5%) had primary lung cancer, seven underwent surgery, and one received chemoradiation. The other patients were also followed up and received appropriate therapeutic interventions. Conclusions: Before ophthalmic surgery, few patients required actual therapeutic interventions based on their CXR results. However, many abnormal findings were revealed in elderly patients, including some serious diseases. Furthermore, research has suggested that appropriate therapeutic intervention after ophthalmologic surgery may reduce the risk of a poor life prognosis. This study clearly shows that preoperative CXR is not only useful for perioperative systemic management but also ultimately benefits patients. It is also considered particularly meaningful for patients aged ≥70 years.

Evaluation of a population-wide, systematic screening initiative for tuberculosis on Daru island, Western Province, Papua New Guinea

BackgroundA population-wide, systematic screening initiative for tuberculosis (TB) was implemented on Daru island in the Western Province of Papua New Guinea, where TB is known to be highly prevalent. The initiative used a mobile van equipped with a digital X-ray device, computer-aided detection (CAD) software to identify TB-related abnormalities on chest radiographs, and GeneXpert machines for follow-on diagnostic testing. We describe the results of the TB screening initiative, evaluate its population-level impact and examine risk factors associated with TB detection.MethodsThrough a retrospective review of screening data, we assessed the effectiveness of the screening by examining the enrolment coverage and the proportion of people with TB among screened subjects. A cascade analysis was performed to illustrate the flow of participants in the screening algorithm. We conducted univariate and multivariate analyses to identify factors associated with TB. Furthermore, we estimated the number of additional cases detected by the project by examining the trend of routine TB case notifications during the intervention period, compared to the historical baseline cases and trend-adjusted expected cases.ResultsOf the island’s 18,854 residents, 8,085 (42.9%) were enrolled and 7,970 (98.6%) had chest X-ray interpreted by the CAD4TB software. A total of 1,116 (14.0%) participants were considered to have abnormal CXR. A total of 69 Xpert-positive cases were diagnosed, resulting in a detection rate of 853 per 100 000 population screened. 19.4% of people with TB had resistance to rifampicin. People who were in older age groups (aOR 6.6, 95%CI: 1.5–29.1 for the 45–59 age group), were severely underweight (aOR 2.5, 95%CI:1.0-6.1) or underweight (aOR 2.1, 95%CI: 1.1–3.8), lived in households < 5 people (aOR 3.4, 95%CI:1.8–6.6) and had a past history of TB (aOR 2.1, 95%CI: 1.2–3.6) were more likely to have TB. The number of bacteriologically confirmed TB notified during the intervention period was 79.3% and 90.8% higher than baseline notifications and forecasted notifications, respectively.ConclusionThe screening project demonstrated its effectiveness with the high Xpert-positive TB prevalence among the participants and by successfully yielding additional cases of bacteriologically confirmed TB including rifampicin-resistant TB. The results and lessons learnt from the project should inform future TB screening initiatives in Papua New Guinea.

Serum ACE2 and S19P gene polymorphism in Egyptian patients with COVID-19 infection: correlation with disease severity

The expression of ACE2 is linked to disease severity in COVID-19 patients. The ACE2 receptor gene polymorphisms are considered determinants for SARS-CoV-2 infection and its outcome. In our study, serum ACE2 and its genetic variant S19P rs73635825 polymorphism were investigated in 114 SARS-CoV-2 patients. The results were compared with 120 control subjects. ELISA technique and allele discrimination assay were used for measuring serum ACE2 and genotype analysis of ACE2 rs73635825. Our results revealed that serum ACE2 was significantly lower in SARS-CoV-2 patients (p = 0.0001), particularly in cases with hypertension or diabetes mellitus. There was a significant difference in the genotype distributions of ACE2 rs73635825 A > G between COVID-19 patients and controls (p-value = 0.001). A higher frequency of the heterozygous AG genotype (65.8%) was reported in COVID-19 patients. The G allele was significantly more common in COVID-19 patients (p < 0.0001). The AG and GG genotypes were associated with COVID-19 severity as they were correlated with abnormal laboratory findings, GGO, CXR, and total severity scores with p < 0.05. Our results revealed that the ACE2 S19P gene variant is correlated with the incidence of infection and its severity, suggesting the usefulness of this work in identifying the susceptible population groups for better disease control.

Radiographic patterns and severity scoring of COVID-19 pneumonia in children: a retrospective study

BackgroundChest radiography (CXR) is an adjunct tool in treatment planning and monitoring of the disease course of COVID-19 pneumonia. The purpose of the study was to describe the radiographic patterns and severity scores of abnormal CXR findings in children diagnosed with COVID-19 pneumonia.MethodsThis retrospective study included children with confirmed COVID-19 by reverse transcriptase-polymerase chain reaction test who underwent CXR at the arrival. The CXR findings were reviewed, and modified radiographic scoring was assessed.ResultsThe number of abnormal CXR findings was 106 of 976 (10.9%). Ground-glass opacity (GGO) was commonly found in children aged > 9 years (19/26, 73.1%), whereas peribronchial thickening was predominantly found in children aged < 5 years (25/54, 46.3%). Overall, the most common radiographic finding was peribronchial thickening (54/106, 51%). The lower lung zone (56/106, 52.8%) was the most common affected area, and there was neither peripheral nor perihilar predominance (84/106, 79.2%). Regarding the severity of COVID-19 pneumonia based on abnormal CXR findings, 81 of 106 cases (76.4%) had mild lung abnormalities. Moderate and severe lung abnormalities were found in 21 (19.8%) and 4 (3.8%) cases, respectively. While there were no significant differences in the radiographic severity scores among the various pediatric age groups, there were significant disparities in severity scores in the initial CXR and medical treatments.ConclusionsThis study clarified the age distribution of radiographic features across the pediatric population. GGO was commonly found in children aged > 9 years, whereas peribronchial thickening was predominant in children aged < 5 years. The lower lung zone was the most common affected area, and the high severity lung scores required more medical treatments and oxygen support.

1882. Contact Investigation of Congenital Tuberculosis in a Neonatal Intensive Care Unit in South Korea

Abstract Background Congenital tuberculosis (TB) is uncommon and difficult to detect in neonates due to its nonspecific symptoms. We conducted a contact investigation of infants and healthcare workers (HCWs) exposed to a neonate with congenital TB in a neonatal ICU (NICU) in Korea. Methods A premature infant born was admitted to NICU on September 16, 2022. On October 24, the infant's mother was diagnosed with miliary TB, and infant’s sputum AFB stain showed 4 positive results. All NICU infants and HCWs during the same period were screened for active pulmonary TB using chest radiography (CXR) immediately. Exposed infants were evaluated with a TST and CXR three months after exposure. Interferon-Gamma Release Assay (IGRA) testing was performed on those with a positive TST or abnormal CXR finding. Prophylactic rifampin was provided to the exposed infants for 3 months, as index had isoniazid-resistant M. tuberculosis infection. Exposed HCWs underwent IGRA testing immediately after exposure (1st IGRA) and at 8 to 10 weeks post-exposure (2nd IGRA), and CXR was performed 6 months after exposure. Results Five out of 82 exposed infants had positive TST (≥ 10 mm) results, while all 31 infants who underwent IGRA testing had negative results. All five with positive TST had received BCG vaccination a median 105 days before. Of the 119 exposed HCWs, three had a conversion; two had negative results (on annual IGRA testing performed according to the national TB prevention Act) before exposure and positive at 1st IGRA test, and one had negative 1st IGRA test then positive 2nd IGRA test. None had active TB during 6-month follow-up. Conclusion We found that 6% of exposed infants had positive TST results and 0% had positive IGRA, while 2.5% of exposed HCWs had conversion. Considering the possibility of false positive TST results due to prior BCG vaccination, the chance of transmission to the infants would be 0%; otherwise, it would be 6.1%. Disclosures All Authors: No reported disclosures

Frequency of abnormal findings on chest radiograph after positive PPD in children and adolescents in an urban setting in the United States

BackgroundChest radiographs (CXR) for tuberculosis (TB) screening in children are valuable in high-burden settings. However, less certain in low prevalence contexts. In the United States, positive PPD is sufficient to treat for “latent” TB, or TB infection in asymptomatic patients. ObjectiveWe sought to determine frequency of abnormal CXR findings after a positive purified protein derivative (PPD) test at a tertiary pediatric center in the United States. MethodA retrospective evaluation was conducted of patients (0–18 years) with a CXR after a positive PPD (e.g., known exposure, employment, migratory requirements or before immunosuppression) between 2011 and 2021. Clinical information, demographics, and reason for PPD were recorded from health record. CXRs were evaluated using initial report and by a pediatric radiologist with special interest in TB and 8 years of experience. ResultOf 485 patients, median [interquartile range (IQR)] age 8.5[3.3–14.4], abnormal CXRs were described in 5 (1%). Most common reasons for PPD included: close contact with someone with TB or with high risk for TB. Most patients 373 (76.9%) received treatment for latent TB, and 111 (22.9%) no treatment. One patient (0.2%) received treatment for active disease. Radiographic findings included isolated lymphadenopathy (n = 2), consolidation (n = 1), pleural fluid/thickening (n = 1) and a patient with lymphadenopathy and a calcified nodule (n = 1). ConclusionIn our experience, prevalence of chest radiographs findings for patients with positive PPD was very low. Moreover, no cases of severe disease were seen and those with abnormal findings would not merit treatment change under current WHO guidelines.

Analysis of Pneumonia Area Development in Covid-19 Patients based on Sequential X-Ray Images Using the Seq_UB Architecture

Introduction During the covid pandemic, radiologists diagnosed covid patients by analyzing chest X-ray images. The existence of a quantitative system can help visual observation of lung conditions by radiologists. Purpose of research This research aims to develop an image segmentation algorithm, Seq_UB, which can monitor the development of the lung condition of Covid-19 patients periodically. The Seq_UB algorithm was developed by modifying the UNet system using different CNN layers according to the UBNet v1 algorithm. Materials and methods The dataset for training uses the Montgomery USA Dataset, which contains 138 CXRs with a resolution of 4,020×4,892, of which there are 80 normal CXR images and 58 CXR images of patients identified with tuberculosis; the Shenzhen Hospital Dataset consists of 662 CXR images, of which there are 336 abnormal CXR images. Result and discussion The results show that reducing the input image size does not significantly affect the accuracy of the segmentation results. However, reducing the input image size will affect the resolution of the segmentation results. Where the smaller the input image size, the lower the resolution obtained. This will have an impact on the final interpretation of the segmentation results. Research shows that an input image size of 512 is the best because the resolution of the segmentation results is still very accurate. This study shows that the Seq_UB architecture can perform X-ray image segmentation with relatively stable accuracy and lower computational burden. An interesting pattern was found, where Covid-19 patients quantitatively experienced fluctuations in image segmentation size. Conclusions The Seq_UB system can perform well with a segmentation accuracy of 96 %, and the processing speed takes 0.91 s. A desktop GUI was designed to segment X-ray images more effectively. HIGHLIGHTS Development of the Seq_UB algorithm: This research presents the development of an X-ray image segmentation algorithm with a computational workload that is faster, more accurate, and lighter Quantitative estimation of the lung area percentage of Covid-19 patients based on segmentation with the Seg_UB model Monitoring the development of lung conditions of Covid-19 patients quantitatively by comparing it with normal CXR using the Seg_UB model GRAPHICAL ABSTRACT

The Urgent Need for Cardiopulmonary Fitness Evaluation among Wildland Firefighters in Thailand.

Wildland firefighting is a high-risk occupation. The level of cardiopulmonary fitness can indicate whether wildland firefighters are ready to perform their job duties. This study's objective was to determine wildland firefighters' cardiopulmonary fitness using practical methods. This cross-sectional descriptive study aimed to enroll all 610 active wildland firefighters in Chiang Mai. The participants' cardiopulmonary fitness was assessed using an EKG, a chest X-ray, a spirometry test, a global physical activity questionnaire, and the Thai score-based cardiovascular risk assessment. The NFPA 1582 was used to determine "fitness" and "job restriction". Fisher's exact and Wilcoxon rank-sum tests were used to compare cardiopulmonary parameters. With a response rate of 10.16%, only eight wildland firefighters met the cardiopulmonary fitness requirements. Eighty-seven percent of participants were in the job-restriction group. An aerobic threshold of eight METs, an abnormal EKG, an intermediate CV risk, and an abnormal CXR were the causes of restriction. The job-restriction group had a higher 10-year CV risk and higher systolic blood pressure, although these differences were not statistically significant. The wildland firefighters were unfit for their task requirements and were more at risk of cardiovascular health compared to the estimated risk of the general Thai population. To improve the health and safety of wildland firefighters, pre-placement exams and health surveillance are urgently needed.

Image Turing test and its applications on synthetic chest radiographs by using the progressive growing generative adversarial network

The generative adversarial network (GAN) is a promising deep learning method for generating images. We evaluated the generation of highly realistic and high-resolution chest radiographs (CXRs) using progressive growing GAN (PGGAN). We trained two PGGAN models using normal and abnormal CXRs, solely relying on normal CXRs to demonstrate the quality of synthetic CXRs that were 1000 × 1000 pixels in size. Image Turing tests were evaluated by six radiologists in a binary fashion using two independent validation sets to judge the authenticity of each CXR, with a mean accuracy of 67.42% and 69.92% for the first and second trials, respectively. Inter-reader agreements were poor for the first (κ = 0.10) and second (κ = 0.14) Turing tests. Additionally, a convolutional neural network (CNN) was used to classify normal or abnormal CXR using only real images and/or synthetic images mixed datasets. The accuracy of the CNN model trained using a mixed dataset of synthetic and real data was 93.3%, compared to 91.0% for the model built using only the real data. PGGAN was able to generate CXRs that were identical to real CXRs, and this showed promise to overcome imbalances between classes in CNN training.

Diagnostic yield of chest radiograph in management of adults with difficult-to-treat chronic cough-retrospective study.

Chest radiograph (CXR) is a routine imaging test in adults with chronic cough (CC), while value of thoracic computed tomography (CT) in these patients is still a matter of discussion. The aims of the study were to assess the diagnostic yield of CXR and to evaluate the impact of thoracic CT on management of patients with difficult-to-treat CC referred to our cough clinic. The retrospective analysis of paired CXR and CT results was performed in 189 consecutive adults treated due to CC between 2015-2019 in our cough clinic. CC was defined as cough >8 weeks being the main or isolated ailment. The sensitivity, specificity, negative/positive predictive value (NPV, PPV) and diagnostic accuracy of CXR were calculated based on chest CT scan as the "gold standard". Only those CT scans which revealed abnormalities potentially related to CC and were associated with the changes in further diagnostic or therapeutic approach were construed as relevant CT findings during final analysis. The median age of patients (male/female ratio 53/136) was 58 years (IQR 44-67), only 6 subjects (3.0%) were active smokers, median CC duration was 48 months (IQR 24-120). CXR revealed abnormal findings in 23/189 (12.2%) patients. Normal CXR was confirmed by CT in 141 subjects (141/166; 84.9%). In 25/166 (15.1%) patients, CT showed abnormalities that could explain the cause of CC and changed either the diagnostic protocol or therapy. In patients with abnormal CXR, CT confirmed abnormal findings in 8 cases (8/23, 34.8%). The sensitivity, specificity, PPV, NPV, diagnostic accuracy were 24.2%, 90.4%, 34.8%, 84.9% and 78.8%, respectively. CXR shows a limited diagnostic yield in adults with difficult-to-treat CC referred to cough clinic. Chest CT scan may add significant data impacting the diagnostic and therapeutic approach in these patients.

Chest radiography as a predictor of prognosis in COVID-19

Chest Radiography (CXR) is typically the first-line imaging modality used for patients with suspected respiratory tract infections, including COVID-19. CXRs may be normal in early or mild disease. Of patients with COVID-19 requiring hospitalization one study has demonstrated that 69% had an abnormal CXR at the initial time of admission, and 80% had radiographic abnormalities sometime during hospitalization [1]. Chest CT findings have been linked to disease severity and prognosis [2], however the prognostic implications of normal vs abnormal CXR findings on presentation to hospital with COVID-19 symptoms is less clear. This retrospective study was conducted to investigate CXR findings at admission and the predictive value in terms of subsequent diagnosis and outcomes in such patients.

EP01.06-002 Impact of Immediate AI Enabled Patient Triage to Chest CT on the Lung Cancer Pathway: LungIMPACT

In England, 30% of patients die within 90 days of diagnosis and late diagnosis is strongly implicated in comparatively poor survival shown by the International Cancer Benchmarking Partnership. UK guidance recommends the chest radiograph (CXR) for initial investigation of certain red-flag symptoms but CXRs are done for many indications and may pick up lung cancer as an incidental finding. Thus, the National Optimal Lung Cancer Pathway (NOLCP) was developed to address, amongst other issues, a rapid process from progress from abnormal CXR to CT and clinic.

CXR severity scores of COVID 19 infection in Sri Lanka: findings of a multicenter study during the first wave of the pandemic

Introduction: Chest X-ray initially remained the only imaging modality in the first wave of the COVID -19 pandemic in Sri Lanka similar to many other low resource settings. Sri Lanka claimed a cluster epidemic status achieving a case fatality rate well below the global rate during the first wave. Objectives: To describe degree of lung involvement on CXR as a severity score and correlate severity scores with symptom duration, presence of comorbidities and demographic factors. Methods: A retrospective study at four main hospitals in Sri Lanka included all RT-PCR positive COVID-19 patients who underwent CXR from January to mid May, 2020. Both initial and follow-up CXR were independently double reported by a team of four radiologists and discrepancy reported by a fifth radiologist for radiographic findings and lung involvement. Clinical and demographic data was retrieved from hospital records. A severity score was calculated for each CXR. Associations were analyzed for CXRs with a severity score of 1 or more. Results: 217 CXRs of 133 patients (99 men, mean age 43.9±15.7 years;133 initial CXRs of 132 symptomatic patients; 84 follow-up radiographs of 33 patients) revealed 96(96/133;72.2%) normal initial CXRs. 12 patients with normal initial CXRs(12/96;12.5%) underwent follow up CXR but none was abnormal. Majority (21/37;56.75%) with abnormal CXR had mild (severity score 1-2) lung involvement. A severity score of 1 or more was associated with comorbidities (OR=3.14), male sex (OR=5.93) and increasing age (OR=1.06). Conclusion: Majority of CXR in COVID-19 patients were normal during first wave in Sri Lanka. Majority with abnormal CXR had mild lung involvement.

Chest X-Ray as a Diagnostic and Prognostic Tool For Covid-19; A Tertiary Care Hospital Based Study

Introduction: The radiological investigations are not diagnostic of COVID-19 disease but help in management. CT scan is not available worldwide; therefore, x-ray chest (CXR) is ideal for assessment of disease severity using scoring system. This study was conducted to see various CXR findings and relation of severity with outcome. Materials and Methods: This study was conducted at Dallah hospital Saudi Arabia. All admitted confirmed cases of COVID-19, above age of 18-year were included. CXR were done at baseline, after 5-7 days and after 13-15 days. Patient with previous heart failure, chronic obstructive pulmonary diseases or pulmonary fibrosis, Pregnant and lactating ladies were also excluded.Results: Out of total 629 patients 67.6 % were males. There was no statically significant difference in mortality in male to female patients. The mean age was 42.67+15.13 (range 18-83) years. Patients with age more than 50-year were 58.9% and had severe infection (p=0.041) with high mortality (p=0.045). The 63% patients had abnormal CXR at baseline. The common CXR features detected were consolidation (45%), followed by ground glass appearance (43%). Only 0.8% patients had pleural effusion and one patient with pneumothorax. Patients with bilateral lung infiltration was 67.5% and mostly it was in lower zones (63%). The follow-up CXR revealed an increase in severity score related to mortality (p&lt;0.001). Conclusion: In COVID-19 infection CXR may be a predictor of severity of disease and monitoring of disease may be done by serial CXR.

Outcome of Neonates Born to COVID-19 Positive Mothers at a Tertiary Centre: A Retrospective Cohort Study

Introduction: In the context of the COVID-19 pandemic, studies on perinatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection play an essential role in the understanding of the disease which in turn is necessary for optimal management of affected neonates. Aim and Objective: To determine the clinical outcomes in neonates born to mothers with SARS-CoV-2 infection and to identify possible risk factors in perinatal transmission. Materials and Methods: This was a retrospective cohort study performed at level-3 teaching Neonatal Intensive Care Unit (NICU) in South India. Medical records of all mothers who delivered in the COVID-19 facility and neonates born to COVID-19 confirmed mothers from April 15, 2020, to September 15, 2021, were collected and analyzed. Results: Of 15,720 deliveries, 556 mothers who tested positive for COVID-19 delivered 563 babies (7 twins), of which 6.3% were positive for SARS-CoV-2. Out of 563 babies, 14.5% were preterm and 95% were asymptomatic. Among COVID-19 positive mothers, cesarean was the most common mode of delivery (73.5% and 88% in COVID-19 positive and negative neonates respectively; P value = .01) and most of the babies were roomed-in (85.2% in COVID-19 positive and 94.6% in COVID-19 negative neonates; P value = .02). COVID-19 positive neonates had significantly high probability of pneumonia ( P value = .003), sepsis ( P value = .03), septic shock ( P value = .01), and abnormal CXR ( P value = .01). There was no significant difference in the mortality rate. Conclusion: COVID-19 positive status of the mother is not associated with increased risk of preterm birth, neonatal admission, morbidity, or mortality. The risk of transmission was not found to be associated with direct breastfeeding or rooming-in.

Systemic White Blood Cell Count as a Biomarker for Malignant Cerebral Edema in Large Vessel Ischemic MCA Stroke

ObjectivesLarge middle cerebral artery (MCA) strokes remain a major cause for mortality and morbidity all over the world, and therefore early identification of patients with the highest risk for malignant cerebral edema is crucial for early intervention. Neutrophils to lymphocytes ratio (NLR) and peripheral total white blood cell (WBC) count are inflammatory markers done routinely for all patients, and this study evaluated the use of NLR and elevated white blood cell count within the first 24 h of MCA ischemic stroke onset, with the absence of significant hemorrhagic transformation, to predict malignant cerebral edema. Materials and methodsA total of 156 patients with large MCA strokes were included. We collected demographic, clinical, radiological data, and NLR and WBCs within the first 24 h from admission.We excluded patients who had any underlying infections diagnosed 7 days before or within 72 h after admission. We used a body temp of 38 C or more, abnormal CXR or abnormal urine analysis within the first 72 h to exclude patients with possible infections.We excluded immune-compromised patients and patients on steroid therapy. We compared the NLR and WBC count in patients who developed malignant cerebral edema versus the patients who did not. NLR > 3.5 and < 3.5 was used for comparison. We then conducted multivariate logistic regression models to explore the relationship between cerebral edema, WBCs and NLR count simultaneously. ResultsNLR, WBC, radiological involvement of more than 50% of MCA territory infarction on presentation, hyperdense MCA sign, and NIH stroke scale were all significantly higher in patients with malignant cerebral edema within the first 24 h. Using univariate logistic regression, NLR performs better than WBC when predicting the occurrence of malignant cerebral edema (AUC = 0.74 vs. 0.62). However, NIH stroke scale scores, and radiological involvement of more than 50% of MCA territory infarction on the first 24 h of presentation on CT scan both showed better discriminative performance for malignant cerebral edema than NLR (AUC = 0.84 and 0.76, respectively). When combined, NLR > 3.5 paired with the NIH stroke scale score had the best predictive performance (AUC = 0.87). ConclusionNLR > 3.5 can be used for early prognostication in patients with large vessel MCA ischemic strokes with no significant hemorrhagic transformation within the first 24 h regardless if they had reperfusion therapy or not. Combining NLR of > 3.5 in addition to high NIHSS provided the best predictive model in our study. Further studies are needed to further develop the best predictive model in diverse populations.

Concomitant pulmonary disease is common among patients with extrapulmonary TB.

SUMMARYBACKGROUND :Microbiologic screening of extrapulmonary TB (EPTB) patients could inform recommendations for aerosol precautions and close contact prophylaxis. However, this is currently not routinely recommended in India. Therefore, we estimated the proportion of Indian patients with EPTB with microbiologic evidence of pulmonary TB (PTB).METHODS :We characterized baseline clinical, radiological and sputum microbiologic data of 885 adult and pediatric TB patients in Chennai and Pune, India, between March 2014 and November 2018.RESULTS :Of 277 patients with EPTB, enhanced screening led to the identification of 124 (45%) with concomitant PTB, including 53 (19%) who reported a cough >2 weeks; 158 (63%) had an abnormal CXR and 51 (19%) had a positive sputum for TB. Of 70 participants with a normal CXR and without any cough, 14 (20%) had a positive sputum for TB. Overall, the incremental yield of enhanced screening of patients with EPTB to identify concomitant PTB disease was 14% (95% CI 12–16).CONCLUSIONS :A high proportion of patients classified as EPTB in India have concomitant PTB. Our results support the need for improved symptom and CXR screening, and recommends routine sputum TB microbiology screening of all Indian patients with EPTB.

Residual symptoms, lung function, and imaging findings in patients recovering from SARS-CoV-2 infection.

Symptoms following acute COVID-19 infection are common, but their relationship to initial COVID-19 severity is unclear. We hypothesize that residual symptoms are related to disease severity, and severe acute COVID-19 infection is more likely to cause residual pulmonary damage. This study aims to evaluate symptoms, lung function, and abnormal imaging within 3 months following COVID-19 infection, and to determine whether they are related to initial disease severity. A cross-sectional study was carried out at a designated post-COVID clinic in Hadassah Medical Center, Jerusalem, Israel. Patients with PCR-confirmed SARS-CoV-2 infection were evaluated within 12 weeks following infection and included both admitted and non-admitted subjects. All study participants underwent assessment of symptoms, quality of life (SGRQ), pulmonary function tests, and imaging. A total of 208 patients (age 49.3 ± 16 years) were included in the study. Initial disease severity was mild in 86, moderate in 49, and severe in 73 patients. At the time of follow-up, there were no differences in frequency of residual symptoms or in SGRQ score between groups. Patients with severe COVID-19 were more likely to have residual dyspnea (p = 0.04), lower oxygen saturation (p < 0.01), lower FVC and TLC (p < 0.001, p = 0.03 respectively), abnormal CXR (p < 0.01), and abnormal CT scan (p < 0.01) compared to other groups.Frequency of symptoms and impairment of quality of life at 12 week follow-up are common and are not related to severity of initial COVID-19 disease. In contrast, reduced lung function and abnormal pulmonary imaging are more common in patients with more severe acute COVID-19 infection.

Evidence Based Scarce Resource Allocation During the COVID-19 Pandemic: A Case Study of Bamlanivimab Administration in the Emergency Department.

Background: Patients presenting for emergency department (ED) evaluation may be appropriate for treatment with monoclonal antibodies for mild to moderate COVID-19. While many sites have implemented infusion centers for these agents, EDs will continue to evaluate these patients where appropriate identification and efficient infusion of eligible patients is critical. Objectives: Patients receiving bamlanivimab in the EDs of an academic medical center are described. The primary objective was to describe operational metrics and secondary objectives reported clinical outcomes. Methods: Patients receiving bamlanivimab and discharged from the ED were included from November 16, 2020 to January 16, 2021 in the retrospective, observational cohort. Primary outcome was adherence to institutional criteria. Secondary outcomes included ED visit metrics, clinical characteristics, and return visits within 30 days. Risk factors for return visits were assessed with regression. Results: One hundred nineteen patients were included. Most (71%) were diagnosed with COVID-19 during the ED visit and median symptom duration was 3(IQR 2-5) days. Median number of risk factors for progression to severe disease was 2 (IQR 1-2). Thirty percent had a documented abnormal chest x-ray. Institutional criteria adherence was 99.2%. Median time from ED room to bamlanivimab was 4 (IQR 3.1-5.2) hours. Thirty patients had return visit within 30 days; 19 were COVID-19 related. Two multivariable regression models were analyzed for COVID-19 related return visit. Characteristics on ED presentation were considered in Model I: male gender (OR 3.01[0.97-9.31]), age (per 10 years) (OR 1.49[1.05-2.12]), African-American race (OR 3.46[1.09-11.06]), and symptom duration (per day) (OR 1.34[1.05-1.73]). Model II included labs and imaging acquired in ED. In Model II, age (per 10 years) (OR 1.52[1.07-2.16]) and abnormal CXR (OR 5.74[1.95-16.9]) were associated with COVID-19 related return visits. Conclusions: Administration of bamlanivimab to ED patients can be done efficiently, with the potential to reduce COVID-19 related return visits. Age and abnormal imaging were independent predictors of COVID-19 return visits.

Does the initial chest radiograph severity in COVID-19 impact the short- and long-term outcome? – a perspective from India

Purpose The chest radiograph (CXR) is among the most widely used investigations in coronavirus disease 2019 (COVID-19) patients. Little is known about its predictive role on the long-term outcome. The purpose of this study was to explore its association with the short and long-term outcome in COVID-19 patients. Methods A total of 1530 patients were assessed for the presence, radiographic pattern and distribution of lung lesions observed on baseline chest radiographs obtained at admission. The Brixia scoring system was applied for semiquantitative assessment of lesion severity. Short-term outcome was determined by clinical severity, duration of hospitalization and mortality. The 1415 survivors in this group were assessed after 5–6 months for the presence of residual symptoms. Results About 67% patients had an abnormal baseline CXR. Bilateral involvement with a basal preponderance was observed and ground-glass opacification was the most frequent finding. The Brixia score ranged from 0 to 16, median 2, interquartile range (IQR) [0–6]. About 36% patients were symptomatic on 5–6-month follow-up, with fatigability being the commonest symptom. A good correlation was observed between the CXR score and disease severity as well as duration of hospitalization. On multivariate analysis, the CXR score was found to be a significant independent predictor of in-patient mortality as well as presence of long-term residual symptoms in survivors. Conclusions Disease severity as seen on the chest radiograph appears to play an important role in driving the short and long-term consequences of COVID-19 and could serve as a prognostic indicator, which influences short-term management and long-term follow-up.