Abnormal X-ray Findings Research Articles

Simultaneous alleviation of verification and reference standard biases in a community-based tuberculosis screening study using Bayesian latent class analysis.

Estimation of prevalence and diagnostic test accuracy in tuberculosis (TB) prevalence surveys suffer from reference standard and verification biases. The former is attributed to the imperfect reference test used to bacteriologically confirm TB disease. The latter occurs when only the participants screening positive for any TB-compatible symptom or chest X-ray abnormality are selected for bacteriological testing (verification). Bayesian latent class analysis (LCA) alleviates the reference standard bias but suffers verification bias in TB prevalence surveys. This work aims to identify best-practice approaches to simultaneously alleviate the reference standard and verification biases in the estimates of pulmonary TB prevalence and diagnostic test performance in TB prevalence surveys. We performed a secondary analysis of 9869 participants aged ≥15 years from a community-based multimorbidity screening study in a rural district of KwaZulu-Natal, South Africa (Vukuzazi study). Participants were eligible for bacteriological testing using Xpert Ultra and culture if they reported any cardinal TB symptom or had an abnormal chest X-ray finding. We conducted Bayesian LCA in five ways to handle the unverified individuals: (i) complete-case analysis, (ii) analysis assuming the unverified individuals would be negative if bacteriologically tested, (iii) analysis of multiply-imputed datasets with imputation of the missing bacteriological test results for the unverified individuals using multivariate imputation via chained equations (MICE), and simultaneous imputation of the missing bacteriological test results in the analysis model assuming the missing bacteriological test results were (iv) missing at random (MAR), and (v) missing not at random (MNAR). We compared the results of (i)-(iii) to the analysis based on a composite reference standard (CRS) of Xpert Ultra and culture. Through simulation with an overall true prevalence of 2.0%, we evaluated the ability of the models to alleviate both biases simultaneously. Based on simulation, Bayesian LCA with simultaneous imputation of the missing bacteriological test results under the assumption that the missing data are MAR and MNAR alleviate the reference standard and verification biases. CRS-based analysis and Bayesian LCA assuming the unverified are negative for TB alleviate the biases only when the true overall prevalence is <3.0%. Complete-case analysis produced biased estimates. In the Vukuzazi study, Bayesian LCA with simultaneous imputation of the missing bacteriological test results under the MAR and MNAR assumptions produced overall PTB prevalence of 0.9% (95% Credible Interval (CrI): 0.6-1.9) and 0.7% (95% CrI: 0.5-1.1) respectively alongside realistic estimates of overall diagnostic test sensitivity and specificity with substantially overlapping 95% CrI. The CRS-based analysis and Bayesian LCA assuming the unverified were negative for TB produced 0.7% (95% CrI: 0.5-0.9) and 0.7% (95% CrI: 0.5-1.2) overall PTB prevalence respectively with realistic estimates of overall diagnostic test sensitivity and specificity. Unlike CRS-based analysis, Bayesian LCA of multiply-imputed data using MICE mitigates both biases. The findings demonstrate the efficacy of these advanced techniques in alleviating the reference standard and verification biases, enhancing the robustness of community-based screening programs. Imputing missing values as negative for bacteriological tests is plausible under realistic assumptions.

The Predictive Factors Associated with In-Hospital Mortality of Melioidosis: A Cohort Study.

Background and Objectives: Melioidosis is an infectious disease caused by Burkholderia pseudomallei, and it has a wide range of clinical symptoms. It is endemic in tropical areas, including Southeast Asia. Despite the availability of effective treatment, the mortality rate is still high, especially in patients presenting with septic shock. The aim of this study was to determine and explore clinical characteristics, microbiology, treatment outcomes, and factors associated with in-hospital mortality which could predict prognosis and provide a guide for future treatment. Materials and Methods: The population in this retrospective cohort study included all 262 patients with a diagnosis of melioidosis who were hospitalized at Surin Hospital, Surin, Thailand, from April 2014 to March 2017. We included patients older than 15 years with a positive culture for B. pseudomallei. Data regarding the clinical characteristics, microbiology, and treatment outcomes of the patients were collected and analyzed. The patients were divided into two groups dependent on outcome, specifically non-survival and survival. Logistic regression was performed to determine the risk factors associated with in-hospital mortality. Results: Out of the 262 patients with melioidosis during the study period, 117 (44.7%) patients died. The mean age was 57.2 ± 14.4 years, and 193 (73.7%) patients were male. The most common comorbidity was diabetes (123, 46.9%), followed by chronic kidney disease (35, 13.4%) and chronic liver disease (31, 11.8%). Four risk factors were found to be associated with in-hospital mortality, including age (adjusted odds ratio (aOR) 1.04, 95%CI: 1.01-1.07), respiration rate (aOR 1.18, 95%CI: 1.06-1.32), abnormal chest X-ray finding (aOR 4.79, 95%CI: 1.98-11.59), and bicarbonate levels (CO2) (aOR 0.92, 95%CI: 0.85-0.99). Conclusions: Our study identified age, respiration rate, abnormal chest X-ray finding, and CO2 levels are predictive factors associated with in-hospital mortality in melioidosis patients. Physicians should be aware of these factors, have access to aggressive treatment options, and closely monitor patients with these risk factors.

Chronic Low Back Pain: Prevalence, Impact on Quality of Life, and Predictors of Future Disability.

In primary healthcare settings, chronic low back pain (cLBP) is a widespread health issue with a great global impact. A cross-sectional analytical study was performed on 918 adults attending primary healthcare settings in Makkah, Saudi Arabia, to estimate the cLBP prevalence, its effect on health-related quality of life (QOL), and predictors of subsequent disability. The visual analog scale of pain(VAS), World Health Organization Quality of Life Scale (WHO-QOL), and Oswestry low back pain disability index (ODI) were used to assess back pain severity, impact on QOL, and physical disability, respectively. The prevalence of cLBP among adults attending primary care settings in Makkah City was 25.9%, and 88.6% of them had a limited range of motion of the spine. About 58.1% had abnormal radiological findings detected by MRI. Based on the VAS scale, most patients (83.8%) had mild pain. The median (IQR) QOL score was 70 (60-80). Minimal and moderate disability scores were prevalent among 16.2% and 65.7% of patients, respectively. Disability scores were independently predicted by a lower QOL score (beta = -0.39, 95%CI = -0.49 to -0.29, p < 0.001) and higher VAS scores (beta = 0.47, 95%CI = 0.38-0.56, p < 0.001). Furthermore, disability was independently associated with having post-void residual volume (PVRV) (beta = 5.84, 95%CI = 1.97-9.72, p = 0.004) and abnormal X-ray findings (beta = 7.10, 95%CI = 1.77-12.4, p = 0.010). cLBP is common among adults attending primary care settings in Makkah City; it is associated with moderate disability and lower health-related QOL.

To study ultrasound and chest X-ray findings and their role in the diagnosis of dengue fever in children.

Dengue fever is a fatal viral illness affecting almost all age groups and is seen in almost all tropical countries. Ultrasonography (USG) can be a useful tool for the assessment and diagnosis of dengue fever. The study aimed to evaluate X-ray and ultrasound findings in children with dengue fever. This was a prospective and cross-sectional study that was carried out in a hospital in Mumbai for over one year. All relevant data were collected, validated, and analyzed statistically on the software Epi Info 7. Abnormal X-ray findings noticed were pleural effusion, pneumonia, and bilateral nodular opacities. Pleural effusion and respiratory complications were more common in severe dengue (P < 0.05). Out of the 37 patients on whom USG was done, 33 (89.18%) had abnormal and 4 (10.81%) had normal USG findings. Of the 17 patients with dengue who showed warning signs, 16 (89.9%) had abnormal USG findings. Plasma leakage in the form of ascites and effusion was commonly seen. One hundred percent of patients with severe dengue had abnormal USG findings. The abnormal USG findings were more commonly detected between 5-7 days and were more commonly associated with IgG + IgM-positive serology. Ultrasonography is a good modality for the diagnosis and evaluation of dengue patients. Serial ultrasound should be done for the assessment and evaluation of said patients.

Pneumatosis intestinalis with free air in the abdominal cavity caused by nintedanib.

This is the first case confirmed the association between PI development and nintedanib by the reproducibility of PI development. In patients taking a combination treatment with corticosteroid and nintedanib, clinicians should be careful regarding the development of PI although the patient improved only after discontinuation of nintedanib treatment.

Prospective study of acute illness observational scale in children of age 2 months to 5 years with respiratory illness, its corelation with radiological findings prognosis and who grading of ARI in inpatients of teritiary care hospital

: In children under the age of five, acute respiratory illness (ARI) is the leading cause of preventable mortality. For the early detection of seriousness andIn the current study, timely treatment of ARI Acute illness observation scale (AIOS) an illness severity was used. To study correlation of AIOS with WHO grading of pneumonia, radiological findings and prognosis in children of age 2 months to 5years.A two-month hospital-based prospective observational research was done on 80 children aged 2 to 59 months who were admitted to the hospital with pneumonia throughout the study period.: The association between AIOS score versus WHO grading ( severity) was statistically significant with P value of &amp;#60;0.0000001. There is a linear positive relationship between the AIOS score and WHO grading (severity the association between AIOS score and WHO grading (severity) is statistically significant with P value of &amp;#60;0.00001. There is a linear positive relationship between the AIOS score and duration of hospital stay. The association between AIOS score and duration of hospital stay is statistically significant with P value of &amp;#60;0.00001. The mean AIOS score at the time of admission was greater in cases which died than the cases which were discharged. AIOS scoring is useful in anticipate abnormal x-ray findings in acute respiratory illness in 2-59 months old children.

POST-OPERATIVE CHEST X-RAY FINDINGS AND TEMPORAL LUNG CHANGES IN RELATION TO ANAESTHESIA METHOD PERFORMED DURING OPEN-HEART SURGERIES WITH CARDIOPULMONARY BYPASS

Aim. To evaluate and assess the role of anaesthesia type in the development of lung X-ray changes after open-heart surgery. Methods. This is a retrospective study. During the period of 2019 11–2021 06, 287 patients underwent open-heart surgery with general anaesthesia (GA) (230 patients) or thoracic epidural analgesia with general anaesthesia (TEA + GA) (57 patients). We have collected data of patients’ X-rays that were performed on the first and the fifth day after the surgery. Results. There is a statistically significant relation that patients who received TEA + GA developed more chan­ges of venous stasis (p&lt;0.05) in lungs X-ray on the first day post-surgery. Other findings revealed that following surgery, all the chest X-ray changes were detected more frequent in patients who had GA vs. TEA + GA perfor­med. Nevertheless, these results didn’t show statistical significance (p&gt;0.05). Conclusions. The study reveals that there is a difference between anaesthesia method used for the development of abnormal pulmonary X-ray findings. The study shows that people who received TEA + GA were more prone to developing venous stasis post-surgery.

Cost-effectiveness analysis of routine follow-up for hip fracture patients after dynamic hip screw and intramedullary nail fixation

• Determining the appropriate outpatient management for patients following IM Nail or DHS for neck of femur fractures should be directed by clear objectives. • Routine post-operative surgical encounters with these patients rarely alter their clinical management. • We propose more selective follow-up protocols and adequately resourcing virtual alternatives. • The current outpatient hip fracture care pathway should be optimised to focus on comprehensive multidisciplinary treatment such as rehabilitation, fracture prevention and bone health optimisation. The rising number of hip fractures has incentivised several quality improvement initiatives aimed at improving outcomes. These include the national hip fracture audit and the best practice tariff. Whilst there is an established standard of care for inpatients, the optimal outpatient management of patients after hip fracture fixation remains undefined. We aim to evaluate the cost-effectiveness of routine surgical appointments and provide evidence to support an improved outpatient hip fracture care pathway that focuses on more comprehensive multidisciplinary treatment. This study retrospectively examined all patients who underwent either dynamic hip screw or intramedullary nail fixation for hip fragility fracture at our hospital over a 3-year period. Data was obtained from the Irish Hip Fracture Database (IHFD), the national integrated imaging system (NIMIS) and the medical charts. The number of outpatient appointments, postoperative radiographs and estimated cost of these patient encounters was examined. The rate of revision surgery as well as the type and timing of these interventions was also analysed. We included 272 patients. The mean number of inpatient and outpatient radiographs was 1.13 and 1.54 per patient respectively. There were 428 outpatient appointments scheduled, an average of 1.6 (SD 1.5) per patient. The median length of stay was 12 days (IQR 8-17). Only 16 (5.8%) patients had abnormal X-ray findings and only 8 (2.9%) patients underwent revision surgery. The majority (15/16, 94%) of patients with surgical complications presented with significant symptoms. There was a 13.1% DNA rate resulting in a cost to the health service of €1,400. The combined total cost of follow-up for all patients over the 3 year period was €92,252. Routine postoperative surgical encounters rarely alter a patient's management and contribute significantly to healthcare costs, resources and time loss for patients and their carers. We propose more selective follow-up protocols, adequately resourcing virtual alternatives and an improved outpatient hip fracture care pathway that focuses on comprehensive multidisciplinary treatment such as rehabilitation, fracture prevention and bone health optimisation.

Mortality characteristics during the two waves of COVID-19 in India

Objective: To evaluate patient demographic characteristics and risk factors for mortality during the first and the second wave among COVID-19 patients in a tertiary care hospital of India. Methods: Data were taken from the hospital's electronic system for COVID-19 patients from August 2020 to December 2020, and the second from January 2021 to May 2021. The mortality rate, demographic and clinical characteristics, laboratory profile, and reasons for the death of the two waves were retrieved and compared, and the risk factors of the two waves were determined. Results: In the first wave, 1 177 COVID-19 cases visited the hospital and 96 (8.2%) died. In comparison, the death rate in the second wave was significantly higher (244/2 038, 12.0%) (P&lt;0.001). No significant difference in age [60 (50-69) vs. 60.5 (53-70), P=0.11] or gender (P=0.34) was observed between the two waves. Compared to the first wave. there were significantly more cases with fever, cough, weakness, loss of taste and smell, and sore throat during the second wave (P&lt;0.05), but significantly fewer cases with kidney disease (6.6% vs. 13.5%, P=0.038) and diabetes mellitus (35.7% vs. 50.0%, P=0.015). Besides, during the second wave, more patients had abnormal X-ray findings, higher levels of lymphocytes and serum ferritin (P&lt;0.05). In addition, there were significant differences in the rate of death cases with acidosis, septic shock, acute kidney injury, diabetes mellitus, cardiovascular events, hypothyroidism (P&lt;0.05). Multivariate regression showed that during the first wave, age (OR: 1.10; 95% CI: 1.02-1.21), diabetes mellitus (OR: 3.16; 95% CI: 2.08-3.53), and abnormal X-ray (2.67; 95% CI: 2.32-2.87) were significant independent risk factors of mortality; while in the second wave, age (OR: 1.13; 95% CI: 1.12-1.28), diabetes mellitus (OR: 8.98; 95% CI: 1.79-45.67), abnormal X-ray (OR: 12.83; 95% CI: 2.32-54.76), high D-dimer (OR: 10.89; 95% CI: 1.56-134.53), and high IL-6 (OR: 7.89; 95% CI: 1.18-47.82) were significant independent risk factors of mortality . Conclusion: Overall mortality and incidence of severe diseases are higher in the second wave than the first wave. Demographic characteristics, co-morbidities, and laboratory inflammatory parameters, especially D-dimer and IL-6, are significant risk facors of mortality during the COVID-19 pandemic.

Utility of lateral scapular radiographs in initial evaluation of nontraumatic shoulder conditions

Lateral scapular radiographs have been routinely included in the initial radiographic examination of both traumatic and nontraumatic shoulder conditions. With the advance of modern imaging modalities, the clinical utility of the lateral scapular view has become questionable. The purpose of the study was to assess the utilization of the lateral scapular view among the members of the American Shoulder and Elbow Surgeons (ASES) and to determine the clinical utility of the lateral scapular view in the initial evaluation of nontraumatic shoulder conditions. The study consisted of two parts. The first part involved an online survey of ASES members, which asked them 3 questions regarding their preference for radiographic evaluation of new patients with nontraumatic shoulder pain. The second part involved a clinical vignette-based survey, where 4 shoulder surgeons at our institution were given 50 clinical vignettes and asked to independently answer 4 questions regarding the most probable diagnosis, abnormal radiographic findings, further imaging studies, and treatment plan for each case. The survey was repeated twice; the first was given without a lateral scapular view, and the second given 4 weeks later with a lateral scapular view included. We obtained diagnostic accuracy and percent agreement of each surgeon over two surveys and intraobserver and interobserver reliability on each variable. Of a total of 235 ASES members who responded to the online survey, 193 (82.1%) indicated their routine use of a lateral scapular view. The most common reason for obtaining the view was better characterization of acromion morphology (75.4%). The clinical vignette-based survey showed substantial intrarater reliability (κ > 0.6) of the 4 surgeons between the two surveys for the most probable diagnosis, abnormal x-ray findings, and further imaging studies, while the intrarater reliability for treatment plan was moderate (κ= 0.548). The mean diagnostic accuracy of the 4 surgeons was almost equal (74% vs. 75%) between the surveys. Overall, each surgeon's percent agreement across the 2 surveys was over 70%. None of the 4 surgeons recommended a lateral scapular view for further imaging during the first survey; each wanted either advanced imaging (computed tomography, magnetic resonance imaging) or none. The addition of a lateral scapular radiograph in the presence of other orthogonal views does not appear to improve surgeons' diagnostic accuracy or affect their decision-making on the treatment plan in nontraumatic shoulder conditions. The clinical utility of the lateral scapular view may need to be reassessed in this setting.

Hematological profile and biochemical markers of COVID-19 non-survivors: A retrospective analysis

BackgroundCoronavirus disease is primarily transmitted through the respiratory route and bodily contact. The fatality in COVID-19 cases was alarming in the initial days. This study analyzes hematological and biochemical markers of COVID-19 non-survivors. Material and methodsIn this single-center study, records of 249 patients hospitalized with COVID-19 were studied for hematological profile and biochemical markers. Records of patients with laboratory-confirmed COVID-19 disease hospitalized between April 14, 2020, to August 15, 2020, were included in the analysis. ResultsSignificantly, the disease mortality was associated with increased procalcitonin (P < 0.05), C-reactive protein (P < 0.05), aspartate transaminase (P < 0.05), serum potassium (P < 0.05), neutrophils count (P < 0.05), white blood cell count (P < 0.05), prothrombin time (P < 0.05) and activated prothrombin time (P < 0.05) in patients reported abnormal x-ray findings. Further, patients with abnormal radiological findings significantly showed a reduced level of lymphocyte counts (P < 0.05), oxygen saturation (P < 0.05), and partial oxygen pressure (P < 0.05). Reduced level of aspartate aminotransferase (P < 0.05), alanine aminotransferase (P < 0.05) and lactate dehydrogenase (P < 0.05) reported significant association with mortality among patients with COVID-19. ConclusionsThe clinicians may consider the hematological and biochemical parameters in the patients with COVID-19 in future decision-making. These indicators might support clinical decisions to identify high fatality cases and poor diagnosis in the initial admission phase. In COVID-19 patients, we recommend close monitoring on procalcitonin, C-reactive protein, neutrophils count, and white blood cell count as a clinical indicator for potential progression to critical illness.

441. Clinical Characteristics of Pediatric SARS-CoV-2 Infection and Coronavirus Disease 2019 (COVID-19) in Kuwait

BackgroundClinical presentation of coronavirus disease-2019 (COVID-19) ranges from asymptomatic to severe and life threatening. National-level registries found that children, generally, have less severe disease when compared to adults. However, most asymptomatically infected children will not present to hospital and may be missed. We aimed to describe the clinical characteristics in pediatric COVID-19 patients in Kuwait, and to estimate the potential duration of viral shedding.MethodsA retrospective cohort study was performed in Jaber Alahmad Hospital (JAH) from Feb. 29th to Apr. 30th, 2020. During the study period and as part of the public health measures to contain COVID-19, all SARS-CoV-2 infected patients 1 month-18 years old, regardless of symptoms, were hospitalized at JAH, and were included. Demographics, clinical data, and laboratory results were collected. Polymerase chain reaction (PCR) negativity was defined as having two consecutive negative PCR results from a respiratory specimen. Descriptive statistics and multivariable regression analyses were performed.ResultsA total of 134 pediatric SARS-CoV-2 infections were identified. Of those, 91 patients (67.9%) were asymptomatic, the remaining cases had mild COVID-19 illness and mild pneumonia. The median age was 8.8 years (IQR: 4.7–12.4), 55.2% were males, and 89.5% were healthy. Cough and fever were the most commonly reported symptoms. The median duration to PCR negativity was 15 days (IQR: 13–19) for symptomatic patients and 15.5 days (IQR: 14–21) for asymptomatic patients. Predictors for symptoms included abnormal procalcitonin (aOR 6.6; 95% CI 1.48 -29.3), C-reactive protein (aOR 9.10; 95% CI 1.29–32.13), and X-ray finding of pneumonia (aOR 6.44; 95% CI 1.29–32.13).ConclusionAsymptomatic SARS-CoV-2 infection is very common in children. Among symptomatic patients, the disease seems to be mild. Children exhibit substantial duration of viral shedding, as measured by PCR positivity, regardless of symptoms.Disclosures Jesse Papenburg, MD, AbbVie (Consultant, Scientific Research Study Investigator, Research Grant or Support, Speaker’s Bureau)BD Diagnostics (Research Grant or Support)Cepheid (Speaker’s Bureau)MedImmune (Scientific Research Study Investigator)Sanofi Pasteur (Scientific Research Study Investigator)Seegene (Research Grant or Support, Speaker’s Bureau)

The lesion of the osteo-articular system in the onset of acute leukemia in childhood

According to different authors, the osteoarticular syndrome is observed in every third patient with acute leukemia. The polymorphism of the clinical manifestations presents a diagnostic difficulty, while the abnormal x-ray findings are not traditional characteristics of patients with leukemia. In some cases, bone manifestations may be the first and only symptom of acute lymphoblastic leukemia, complicating the diagnosis and postponing the correct diagnosis. The article describes 3 clinical cases of patients with a lesion of the osteo-articular system in the onset of acute leukemia. Despite the current complex laboratory and instrumental research methods, a particular attention should be paid to the difficulties of differential diagnosis between acute leukemia and other lesions of the osteo-articular system.

The impact of chest radiography and Xpert MTB/RIF testing among household contacts in Chennai, India.

Tuberculosis prevalence surveys have demonstrated the benefit of screening with chest x-ray (CXR) and sensitive diagnostic tests compared to symptoms and smear microscopy. However, in programmatic practice there is little evidence on the yield of different algorithms. We implemented contact tracing in Chennai, India for adult sputum-positive TB patients registered from January 2015 to March 2016. Patients with symptoms or abnormal X-ray findings further underwent testing using Xpert MTB/RIF (Xpert) and smear microscopy. A retrospective cohort study was done to summarize the key findings. We verbally screened 5553 contacts for symptoms, CXR through private sector collaboration, Xpert, and smear microscopy. Overall, 1312 (23.6%) contacts screened positive. CXR alone identified 531 (40.5%) of them, 679 (51.8%) were symptom-positive only, while 102 (7.8%) were positive on both the symptom and CXR screen. Overall, 35 bacteriologically positive cases were identified (0.7%). A standard approach of symptoms screening followed by microscopy identified only 9 (25.7%) of the total number of bacteriologically positive cases, whereas the combination of a CRX screening followed by microscopy identified 13 (37.1%) of the cases. The algorithm of symptoms screening followed by Xpert testing, detected 20 cases, whereas the combination of symptoms and CXR followed by Xpert increased this number to 35 (75% increase compared to symptoms and Xpert). Optimal use of more sensitive screening tests, better diagnostic tests, and novel private sector engagement can improve diagnostic yield in a programmatic setting.

A CASE OF MAC IN A PATIENT WITH CHRONIC SILICOSIS

SESSION TITLE: Medical Student/Resident Occupational and Environmental Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Our patient is a 32-year-old male with chronic silicosis who presented with one week of worsening dyspnea and cough in the setting of a 40 pound weight loss over 3 months. CASE PRESENTATION: The patient was diagnosed with silicosis in 2015 (Image 1) in the setting of prolonged work with cutting porous stone without use of PPE; he had a negative mycobacterial work-up then. He was lost to follow-up and continued to work until one week prior to this presentation. On hospital presentation he was found to be febrile, severely cachectic, using accessory muscles for respiration, and with fine bilateral inspiratory crackles diffusely. He was subsequently admitted to the ICU for hypercapnic and hypoxemic respiratory failure requiring non-invasive ventilation (NIV). CT findings suggested progressive massive fibrosis (PMF) with eggshell calcifications of mediastinal lymph nodes; however, a cavitary infectious process could not be ruled out (Image 2 and 3). He was started on empiric antibiotics for bacterial pneumonia. Laboratory testing revealed negative bacterial, fungal, and viral sputum/blood cultures. He showed marginal improvement in respiratory status after initiating NIV and completing antibiotics. Although the initial AFB sputum smears were negative, two weeks later two separate AFB cultures each grew Mycobacterium Avium Complex (MAC). He was fully weaned off NIV after starting anti-mycobacterial therapy. Given the imaging and his clinical improvement, this decompensation was thought to be secondary to PMF with MAC superinfection. DISCUSSION: Silicosis occurs following chronic occupational exposure to aerosolized silica from mining, stone cutting, or sandblasting. Patients often are asymptomatic despite abnormal x-ray findings. Imaging of chronic silicosis typically follows nodular patterns of inflammation (which was noted on our patient's initial diagnosis) and in more acute presentations ground-glass opacities and crazy paving have been described. Our patient's clinical presentation and CT findings of diffuse coalescent densities and cavitations led us to consider PMF and mycobacterial disease over simple silicosis. PMF is a rare, and in most cases irreversible, complication of silicosis defined as conglomeration of dense fibrosis preferentially involving the upper lung lobes. Eggshell calcifications of lymph nodes are often described. Mycobacterial infection is also a rare complication of silicosis, classically with mycobacterium tuberculosis (TB); however there have been many case reports with silicosis patients developing MAC infections. These mycobacterial infections present with constitutional and TB-like symptoms such as weight loss. CONCLUSIONS: Progressive massive fibrosis in silicosis is a rare complication that leads to severe structural lung disease and respiratory failure. Mycobacterial superinfection, including MAC, should be considered in decompensated patients with silicosis. Reference #1: Jiro Fujita,Takumi Kishimoto,Yuji Ohtsuki,Eriko Shigeto,Takayuki Ohnishi,Masahiro Shiode,Yasufumi Yamaji,Ichizo Suemitsu,Ichiro Yamadori,Shuji Bandoh,Kazutaka Nishimura,Toshiharu Matsushima,Toshihiko Ishida. Clinical features of eleven cases of Mycobacterium avium-intracellulare complex pulmonary disease associated with pneumoconiosis. Respir Med. 2004 Aug;98(8):721-5. DISCLOSURES: No relevant relationships by Neel Bhan, source=Web Response No relevant relationships by Nicola Hanania, source=Web Response No relevant relationships by Lauren Nicholas Herrera, source=Web Response No relevant relationships by Hal Zhang, source=Web Response

Clinical profile of tracheo-bronchial foreign body inhalation at tertiary care center

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Inhalation of foreign bodies can be life threatening and are common in paediatric age group with peak incidence in the age group of 1-3 years. The objectives were to study the clinical profile of foreign body (FB) inhalation and to study the complications of tracheo-bronchial foreign body and rigid bronchoscopy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A cross-sectional hospital based diagnostic study conducted for 1 year, done on 50 patients with FB inhalation, included consecutively in study after obtaining informed consent. Patients were assessed and interviewed for socio demographic details and examined using chest X-ray PA view, routine investigations and pre-anaesthetic evaluation. After all investigations a diagnostic bronchoscopy under general anaesthesia was performed to extract the foreign body. Data were analyzed through tables and diagrams and appropriate test of significance by Epi Info software. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Total 50 FB inhalation cases (up to 10 years) in which 40% presented within 5 days to 2 weeks after inhalation. 92% were presents with cough and on chest examination 88% found to had decreased air entry, 72% presents with decreased movement and dull percussion on affected side. 70% of patients had abnormal chest X-ray finding. Foreign body found were groundnut (44%) followed by supari (32%) mostly in right main bronchus. We observed 10% patients with pneumonia, 4% had granuloma and 2% had bronchospasm.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Prevention is best, but early recognition remains a critical factor in the treatment of FB inhalation in children. &lt;/p&gt;

Tracheobronchial foreign body aspiration in children: A retrospective single-center cross-sectional study.

Foreign body (FB) aspiration is a common and serious problem in childhood as it requires early recognition and treatment to avoid potentially lethal consequences. This study aimed to characterize the clinical and epidemiological features of airway FBs in a pediatric Chinese population.A retrospective review of medical records of children aged 0 to 14 years who attended with a diagnosis of FB aspiration the Shanghai Children's Hospital between January 2013 and December 2017 was carried out. Descriptive analysis was used to assess patient's demographics, clinical, radiographic, bronchoscopic findings, time to presentation, and characteristics of the FBs.Among the 200 patients included in the study, 92% were under 3 years of age, with a peak incidence of FB aspiration occurring between 1 and 2 years old. The male to female ratio was about 2.6:1. Twenty-three percent of the patients were admitted within 24 hours of the event, 40% within 1 week, 30% within 1 month, and 7% more than 1 month after aspiration. The most common presenting symptoms of laryngotracheal FBs were cough, dyspnea, and wheezing; those of bronchial FBs were cough, decreased air entry, and wheezing. Chest X-ray was normal in four-fifths of the children with laryngotracheal FBs, whereas most common abnormal X-ray findings in children with bronchial FBs were mediastinal shift, obstructive emphysema, and pneumonia. There was a trend that in children younger than 2 years FBs were more frequently found in the left bronchus, whereas in older children FBs were more frequently found in the right bronchus. Ninety-three percent of the removed FBs were organic materials such as food items and the most frequently aspirated FBs were peanuts. Flexible bronchoscopy was performed in 82.5% of the patients, while rigid bronchoscopy or direct laryngoscopy in 17.5% of the patients. Four patients were subjected to thoracic surgery and 1 died during rigid bronchoscopy due to acute respiratory failure.FBs is a frequent pathology among Chinese children. Tracheobronchial FBs should be strongly suspected in young children who have sudden onset of cough and wheezing episode, even when physical and radiographic evidence is absent.

Musculoskeletal disorders, psychosocial stress and associated factors among home-based migrant care workers.

Prevalence of musculoskeletal disorders (MSDs) and psychological stress in home-based female migrant care workers (MCWs) remain unknown. To 1) investigate the prevalence of MSDs and psychological stress and associations between subjective questionnaires on MSDs/psychological stress and biomedical examinations, and 2) identify the risk factors related to MSDs and psychological stress. This study recruited 85 MCWs. Data was collected using questionnaires, urine analysis and X-ray examinations. Correlations between subjective questionnaires and biomedical examinations were investigated. Multivariable logistic regression analyses were used to explore risk factors. The prevalence of MSDs and psychological stress were 70.6% and 37.6%, respectively. MSDs were commonly reported over the neck, lower back, shoulders, and upper back. There was a moderate correlation between MSDs and abnormal X-ray findings. Risk factors associated with MSDs included higher education level, frequent transferring and bedside care activities, lacking caregiver training in Taiwan, inadequate sleep, and drinking tea or coffee. Risk factors associated with psychological stress included inadequate salary, lacking caregiver training in Taiwan, and insufficient knowledge of body mechanics techniques. MSDs and psychological stress were common among home-based female MCWs. Educational level, frequent transferring and bedside care activities, and lack of caregiver training in Taiwan, were the most dominant risk factors.

Biomechanical analysis of supra-acetabular insufficiency fracture using finite element analysis

BackgroundSupra-acetabular insufficiency fractures (SAIFs) occur in the upper acetabulum and are rare compared with insufficiency sacral, femoral head, or ischial fractures. However, SAIFs are known to occur in low grade trauma, and the underlying mechanism is still remained unclear. MethodsWe performed biomechanical analysis using finite element analysis to clarify the mechanisms underlying the development of SAIFs. Patient-specific models and bone mineral density (BMD) were derived from pelvic computed tomography data from two patients with SAIF (unaffected side) and two healthy young adults. The bone was assumed to be an isotropic, linearly elastic body. We assigned Young's modulus of each element to the pelvis based on the BMD, and reported the relationships for BMD–modulus. Clinically relevant loading conditions—walking and climbing stairs—were applied to the models. We compared the region of failure risk in each acetabulum using a maximum principal strain criterion. ResultsThe average supra-acetabular BMD was less than that of the hemi-pelvis and femoral head, but was higher than that of the femoral neck and greater trochanter. Greater minimum principal strain was concentrated in the supra-acetabular portion in both the SAIF and healthy models. In the SAIF models, the higher region of the failure risk matched the fracture site on the acetabulum. ConclusionsRelative fragility causes compressive strain to concentrate in the upper acetabulum when walking and climbing stairs. When presented with a patient complaining of hip pain without apparent trauma or abnormal X-ray findings, physicians should consider the possibility of SAIF and perform magnetic resonance imaging for the diagnosis of SAIF.

Seropositive Rheumatoid Arthritis with Very Unusual X-ray Findings

We described the case of a 23-year-old Nepalese man with seropositive rheumatoid arthritis and abnormal x-ray findings, found to be due to a very rare bone disease: Camurati Engelmann disease or progressive diaphyseal dysplasia (PDD). This is the first case reported in the Gulf area, although approximately 300 cases have been described worldwide. These patients usually present with limb pain and easy fatigability. Our patient first presented with bilateral, symmetrical inflammatory polyarthritis involving the knees, ankles and wrists but sparing the hands and feet. The diagnosis of PDD in our case was based on the classic radiological findings and a bone scan.LEARNING POINTSRheumatoid arthritis is a common condition with typical radiological findings.Any unusual radiological finding should be carefully assessed and explained.In our case the unusual findings were due to progressive diaphyseal dysplasia.