Chest Examination Research Articles

CT Urology에서 가돌리늄 조영제 제거를 위한 이중에너지 CT의 Virtual Non-Contrast 기술의 평가

Residual gadolinium contrast agents in the urinary tract following MRI contrast-enhanced examinations often presents as elevated Hounsfield Unit (HU) values on CT scans, impeding the efficacy of CT urology procedures. This study aims to explore the feasibility of addressing this challenge through the application of the Dual-Energy Computed Tomography (DECT) Virtual Non-Contrast (VNC) technique across various energy levels. HU values of residual gadolinium contrast agent in the renal pelvis and ureter were measured in patients who underwent MRI contrast-enhanced examinations followed by non-contrast CT chest examinations. Subsequently, gadolinium contrast agent mixtures, such as Max, Mean, and Min Mixtures, were created and scanned together with normal saline using DECT at various energy levels. Additionally, an iodine mixture and a virtual stone representing urolithiasis were fabricated and evaluated. The results demonstrated a significant reduction in contrast enhancement of gadolinium contrast agent with DECT VNC at 70 kV and Sn150 kV. The Min Mixture closely resembled normal saline in both HU and Contrast-to-Noise Ratio (CNR), facilitating the differentiation between iodine contrast agent and virtual urolithiasis. Therefore, utilizing DECT VNC after a 1-hour and 30-minute interval following MRI contrast-enhanced examinations effectively eliminates gadolinium contrast agents, improving the efficacy of CT Urology imaging procedures.

Lung cancer after kidney transplantation: a 50-year experience at a single institution

PurposeTo investigate the clinical characteristics of lung cancer that develops after kidney transplantation.MethodsThe clinical data of patients with lung cancer diagnosed after kidney transplantation were collected retrospectively. The medical records were extracted from our database. All patients underwent routine chest examination after kidney transplantation.ResultsIn total, 17 lung tumors were detected in 15 (0.6%) of 2593 patients who underwent kidney transplantation at our institution. Eleven lung tumors were completely resected from a collective 10 patients (surgical group). The remaining five patients did not receive surgical treatment (nonsurgical group). The surgical group underwent wedge resection (n = 5), segmentectomy (n = 1), lobectomy (n = 3), and bilobectomy (n = 1). The pathological stages were 0 (n = 1), IA1 (n = 2), IA2 (n = 4), IA3 (n = 2), and IB (n = 1). The surgical group had a significantly better prognosis than the nonsurgical group. There were no perioperative complications related to kidney transplantation in either group.ConclusionsRoutine chest examination would be useful for the early diagnosis and treatment of lung cancer after kidney transplantation. Moreover, surgical resection for early-stage lung cancer was associated with a better prognosis for kidney transplantation patients.

A Review on Lung Cancer with Emphasis on Current Treatment

Cancer is a broad term that refers to more than 277 types of cancer. It is a disease that results from a variety of causes, including mutations resulting from oncogene activation, tumor suppressor gene failure, or other factors. Mutations in these genes cause abnormal cell growth. Lung cancer is one of the leading causes of cancer in the world. Lung cancer, also known as lung cancer, is a lung disease caused by the uncontrolled growth of cells in tissues. Risk factors include smoking , exposure to radon gas, asbestos, secondhand smoke, and pollution. The two types of lung cancer are small cell lung cancer (SCLS) and non-small cell lung cancer (NSCLS). Common symptoms include cough, hemoptysis, weight loss, fatigue, fever or clubbing, hypercalcemia, myasthenic syndrome (muscle fatigue), and changes. Lung cancer is classified by histological type and stage using TNM (tumor, tumour, and metastasis). Treatment depends on the type of cancer and includes surgery, radiation and chemotherapy. Long-term intake of vitamin A, vitamin D, or vitamin E does not reduce the risk of lung cancer. Consuming more vegetables and fruits will reduce the risk. There is no clear link between diet and lung cancer. Most patients with advanced NSCLC who respond to surgery are treated with adjuvant chemotherapy. Histological diagnosis can be made by sputum cytology, thoracentesis, access to lymph nodes, bronchoscopy, transthoracic needle aspiration, video-assisted thoracoscopy or thoracotomy. Initial evaluation of metastatic disease is based on history and physical examination, chest examination, computed tomography, PET scan, and clear tissue of mediastinal involvement. Despite the interest in screening among scientists and doctors, there is no major organization recommending screening for early detection of lung cancer. Smoking is still an important part of primary prevention.

Typical values statistical analysis for adult chest and abdomen-pelvis CT examinations

The use of DRLs has been extensively documented in the literature as a tool for protocol optimization across different x-ray imaging modalities in different countries. It recognizes the importance of developing and validating methods capable of correlating DRL quantities (CTDIvol, DLP and SSDE) with the technical parameters employed in CT studies. Such correlations must be supported by robust statistical methodologies in order to ensure the adoption of adequate optimization decisions. The aim of this work was to apply the Generalized Additive Model (GAM) statistical analysis in adult non-contrast chest and abdomen-pelvis CT typical values. These patient cohorts were statistically evaluated to identify correlations with key-parameters associated to the demographic patient information and machine dependent data, taking into account patients’ effective diameters, d, and body mass indexes (BMI). GAM was implemented considering each anatomical region in order to correlate the log-transformed DRL quantities (DRLq's) as outcomes given different key predictors related to image acquisition and patient characteristics. A total of 956 CT patient data were collected in this retrospective single-center study. Demographic variables demonstrate that age is not or it is just weakly-correlated to the DRLq's resulting from chest procedures, but it is strongly correlated when considering abdomen-pelvis examinations. Gender is correlated to the DRLq's for chest examinations adopting d as a key predictor but it is only correlated with DLP adopting the BMI as a key predictor. The level of accuracy provided by the GAM was adequate for interpreting the large fluctuations of the DRLq's, technical parameters and demographic data observed for the studied patient cohorts. Our results reflect the importance of a comprehensive statistical evaluation of typical values. The domain of this technique is important to different CT imaging chain stakeholders and its application can be a key tool for decision-making process to effective optimization strategies.

Introducing fitting models for estimating age-specific dose and effective dose in paediatric patients undergoing head, chest and abdomen-pelvis imaging protocols: a patient study.

Concerns regarding the adverse consequences of radiation have increased due to the expanded application of computed tomography (CT) in medical practice. Certain studies have indicated that the radiation dosage depends on the anatomical region, the imaging technique employed and patient-specific variables. The aim of this study is to present fitting models for the estimation of age-specific dose estimates (ASDE), in the same direction of size-specific dose estimates, and effective doses based on patient age, gender and the type of CT examination used in paediatric head, chest and abdomen-pelvis imaging. A total of 583 paediatric patients were included in the study. Radiometric data were gathered from DICOM files. The patients were categorised into five distinct groups (under 15 years of age), and the effective dose, organ dose and ASDE were computed for the CT examinations involving the head, chest and abdomen-pelvis. Finally, the best fitting models were presented for estimation of ASDE and effective doses based on patient age, gender and the type of examination. The ASDE in head, chest, and abdomen-pelvis CT examinations increases with increasing age. As age increases, the effective dose in head and abdomen-pelvis CT scans decreased. However, for chest scans, the effective dose initially showed a decreasing trend until the first year of life; after that, it increases in correlation with age. Based on the presented fitting model for the ASDE, these CT scan quantities depend on factors such as patient age and the type of CT examination. For the effective dose, the gender was also included in the fitting model. By utilising the information about the scan type, region and age, it becomes feasible to estimate the ASDE and effective dose using the models provided in this study.

Traumatic bronchial transection following blunt trauma in a teenager: A case report

Tracheobronchial injury (TBI) is an uncommon, life-threatening chest injury, particularly in children, that can occur as a result of iatrogenic or unintentional trauma. It can induce airway obstruction and precipitate life-threatening respiratory failure. However, clinical manifestations can vary, posing challenges in establishing a diagnosis. We report an 11-year-old male presented with respiratory difficulty and neck swelling immediately after falling from a height of 15 meters. Chest examination revealed absent air entry in the right lung and decreased air entry in the left lung. A chest computed tomography (CT) scan revealed a right-sided pneumothorax and a complete transection of the right main bronchus 7mm from the carina. Bilateral thoracostomy and chest tube insertion were performed. The patient was further evaluated by fibreoptic bronchoscope, which showed a complete transection of the right main bronchus. However, due to the progression of subcutaneous emphysema and persistent pneumothorax, the patient subsequently underwent surgical repair of the bronchial damage with a successful outcome. In conclusion, this case report presents a rare clinical entity of TBI in children. Heightened clinical suspicion, prompt stabilization, and multidisciplinary care involving healthcare specialists are essential for the survival of TBI patients. Often, a tailored surgical approach is necessary for definitive repair.

Male’s Primary Breast Lymphoma: Rare Entity of Breast Malignancy, Wad Madani Teaching Hospital, Gezira State, Sudan, August 2023

<i>Background</i>: Primary breast lymphoma is a malignant lymphoma primarily involving breast in absence of previously detected lymphoma localizations. <i>Method</i>: A male of forty years old admitted to Department of Surgery; Wad Madani Teaching Hospital; Gezira State; Sudan; complaining of left breast lump for three months. Condition observed as a painful swelling in left breast, increasing gradually in size, associated with continuous high-grade fever, no rigors and relieved by analgesia, no nipple discharges. Had significant weight loss, anorexia, fatigability, back pain, dry cough with no hemoptysis, no history of headache, and no past or family history of similar condition. Examination: patient looks ill, pale, and not jaundiced. Breast examination: Left breast was larger than right one. Left breast: no nipple destruction, nipple was directed downward medially, no skin changes or dimpling, and no ulceration. There was a mass in left upper outer quadrant, measuring 6*7 cm, smooth surface, hard in consistency with well-defined edges, and attached to muscles but not to skin. No palpable axillary lymph nodes. Right breast was normal. Chest and abdominal examination were unremarkable. Investigations: Fine needle aspiration cytology showed poorly differentiated carcinoma. Incisional biopsy revealed: high grade Non-Hodgkins Lymphomas (Diffuse Large B Cell Lymphoma). He was referred to oncological department for neoadjuvant chemoradiotherapy. Conclusion and <i>Recommendation</i>: Primarily breast lymphoma is extremely rare among male, showing features mimicking breast carcinoma. Incisional biopsy was recommended for investigation of breast lump especially among males.

Portable Dynamic Chest Radiography: Literature Review and Potential Bedside Applications.

Dynamic digital radiography (DDR) is a high-resolution radiographic imaging technique using pulsed X-ray emission to acquire a multiframe cine-loop of the target anatomical area. The first DDR technology was orthostatic chest acquisitions, but new portable equipment that can be positioned at the patient's bedside was recently released, significantly expanding its potential applications, particularly in chest examination. It provides anatomical and functional information on the motion of different anatomical structures, such as the lungs, pleura, rib cage, and trachea. Native images can be further analyzed with dedicated post-processing software to extract quantitative parameters, including diaphragm motility, automatically projected lung area and area changing rate, a colorimetric map of the signal value change related to respiration and motility, and lung perfusion. The dynamic diagnostic information along with the significant advantages of this technique in terms of portability, versatility, and cost-effectiveness represents a potential game changer for radiological diagnosis and monitoring at the patient's bedside. DDR has several applications in daily clinical practice, and in this narrative review, we will focus on chest imaging, which is the main application explored to date in the literature. However, studies are still needed to understand deeply the clinical impact of this method.

Persistent Shortness of Breath in Post-COVID-19 Patients: Inducible Laryngeal Obstruction Can Be a Cause

BackgroundInducible laryngeal obstruction (ILO) is the adduction of the true vocal folds during inspiration or, less frequently, expiration. Its etiology is unknown. PurposeThis study aimed to identify ILO as a possible cause of shortness of breath (SOB) in post-COVID-19 patients. MethodsA retrospective study was conducted on 59 post-COVID-19 adults complaining of shortness of breath. We collected the cases' clinical and chest imaging data, including demographic data, pulmonary function test, CT chest, and laryngeal endoscopic examination. A visual score was used to assign the severity of the glottic obstruction. The grades of this score ranged from 0 (complete patency) to 3 (almost complete closure). ResultsILO was detected in 8 out of 59 cases (13.5%). Two cases out of 8 had glottic closure grade 1, while 5 cases had glottic closure grade 2, and one had glottic closure grade 3. There was a positive correlation between ILO grades (the severity of glottic closure) and pulmonary function test (PFT) results (the degree of upper airway restriction). Pulmonary function tests in ILO have a specific pattern. It was typical for the expiratory loop to be normal and the inspiratory loop to be flattened. ConclusionILO is a possible cause of SOB in post-COVID-19 adult cases. It should be considered during evaluation and management.

Needle Aspiration in Tuberculosis-Associated Secondary Spontaneous Pneumothorax

Introduction: The management of tuberculosis-associated secondary spontaneous pneumothorax mostly requires chest tube insertion for complete drainage and resolution. We reported a case of tuberculosis-associated secondary spontaneous pneumothorax that improved with needle aspiration. Case: A 29-year-old female with pulmonary tuberculosis presented with sudden onset shortness of breath. Chest examination revealed asymmetry, decreased vocal fremitus, hypersonor, and decreased vesicular sound in the right lung field. Chest radiograph showed right pneumothorax with a 2 cm intrapleural distance. Needle aspiration was performed because the patient refused chest tube insertion. The first needle aspiration evacuated approximately 615 cc of air. The second needle aspiration was repeated 24 hours later due to clinical deterioration, and 610 cc of air was evacuated. Chest radiograph evaluation on the 6th day of treatment showed no pneumothorax. During hospitalization, the patient received oxygen therapy, anti-tuberculosis drugs, chest physiotherapy, and other symptomatic therapies such as mucolytics. The patient's condition improved, and she was discharged on the 9th day of hospitalization. Tuberculosis-associated secondary pneumothorax occurs in 1-3% of cases. Conclusion: Needle aspiration is a therapeutic modality for tuberculosis-associated secondary spontaneous pneumothorax. This modality has several advantages, including shorter length of stay, less cost and pain, and fewer complications. Needle aspiration combined with oxygen therapy, anti-tuberculosis drugs, and chest physiotherapy should be the modality of treatment for tuberculosis-associated secondary pneumothorax.

Exposure frequency and radiation dose from CT examinations in Huaian.

This study quantified the exposure frequency and established the local diagnostic reference levels (DRLs) for the most common computed tomography (CT) examinations. A combined method census and sampling survey was used to quantify both frequency and radiation dose of CT examinations. Data were acquired through Picture Archiving and Communication System (PACS) or Radiology Information System (RIS). The annual frequency of CT examinations was 239.8 per 1000 inhabitants. The P75 of volume CT dose index (CTDIvol) to adult patients from CT scanning for head, chest, abdomen and lumbar spine examinations were 63.0, 12.4, 20.0 and 24.0mGy, respectively. The P75 of dose-length product were 858.6, 416.0, 620.7 and 559.2mGy·cm, respectively. This dose audit of CT practice can act as a starting point for establishing Huaian local DRLs and could be a reference for dose optimisation in China. This study compared DRLs in different countries and analysed some reasons for the rapid growth of CT examination frequency in Huaian.

Evaluation of radiation dose and radiation-induced cancer risk associated with routine CT scan examinations

Using patient-specific data, the present study aimed to identify organ and effective dose to estimate the lifetime attributable risks (LARs) of cancer incidence and mortality associated with routine CT procedures. A cross-sectional investigation was conducted on 515 patients who underwent CT scan. The effective dose was computed using two methods: first, the ImPACT software and relevant conversion factors. Second, the effective dose was determined using the scanner-derived DLP and AAPM TG 23's conversion factor. Using the biological effects of ionizing radiation (BEIR VII) report, LAR of cancer incidence and mortality were computed. The greatest mean organ doses for abdomen-pelvis, routine chest, chest HRCT, brain, and sinus examinations were 20.64 ± 3.27 mGy (kidneys), 21.55 ± 5.47 mGy (thymus and esophagus), 10.51 ± 1.31 mGy (thymus and esophagus), 22.72 ± 3.01 mGy (lens), and 18.56 ± 1.25 mGy (lens) respectively. Using ImPACT dosimetry software, the mean effective dose for routine chest, abdomen-pelvis, HRCT chest, brain, and sinus examinations was 8.46 mSv, 10.13 mSv, 4.19 mSv, 1 mSv, and 0.68 mSv, respectively. Using the DLP to effective dose conversion factor, the mean effective dose was lower. The mean cancer incidence risks per 100,000 people were 63.33, 54.98, 27.82, 6.31, and 5.22 for abdomen-pelvis, routine chest, HRCT, brain, and sinus examinations, respectively. The mean LAR of cancer mortality for all cancer was 38.22, 33.17, 16.72, 3.87, 2.93 for abdomen-pelvis, routine chest, HRCT, brain, and sinus examinations, respectively, per 100,000 people. Thus, CT scan exams are connected with a non-negligible risk of cancer, and patient radiation dose must be optimized to limit radiation risk.

Bilateral Peritonsillar Abscess in Pediatric Age: A Case Report

Background: Bilateral peritonsillar abscesses are a rare occurrence in children. Peritonsillar abscess is characterized by the pushing of the tonsils forward and toward the uvula. Untreated acute tonsillitis can lead to the development of peritonsillar abscesses as an early complication. Case presentation: The study presents a rare case report of a 5-year-old male with no prior medical conditions presented with a history of fever (38.5°) and a runny nose for the past 2 days. No abnormalities were observed in chest, cardiovascular, abdominal, or central nervous system examination. Nevertheless, the tonsils appeared to be pushed by a mass and the uvula deviated. Computed tomography (CT) revealed enlarged bilateral palatine tonsils with a few small peritonsillar abscesses measuring 0.7 cm. Thus, bilateral palatine tonsillitis with few peritonsillar small abscesses associated with multilevel cervical lymphadenopathy was diagnosed. Conclusion: The emphasis of the report is the importance of considering peritonsillar abscess as a differential diagnosis when encountering a child with previously reported clinical presentations and characteristics, as in the aforementioned case.

Thoracic Endometriosis Syndrome: a case series and review of literature

Background: The presence of endometrial tissue in the tracheobronchial tree, pleural, and lung is normally referred to as thoracic endometriosis. The association of catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and pulmonary nodules is referred to as thoracic endometriosis syndrome (TES). TES is rare but not as rare as it has always been thought of.
 Case summaries:
 Case 1: We present EA, a 26-year-old chef/baker who presented to our unit on account of recurrent cyclical right sided chest pain and difficulty in breathing, recurrent haemoptysis and cyclical abdominal pain and swelling with multiple tender umbilical nodules. On general physical examination she was found to be in respiratory distress but not cyanosed with peripheral arterial oxygen saturation 97% on room air. Examination of the chest revealed a right sided chest fullness and reduced movement with breathing. Percussion note was stony dull and absent of breath sound on right hemithorax. Abdominal examination revealed a moderately distended abdomen with positive fluid thrill. Both Pleurocentesis (thoracocentesis) and paracentesis abdominis yielded a haemorrhagic fluid acellular and pleural and lung biopsy demonstrated endometrial stroma and glands. Imaging examination by way of chest X-ray showed a homogenous opacity of the right hemithorax, and pulmonary nodule following drainage. A diagnosis of Thoracic Endometriosis Syndrome was made. She had VAT with lung and pleural biopsy, pleural abrasion and a thoracostomy tube drainage.
 Case 2: We present IAE, a 29year-old Po+0 who presented to our unit on account of recurrent cyclical right sided chest pain and difficulty in breathing, unproductive cough. On general physical examination she was found to be in moderate respiratory distress but not cyanosed with peripheral arterial oxygen saturation of 98% on room air. Chest examination revealed an apical flattering of anterior chest wall with left trachea deviation. Percussion note was stony dull on the right lower third and hyper resonance middle and upper zones of right hemithorax. Pleurocentesis (thoracocentesis) yielded air and haemorrhagic fluid acellular and pleural and lung biopsies demonstrated endometrial stroma and glands. Imaging examination by way of chest X-ray and chest CT-scan showed air fluid level of the right hemithorax. A diagnosis of TES was made. She had Laparoscopy and VAT at the same sitting with pleural and lung biopsies. She was managed medically after closed thoracostomy tube drainage. She had partial collapse of right lower lobe and thoracotomy with right lower lobectomy was planned but patient declined. She also had Stage IV endometriosis by (rASRM)/ENZIAN systems
 Case 3: We present JA a 29-year-old lady, a filling station attendant who presented to our unit with a history of gradual onset of right sided chest pain, progressive difficulty in breathing and non-productive cough, and abdominal pain and swelling. On general physical examination she was found to be in respiratory distress but not cyanosed with SPO2 of 98% on room air. Examination of the chest revealed a right apical flattening, reduced ipsilateral chest movement with breathing. Percussion notes were stony dull and absent air entry on the ipsilateral hemithorax. Abdominal examination showed a mildly distended abdomen with a positive shifting dullness. Both Pleurocentesis (thoracocentesis) and paracentesis abdominis yielded a haemorrhagic fluid acellular at cytology and pleural and lung biopsy demonstrated endometrial stroma and gland. Imaging examination by way of chest X-ray showed a homogenous opacity of the right hemithorax. A diagnosis of Familial Thoracic Endometriosis Syndrome (FTES). Had USS guided lung and pleural biopsy and a thoracostomy tube drainage. She had chemical pleurodesis with tetracycline
 Conclusion: Thoracic endometriosis syndrome is the diagnosis in a lady of reproductive age who present with cyclic or a cyclical recurrent right sided chest pain, cyclical or a cyclical dyspnoea, haemoptysis, cyclical or a cyclical abdominal swelling and peritonitis.

Distribution of regional lung function in upright healthy subjects determined by electrical impedance tomography in two chest examination planes.

Objective. The variation in pulmonary gas content induced by ventilation is not uniformly distributed in the lungs. The aim of our study was to characterize the differences in spatial distribution of ventilation in two transverse sections of the chest using electrical impedance tomography (EIT).Approach. Twenty adult never-smokers, 10 women and 10 men (mean age ± SD, 31 ± 9 years), were examined in a sitting position with the EIT electrodes placed consecutively in a caudal (6th intercostal space) and a cranial (4th intercostal space) chest location. EIT data were acquired during quiet breathing, slow and forced full expiration manoeuvres. Impedance variations representing tidal volume (VT), vital capacity (VC), forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were calculated at the level of individual image pixels and their spatial distribution was determined using the following EIT measures: the centres of ventilation in ventrodorsal (CoVvd) and right-to-left direction (CoVrl), the dorsal and right fractions of ventilation, the coefficient of variation (CV) and the global inhomogeneity (GI) index.Main results. The sums of pixel ventilation-related impedance variations reproduced reliably the volumetric dissimilarities amongVT, VC, FEV1and FVC, with no significant differences noted between the two examination planes. Significant differences in ventilation distribution were found between the planes during tidal breathing and slow full expiration, mainly regarding the ventrodorsal direction, with higher values of CoVvdand dorsal fraction of ventilation in the caudal plane (p< 0.01). No significant differences in the spatial distribution of FEV1and FVC were detected between the examination planes.Significance. The spatial distribution of ventilation differed between the two examination planes only during the relaxed (quiet breathing and slow VC manoeuvre) but not during the forced ventilation. This effect is attributable to the differences in thoracoabdominal mechanics between these types of ventilation.

Radiation dose assessment: Establishment of local diagnostic reference levels for selected radiography examinations across three prominent hospitals in Sudan

Due to variation among radiographers’ practice, and the importance of unifying practice during radiography for optimizing radiation level and image quality, the current manuscript aims to assess the radiation dose level and propose local diagnostic reference levels (LDRL) for posterior-anterior (PA) chest, antero-posterior (AP) abdomen, and pelvis examinations in two hospitals in Khartoum (‘K’) and one hospital in Wad-Medani (‘M’) cities, Sudan. Along with patient demographics like height and weight, the radiation exposure parameters including tube potential, current, and radiation duration were documented. This included 732 patients whose tests were conducted at one of three departments located in two different cities. The entrane surface air kerma (ESAK) was calculated using DosCal software and an Unfors -Xi-meter. The average ESAK for an X-ray of the chest was 0.18 mGy in M, 0.19 mGy in K (averaged over two hospitals in the K), for the abdomen it was 1.1 and 1.23 mGy, and for the pelvis it was 1.8 and 01.9 mGy respectively. The proposed DRL was achieved from the third quartile of radiation dosage of data, and it was 0.21, 1.7 and 1.9 mGy for the chest, abdomen and pelvis respectively. There was a wide variation in dosage levels among the three hospitals. The current proposed DRL was lower than most literature for the chest, abdomen and pelvis. More studies are recommended for other examinations such as skull and contrast media studies.

Seorang Wanita Usia 23 Tahun Dengan Anemia Mikrositik Hipokromik Suspect Systemic Lupus Erythematosus (SLE)

Systemic Lupus Erythematosus (SLE) is an autoimmune inflammatory disease with diverse clinical manifestations, disease course and prognosis, and it is difficult to predict the onset of acute and subtle manifestations, can attack various organs of the body, and can recur. Hematological manifestations in SLE occur frequently and are one of the criteria for ACR. Thrombocytopenia occurs in 25% - 50% of patients, leukopenia occurs in around 50% and hemolytic anemia with positive Coombs test results in around 10%. Cytopenia that occurs is usually the result of peripheral damage mediated by autoantibodies that cause bone marrow hypercellularity. In rare cases, hypocellularity occurs in the bone marrow due to mediation of T cells that inhibit hemopoetic cells, which causes bone marrow failure and causes anemia gravis. A 23 year old woman came with complaints of paleness, fatigue, decreased appetite, joint pain, nausea, vomiting, headaches, dizzy eyes. On laboratory examination on June 12 2023, microcytic hypochromic anemia was found, on June 13 2023, microcytic hypochromic anemia was found, on peripheral blood morphology examination, anemia was suspected due to iron deficiency, and there was a bacterial and parasitic infection process, on June 15 2023, hypokalemia was found. , hyperchloremia, hypocalcemia. On June 16, 2023, microcytic hypochromic anemia was found. On ECG examination, benign Ves arrhythmia was found. On chest examination, the lung showed no abnormalities, the cast size was normal. On ultrasound examination, Nephrolithiasis Dextra was found. So it was found on physical examination, and the patient's supporting examination was confirmed as microcytic hypochromic anemia suspect systemic lupus erythematosus, however in the patient in this case report it could not be established as systemic lupus erythematosus, because the patient was not willing to be referred to Zainal Abidin General Hospital, Banda Aceh for treatment. further examination.

Care of Injured Children Compared to Adults at District and Regional Hospitals in Ghana and the Impact of a Trauma Intake Form: A Stepped-Wedge Cluster Randomized Trial

BackgroundThis study aimed to determine the effectiveness of a standardized trauma intake form (TIF) to improve achievement of key performance indicators (KPIs) of initial trauma care among injured children, compared to adults, at non-tertiary hospitals in Ghana. MethodsA stepped-wedge cluster randomized trial was performed with research assistants directly observing the management of injured patients before and after introducing the TIF at emergency units of 8 non-tertiary hospitals for 17.5 months. Differences in outcomes between children and adults in periods before and after TIF introduction were determined with multivariable logistic regression. Differences in outcomes among children after TIF introduction were determined using generalized linear mixed regression. ResultsManagement of 3889 injured patients was observed; 757 (19%) were children <18 years. Trauma care KPIs at baseline were lower for children compared to adults. Improvements in primary survey KPIs were observed among children after TIF introduction. Examples include airway assessment [279 (71%) to 359 (98%); adjusted odds ratio (AOR): 74.42, p = 0.005)] and chest examination [225 (58%) to 349 (95%); AOR 53.80, p = 0.002)]. However, despite these improvements, achievement of KPIs was still lower compared to adults. Examples are pelvic fracture evaluation [children: 295 (80%) vs adults: 1416 (88%), AOR: 0.56, p = 0.001] and respiratory rate assessment (children: 310 (84%) vs adults: 1458 (91%), AOR: 058, p = 0.030). ConclusionsWhile the TIF was effective in improving most KPIs of pediatric trauma care, more targeted education is needed to bridge the gap in quality between pediatric and adult trauma care at non-tertiary hospitals in Ghana and other low- and middle-income countries. Type of StudyStepped-wedged cluster randomized controlled trial. Level of EvidenceI.

Feasibility study for the evaluation of doses received by organs during medical exposure for pediatric patient undergoing CT scan and estimation of the potential risk of radiation-induced cancers

Computed Tomography (CT) continues to contribute a significant portion of the total collective dose delivered to the public from medical procedures involving ionizing radiation. Children are considered to be at higher risk of developing radiation induced cancer due to the young age of exposure and increased tissue radio sensitivity. Organ dose estimation is essential for pediatric patient cancer risk assessment. The aim of this study was to evaluate the excess risk of radiation induced cancer following exposure to low-dose ionizing radiation from pediatric CT scans.We collected information from Radiation Dose Structured Report (RDSR) in 2 radiology department for 3 protocols and three (3) different age group in pediatric CT scan.We estimated the excess of cancer risk by using the Radiation Risk Assessment Tool RadRAT). For that, we calculate first the organ doses with National Cancer Institute for CT (NCICT). Effective dose and Size Specific Dose Estimate were also estimated, CTDI and DLP recorded from the RDSR were compared by the ones given by the software. The doses received by 30 organs including both inside and outside the scanning range were calculated and compared for the different age groups and protocols.The excess risk observed here range between 0.6 and 10.1‰ for respectively the thorax and Abdomen protocol in boy's cohort. This can be due to the significant dose variability observed among radiological protocols defined for the same CT scan and patient of the same age. For a head examination, a ratio of 2–4, depending on the age of the child, is estimated between the maximum and minimum doses delivered to the brain. For the other types of examination, this ratio is even greater: around 9 for chest examinations, 16 for abdominopelvic explorations.Careful justification of pediatric CT scans and dose optimization should be available in hospitals to minimize risks.

Perbandingan Dosis Radiasi Pemeriksaan Radiografi Thoraks PA Menggunakan Faktor Eksposi: Standar dan High kVp Berdasarkan Database DRL Si-INTAN BAPETEN

The usage of high kV has yet to be debated, so it is not fully used in PA chest radiographic examinations. However, The World Health Organization (WHO) and the Commission of European Communities (CEC) recommend using high kV, which can reduce the radiation dose to a minimum while maintaining the quality of the radiographic image. This study aimed to analyze the radiation dose for posterior-anterior (PA) chest radiography examinations using exposure factors: standard and high kV. This research method uses a retrospective study of the results of PA chest radiography examinations database diagnostic reference level (DRL) BAPETEN between 2018-2022. The PA chest examination data are the procedure, patient position, age, body weight, exposure factors (kVp and mAs), and ESAK dose (mGy). Then, use a standard exposure factor between 60-75 kVp and tube current-time of 6-12 mAs, while the exposure factor is high kV between 90-109 kVp and tube current-time of 0.7-4 mAs. After that, statistical analysis was carried out using IBM SPSS version 26 and Microsoft Excel. Determination of the average value and percentage difference in radiation dose of standard exposure factors and high kV. Then, proceed with statistical tests mann-whitney to determine the difference in the average radiation dose value between standard and exposure factors high kVp. The study showed that the average radiation dose for the standard kV exposure factor for the PA chest radiography examination was 0.179 mGy, while the high kV was 0.146 mGy. The dose difference between standard kV and high kV is 18.43%, with exposure factor radiation dose high kV lower than the standard exposure factor. For statistical test results, mann-whitney results p-value &lt; 0,000. High kV could be a procedure to optimize exposure factors for PA chest radiography examination. Keywords: Exposure factors, High kV, Optimization, DRL, Chest PA