Bronchial Breathing Research Articles

IJCM_83A: Primary Ciliary Dyskinesia in a child

Background: PCD is rare genetic disorder with incidence of 1:10,000. We present a 10-year-boy who came with recurrent respiratory-infections with Dextrocardia and bilateral Bronchiectasis for interesting clinical presentation. Objective: PCD is rare inherited disease with mutations which impair normal cilia function, characterized by impaired muco-ciliary clearance, causing recurrent-respiratory infections leading to bronchiectasis. Treatment includes preventing and managing complications. Methodology: 10-year-old child came cough-cold since 2 days, and hurried breathing since 1 day. Child had multiple episodes of respiratory- infections which was treated with antibiotics and nebulization on OP basis. Developmental delay also noted, currently in speech domain, can speak 2-3 words. On examination, open mouth breathing and clubbing(grade 3) present. On auscultation bilateral bronchial breath sounds with coarse crepitations. Heart sounds heard louder on right side, but no murmur was heard. Chest X-ray and 2D-ECHO showed Situs-Solitus with Dextrocardia. Child required non-invasive ventilation and IV antibiotics for treatment. Child was weaned off to room air by day 4. CT Thorax done showed bronchiectatic changes in bilateral lung with volume loss of right hemithorax with mediastinal shift to right. CT Nasopharynx and OMC done for open-mouth breathing was normal, and advised steroid nasal spray for nasal blockage. Physiotherapist counselled parents about postural drainage. Genetic testing for PCD was sent, report awaited. He is on regular follow up and doing well. Results: Primary defect in PCD is structure and/or function of cilia leading to accumulation of secretions. Diagnostic criteria includes recurrent chest infections, bronchitis, and rhinitis, with situs-inversus, infertility, decreased mucociliary clearance and cilia showing ultrastructural defect on electron microscopy. We suspected PCD with clinical features and imaging studies. Conclusion: Patients are frequently troubled by repeated infections for which they need to seek medical attention which is reason for morbidity. As there is no specific treatment, early diagnosis and prevention of complication is key to management.

Clinical predictors of hypoxic pneumonia in children from the Eastern Highlands Province, Papua New Guinea: secondary analysis of two prospective observational studies

BackgroundPneumonia is the leading cause of death in young children globally and is prevalent in the Papua New Guinea highlands. We investigated clinical predictors of hypoxic pneumonia to inform local treatment guidelines in this resource-limited setting. MethodsBetween 2013 and 2020, two consecutive prospective observational studies were undertaken enrolling children 0-4 years presenting with pneumonia to health-care facilities in Goroka Town, Eastern Highlands Province. Logistic regression models were developed to identify clinical predictors of hypoxic pneumonia (oxygen saturation <90% on presentation). Model performance was compared against established criteria to identify severe pneumonia. FindingsThere were 2067 cases of pneumonia; hypoxaemia was detected in 36·1%. The strongest independent predictors of hypoxic pneumonia were central cyanosis on examination (adjusted odds ratio [aOR] 5·14; 95%CI 3·47-7·60), reduced breath sounds (aOR 2·92; 95%CI 2·30-3·71), and nasal flaring or grunting (aOR 2·34; 95%CI 1·62-3·38). While the model developed to predict hypoxic pneumonia outperformed established pneumonia severity criteria, it was not sensitive enough to be clinically useful at this time. InterpretationGiven signs and symptoms are unable to accurately detect hypoxia, all health care facilities should be equipped with pulse oximeters. However, for the health care worker without access to pulse oximetry, consideration of central cyanosis, reduced breath sounds, nasal flaring or grunting, age-specific tachycardia, wheezing, parent-reported drowsiness, or bronchial breathing as suggestive of hypoxaemic pneumonia, and thus severe disease, may prove useful in guiding management, hospital referral and use of oxygen therapy.

Assessment of performance and confidence level of simulation based clinical examination of respiratory system in undergraduate medical students of a medical college: a comparative cross-sectional study

Introduction: Students in the preclinical phase have adequate clinical exposure to normal physiological findings of clinical examinations performed in healthy peers but do not have exposure to pathological findings other than theoretical knowledge, which is challenging for students during the clinical phase of curricula in examining actual patients. Simulation based medical education (SBME) has recently emerged to address this gap. This study aimed to assess performance and confidence level of simulation based clinical examination of respiratory system in preclinical undergraduate medical students of a medical college. Methods: A comparative cross-sectional study was conducted in the Department of Human Physiology of Medical College. All second year medical students using purposive sampling were taken. Students were divided into three groups and subdivided into six subgroups and each subgroup carried out examination in either healthy subjects or both healthy subjects and manikin. Predesigned proforma was used for assessment of students and the clinical examination process was invigilated by certified physiologists. Results: Students who received both simulation and conventional tutoring methods were able to accurately identify all lung sounds better as compared to those with conventional tutoring with the percentage difference being maximum in identifying vesicular (29 vs 6), stridor (28 vs 6), and bronchial (25 vs 6) breath sounds and least in identifying coarse crackles (3 vs 2). Majority (39 out of 41) of the students receiving SBME of respiratory system were satisfied with the simulation based practice and 34 of those students were even confident on clinical examination. Conclusion: SBME increases performance status and confidence level in medical students. A practical curriculum can be planned to incorporate simulation based clinical examination in preclinical medical students in practical sessions.

Can serum procalcitonin be used for severity identification and guiding treatment of children admitted with community-acquired pneumonia? – A cross-sectional study

Background: Community-acquired pneumonia (CAP) remains one of the leading causes of mortality and morbidity in children under 5 years of age. Early diagnosis and effective management remain the cornerstone to reduce complications and fatalities associated with CAP. Lately, C-reactive protein (CRP) and procalcitonin (PCT) have gained much attention as useful biomarkers in CAP. Recent data suggest that a very low PCT value has a high negative predictive value while identifying a population of children at low risk of typical bacterial infections. Hence, we propose to take up this study to assess the clinical utility of PCT in pediatric CAP. Aims and Objectives: The aim of this study was to study serum PCT level in children with the clinical diagnosis of CAP admitted at R.G Kar Medical College and Hospital, Kolkata, and its role in severity identification and contribution in the treatment of CAP. Materials and Methods: This cross-sectional hospital-based observational study was performed from January 2020 to June 2021 in the R.G Kar Medical College and Hospital, Kolkata, West Bengal, India. A total of 50 children were included within the age group of 2 months–5 years with CAP admitted in the Children’s ward and intensive care unit at our hospital. Clinical characteristics such as age, sex, symptoms such as history of fever, difficulty feeding or drinking, convulsion, lethargy, cyanosis, chest in-drawing, respiratory rates, auscultatory findings such as air entry of bilateral lungs, added sounds like-(inspiratory crept, bronchial breathing), and oxygen saturation were studied. Routine investigations such as complete blood count, serum CRP, blood culture, and chest radiograph sent along with serum PCT. Results: Out of 50 children diagnosed with CAP, 30 (60%) fell within the age range of 2–5 months of age. Among the study population, 70% of children displayed weakly positive and 20% strongly positive serum PCT values. A strong correlation (P &lt; 0.001) was revealed between the severity of pneumonia and PCT, and also a positive correlation (P &lt; 0.001) between clinical outcome and PCT. However, the role in contribution in early diagnosis could not be concluded. Conclusion: This study concluded that serum PCT may be used as a valuable indicator for assessing the severity and prognosis of CAP. All children with elevated PCT who were prescribed antibiotics did not experience further complications of CAP.

The Art of Diagnosis from Breath Sound: A Literature Review

Breath sounds provide relevant information related to lung abnormalities. It is often difficult to differentiate between breath sounds, this is due to the different characteristics of each breath sound. Differentiating the types of breath sounds is crucial in making an accurate diagnosis. Breath sounds are divided into normal breath sounds and abnormal (additional) breath sounds. Normal breath sounds are sounds that originate from the chest wall, such as tracheal, bronchial, bronchovesicular and vesicular breath sounds. Meanwhile, abnormal (additional) breath sounds are breath sounds that indicate an abnormal condition in the respiratory system. Normal and abnormal breath sounds have different characteristics such as intensity, duration, frequency, quality of air flow, air flow pattern, air distribution, body position, location of sound production, changes in pressure and vibration of dense tissue in the lungs.

Severe community-acquired pneumonia: principles of diagnostics and intensive therapy

BACKGROUND. Pneumonia is an important medical and social problem due to its high prevalence, high rates of disability and mortality, and significant economic losses due to this disease. In Ukraine in 2017, the incidence of pneumonia among adults was 384.0 cases per 100,000 population, and the mortality rate was 11.7 per 100,000 population, i. e. more than 3 % of those who had pneumonia died. Community-acquired pneumonia (CAP) is the leading cause of morbidity and mortality from pneumonia among all age groups worldwide: 3-4 million people suffer from CAP with high morbidity and mortality.&#x0D; OBJECTIVE. To analyze the pathogenesis, diagnosis, and treatment of severe CAP from the modern literature data to optimize the treatment of this group of patients.&#x0D; MATERIALS AND METHODS. Bibliosemantic, comparative, and system analysis methods were used. The proposed recommendations are based on the analysis of modern literature, the results of randomized studies, and meta-analyses devoted to the investigation of the problem of diagnosis and management of severe CAP.&#x0D; RESULTS AND DISCUSSION. The problems of pathogenesis, diagnosis, and treatment of severe CAP were analyzed using modern literature data to optimize the treatment of this group of patients. CAP can be caused by various pathogens, such as Streptococcus pneumoniae, Haemophilus influenzae, atypical bacteria (eg, Chlamydia pneumoniae, Mycoplasma pneumoniae, Legionella species), and viruses. It is quite difficult to establish the etiology of pneumonia even with the use of modern microbiological technologies, therefore, in many countries of the world, a classification is used that takes into account the conditions of the occurrence of the disease, the features of the infection of the lung tissue, as well as the immune reactivity of the patient’s organism. This classification makes it possible to predict the probable causative agent of the disease with a fairly high degree of probability. The diagnosis of CAP is considered established in the presence of radiologically confirmed focal infiltration of lung tissue and at least two of the following clinical signs: acute onset of the disease with a body temperature &gt;38 °C, cough with sputum, physical signs (muffled or dull percussion sound, weakened and/or harsh bronchial breathing, a focus of sonorous small vesicular rales and/or crepitations), leukocytosis (&gt;10×109 /L), and/or shift to rod nuclear cells (&gt;10 % of them). The severity of CAP is assessed clinically, as well as using the criteria given in the scales to determine the need for the patient to be hospitalized or admitted to the intensive care unit (ICU). Patients with CAP requiring mechanical ventilation or with septic shock should be admitted to the ICU.&#x0D; CONCLUSIONS. Severe CAP is associated with high morbidity and mortality, and although there are European and non-European guidelines for CAP, there are no specific guidelines for severe CAP. These international guidelines from ERS, ESICM, ESCMID, and ALAT present evidence-based clinical recommendations for the diagnosis, empiric treatment, and antibiotic therapy of severe CAP according to the GRADE approach. In addition, existing knowledge gaps were identified and recommendations for future research were provided.

Clinical predictors of radiological pneumonia in children with severe community acquired pneumonia

Background: Pneumonia causes one-third of all under 5 deaths from infections. Typically cough, fever, pleuritic chest pain, fatigue and loss of appetite are presenting symptoms of pneumonia. Even though chest radiograph improves the diagnosis of paediatric community acquired pneumonia to a certain degree, however its interpretation is subjective, moreover exposure to ionizing radiation, cost, the time and space used, and the need to wait for the radiograph and to see the clinician again limits its use in in resource limited settings. In this study, it was aimed to determine clinical predictors of radiological pneumonia in children with severe community acquired pneumonia which may help in judicious use of X-ray and rational management with antibiotics, in these children. Methods: This was a case control, observational study which was conducted in post graduate department of paediatrics, children hospital on all paediatric patients between ages 2 months and 5 years, who presented to the paediatric emergency department and were diagnosed with severe community acquired pneumonia as per World Health Organization (WHO) guidelines, were included. Results: The study was conducted on 100 cases of severe radiological pneumonia and 200 controls of non-radiological pneumonia. From admission to discharge, children were followed and multiple clinical parameters were compared. Among 100 cases, 72 (72%) had wheezing, 70 (70%) had cyanosis, 67 (67%) had tachypnea, 67 (67%) had hypoxemia, 59 (59%) had grunting, and 42 (42%) had bronchial breathing. Similarly, among 200 controls, 165 (82.5%) had wheezing, 116 (58%) had cyanosis, 97 (48.5%) had tachypnea, 58 (29%) had hypoxemia, 90 (45%) had grunting and 19 (9.5%) had bronchial breathing. The difference is statistically significant. Conclusions: It can be concluded from our study that presence of cyanosis, tachypnea, hypoxemia, grunting and bronchial breathing are the positive predictors of radiological pneumonia, while as presence of wheezing are negative predictors of radiological pneumonia.

Anti-Glomerular Basement Membrane Disease in a Six-year-old Child: A Rare Presentation

Antiglomerular basement membrane (anti-GBM) disease is a rare small vessel vasculitis caused by auto-antibodies targeting auto-antigen expressed in basement membranes of capillary beds in lungs and kidneys. A six-year-old male presented with fever, cough, and generalized weakness for three days with respiratory distress for one day. The child had three prior admissions with similar complaints and was treated as a case of lower respiratory tract infection with severe iron deficiency anemia in the past. Multiple packed red cell transfusions were required in these past admissions. In this current admission, he had tachycardia, tachypnea, severe pallor, right-sided lung crepitations &amp; bronchial breath sounds. The hemogram showed severe anemia and leukocytosis. Urine examination showed mild proteinuria and microscopic hematuria. Chest X-ray (current admission) showed right middle and lower zone consolidation. HRCT of the chest revealed an interstitial pattern. A lung biopsy showed pulmonary hemorrhage and positive Prussian blue staining. Raised anti-GBM titers confirmed diagnosis of anti-GBM disease. Renal biopsy revealed normal glomerular morphology on histopathology; with immune fluorescence showing linear positivity for IgG (3+), Kappa (3+), and Lambda (3+). Electron microscopy reported mild effacement of visceral epithelial foot processes and subepithelial/intramembranous electron-dense deposits. He was treated with intravenous methylprednisone for 5 days followed by oral prednisolone for one month, which was thereafter tapered to a lower maintenance dose for 18 months. The child received six cycles of intravenous cyclophosphamide along with a daily low dose of steroids. Currently, the child is asymptomatic after one year of follow-up with seroconversion (antiGBM titers decreased) and normalization of the chest radiograph.

Acute chest syndrome in adult patients with sickle cell disease: The relationship with the time to onset after hospital admission.

Data on acute chest syndrome (ACS) in adult sickle cell disease patients are scarce. In this study, we describe 105 consecutive ACS episodes in 81 adult patients during a 32-month period and compare the characteristics as a function of the time to onset after hospital admission for a vaso-occlusive crisis (VOC), that is early-onset episodes (time to onset ≤24 h, 42%) versus secondary episodes (>24 h, 58%; median [interquartile range] time to onset: 2 [2-3] days). The median age was 27 [22-34] years, 89% of the patients had an S/S or S/β0 -thalassaemia genotype; 81% of the patients had a history of ACS (median: 3 [2-5] per patient), only 61% were taking a disease-modifying treatment at the time of the ACS. Fever and chest pain were noted in respectively 54% and 73% of the episodes. Crackles (64%) and bronchial breathing (32%) were the main abnormal auscultatory findings. A positive microbiological test was found for 20% of episodes. Fifty percent of the episodes required a blood transfusion; ICU transfer and mortality rates were respectively 29% and 1%. Secondary and early-onset forms of ACS did not differ significantly. Disease-modifying treatments should be revaluated after each ACS episode because the recurrence rate is high.

Clinical Findings and Radiological Evaluation of WHO-Defined Severe Pneumonia Among Hospitalized Children.

The leading infectious cause of death in children worldwide is pneumonia. Pneumonia claimed the lives of 740,180 kids under the age of five in 2019, accounting for 14% of all fatalities and 22% of deaths in kids between the ages of 1 and 5. Children and families worldwide are affected by pneumonia, but South Asia and Africa have the highest fatality rates. This study aims to determine the clinical risk factors and radiological assessment of the World Health Organization (WHO)-defined severe pneumonia in Pakistani hospitalized children. This cross-sectional study was carried out in the pediatric department of the Hayatabad Medical Complex between January 2021 and December 2021. The study included kids who had a fever, cough, and fast or difficulty breathing between the ages of 2 and 60 months. All of the included clinical pneumonia cases were acquired in the community. A total of 360 clinically confirmed patients with pneumonia who presented with fever, cough, and fast or difficulty breathing were enrolled. Age ranged between 2 and 60 months, with a mean age of ±31 months. There were 168 (46.7%) males and 192 (53.3%) females. About 232 (64.4%) had radiological pneumonia, while the rest of the pneumonia cases 128 (35.5%) were without a radiological diagnosis. The most common presenting complaint was noisy breathing 119 (33%), followed by refusal of feeds 81 (22.5%), lethargy 69 (19.2%), seizure 40 (11.1%), nasal drainage 29 (8%), and abdominal pain 22 (6.1%). The most specific clinical finding of radiographic pneumonia was bronchial breathing, while tachypnea was the most sensitive sign.

Cough, with a sac of marbles in the chest.

A 48-year-old male patient presented with productive cough, dyspnea and abdominal pain of 2 months duration. He was diagnosed with diabetes mellitus 6 months ago and had not been regular with his medications. Clinical examination revealed a respiratory rate of 18 per min with room air saturation of 95%, and a paucity of movements with bronchial breath sounds identified on inspection and auscultation, respectively, over the right hemithorax. Chest skiagram and computed tomography images of his thorax are shown below [Figure 1].Figure 1: (a) shows chest skiagram and (b–d) shows high-resolution computed tomography images of the chest. A description of the images is in the accompanying textQuestion: What is the diagnosis? Answer: Pulmonary and hepatic hydatid disease. DISCUSSION The chest skiagram [Figure 1a] revealed a well-defined round radio-opacity in the right mid zone with a crescentic hyperlucent medial margin, called the crescent sign (white arrow). Figure 1b is a coronal view of high-resolution computed tomography (HRCT) scan of the chest lung window, which shows a large cyst in the right lung, with multiple small rounded opacities with fluid attenuation, some of which appear to be floating within it, appearing like a sac of marbles. This is consistent with a diagnosis of a hydatid cyst with multiple daughter cysts within it. There are pockets of air seen between the outer pericyst and inner endocyst, aptly named ‘air-crescent sign’ (blue arrow) and ‘signet ring sign’ (red arrow), which suggest a ruptured or complicated hydatid cyst. Figure 1c, the sagittal section of the HRCT scan of the chest lung window at the level of the aortic outflow tract, shows the ruptured hydatid cyst in the right lung. The daughter cysts have collected in the dependent area of the larger cyst, with some appearing to ‘rise’ over the rest, or the ‘rising-sun sign’ (blue arrow). Also seen is a small air pocket inferiorly (red arrow) between the pericyst and endocyst, called the ‘air-bubble sign’. The presence of air on either side of the endocyst (red arrowheads) gives the appearance of an ‘onion-peel sign’, or the ‘cumbo sign’. Figure 1d shows a large well-defined homogenous cyst in the right lobe of the liver.[1] Blood investigations revealed uncontrolled blood sugar levels. Armed with the characteristic radiology above, and supplemented by a positive serum latex agglutination test for Echinococcus antigen, he was diagnosed with pulmonary and hepatic hydatid disease. He was started on oral albendazole and subsequently underwent pericystectomy of lung cyst along with partial pericystectomy of cyst in the liver. Post-surgery, he is at present asymptomatic and is on regular follow-up. Hydatid disease is a zoonosis, commonly caused by the accidental ingestion of ova of the tapeworm Echinococcusgranulosus, which subsequently develop into larvae in the host intestine and migrate to other parts of the body where they develop into embryos, with the liver and lung being the most commonly involved organs.[1] Characteristic thoracic radiology should lead clinicians to suspect pulmonary hydatid disease, especially when dealing with patients with non-resolving pneumonia or lung mass. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Person Identification Using Bronchial Breath Sounds Recorded by Mobile Devices

Person Identification Using Bronchial Breath Sounds Recorded by Mobile Devices

Burden of active pulmonary tuberculosis among patients with diabetes in Dar es Salaam, Tanzania: a cross-sectional study

ObjectivesWe aimed to determine the prevalence, associated factors and describe the chest radiographic findings for active pulmonary tuberculosis (TB) among patients with diabetes mellitus (DM) attending a diabetic clinic in...

A comprehensive guide for managing antibiotic therapy in pediatric pneumonia

Pneumonia is a respiratory infection characterized by inflammation of the alveolar space and interstitial tissue of the lungs. Pneumonia has numerous potential etiologies, the most common of which is infectious and is classified according to several factors. Pneumonia is most transmitted via aspiration of airborne pathogens but may also result from the aspiration of stomach contents. The most likely causal pathogens can be narrowed down based on the patient’s age, immune status, and where the infection was acquired. Pathogens that commonly affect the pediatric population often differ from those seen in adults. Typical pneumonia manifests with, fever, sudden onset of malaise, and a productive cough. On auscultation, crackles and bronchial breath sounds are audible. Atypical pneumonia manifests with the gradual onset of unproductive cough, dyspnea, and extrapulmonary manifestations. Diagnosis is based on history and exam. In some cases, supportive information is obtained through lab investigations and imaging reports. Management consists of empiric antibiotic treatment and supportive measures.

Management of Local Anesthetics Systemic Toxicity in a 66-Year-Old Male Undergoing Nephrostomy Percutaneous

Background: Neuraxial anesthesia compares favourably with other systemic and regional methods about safety and efficacy. The complications related to neuraxial anaesthesia including transient neurological symptoms, inadvertent intrathecal injection and cardiac arrest. Local anesthetics systemic toxicity (LAST) is one of a life-threatening complication when the effects of local anesthetics reach the systemic circulation. Case: We report a local systemic toxicity on 66-year-old male who underwent bilateral nephrostomy percutaneous. Patient were hemodynamically stable and were placed in supine position, preoperatively. Head-to-toe examination showed an increased bronchial breath sounds and rough crackles in the 4-5 left and right intercostal space. Laboratory examinations revealed anemia (Hb 10.6 g/dl) and impairment on kidney function (ureum 148 mg/dl; creatinine 4.9 mg/dl). Patient were planned to do an epidural at the level of L2 - L3 with a 14 ml levobupivacaine 0.5% in incremental doses 5 mg - 5 mg – 4 mg. Shortly after receiving the third incremental doses of levobupivacaine the patient experienced in disruption on cardiovascular and neurovascular system which showed as persistent bradycardia and loss of consciousness. Patient decided to undergo general anesthesia with lipid emulsion infusion and showed an improvement afterwards. Conclusion: The main principle of LAST management is to ensure adequate ventilation and organ perfusion with sufficient oxygen-rich-blood to perfuse on brain, heart, and kidneys to prevent acidosis until lipid emulsion therapy. LAST management requires prompt and precise diagnosis and treatment to get a good outcome.

Congenital Cystic Adenomatoid Malformation of the Left Lung Presenting in an Adult

A 37-year-old male presented with complaints of cough and dyspnoea on exertion since childhood. His general physical examination was unremarkable. Respiratory examination showed ipsilateral volume loss with bronchial breathing in all the areas of left side. Other systems examination was normal.

Primary Achalasia with Pneumoesophagus and Bronchopleural Fistula Causing Right Lung Collapse and Bronchiectasis

A 35-year-old male non-smoker, presented with a history of recurrent respiratory tract infections, associated with intermittent haemoptysis and haematemesis since childhood. His vital parameters were normal with pulse oximetry saturation of 97% on room air. On physical examination, clubbing was observed. Chest auscultation revealed tubular type of bronchial breath sounds over the right hemithorax.

A leaking food pipe: Bronchoesophageal fistula secondary to lung cancer

A 58-year-old female with advanced lung cancer, hypertension, hyperlipidemia, pulmonary artery thrombosis, bilateral subclavian artery stenosis, and vocal cord dysfunction presented to the ER with cough, shortness of breath, dysphagia, and weight loss. HR 114 bpm, RR 24/min, SpO2 95% on 4L, Temperature 36.2o C. She was lethargic, chronically ill-looking, and had bronchial breath sounds and crackles in the right upper lobe. Chest x-ray revealed enlarging previously known right upper lobe mass and loculated right pleural effusion. Contrast CT of the chest showed unchanged necrotic right apical mass, increased consolidation inferior to a mass in the right middle lobe, and metastatic infiltration of the right lateral 6th rib. She also had purulent secretions in all airways on bronchoscopy. Shortly after bronchoscopy, she had an episode of aspiration and required Intensive Care Unit (ICU) admission.

Fractal and Time-series A nalyses based Rhonchi and Bronchial Auscultation: A Machine Learning Approach

Objectives: The present work reports the study of 34 rhonchi (RB) and Bronchial Breath (BB) signals employing machine learning techniques, time-frequency, fractal, and non-linear time-series analyses. Methods: The time-frequency analyses and the complexity in the dynamics of airflow in BB and RB are studied using both Power Spectral Density (PSD) features and non-linear measures. For accurate prediction of these signals, PSD and non-linear measures are fed as input attributes to various machine learning models. Findings: The spectral analyses reveal fewer, low-intensity frequency components along with its overtones in the intermittent and rapidly damping RB signal. The complexity in the dynamics of airflow in BB and RB is investigated through the fractal dimension, Hurst exponent, phase portrait, maximal Lyapunov exponent, and sample entropy values. The greater value of entropy for the RB signal provides an insight into the internal morphology of the airways containing mucous and other obstructions. The Principal Component Analysis (PCA) employs PSD features, and Linear Discriminant Analysis (LDA) along with Pattern Recognition Neural Network (PRNN) uses non-linear measures for predicting BB and RB. Signal classification based on phase portrait features evaluates the multidimensional aspects of signal intensities, whereas that based on PSD features considers mere signal intensities. The principal components in PCA cover about 86.5% of the overall variance of the data class, successfully distinguishing BB and RB signals. LDA and PRNN that use non-linear time-series parameters identify and predict RB and BB signals with 100% accuracy, sensitivity, specificity, and precision. Novelty: The study divulges the potential of non-linear measures and PSD features in classifying these signals enabling its application to be extended for low-cost, non-invasive COVID-19 detection and real-time health monitoring. Keywords: lung signal, fractal analysis, sample entropy, non­linear time­series, machine learning techniques

Recovery of Children from Acute Lower Respiratory Tract Infection(Pneumonia and Bronchiolitis) : In a tertiary Care Hospital

Backgrounds: Children are mostly the victims of pneumonia and bronchiolitis for which they are often hospitalized. Acute respiratory infection(ARI)results in 1.9 million deaths per year in developing countries(Taneja et. al 2009). It is important to know the recovery time of individual acute lower respiratory tract infection (ALRTIs) like pneumonia and bronchiolitis for better understanding the clinical feature and outcome. Knowing the length of stay (LOS) in case of ALRTI has not yet been worked out and studied well.&#x0D; Objective: To determine the recovery of different clinical features Length of hospital Stay and outcome of two common LRTIs viz pneumonia and bronchiolitis.&#x0D; Methods: A cross-sectional analytical study was done in department of pediatrics of Dhaka Medical College Hospital during the from October 2013 to September 2014. Cases were selected according to selection criteria. Pneumonia was diagnosed on the basis of fever, cough, breathing difficulty, and found chest indrawing, fast breathing, and bronchial breath sound or crackles on examination and consolidation or patchy opacity in chest X-ray and bronchiolitis on the basis of presence of runny nose followed by cough, breathing difficulty and wheeze on auscultation in a child below 2 yrs. Cases of pneumonia were treated with standard protocol of WHO and cases of bronchiolitis were treated with national guideline. The cases were followed up 12 hourly for 8 days using case collection sheet by monitoring 17 clinical features.&#x0D; Results : There were 54 cases of pneumonia and 54 cases of bronchiolitis. Baseline selected clinical-sociodemographic parameters of both the cases were similar in terms of sociodemographic status and some clinical features. The following clinical features were similar in both groups viz. cough(100% vs 100%) breathing difficulty (100%vs 100%), feeding difficulty (92.6%vs96.3%), chest indrawing(92.6%vs 96.3%).The dissimilar clinical features were fever (100%vs77.8%, p&lt;0.001), runny nose (40.7%vs 100%, p&lt;0.001%) sleeping difficulty (92.6% vs 77.8% p&lt;0.03) wheeze (29.6% vs 100%, p&lt;0.001) crackles(100% vs 18.5%, p&lt;0.001). Dynamics of improvement in clinical features:Significant number of cases of pneumonia did not improve from breathing difficulty (40.7%) , feeding difficulty(40.7%), restlessness(16.7%), sleeping difficulty(76.9%), chest indrawing (63%), documented fever(54%) within 3 days, but more than 90% cases of bronchiolitis recovered from above mentioned clinical features. (P&lt;0.001). Social smile returned to only 68% in case of pneumonia but 100% cases of bronchiolitis(p&lt;0.001) with in 4 days.&#x0D; Conclusion: This study was concluded that almost 89% cases of pneumonia and 100% cases of bronchiolitis recovered. Length of hospital stay(LOS) was 5.8±2.1 days in pneumonia and LOS was 3.2±0.7 in bronchiolitis. Mortality was higher in cases pneumonia (3.7%) than cases of Bronchiolitis(0.0%).&#x0D; Sir Salimullah Med Coll J 2021; 29(2): 124-131