Chest X-ray Changes Research Articles

A-002 Analytical Validation of the Zybio High Sensitivity Cardiac Troponin I CLIA Assay

Abstract Background High-sensitivity cardiac troponin (hs-cTn) plays a pivotal role in the early diagnosis of Acute Coronary Syndrome (ACS). With technological advancements, the sensitivity of troponin assays has significantly improved. The International Federation of Clinical Chemistry (IFCC) criteria for hs-cTn assays include a total imprecision (Coefficient of Variation, CV) ≤10% at the gender-specific 99th percentile value and detectable levels in ≥50% of a healthy population. This study aims to evaluate the performance of Zybio's hs-cTnI assay against these high-sensitivity standards Methods This study involved 1661 individuals undergoing routine health checks at Chongqing Medical University Third Hospital. Exclusion criteria included recent medication use, abnormal NT-proBNP levels, significant cardiac silhouette changes in chest X-rays, age <20, incomplete data, pregnancy, or history of severe chronic diseases. Participants were classified into apparent healthy and healthy groups based on blood pressure, lipid profiles, and electrocardiogram results. Laboratory examinations included hs-cTn and NT-ProBNP concentrations using Zybio's chemiluminescence instrument EXI2400 and associated reagent kits, with other parameters measured using standard biochemical and high-performance liquid chromatography methods. Results Of the 1247 participants (556 males, 691 females) included in the final analysis, 1157 showed detectable hs-cTnI levels above the limit of detection (LOD), yielding an overall detection rate of 92.78%. Detection rates were 93.71% in males and 92.04% in females. The total imprecision (CV) of hs-cTnI at gender-specific 99th percentile values over 20 days was below 10%, meeting the high-sensitivity criteria. This finding was consistent across lower and higher concentration ranges. Conclusions The Zybio hs-cTnI assay demonstrated a high detection rate in a healthy population, with 92.78% detectability overall, 93.71% in males, and 92.04% in females. The assay met the high-sensitivity criteria of IFCC, with a total imprecision (CV) of less than 10% at the gender-specific 99th percentile levels. These results validate the utility of Zybio's hs-cTnI assay for clinical application in the early diagnosis of ACS.

A Case Report of Korean Medicine Treatment for Chronic Obstructive Pulmonary Disease Patient with Dyspepsia and Anorexia after Surgery for Colon Cancer and Chemotherapy

Objectives: The purpose of this case study was to report the therapeutic effect of Korean medicine treatment for chronic obstructive pulmonary disease (COPD) patient with dyspepsia and anorexia after surgery for colon cancer and chemotherapy.Methods: A patient with COPD was hospitalized to treat dyspnea, dyspepsia, and anorexia that occurred after surgery for colon cancer and chemotherapy during 22 days. The patient was treated with herbal medicine (Yangjin-tang), acupuncture, pharmaco-puncture, herbal steam therapy, moxibustion, and pulmonary rehabilitation. The effectiveness of the treatment was assessed with modified Medical Research Council (mMRC) scale, Numeric Rating Scale (NRS) for dyspnea and dyspepsia, walking distance, weight, peak expiratory flow (PEF), radiography, pulmonary function test, and laboratory test.Results: The Korean medicine treatment improved mMRC from Grade 4 to Grade 3, NRS of both dyspnea and dyspepsia, walking distance, and maxillary sinusitis on paranasal sinus X-ray. However, there were no changes in weight, PEF, and chest X-ray.Conclusion: The Korean medicine treatment was effective in improving the symptoms of the COPD patient, including dyspnea, dyspepsia, and anorexia. This study suggests that Korean medicine treatment can have therapeutic effect on comorbidities such as dyspepsia and anorexia.

Multisystemic Inflammatory Syndrome in Children (MIS-C) With COVID-19 and Kidney Involvement: Poor Outcomes in a Case Series.

Multisystemic inflammatory syndrome (Mis-C) has emerged in May 2020 as a serious complication of coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). A total of 6 children presented to tertiary care hospitals with Mis-C, of which 5 (83%) have died during hospitalization. All included patients presented with respiratory symptoms (ranged from mild to severe acute respiratory distress syndrome) and gastrointestinal symptoms. Most of the patients are known to have medical illnesses. Pediatric Risk of Mortality (PRISM) IV score ranged from 3 to 87. All patients developed acidosis and varying stages of acute kidney injury and electrolyte disturbances. All were treated for coagulopathy, thrombocytopenia, bacterial infections as well as antiviral medications (either ritonavir or lopinavir). Most patients had chest X-ray changes either unilateral or bilateral lung changes. Multisystemic inflammatory syndrome is a rare, yet serious complication of SARS-CoV2 infection in children. Multisystem involvement should be anticipated and promptly treated.

Definitions of pulmonary exacerbation in people with cystic fibrosis: a scoping review

BackgroundPulmonary exacerbations (PExs) are clinically important in people with cystic fibrosis (CF). Multiple definitions have been used for PEx, and this scoping review aimed to identify the different definitions reported...

Utility of chest x-ray for tracheostomy tube placement in pediatric patients.

To evaluate the utility of ordering chest x-rays after pediatric tracheostomy tube placement in identifying acute, post-operative complications and how it impacts clinical decision-making. In this retrospective cohort study, we identified tracheostomies performed in 139 pediatric patients through CPT codes over a 5-year period from 2013 to 2018. Manual chart review was performed for demographic and clinical characteristics, pre-procedure and post-procedure chest x-ray interpretations, and the presence of complications. Each complication was reviewed to see if action was taken due to post-procedure chest x-ray findings. Multivariable logistic regression was performed to determine associations with changes in pre-procedure versus post-procedure chest x-rays. In a cohort of 139 pediatric patients with pre-procedure and post-procedure chest x-rays, 40 (28.8%) of patients had new significant post-procedure chest x-ray findings compared to pre-procedure chest x-ray findings. Of these 40 instances of changes in pre-procedure versus post-procedure chest x-ray findings, only eight resulted in action being taken due to the observed findings. Among these eight instances of action being taken, only one instance involved in invasive action being taken with a bronchoscopy. With multivariable regression analysis, patient age, race, gender, and the presences of genetic syndromes, were not found to be significant risk factors in predicting changes in pre-procedure versus post-procedure chest x-ray. In our study, post-procedure chest x-ray after tracheostomy tube placement did not significantly impact clinical decision making. It may be worth reconsidering the value in routine chest x-rays after tracheostomy tube placement in pediatric patients.

A novel ensemble learning framework based on a genetic algorithm for the classification of pneumonia

Pneumonia is a disease that can be detected by the opacity changes in chest X-rays and can lead to fatal consequences. Medical image analysis has several challenges, such as limited labeled datasets, imbalanced class distribution, image noise, and overfitting, so individual Convolutional Neural Networks (CNNs) are insufficient to detect pneumonia accurately. Although ensemble CNN models have been used in previous studies, the literature lacks guidance on identifying the optimal CNN models and weight ratio to combine them. In this study, we propose a novel ensemble CNN framework to accurately detect pneumonia, with optimum weights set by a Genetic Algorithm (GA). Firstly, a noise outside the lung was removed, and the model performance was enhanced by performing lung segmentation on Chest X-ray. The performances of several CNN models were analyzed by hyperparameter optimization. The framework combines the three models that give the best accuracy and the two models that provide the lowest false-negative value with the ensemble method in the ratio of the most appropriate weights. The proposed framework provided the best performance on the public test dataset with an accuracy of 97.23% and an F1-score of 97.45% compared to state-of-the-art methods. The study's main contributions are determining suitable models and their optimal weights of the ensemble method based on the GA. The proposed framework enables a rapid and effective diagnostic process, less costly healthcare services, and more efficient use of resources. The demo-link is https://www.youtube.com/watch?v=KZ50K3HL70U.

Prevalence, Clinical Characteristics and Determinants of Unsuccessful Treatment Outcomes Among Pulmonary Tuberculosis Patients: A 5-Year Registry-Based Retrospective Cohort Study.

Despite the existence of effective medications, pulmonary tuberculosis (PTB) remains a significant global public health concern, The evaluation and feedback of national TB control programs are crucial, requiring diligent monitoring of TB treatment outcomes and analysis of the factors influencing these outcomes. This study aims to provide valuable insights into the challenges faced by TB patients, which can inform better strategies for treatment and management in the future. We conducted a study in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia (KSA), from January 1, 2018 to December 31, 2023. The study was a registry-based retrospective cohort study. Patients' data were sourced from the National Tuberculosis Registry database of Saudi Arabia. Treatment outcomes were determined as either success or failure, considering clinical evaluation, changes in chest X-rays, and the results of subsequent sputum examinations during follow-up. To evaluate the data, SPSS version 28.0 was used. A total of 427 PTB patients participated in the study. The results show successful treatment outcomes among 88.5% of patients. Among the patients, males exhibited a higher likelihood of treatment failure as compared to females (aOR 1.3; 95%Cl 1.2-1.5, p < 0.001). Patients with positive sputum smear (aOR 1.3; 95%Cl 1.1-1.3 p < 0.00) and the presence of cough were associated with an increased risk of treatment failure (aOR1.5; 95%Cl 1.1-1.4, p < 0.001). This study shows that the percentage of unsuccessful treatment outcomes is high, ie, 11.5%, due to patients' deaths and loss to follow-up. Enhanced supervision and treatment monitoring for tuberculosis patients at high risk of treatment failure can lead to improved treatment success rates in Saudi Arabia.

CHD-CXR: a de-identified publicly available dataset of chest x-ray for congenital heart disease.

Congenital heart disease is a prevalent birth defect, accounting for approximately one-third of major birth defects. The challenge lies in early detection, especially in underdeveloped medical regions where a shortage of specialized physicians often leads to oversight. While standardized chest x-rays can assist in diagnosis and treatment, their effectiveness is limited by subtle cardiac manifestations. However, the emergence of deep learning in computer vision has paved the way for detecting subtle changes in chest x-rays, such as lung vessel density, enabling the detection of congenital heart disease in children. This highlights the need for further investigation. The lack of expert-annotated, high-quality medical image datasets hinders the progress of medical image artificial intelligence. In response, we have released a dataset containing 828 DICOM chest x-ray files from children with diagnosed congenital heart disease, alongside corresponding cardiac ultrasound reports. This dataset emphasizes complex structural characteristics, facilitating the transition from machine learning to machine teaching in deep learning. To ascertain the dataset's applicability, we trained a preliminary model and achieved an area under the receiver operating characteristic curve (ROC 0.85). We provide detailed introductions and publicly available datasets at: https://www.kaggle.com/competitions/congenital-heart-disease.

Chest X-ray Features of HIV-Associated Pneumocystis Pneumonia (PCP) in Adults: A Systematic Review and Meta-analysis.

The performance of chest x-ray (CXR) features for Pneumocystis pneumonia (PCP) diagnosis has been evaluated in small studies. We conducted a systematic review and meta-analysis to describe CXR changes in adults with HIV-associated laboratory-confirmed PCP, comparing these with non-PCP respiratory disease. We searched databases for studies reporting CXR changes in people >15 years old with HIV and laboratory-confirmed PCP and those with non-PCP respiratory disease. CXR features were grouped using consensus terms. Proportions were pooled and odds ratios (ORs) generated using random-effects meta-analysis, with subgroup analyses by CD4 count, study period, radiology review method, and study region. Fifty-one studies (with 1821 PCP and 1052 non-PCP cases) were included. Interstitial infiltrate (59%; 95% CI, 52%-66%; 36 studies, n = 1380; I2 = 85%) and ground-glass opacification (48%; 95% CI, 15%-83%; 4 studies, n = 57; I2 = 86%) were common in PCP. Cystic lesions, central lymphadenopathy, and pneumothorax were infrequent. Pleural effusion was rare in PCP (0%; 95% CI, 0%-2%). Interstitial infiltrate (OR, 2.3; 95% CI, 1.4-3.9; I2 = 60%), interstitial-alveolar infiltrate (OR, 10.2; 95% CI, 3.2-32.4; I2 = 0%), and diffuse CXR changes (OR, 7.3; 95% CI, 2.7-20.2; I2 = 87%) were associated with PCP diagnosis. There was loss of association with alveolar infiltrate in African studies. Diffuse CXR changes and interstitial-alveolar infiltrates indicate a higher likelihood of PCP. Pleural effusion, lymphadenopathy, and focal alveolar infiltrates suggest alternative causes. These findings could be incorporated into clinical algorithms to improve diagnosis of HIV-associated PCP.

Accelerated silicosis in sandblasters: Pathology, mineralogy, and clinical correlates.

With increasing reports of accelerated and acute silicosis, PMF, and autoimmune disease among coal miners and silica-exposed countertop workers, we present previously incompletely-described pulmonary pathology of accelerated silicosis and correlations with mineralogy, radiography, and disease progression in 46 Texas oilfield pipe sandblasters who were biopsied between 1988 and 1995. Worker examinations included pulmonary function tests, chest X-ray (CXR), high-resolution computed tomography (HRCT), and Gallium-67 scans. Quantitative mineralogic analysis of pulmonary parenchymal burden of silica, silicates, and metal particles used scanning electron microscopy with energy dispersive x-ray spectroscopy (SEM EDS). Workers had clinical deterioration after <10 years exposure in dusty workplaces. Althoughinitial CXR was normal in 54%, Gallium-67 scans were positive in 68% of those with normal CXR, indicating pulmonary inflammation. The histology of accelerated silicosis is diffuse interstitial infiltration of macrophages filled with weakly birefringent particles with or without silicotic nodules or alveolar proteinosis. Lung silica concentrations were among the highest in our database, showing a dose-response relationship with CXR, HRCT, and pathologic changes (macrophages, fibrosis, and silicotic nodules). Radiographic scores and diffusing capacity worsened during observation. Silica exposure was intensified, patients presented younger, with shorter exposure, more severe clinical abnormalities, higher lung particle burdens, and more rapid progression in a subset of patients exposed to recycled blasting sand. Accelerated silicosis may present with a normal CXR despite significant histopathology. Multivariable analyses showed silica, and not other particles, is the driver of observed radiologic, physiologic, and histologic outcomes. Eliminating this preventable disease requires higher physician, public health, and societal awareness.

Treatment outcomes of retreated patients with isoniazid/rifampicin resistant pulmonary tuberculosis.

About 8% of TB cases worldwide are estimated to have rifampicin-susceptible, isoniazid-resistant tuberculosis (Hr-TB), ranging from 5 to 11% regions. However, Hr-TB has not received much attention while comparing to be given high priority to the management of rifampicin-resistant tuberculosis (RR-TB). This study aimed to compare the differences of treatment effects for Hr-TB and RR-TB, so as to intensify the treatment and management of Hr-TB. A retrospective study was used to collect bacteriologically positive retreated patients with isoniazid/rifampicin resistant pulmonary tuberculosis, who were conducted at 29 tuberculosis control institutions in China from July 2009 to June 2021. We assessed effectiveness and safety of retreated patients with isoniazid/ rifampicin resistant pulmonary tuberculosis. A total of 147 with either positive smear or cultures were enrolled, and 80 cases were in Hr-TB group and 67 cases were in RR-TB group. There was no significant difference in terms of age, sex, body mass, type of retreatment and comorbid diabetes between the two groups (P > 0.05). The rate of number of lesions involving lung fields ≥ 3 in Hr-TB group 75.9% (60/79) was significantly higher than RR-TB group 56.7% (38/67) (χ2 = 6.077, P = 0.014). There was no statistically significant difference (P = 0.166) with regard to the treatment outcomes of the two groups, the cure rates were 54.7% (41/75) and 53.6% (30/56), respectively, and the failure rate in Hr-TB group 22.7% (17/75) was 10% higher than RR-TB group 10.7% (6/56). The rate of negative sputum smear at the end of the second month (65.7%) in the Hr-TB group was significantly lower than that in the RR-TB group (85.7%) (P = 0.025). There were no significant differences in the incidences of serious adverse reactions and chest X-ray changes between the two groups (P > 0.05). During the 5-year follow-up, recurrence in the Hr-TB group (7 cases, 14.9%) was no significantly lower than that in the RR-TB group (4 cases, 11.8%) (P = 0.754). The treatment of retreated Hr-TB patients was difficult and could be statistically similar or considerably worse than RR-TB. It's urgent to conduct further evaluation of the treatment status quo to guide the guideline development and clinical practice of Hr-TB patients.

Severity of radiographic changes in patients with COVID-19 pneumonia - experience from secondary-level hospital

Introduction/Objective. Chest X-ray (CXR) is a common diagnostic procedure for monitoring the course and outcome of pneumonia. The aim of the study was to examine the frequency, type and degree of CXR changes in COVID-19 pneumonia and compare it with demographic data and the presence of comorbidities. Methods. In this retrospective study, CXRs taken on the day of admission were analyzed for 620 patients with COVID-19. CXR were defined as ground-glass opacification (GGO), consolidation, reticular changes, pulmonary nodules, and pleural effusions. CXR severity score (CXR-SS) was determined based on the adjusted Radiographic Assessment of Lung Edema score. SPSS version 17.0 was used for statistical analyses. Results. The average age was 62.75 ? 14.8 years 66.5% of analyzed patients had comorbidities. CXR changes were bilateral in 53.2%, dominant in the lower lung in 68.1% and diffuse in 24.5%. GGO were present in 55%, reticular changes in 37.3%, and consolidations in 24% of patients. Based on CXR-SS, 47.2% of patients had mild pneumonia, 40.2% moderate, 7.9% severe, and 4.6% very severe. Severe/very severe pneumonia was in 71.8% of older than 65 years. Bilateral changes were found in 97.4% of people with severe/very severe pneumonia, diffuse in 56.4%, and consolidation in 66.7% of the patients. GGO were in 58.1% of subjects with mild/moderate pneumonia. Conclusion. CXR in patients with COVID-19 pneumonia are more frequently bilateral, dominantly peripheral, in the lower lung zone. The degree of diffuse changes is proportional to older age and more frequent comorbidities. In a severe form of the disease, consolidation and reticular opacification dominate.

The Comparison Of Chest X-Ray Changes Between Post-Covid-19-Infection Patients With Mild-Moderate Severity And Severe-Critical Severity At Ugm Academic Hospital

Introduction: Post-COVID-19 syndrome can be seen from the radiological findings on the chest X-ray (CXR). However, limited studies compared CXR changes in post-COVID-19 patients based on their severity. Methods: Thirty-three post-hospitalized COVID-19 patients who came to the Long COVID Clinic at UGM Academic Hospital were divided into mild-moderate and severe-critical groups. The CXR were taken during hospital admission, in the 4th week, and in the 8th week. CXR images were assessed with the Brixia Score method. Results: The Brixia score in the mild-moderate group (n = 17) and severe-critical (n = 16) group showed a trend of change, which increased in the 4th week and decreased in the 8th week. However, there were no significant changes between the two groups during hospital admission, in the 4th week, and in the 8th week. The Brixia score during hospital admission and in the 8th-week follow-up in the mild-moderate group was significantly lower than that of the severe-critical group. Clinically, the mean Brixia score in the mild-moderate group ranges from mild pneumonia, while the severe-critical group ranges from moderate pneumonia. Conclusion: There is no significant resolution of the CXR until the 8th-week follow-up in post-COVID-19 infection patients with mild-moderate and severe-critical severity. However, the CXR during hospital admission and the 8th week is better in post-COVID-19 infection patients with mild-moderate severity. Keywords: chest X-ray, COVID-19, infectious disease, post-COVID-19 syndrome, severity,

Macrolide-resistant Mycoplasma pneumoniae in an Iranian Pediatric Sample with Community-Acquired Pneumonia

Background: To the best of our knowledge, the prevalence of macrolide-resistant Mycoplasma pneumoniae (MRM) in Iranian children has not been investigated. Objectives: The present study aimed to evaluate the prevalence of MRM in Iranian children with community-acquired pneumonia (CAP). Methods: A total of 222 children with CAP, aged 3 - 15 years, who were hospitalized in 10 different children's hospitals, were enrolled in this study. Mycoplasmas were detected using the polymerase chain reaction (PCR) assay. The severity of CAP was evaluated according to the Infectious Diseases Society of America (IDSA) guidelines. The level of C-reactive protein (CRP) was also measured by the particle-enhanced turbidimetric immunoassay. Additionally, the chest X-rays of children with CAP were recorded and sent to a radiologist for further evaluation. Results: Twenty-one children (9.4%) diagnosed with CAP also had M. pneumoniae infection, 17 (77.27%) of whom were positive for A2063G transition and high-level macrolide resistance. The severity of CAP (P ≥ 0.99), CRP level (0.07), and chest X-ray changes (P = 0.08) were not significantly different between children with MRM pneumonia and those with macrolide-susceptible M. pneumoniae. Conclusions: The prevalence of high-level MRM pneumonia in children is high in Iran, similar to other Asian countries. However, this type of Mycoplasma infection was not associated with the severity of CAP and did not have significant effects on chest X-ray (CXR) changes or the CRP level in the patients.

Pediatric pulmonary multisystem langerhans cell histiocytosis: does lung lesion severity affect the outcome?

BackgroundThe pediatric pulmonary multisystem Langerhans cell histiocytosis (PPM LCH) is associated with either low risk or high risk organ(s). The nodulo-cystic lung lesions although pathognomonic, yet are very variable in severity and remain a source of controversy in certifying pulmonary LCH diagnosis. The study aimed to examine the prognostic value of clinical respiratory manifestations and radiological lung lesions severity. This is through associating a CT chest triad of bilateral, extensive and diffuse lesions. It is a retrospective study of 350 LCH patients who received systemic treatment at Children’s Cancer Hospital Egypt during the period from 2007 to 2020.ResultsSixty-seven patients (67/350–19.1%) had PPM LCH at presentation. Severe lung lesions were present in 24 of them. The median follow-up period was 61 months (IQR: 3.4–8.3). The 5-year overall survival (OS) and event free survival (EFS) was 89% and 56.6% respectively. The EFS, for severe radiological lesions triad was 38% ± 20.7 versus 66% ± 16.2 for non-severe lesions triad p 0.002, while for presence of chest X-ray changes 27% ± 22.344 versus absence of chest X ray changes 66% ± 14.7 p 0.001, for clinical respiratory manifestations 13% ± 13.9 versus none 62% ± 22.9 p < 0.001, for RO− with severe lung lesions 47% ± 30.4 versus RO− without severe lung lesions 69% ± 5.9 p 0.04. There was a tendency for the independent prognostic impact of severe lung involvement; aHR = 1.7 (95% CI 0.92–3.13, p = 0.09).ConclusionAlthough the lung is a low -risk organ per se in LCH, our study demonstrates a non negligeable prognostic impact of severe lung involvement in the risk stratification of pediatric LCH. This warrants further study and external validation.

Predictive power of chest radiography for infectious or inflammatory lung disease.

Children frequently present with chronic cough, recurrent respiratory infections, and dysphagia. These symptoms are poor predictors of significant inflammatory lung disease, such as from chronic aspiration. Bronchoalveolar lavage (BAL) is the gold standard for identification of lung infection and airway inflammation but is expensive and requires sedation. Chest X-rays (CXR) are inexpensive, low-radiation tests that do not require sedations and can document findings associated with infectious or inflammatory lung disease. The accuracy of CXR to predict or exclude infectious or inflammatory lung disease has not been directly evaluated and is unknown. Retrospective cohort of all pediatric patients who underwent FFB with BAL within 2weeks of a CXR. Blinded CXR images reviewed for findings consistent with inflammatory disease by two senior pediatric radiologists. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for CXR to identify significant inflammation and/or infection on BAL were calculated. Three hundred and forty-four subjects included. Two hundred and sixty-three had positive CXR (77%), 183 had inflammatory BAL (53%), and 110 had infection (32%). The sensitivity of CXR changes for BAL inflammation, infection, and either inflammation or infection was 84.7, 90.9, and 85.3, respectively. The PPV of CXR was 58.9, 38.0, and 59.7. The NPV of CXR was 65.0, 87.5, and 66.3. Although CXR are inexpensive, do not require sedation, and are of low radiation dose, the ability of an entirely normal CXR to exclude active inflammatory or infectious lung disease is limited.

COVID-19-associated pulmonary aspergillosis

Abstract Invasive pulmonary aspergillosis (IPA) is now been recognized as a possible secondary infection affecting COVID-19 recovery and increasing mortality. It can be explained due to factors such as direct epithelial injury, hypercoagulable and hyperinflammatory states, and the use of immunosuppressive treatment. We managed five such cases in a post-COVID intensive care unit facility at a tertiary care institute in North India. All patients had high oxygen demand, positive serum galactomannan (GM) index, and significant chest X-ray changes. All patients showed an initial improvement after receiving intravenous antifungal treatment with voriconazole. Systemic markers were suboptimal for the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA) with a sensitivity of less than 50%. GM assay has been validated in BAL and serum in numerous studies. Serum GM is a sensitive marker for IPA in patients with neutropenia; however, in nonneutropenic critically ill patients, serum GM exhibited a sensitivity of 25%, although a negative serum result cannot exclude the diagnosis of CAPA. The diagnosis of CAPA is challenging, and in patients with severe COVID-19 pneumonia may be associated with a worse prognosis. GM levels can be used for the diagnostic purpose of probable CAPA cases and administration of prophylactic treatment with voriconazole is still under debate.

The natural history of untreated pulmonary tuberculosis in adults: a systematic review and meta-analysis.

Stages of tuberculosis disease can be delineated by radiology, microbiology, and symptoms, but transitions between these stages remain unclear. In a systematic review and meta-analysis of studies of individuals with untreated tuberculosis who underwent follow-up (34 cohorts from 24 studies, with a combined sample of 139 063), we aimed to quantify progression and regression across the tuberculosis disease spectrum by extracting summary estimates to align with disease transitions in a conceptual framework of the natural history of tuberculosis. Progression from microbiologically negative to positive disease (based on smear or culture tests) in participants with baseline radiographic evidence of tuberculosis occurred at an annualised rate of 10% (95% CI 6·2-13·3) in those with chest x-rays suggestive of active tuberculosis, and at a rate of 1% (0·3-1·8) in those with chest x-ray changes suggestive of inactive tuberculosis. Reversion from microbiologically positive to undetectable disease in prospective cohorts occurred at an annualised rate of 12% (6·8-18·0). A better understanding of the natural history of pulmonary tuberculosis, including the risk of progression in relation to radiological findings, could improve estimates of the global disease burden and inform the development of clinical guidelines and policies for treatment and prevention.

Repeated Lung Ultrasound versus Chest X-ray-Which One Predicts Better Clinical Outcome in COVID-19?

The purpose of this study was to evaluate whether changes in repeated lung ultrasound (LUS) or chest X-ray (CXR) of coronavirus disease 2019 (COVID-19) patients can predict the development of severe disease and the need for treatment in the intensive care unit (ICU). In this prospective monocentric study, COVID-19 patients received standardized LUS and CXR at day 1, 3 and 5. Scores for changes in LUS (LUS score) and CXR (RALE and M-RALE) were calculated and compared. Intra-class correlation was calculated for two readers of CXR and ROC analysis to evaluate the best discriminator for the need for ICU treatment. A total of 30 patients were analyzed, 26 patients with follow-up LUS and CXR. Increase in M-RALE between baseline and follow-up 1 was significantly higher in patients with need for ICU treatment in the further hospital stay (p = 0.008). Both RALE and M-RALE significantly correlated with LUS score (r = 0.5, p < 0.0001). ROC curves with need for ICU treatment as separator were not significantly different for changes in M-RALE (AUC: 0.87) and LUS score (AUC: 0.79), both being good discriminators. ICC was moderate for RALE (0.56) and substantial for M-RALE (0.74). The present study demonstrates that both follow-up LUS and CXR are powerful tools to track the evolution of COVID-19, and can be used equally as predictors for the need for ICU treatment.

Pneumonia Detection System Using Deep Learning

Artificial intelligence and machine learning are increasingly being applied in medicine, particularly in biomedical imaging and diagnostic procedures. Machine learning algorithms are being used to process chest X-ray images, enhancing consistency and accuracy in reporting. The research focuses on using deep learning algorithms based on convolutional neural networks to build a processing model for detecting pneumonia-related changes in chest X-rays and classifying them into two groups based on detection results. This approach aims to improve decision-making and accuracy in medical imaging.