Complete Chest Research Articles

Abstract 482: Differences in Ground Reaction Forces and Chest Compression Release Velocity in Professional and Lay Rescuers With and Without the Use of Real-Time CPR Feedback

Purpose: Chest compression release velocity (CCRV) has been associated with survival and favorable neurological outcome after cardiac resuscitation. Both complete chest release and high CCRV contribute to improved venous return during CPR. Differences in compression forces delivered by professional and lay rescuers are reported, which may contribute to differences in CCRV. The aim of this pilot study was to investigate differences in ground reaction force (GRF) and CCRV between professional and lay rescuers during CPR performed on a manikin with and without real-time feedback. Methods: Professional (n = 5) and lay rescuers (n = 11) performed two minutes of continuous compressions on a manikin positioned over a force plate for two trials. CPR feedback provided by a defibrillator was disabled in the first trial and enabled in the second. CPR pads containing an accelerometer were used to calculate individual compression characteristics. Relative maximum and minimum GRFs were calculated for each compression cycle and averaged over each trial. Paired and independent sample t tests and Pearson correlations were conducted in STATA 15.1. Results: CCRV was higher in professionals vs. lay rescuers with feedback disabled and enabled ( p <0.05). Professionals had greater maximal and lower minimum forces than lay rescuers without feedback ( p <0.05), though there were no differences between groups with feedback enabled (Table 1). CCRV was associated with minimum force (r = -0.63, p <0.01) and force range (r = 0.78, p <0.01) in all rescuers. Analysis of GRFs by CCRV for all rescuers indicated lower force minimum (9.71 + 3.16 N, p <0.05) with CCRV >400 mm/s in comparison to CCRV 300-400 mm/s (39.73 + 8.91 N) and CCRV 200-300 mm/s (63.82 + 16.98 N). Conclusions: CPR feedback attenuated differences in GRF between professional and lay rescuers. CCRV was greater in professionals and was associated with measures of GRF, and thus may serve as an indicator of both velocity and amount of chest release.

Abstract 236: Complete Recoil Duration Declines Over the Course of Longer Resuscitations

Introduction: CPR guidelines call for chest compressions within rate and depth ranges and complete chest recoil. Guidelines development has relied on data from the first 10 minutes of resuscitations. We investigated the influence of rate, depth and chest stiffness on complete recoil duration in longer resuscitations. Hypothesis: Decreasing chest stiffness will contribute to reduced complete recoil duration over the course of long resuscitations. Methods: Acceleration and force signals were from monitors used in continuous compression CPR during out-of-hospital resuscitations of adults treated by Tualatin Valley Fire & Rescue (Tigard, OR) from 2013 through 2017. Complete recoil was defined as return to within 5 mm of baseline in the absence of leaning (release force > 2.5 kg-f), stiffness as peak force/peak depth. Influences of rate, depth and stiffness on complete recoil duration were modeled with linear mixed effects models with a random intercept and slope clustered by patient. Results: A total of 1,076,808 compressions without leaning (93% of compressions) were measured from 616 cases with 1888 ± 1118 compressions/case (mean ± std). Observed increases in rate (7%) and depth (2%) were modest, while stiffness declined markedly (-33%) (Fig 1a). All of these changes tend to reduce the duration of complete recoil (p < 0.001). Mean complete recoil duration decreased 21% (Fig 1a) from 160 ms to 126 ms (Fig 1b). Despite its large relative change, stiffness had little effect on complete recoil duration, as did depth. Increasing rate explained most of the decline in complete recoil duration (Fig 1b). Conclusions: Substantial decline in chest stiffness over the course of long resuscitations contributes to reduction of complete recoil duration but little compared to increasing rate. Careful compliance with rate guidelines is paramount in maintaining periods of complete recoil. Depth is relatively well-controlled. Chest molding (decreased stiffness) is of secondary importance.

Does the use of cardiopulmonary resuscitation feedback devices improve the quality of chest compressions performed by doctors? A prospective, randomized, cross-over simulation study

The aim of the study was to compare the quality of chest compressions (CCs) carried out with and without the use of the TrueCPR device during simulated cardiopulmonary resuscitations conducted by trainee doctors. The study was a prospective, randomized, cross-over simulation study. The study involved 65 trainee doctors who were tasked with performing a 2-min cycle of uninterrupted CCs under conditions of a simulated cardiopulmonary resuscitation of adults. CC were carried out in two scenarios: with and without TrueCPR chest compression support. Participants did not have experience in the use of CCs prior to this study. The depth of compressions in regard to CC techniques were varied by 45 mm (IQR 43-48) for manual CC and 53 mm (IQR 51-55) for the TrueCPR device (p < 0.001). The incidence of CCs with and without TrueCPR was: 112 (IQR 103-113) vs. 129 (IQR 122-135) compressions (p = 0.002). The degree of complete chest relaxation with the TrueCPR device was 95% (IQR 76-99) and without the device, 33% (IQR 29-38) (p < 0.001). In the simulation study performed, the use of the TrueCPR device resulted in a significant improvement in the quality of CCs in relation to frequency and depth of CCs and correctness of chest relaxation.

Evaluation of Copeptin during Pulmonary Exacerbation in Cystic Fibrosis.

Copeptin was found to be a stable biomarker of inflammation and stress response in cardiac, renal, metabolic, and respiratory conditions such as pneumonia. The aim of this study was to investigate the copeptin levels in biological fluids (serum and sputum supernatant) of cystic fibrosis pediatric patients during pulmonary exacerbation and remission and to investigate the possible influence of copeptin levels on disease severity and quality of life. Copeptin serum concentrations were measured in 28 pediatric cystic fibrosis (CF) patients: 13 in stable condition and 15 during pulmonary exacerbation. In 10 CF patients, copeptin was also measured in the sputum. In all the patients, we assessed complete blood count, BMI, sputum culture, lung function, and chest imaging (with Brasfield score). The severity of symptoms was assessed using the Shwachman-Kulczycki (SK) score, and the quality of life was assessed with the Cystic Fibrosis Quality of Life Questionnaire-Revised (CFQ-R). Copeptin concentrations in serum and sputum supernatant was measured using an ELISA kit. Statistical analysis was done in Statistica v.12. Serum and sputum copeptin levels were higher in CF patients during pulmonary exacerbation than in a stable period, but the differences were not significant (p = 0.58 and p = 0.13, respectively). Copeptin did not correlate significantly with any clinical, laboratory, or spirometry markers of exacerbation. There was, however, a significant inverse correlation between the serum copeptin level and symptoms severity (r = ‐0.77, p = 0.008) and radiological changes (r = ‐0.5626, p = 0.036) during pulmonary exacerbation in pediatric CF patients. Copeptin also inversely correlated with the quality of life domains in CF patients: vitality and eating habits, mostly loss of appetite (p = 0.031 and p = 0.016, respectively). Copeptin may be useful to identify patients with a higher risk of deterioration to improve their outcomes.

Fever in the tropics: aetiology and clinical profile of fever of unknown origin in children-a prospective observational study in a tertiary care hospital in South India

Background: Fever of unknown origin (FUO) is an important cause of morbidity and mortality in children, especially in tropical countries with varied aetiology and clinical presentation. Aim of this study is to determine the aetiology and outcome of FUO in Indian children. Study design is Prospective, observational study. Methods: We enrolled 75 children aged 1 to 12 years who were admitted with fever &gt;8 days to the paediatric department from January 2015 to August 2016. Initial evaluation included complete blood count, peripheral smear, urine analysis, chest radiography, blood culture and tuberculin test. Results: In 72 children (96%), a definitive diagnosis could be established, whereas 3 children (4%) remained undiagnosed. Most common aetiology of FUO was infectious disease (90.6%) followed by malignancy (4%) and collagen vascular disease (1.3%). Among the infections group, scrub typhus was found to be the commonest aetiology (52%).Conclusions: Infections were the most common etiological factor for FUO in children aged 1-12 years of our region.

The TrueCPR device in the process of teaching cardiopulmonary resuscitation: A randomized simulation trial.

Background:International resuscitation guidelines emphasize the importance of high quality chest compressions, including correct chest compression depth and rate and complete chest recoil. The aim of the study was to assess the role of the TrueCPR device in the process of teaching cardiopulmonary resuscitation in nursing students.Methods:A prospective randomized experimental study was performed among 94 first year students of nursing. On the next day, the participants were divided into 2 groups—the control group practiced chest compressions without the use of any device for half an hour, and the experimental group practiced with the use of TrueCPR. Further measurement of chest compressions was performed after a month.Results:The chest compression rate achieved the value of 113 versus 126 (P < .001), adequate chest compression rate (%) was 86 versus 68 (P < .001), full chest release (%) 92 versus 69 (P = .001), and correct hand placement (%) 99 versus 99 (P, not significant) in TrueCPR and standard BLS groups, respectively. As for the assessment of the confidence of chest compression quality, 1 month after the training, the evaluation in the experimental group was statistically significantly higher (91 vs 71; P < .001) than in the control group.Conclusions:Cardiopulmonary resuscitation training with the use of the TrueCPR device is associated with better resuscitation skills 1 month after the training. The participants using TrueCPR during the training achieved a better chest compression rate and depth with in international recommendations and better full chest release percentage and self-assessed confidence of chest compression quality comparing with standard cardiopulmonary resuscitation training.

Clinical profile of children with tuberculosis from a semi urban referral centre in South India: a prospective observational study

Background: Global TB report 2018 reports that in India, an estimated 2.2 lakh children become ill with tuberculosis (TB) each year. In spite of new rapid diagnostic methods, lack of gold standard test for confirming childhood tuberculosis remains an obstacle for the effective reporting of childhood TB and hence these cases often remain under diagnosed. The main objective was to study the clinical profile of childhood tuberculosis with relevant laboratory investigations aiding in early diagnosis.Methods: A prospective observational hospital-based study was conducted in IRT-Perundurai medical college hospital from April 2016 to March 2018. Children less than 18 years of age with tuberculosis were included in the study. Demographic details, presenting symptoms, family history of TB contact, nutritional status and clinical examination findings were documented. Complete blood count, ESR, Mantoux test, chest X-ray and sputum analyses for AFB were done for all patients.Results: Out of the total 124 children studied, the most common age of presentation of tuberculosis was &gt;10 years of age (n=58, (46.8%)). There was a female preponderance (n=71 (57.25%)). Pulmonary tuberculosis (n= 87, (70.16%)) was the most common form followed by extra pulmonary (n=32, (25.80%)) and disseminated type (n=5, (4%)). Lymph node TB was the most common manifestation (n=20, 62.50%) among extra pulmonary form. Cough (n=75, 60.5%) with sputum (n=55,44.4%) were the predominant symptoms noted followed by fever (n=53, 42.7%). Bacteriological diagnosis was possible in 19.5% (n=17) patients only.Conclusions: This study reinforces that the diagnosis of childhood tuberculosis is based on the constellation of symptom evaluation, contact history, clinical examination, with relevant laboratory investigations.

CT-based radiomics analysis for evaluating the differentiation degree of esophageal squamous carcinoma

To build a CT-based radiomics predictive mode to evaluate the differentiation degree of the esophageal squamous carcinoma. Methods: A total of 160 patients with surgical pathology, complete clinical data and chest CT scanning before operation were retrospectively collected from January 2008 to August 2016. All patients were assigned randomly to a primary data set and an independent validation. Texture analysis was performed on CT images, while the carcinomas were performed by manual segmentation to extract the radiomics features. Radiomics features were extracted and 9 radiomics signatures were finally selected after dimension reduction. Radiomics features were extracted and established via Matlab. Multivariable logistic regression analysis was performed to build the predictive model. A 10-fold cross-validation was used for selecting parameters in the least absolute shrinkage and selection operator (LASSO) model by minimum criteria. The receiver operating characteristic (ROC) curves and areas under ROC curve (AUC) were used to compare the model performance in the primary validation and the independent validation for evaluating the differentiation degree of esophageal squamous carcinoma. Results: Radiomics signature showed great effect in discriminating primary data set and independent validation. The predictive model had a good performance in primary data set. The AUC was 0.791, the sensitivity was 81.6%, and specificity was 72.3%. In the independent validation, the AUC was 0.757, the sensitivity was 70.0%, and the specificity was 73.0%. Conclusion: The predictive model can be used for evaluating the differentiation degree of esophageal squamous carcinoma efficiently, which can be helpful to clinicians in diagnosis and choice of treatment for esophageal squamous carcinoma.

Quantitative and semi-quantitative computed tomography analysis of interstitial lung disease associated with systemic sclerosis: A longitudinal evaluation of pulmonary parenchyma and vessels.

ObjectivesTo evaluate interstitial lung disease associated with systemic sclerosis (SSc-ILD) and its changes during treatment by using quantitative analysis (QA) compared to semi-quantitative analysis (semiQA) of chest computed tomography (CT) scans. To assess the prognostic value of QA in predicting functional changes.Materials and methodsWe retrospectively selected 35 consecutive patients with SSc-ILD with complete pulmonary functional evaluation, Doppler-echocardiography, immunological tests, and chest CT scan at both baseline and follow-up after immunosuppressive therapy. CT images were analyzed by two chest radiologists for semiQA and by a computational platform for texture analysis of ILD patterns (CALIPER) for QA. Concordance between semiQA and QA was tested. Traction bronchiectasis severity was scored. Analysis of ROC curves was performed.ResultsSeventy CT scans were analyzed and QA failed in 4/70 scans. Thus, the final population included 31/35 patients (51.3±12.1 years). QA had a weak-to-good concordance with semiQA (ICC reticular:0.275; ICC ground-glass:0.667) and QA correlated better than semiQA (r = -0.3 to -0.74 vs r = -0.3 to -0.4) with functional parameters. Both methods correlated with traction bronchiectases score and pulmonary artery diameter at CT. A pulmonary artery diameter ≥29mm distinguished patients with lower lung volumes and ILD extent greater than 39% (p<0.001). Changes in QA patterns during treatment were not accurate (AUC: 0.50 to 0.70; p>0.05) in predicting disease progression as assessed by functional parameters, whereas variation in total lung volume at QA accurately predicted changes in the composite functional respiratory endpoint with FVC% and DLco% (AUC = 0.74; 95%CI: 0.54 to 0.93; p = 0.03).ConclusionsPulmonary QA of CT images can objectively quantify specific patterns of ILD changes during treatment in patients with SSc-ILD. Changes in QA patterns do not correlate with functional changes, but variation in total lung volume at QA accurately predicted changes in the composite functional respiratory endpoint with FVC% and DLco%. Pulmonary artery diameter at CT reflects the interstitial involvement, identifying patients with more severe prognosis.

A clinical and echocardiographic study in elderly hypertensive patients

Introduction: Isolated systolic hypertension is the commonest cause of raised blood pressure in the older population. As the age progresses more and more persons will be hypertensive. It is a disease, which is definitely the most prevalent, remediable risk factor for cardiovascular diseases and cerebrovascular diseases. Objective: To study the clinical profile of hypertension in elderly, to find out associated risk factors, especially on cardiac through echocardiography. Materials and Methods: A total number of sixty elderly hypertensive patients of ?60 years with systolic blood pressure ? 140 and diastolic blood pressure ? 90 mm of Hg were included in this study. A detailed history with general and systemic examination with fundus examination was carried out. Complete blood count, urine analysis, blood sugar, renal profile, lipid profile, chest x-ray, electrocardiogram, and echocardiogram were done in all patients. Results: Sixty patients were evaluated, and the mean age was 67.72±7.004 years of which 35 (58.33%) were males and 25 (41.67%) females and the common age group was 60-65 years. Chest pain in 45% and breathlessness in 38.33% were commonest clinical presentation. Family history, smoking history and total cholesterol were associated risk factors of hypertension. Hypertensive retinopathy was observed in 38.33% patients. Ischemic changes in 31.67% followed by left ventricular hypertrophy in 20% were most common electrocardiographic findings. The echocardiographic evaluation showed left ventricular dysfunction in 63.33% was common entity in the form of left ventricular hypertrophy in 30%, left ventricular dilatation in 15% and left ventricular diastolic dysfunction in 48.33%. Ischemic heart disease was diagnosed in 55% patients. Out of these 18 (54.55%) had anterior, 4 (12.12%) lateral, 3 (9.09%) inferior and 4 (12.12%) septal infarcts. One patient had global hypokinesia, and three patients had more than one segment involvement. There was strong co relation b

Diagnostic Accuracy of Computed Tomography Scout Film and Chest X-ray for Detection of Rib Fractures in Patients with Chest Trauma: A Cross-sectional Study.

Background: Rib fractures are a major source of morbidity in patients with chest trauma. Computed tomography (CT) scout film is a low-dose image that is obtained prior to a complete chest CT study for all patients undergoing a CT scan. In this study, we evaluated the diagnostic performance of CT scout film vis-à-vis that of chest X-ray for detection of rib fractures using chest CT scan as the reference standard.Methods: A cross-sectional study was performed at the radiology department of Aga Khan University Hospital (Karachi, Pakistan) from October 1, 2013 to September 31, 2014. Patients who underwent CT chest for evaluation of thoracic trauma were included in the study. Sensitivity and specificity of chest X-ray and CT scout film were calculated.Results: A total of 207 patients were included in the study (193 were male). Penetrating and blunt thoracic injuries affected 104 (50.2%) and 103 (49.8%) patients respectively. On CT chest, 75 (36.2%) patients had evidence of rib fractures. Sensitivity and specificity of CT scout film for detection of rib fractures were 56% and 87.9%, while those of chest X-ray were 61.3% and 98.5% respectively. The overall accuracy of CT scout film and chest X-ray for detection of rib fractures were 76.3% and 85% respectively.Conclusion: Diagnostic performance of CT scout film for detection of rib fractures was comparable to that of the plain chest radiograph. CT scout film does not provide any additional information or advantage over a plain chest radiograph. In patients with severe thoracic trauma, CT chest remains the modality of choice for accurate delineation of rib fractures and associated internal injuries.

Primary Central Nervous System Lymphoma: An Experience of a Regional Cancer Center from India

Background: Primary central nervous system lymphoma (PCNSL) is a rare malignant non-Hodgkin's lymphoma and it accounts for 1% of all intracranial tumors. Only a few PCNSL studies have been reported from India, and hence, we conducted the retrospective study in our institute to analyze the main clinical features at diagnosis and the treatment results in PCNSL. Materials and Methods: We retrospectively reviewed the medical records of 32 patients with PCNSL who were treated from 2003 to 2014. A complete history was recorded, and the physical examination included neurological assessment. Baseline investigations such as complete blood count, blood biochemistry, chest X-ray, HIV serology, and two-dimensional echocardiography were also done. Contrast-enhanced computed tomography (CT) of the brain or magnetic resonance imaging, positron-emission tomography (if affordable), cerebrospinal fluid (CSF) analysis for cytology, histopathological diagnosis (following stereotactic or open biopsy), CT of the thorax and abdomen, and bone marrow biopsy were done. All patients received whole-brain radiotherapy (WBRT) (36–50 Gy) followed by cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) regimen for six cycles. Clinical features and the treatment results were analyzed. Results: A total of 32 patients with PCNSL were studied. The median age was 50 years (range: 32–70 years). Male: female ratio was 2.5:1. All the 32 patients were histologically diffuse large B-cell lymphoma. The most common presenting symptom was headache in 20 (62.5%) patients. The area of involvement was mainly cerebral hemispheres in 22 (68.8%) patients. Multifocal involvement was seen in 22 (68.8%) patients. CSF cytology was negative in all patients. All patients received WBRT (36–50 Gy) followed by CHOP regimen for six cycles. All patients were compliant to radiation as well as chemotherapy. On a median follow-up of 18 months, the median overall survival was 14 months (range: 1–80). Conclusions: Breaking the blood–brain barrier with radiotherapy followed by CHOP chemotherapy results in reasonable outcome in patients of PCNSL, especially in the Indian setting where general built and tolerance is low- to high-dose methotrexate regimens. Newer chemotherapy regimens or targeted therapies need to be evaluated to further improve the survival.

22 State of the art and breast cancer treatments in Tomotherapy

Introduction The most common female cancer is breast cancer. Classically performed in 3D conformational technique (RC3D) on a linear accelerator, it can also be performed on other machines such as Tomotherapy, mainly in case of treatment of both breasts or funnel breast. To use this treatment method for more indications of breast cancer requires a comparative study of ballistics from a linear accelerator with those of Tomotherapy. Methods The treatment delivery on Tomotherapy can be performed helically (”TomoHelical”) or using fixed beams (”TomoDirect 3DCRT” and ”TomoDirect IMRT”). A state of the art of the methods used supported by a comparative dosimetric study will enable us to associate a privileged treatment technique for each indication. Results At the time of writing this summary, the first results follow the publications: for breasts with or without tumor bed, TD-IMRT enable to cover the PTV with a better conformation and save better the organs at risk compared to the conventional technique. Nevertheless, it causes a higher inhomogeneity (hot spots) in the target volume. For complete breasts (with nodes and internal breast chain), double breasts and chest walls, the helical technique reduces the pulmonary and/ or cardiac dose. Conclusions The ballistics performed in Tomotherapy have proven to be mostly equivalent or better than those made in 3D. TD-IMRT appears to be a great technique for the treatment of a breast cancer with or without a tumor bed. The helical technique is adapted for the treatment of complete breasts and chest walls.

A parasternal intercostal perforator flap for esthetic reconstruction after complete chest keloid resection: A retrospective observational cohort study.

To report on the outcome of 35 patients with chest keloids who were treated with intercostal perforator flap surgery plus local radiotherapy at our hospital. We retrospectively analyzed the data of patients with chest keloid who under surgical resection at the Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China between March 2014 and July 2017. We retrieved patient demographic data, donor site position, the perforator pedicle, flap size, angle of flap rotation, complications, and recurrences from the medical records. All patients underwent perforator flap surgery for complete keloid resection followed by radiation at postoperative day 1 and 8 for a total dose 16-18Gy. Thirty-five patients were included in the retrospective analysis. Their mean age was 45.3years (range 24-67years). The mean keloid area was 5-7cm×6-10cm. Surgeries were successful in all cases. There were no perioperative complications. Good outcome with no apparent scar growth was achieved in 88.6% of the cases, and 11.4% of the cases achieved satisfactory outcome with partial scar growth in the incision, but no keloid was observed. Twenty-four months after surgery, none of the resected keloids recurred and none of the donor sites developed new keloids. Intercostal perforator flap surgery is an effective and safe approach for repair of wound formed as a result of excision of relatively large chest keloids which cannot be directly appositioned.

Optimal training frequency for acquisition and retention of high-quality CPR skills: A randomized trial

AimSpaced training programs employ short, frequent CPR training sessions to improve provider skills. The optimum training frequency for CPR skill acquisition and retention has not been determined. We aimed to determine the training interval associated with the highest quality CPR performance at one year. MethodsParticipants were randomized to 1-month, 3-month, 6-month, and 12-month CPR training intervals over the course of a 12-month study period. Practice sessions included repeated two-minute CPR practice sessions with visual feedback and verbal coaching until Excellent CPR was achieved, to a maximum of three attempts. Excellent CPR was defined as a two-minute CPR session with ≥90% of compressions with a depth of 50–60 millimeters, a rate of 100–120 per minute, and with complete chest recoil. CPR performance was assessed in all groups at 12 months. The primary outcome was the proportion of participants able to perform Excellent CPR in each group. ResultsA total of 167 participants were included in the analysis. Baseline assessment showed no difference in CPR performance (p = 0.38). Participants who were trained monthly had a significantly higher proportion of Excellent CPR performance (58%) than those in all other groups (26% in the 3-month group, p = 0.008; 21% in the 6-month group, p = 0.002; and 15% in the 12-month group, p < 0.001). ConclusionShort-duration, distributed CPR training on a manikin with real-time visual feedback is effective in improving CPR performance, with monthly training more effective than training every 3, 6, or 12 months.

Diagnostic Performance of Point of Care Ultrasonography in Identifying Etiology of Respiratory Distress in Neonates

Background: Numerous studies have shown the role of lung ultrasound in identifying etiology of respiratory distress in neonates. Aim of the Work: was to detect the efficacy of ultrasonography versus x-ray in identifying the etiology of respiratory distress in neonates. Patients and Methods: A cross sectional study that includes 50 neonates with respiratory distress. Each included subject was submitted to history taking, complete clinical examination and laboratory investigations including complete blood count and chest radiograph & US images. Results: In the present work, there was no significant difference among sex distribution and mode of delivery but male sex and cesarean sections are the predominant in each group. The reasons for respiratory distress from the clinical diagnosis were respiratory distress syndrome (n = 22), transient tachypnea of newborn (n = 23) and pneumonia (n = 5). The chest radiograph diagnosis of respiratory distress was RDS in 22 neonates, transient tachypnea of newborn in 24 neonates, pneumonia in 2 neonates and RDS or pneumonia in 2 neonates. Overall from the clinical scenario and radiological findings, the final diagnosis was RDS in 24 neonates, TTN in 24 neonates and pneumonia in 2 neonates. The ultrasound diagnosis of respiratory distress was RDS in 24 neonates, TTN in 24 neonates and pneumonia in 2 neonates. Conclusion: This study shows a clear superiority of lung ultrasound over the chest x-rays for the diagnosis of RDS, TTN and pneumonia. Chest Ultrasound cannot replace standard chest X-ray in detecting severity of neonatal RDS because of its tendency to overestimate RDS.

Rare presentation of Guillain-Barre syndrome with complete heart block and neuropathic chest pain mimicking acute coronary syndrome: a case report

Rare presentation of Guillain-Barre syndrome with complete heart block and neuropathic chest pain mimicking acute coronary syndrome: a case report

Abbreviated CT protocol for postoperative surveillance of renal cancer

IntroductionPostoperative surveillance protocols after nephrectomy for kidney cancer include periodic computed tomography (CT) scans of the chest and abdomen. A single study exposes the patient to 21 mSv (equivalent to 7-year exposure to natural background radiation). The objective of this study was to evaluate the hypothesis that an abbreviated CT protocol restricted to the chest and upper abdomen (i.e., to the level of the intervertebral disk L3–L4) is sufficient for routine postnephrectomy follow-up as it detects most tumor recurrence with lower radiation exposure. MethodsWe identified 493 patients treated with radical or partial nephrectomy for localized kidney cancer and followed with periodic CT scans of the chest and abdomen for prolonged periods. The frequency and location of cancer recurrence were documented. The ratio of infield recurrence for the complete chest, and abdomen and for the abbreviated protocol was recorded. The decrease in radiation exposure was calculated. ResultsAt a median follow up of 96 months, 82 patients (16.6%) developed recurrence. The frequent sites of recurrence were the lungs (53), the bones (9), and local recurrence (22). Complete chest and abdominal CT identified 78 of the recurrences (95%) and the abbreviated protocol identifying all but one of these (94%). The abbreviated protocol exposed the patient to 48% (standard deviation 4.3%) less radiation compared to the full protocol. ConclusionsUsing an abbreviated CT protocol that includes the chest and upper abdomen for surveillance after surgery of localized kidney cancer decreases radiation exposure by half with only a minor decrease in the sensitivity of the examination.

Practice Variation in Emergency Department Management of Children With Sickle Cell Disease Who Present With Fever.

Urgent medical evaluation is recommended for patients with sickle cell disease (SCD) and fever. Clear recommendations exist regarding certain aspects of treatment, but other areas lack evidence. We determined practice variation for children with SCD presenting with fever to the emergency department (ED). Retrospective chart review of children ages 3 months to 21 years with SCD presenting to the ED with fever greater than or equal to 38.5°C in the ED or preceding 24 hours. Visits from 3 sickle cell centers were included. Outcomes included blood culture, complete blood count, antibiotic treatment, chest x-ray, urinalysis, electrolytes, and hospital disposition. Differences greater than 10% were considered clinically meaningful. The population included 14,454 visits, of which 4143 (29%) were febrile and met all inclusion criteria. A complete blood count and blood culture were obtained at 94% of visits, and antibiotics were given at 91%, with no differences among sites. Meaningful differences existed for disposition, with 52%, 43%, and 99% of patients admitted to the inpatient units at hospitals A, B, and C, respectively. Differences were seen in obtaining a urinalysis (33%, 17%, and 21%), electrolytes (2%, 50%, and 12%), and chest x-rays for patients 2 years and older (78%, 77%, 64%) for hospitals A, B, and C, respectively. Significant variation exists in the proportion of children who receive a urinalysis, electrolytes, chest x-ray, and, most importantly, admission to the hospital. These examples of practice variation represent potential opportunities to define best care practices for children with SCD presenting to the ED for fever.

A Novel Method of Newborn Chest Compression: A Randomized Crossover Simulation Study.

Objective: To compare a novel two-thumb chest compression technique with standard techniques during newborn resuscitation performed by novice physicians in terms of median depth of chest compressions, degree of full chest recoil, and effective compression efficacy.Patients and Methods: The total of 74 novice physicians with less than 1-year work experience participated in the study. They performed chest compressions using three techniques: (A) The new two-thumb technique (nTTT). The novel method of chest compressions in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist. (B) TFT. With this method, the rescuer compresses the sternum with the tips of two fingers. (C) TTHT. Two thumbs are placed over the lower third of the sternum, with the fingers encircling the torso and supporting the back.Results: The median depth of chest compressions for nTTT was 3.8 (IQR, 3.7–3.9) cm, for TFT−2.1 (IQR, 1.7–2.5) cm, while for TTHT−3.6 (IQR, 3.5–3.8) cm. There was a significant difference between nTTT and TFT, and TTHT and TFT (p < 0.001) for each time interval during resuscitation. The degree of full chest recoil was 93% (IQR, 91–97) for nTTT, 99% (IQR, 96–100) for TFT, and 90% (IQR, 74–91) for TTHT. There was a statistically significant difference in the degree of complete chest relaxation between nTTT and TFT (p < 0.001), between nTTT and TTHT (p = 0.016), and between TFT and TTHT (p < 0.001).Conclusion: The median chest compression depth for nTTT and TTHT is significantly higher than that for TFT. The degree of full chest recoil was highest for TFT, then for nTTT and TTHT. The effective compression efficiency with nTTT was higher than for TTHT and TFT. Our novel newborn chest compression method in this manikin study provided adequate chest compression depth and degree of full chest recoil, as well as very good effective compression efficiency. Further clinical studies are necessary to confirm these initial results.