Full Inspiration Research Articles

Establishing Normative Values of Peak Expiratory Flow Rates in the Paediatric Population in Jharkhand.

Background The peak expiratory flow rate (PEFR) is the maximum flow rate (expressed as L/s) generated during a forceful exhalation, starting from full inspiration. It is an effort-dependent parameter and reflects large airway flow. It depends on lung recoil, muscular strength of patients, and voluntary effort. The PEFR is a simple and easy way to detect early changes in lung function. The PEFR can be measured by a peak flow meter or a spirometer; however, a spirometer is more accurate than a peak flow meter. The PEFR is known to vary according to age, gender, and anthropometric parameters like height, weight, BMI, ethnicity, and altitude. PEFR values for different populations are needed because they helpto determine the variable expiratory flow limitation in asthma. There is no study done to find out the normal PEFR in children in Jharkhand. Hence, this studyaimed to establish the reference values of the PEFR of children in Jharkhand. Methodology Three hundred and sixteen healthy children belonging to the age group of 6-18 years attending the OPD of Rajendra Institute of Medical Sciences, Ranchi were studied. All the children were asked to perform spirometry, and the PEFR was recorded. Patient demographic details like age, sex, height, weight, BMI, and ethnicity were documented. These factors were selectedto see how the PEFR of children in Jharkhand correlated with them and compare it with the values obtained from similar studies conducted in different parts of India. Results Three hundred and sixteen children were studied, consisting of 194 male participants and 122 female participants. The mean PEFR for maleparticipantswas 3.90±1.58L/s and for female participants, it was 4.04±1.49L/s. The correlation coefficient of the PEFR with height was 0.792, that of the PEFR with weight was 0.713 and that of the PEFR with BMI was 0.364. Hence, height is the best predictor of PEFR. The lowest correlation of BMI with PEFR shows that the recent rise in obesity in the paediatric population should not be expected to affect the lung function significantly. Conclusion The mean PEFR of children in Jharkhand is lower than that of children in northern (mean PEFR of maleparticipants=4.41 ± 1.54 L/s, mean PEFR of female participants = 4.17 ± 1.17 L/s) and southern India (mean PEFR of maleparticipants=4.88±1.29 L/s, mean PEFR of female participants = 4.25±1.29 L/s). Compared to neighbouring states in eastern India, the mean PEFR of children in Jharkhand is lower.

A Novel Meta-Heuristic Algorithm Based on Birch Succession in the Optimization of an Electric Drive with a Flexible Shaft

The paper presents the application of a new bio-inspired metaheuristic optimization algorithm. The popularity and usability of different swarm-based metaheuristic algorithms are undeniable. The majority of known algorithms mimic the hunting behavior of animals. However, the current approach does not satisfy the full bio-diversity inspiration among different organisms. Thus, the Birch-inspired Optimization Algorithm (BiOA) is proposed as a powerful and efficient tool based on the pioneering behavior of one of the most common tree species. Birch trees are known for their superiority over other species in overgrowing and spreading across unrestricted terrains. The proposed two-step algorithm reproduces both the seed transport and plant development. A detailed description and the mathematical model of the algorithm are given. The discussion and examination of the influence of the parameters on efficiency are also provided in detail. In order to demonstrate the effectiveness of the proposed algorithm, its application to selecting the parameters of the control structure of a drive system with an elastic connection is shown. A structure with a PI controller and two additional feedbacks on the torque and speed difference between the drive motor and the working machine was selected. A system with rated and variable parameters is considered. The theoretical considerations and the simulation study were verified on a laboratory stand.

Clustering analysis of HRCT parameters measured using a texture-based automated system: relationship with clinical outcomes of IPF

PurposeThe extent of honeycombing and reticulation predict the clinical prognosis of IPF. Emphysema, consolidation, and ground glass opacity are visible in HRCT scans. To date, there have been few comprehensive studies that have used these parameters. We conducted automated quantitative analysis to identify predictive parameters for clinical outcomes and then grouped the subjects accordingly.MethodsCT images were obtained while patients held their breath at full inspiration. Parameters were analyzed using an automated lung texture quantification system. Cluster analysis was conducted on 159 IPF patients and clinical profiles were compared between clusters in terms of survival.ResultsKaplan-Meier analysis revealed that survival rates declined as fibrosis, reticulation, honeycombing, consolidation, and emphysema scores increased. Cox regression analysis revealed that reticulation had the most significant impact on survival rate, followed by honeycombing, consolidation, and emphysema scores. Hierarchical and K-means cluster analyses revealed 3 clusters. Cluster 1 (n = 126) with the lowest values for all parameters had the longest survival duration, and relatively-well preserved FVC and DLCO. Cluster 2 (n = 15) with high reticulation and consolidation scores had the lowest FVC and DLCO values with a predominance of female, while cluster 3 (n = 18) with high honeycombing and emphysema scores predominantly consisted of male smokers. Kaplan-Meier analysis revealed that cluster 2 had the lowest survival rate, followed by cluster 3 and cluster 1.ConclusionAutomated quantitative CT analysis provides valuable information for predicting clinical outcomes, and clustering based on these parameters may help identify the high-risk group for management.

Study on Assessment of the Diameter of Thoracic Aorta by Computed Tomography of Chest

INTRODUCTION: Computed tomography (CT) is frequently used for the evaluation of different aortic diseases which is a good method of measuring the aortic diameter. Thus, knowledge of normal aortic diameters is very important in the assessment of aortic disease.
 METHODS: This was a prospective cross sectional study done on 105 patients who presented in department of Radiodiagnosis in Lumbini Medical College, Palpa, Nepal from February 5th 2022 to February 4th 2023. Plain helical scan was performed using Siemens Somatom 16 slice CT scanner. CT images were obtained in supine position with full inspiration. Diameters of the aorta was measured at the level of aortic valve sinus, ascending aorta, proximal to innominate artery, transverse aortic arch, distal transverse aortic arch, aortic isthmus and descending aorta at the level of diaphragm perpendicular to the axis of the aorta.
 RESULTS: Diameter of thoracic aorta was found to be maximum at ascending aorta with mean of 2.85 cm, followed by aortic valve sinus 2.80 cm, 2.68 cm at proximal to innominate artery, 2.57 cm at proximal transverse arch, 2.41 cm at distal transverse arch, 2.24 cm at isthmus and 2.03 cm at descending aorta at the level of diaphragm. There was smooth tapering of aortic diameter from ascending aorta onwards. There was a significant correlation of mean ascending aorta diameter with the age of the patients(r = 0.475, p< 0.05).
 CONCLUSION: Diameter of thoracic aorta was found to be maximum at the level of the ascending aorta and minimum at the level of diaphragm. The diameter of thoracic aorta had significant correlation with the age of patients.

Intraoperative liver deformation and organ motion caused by ventilation, laparotomy, and pneumoperitoneum in a porcine model for image-guided liver surgery

BackgroundImage-guidance promises to make complex situations in liver interventions safer. Clinical success is limited by intraoperative organ motion due to ventilation and surgical manipulation. The aim was to assess influence of different ventilatory and operative states on liver motion in an experimental model.MethodsLiver motion due to ventilation (expiration, middle, and full inspiration) and operative state (native, laparotomy, and pneumoperitoneum) was assessed in a live porcine model (n = 10). Computed tomography (CT)-scans were taken for each pig for each possible combination of factors. Liver motion was measured by the vectors between predefined landmarks along the hepatic vein tree between CT scans after image segmentation.ResultsLiver position changed significantly with ventilation. Peripheral regions of the liver showed significantly higher motion (maximal Euclidean motion 17.9 ± 2.7 mm) than central regions (maximal Euclidean motion 12.6 ± 2.1 mm, p < 0.001) across all operative states. The total average motion measured 11.6 ± 0.7 mm (p < 0.001). Between the operative states, the position of the liver changed the most from native state to pneumoperitoneum (14.6 ± 0.9 mm, p < 0.001). From native state to laparotomy comparatively, the displacement averaged 9.8 ± 1.2 mm (p < 0.001). With pneumoperitoneum, the breath-dependent liver motion was significantly reduced when compared to other modalities. Liver motion due to ventilation was 7.7 ± 0.6 mm during pneumoperitoneum, 13.9 ± 1.1 mm with laparotomy, and 13.5 ± 1.4 mm in the native state (p < 0.001 in all cases).ConclusionsVentilation and application of pneumoperitoneum caused significant changes in liver position. Liver motion was reduced but clearly measurable during pneumoperitoneum. Intraoperative guidance/navigation systems should therefore account for ventilation and intraoperative changes of liver position and peripheral deformation.

Computed tomography-based imaging biomarker identifies coal workers’ pneumoconiosis

Rationale: The increase in the incidence and the diagnostic limitations of pneumoconiosis have emerged as a public health concern. This study aimed to conduct a computed tomography (CT)- based quantitative analysis to understand differences in imaging results of pneumoconiosis according to disease severity.Methods: According to the International Labor Organization (ILO) guidelines, coal workers’ pneumoconiosis (CWP) are classified into five categories. CT images were obtained only at full inspiration and were quantitatively evaluated for airway structural variables such as bifurcation angle (θ), hydraulic diameter (Dh), wall thickness (WT), and circularity (Cr). Parenchymal functional variables include abnormal regions (emphysema, ground–glass opacities, consolidation, semi consolidation, and fibrosis) and blood vessel volume. Through the propensity score matching method, the confounding effects were decreased.Results: Category 4 demonstrated a reduced θ in TriLUL, a thicker airway wall in both the Trachea and Bronint compared to Category 0, and a decreased Cr in Bronint. Category 4 presented with higher abnormal regions except for ground–glass opacity and a narrower pulmonary blood vessel volume. A negative correlation was found between abnormal areas with lower Hounsfield units (HU) than the normal lung and the ratio of forced expiratory volume in 1 s/forced vital capacity, with narrowed pulmonary blood vessel volume which is positively correlated with abnormal areas with upper HU than the normal lung.Conclusion: This study provided valuable insight into pneumoconiosis progression through a comparison of quantitative CT images based on severity. Furthermore, as there has been paucity of studies on the pulmonary blood vessel volume of the CWP, in this study, a correlation between reduced pulmonary blood vessel volume and regions with low HU values holds significant importance.

Incorporation of CAD (computer-aided detection) with thin-slice lung CT in routine 18F-FDG PET/CT imaging read-out protocol for detection of lung nodules

ObjectiveTo evaluate the detection rate and performance of 18F-FDG PET alone (PET), the combination of PET and low-dose thick-slice CT (PET/lCT), PET and diagnostic thin-slice CT (PET/dCT), and additional computer-aided detection (PET/dCT/CAD) for lung nodules (LN)/metastases in tumor patients. Along with this, assessment of inter-reader agreement and time requirement for different techniques were evaluated as well.MethodsIn 100 tumor patients (56 male, 44 female; age range: 22–93 years, mean age: 60 years) 18F-FDG PET images, low-dose CT with shallow breathing (5 mm slice thickness), and diagnostic thin-slice CT (1 mm slice thickness) in full inspiration were retrospectively evaluated by three readers with variable experience (junior, mid-level, and senior) for the presence of lung nodules/metastases and additionally analyzed with CAD. Time taken for each analysis and number of the nodules detected were assessed. Sensitivity, specificity, positive and negative predictive value, accuracy, and Receiver operating characteristic (ROC) analysis of each technique was calculated. Histopathology and/or imaging follow-up served as reference standard for the diagnosis of metastases.ResultsThree readers, on an average, detected 40 LN in 17 patients with PET only, 121 LN in 37 patients using ICT, 283 LN in 60 patients with dCT, and 282 LN in 53 patients with CAD. On average, CAD detected 49 extra LN, missed by the three readers without CAD, whereas CAD overall missed 53 LN. There was very good inter-reader agreement regarding the diagnosis of metastases for all four techniques (kappa: 0.84–0.93). The average time required for the evaluation of LN in PET, lCT, dCT, and CAD was 25, 31, 60, and 40 s, respectively; the assistance of CAD lead to average 33% reduction in time requirement for evaluation of lung nodules compared to dCT. The time-saving effect was highest in the less experienced reader. Regarding the diagnosis of metastases, sensitivity and specificity combined of all readers were 47.8%/96.2% for PET, 80.0%/81.9% for PET/lCT, 100%/56.7% for PET/dCT, and 95.6%/64.3% for PET/CAD. No significant difference was observed regarding the ROC AUC (area under the curve) between the imaging methods.ConclusionImplementation of CAD for the detection of lung nodules/metastases in routine 18F-FDG PET/CT read-out is feasible. The combination of diagnostic thin-slice CT and CAD significantly increases the detection rate of lung nodules in tumor patients compared to the standard PET/CT read-out. PET combined with low-dose CT showed the best balance between sensitivity and specificity regarding the diagnosis of metastases per patient. CAD reduces the time required for lung nodule/metastasis detection, especially for less experienced readers.

A microintensive research study: The impact of yoga on posture, breathing, and psychosocial variables in young adults with cerebral palsy

Abstract The objective of the study was to demonstrate physical and psychosocial impact of yoga on adults with cerebral palsy (CP). This study was a pre–post intervention study involving 12 adults with CP selected with purposive sampling method. The participants received individualized interventions planned by a special yoga specialist for 10 months. Along with the Yoga intervention they underwent traditional physiotherapy sessions on a once-a-week basis. The participants were evaluated on the following parameters: breathing capacity, posture and physical measurements, and psychological impact. Breathing capacity was assessed using the calibrated spirometer where the maximum volume of air inspired was measured. Chest expansion measurements at rest and full inspiration were recorded at apex of axilla and at xiphoid process. The length of time of Om chanting was recorded in seconds. Physical assessments were done by measuring height, weight, body mass index (BMI), and girth of arm and thighs and a postural assessment against a postural grid. The psychosocial impact was measured using the Depression Anxiety and Stress Scale 21 items (DASS-21). There was no significant effect on BMI (P = 0.404; paired t test). There was significant improvement in the vital capacity (P = 0.04; paired t test) three ball spirometer (P = 0.003; paired t test), Om chanting (P = 0.0001; paired t test), and chest expansion at axilla and xiphoid process (P = 0.0004 and 0.002, respectively; paired t test). DASS-21 scores also showed significant differences (anxiety, P = 0.02; stress, P = 0.07; and depression, P = 0.06). It can, therefore, be concluded that yoga intervention does not impact the physical parameters of young adults with CP. It shows a positive impact on the vital capacity parameters and it also has a positive psychological impact.

Hubungan Antara Kedekatan dan Lama Domisili Di Sekitar TPA Kebon Kongok Desa Suka Makmur Gerung NTB Dengan Arus Puncak Ekspirasi Pada Ibu Rumah Tangga

Peak Expiratory Flow (PEF) is a simple measurement of the maximal flow rate achieved during a strong expiration following a full inspiration. PEF is used as an indicator of lung function. Decreased lung function can be caused by gases emitted from landfill sites. TPA Kebon Kongok is the largest landfill in the province of NTB, which has been operating since 1993. The landfill used open dumping system for a long time before switching to sanitary landfill in 2021. This situation can lead to gas exposure for residents living near the landfill, especially for housewives who spend a lot of time at home. Therefore, this study aims to investigate the relationship between proximity and length of residency around TPA and PEF in housewives. The study was conducted in Suka Makmur village by comparing two hamlets near and far from the landfill. The nearest hamlet (0-1 km) from the landfill was Kedatuk, while the farthest hamlet (1-2 km) was Ketejer. The study used a cross-sectional design with proportionate stratified random sampling technique. The total sample in this study was 183, consisting of 110 samples from the near hamlet of Kedatuk and 73 samples from the far hamlet of Ketejer.There was a significant statistical relationship between proximity to the landfill and PEF (p-value 0.001), while there was no significant relationship between length of residency and PEF (p-value 0.421).There is a significant relationship between proximity to the landfill and PEF, while there is no significant relationship between length of residency and PEF.

Computed Tomography Lung Density Analysis: An Imaging Biomarker Predicting Physical Inactivity in Chronic Obstructive Pulmonary Disease: A Pilot Study.

Physical inactivity correlates with poor prognosis in chronic obstructive pulmonary disease (COPD) and is suggested to be related to lung hyperinflation. We examined the association between physical activity and the expiratory to inspiratory (E/I) ratio of mean lung density (MLD), the imaging biomarker of resting lung hyperinflation. COPD patients (n = 41) and healthy controls (n = 12) underwent assessment of pulmonary function and physical activity with an accelerometer, as well as computed tomography at full inspiration and expiration. E/IMLD was calculated by measuring inspiratory and expiratory MLD. Exercise (EX) was defined as metabolic equivalents × duration (hours). COPD patients had higher E/IMLD (0.975 vs. 0.964) than healthy subjects. When dividing COPD patients into sedentary (EX < 1.5) and non-sedentary (EX ≥ 1.5) groups, E/IMLD in the sedentary group was statistically higher than that in the non-sedentary group (0.983 vs. 0.972). E/IMLD > 0.980 was a good predictor of sedentary behavior in COPD (sensitivity, 0.815; specificity, 0.714). Multivariate analysis showed that E/IMLD was associated with sedentary behavior (odds ratio, 0.39; p = 0.04), independent of age, symptomology, airflow obstruction, and pulmonary diffusion. In conclusion, higher E/IMLD scores are associated with sedentary behavior and can be a useful imaging biomarker for the early detection of physical inactivity in COPD.

MULTI-VIEW CNN FOR TOTAL LUNG VOLUME INFERENCE ON CARDIAC COMPUTED TOMOGRAPHY.

Total lung volume (TLV) at full inspiration is a parameter of significant interest in pulmonary physiology but requires computed tomography (CT) scanning of the full axial extent of the lung. There is a growing interest to infer TLV from cardiac CT scans, which are much more widely available in epidemiologic studies. In this study, we present an original approach to train a multi-view convolutional neural network (CNN) model to infer TLV from cardiac CT scans, which visualize about 2/3rd of the lung volume. Supervised learning is used, exploiting paired full-lung and cardiac CT scans in the Multi-Ethnic Study of Atherosclerosis (MESA). Our results show that our network outperforms existing regression models for TLV estimation, and achieves accuracy and reproducibility comparable to the scan-rescan reproducibility of TLV on full-lung CT.

Idiopathic pulmonary fibrosis is more strongly associated with coronary artery disease than chronic obstructive pulmonary disease

IntroductionPrevious studies have shown that the population attributable risk of low forced expiratory volume in one second (FEV1) for coronary artery disease (CAD) is substantial. FEV1 can be low either because of airflow obstruction or ventilatory restriction. It is not known if low FEV1 arising from spirometric obstruction or restriction are differently associated with CAD. MethodsWe analyzed high resolution computed tomography (CT) scans acquired at full inspiration in lifetime non-smoker adults with no lung disease (controls) and those with chronic obstructive pulmonary disease enrolled in the Genetic Epidemiology of COPD (COPDGene) study. We also analyzed CT scans of adults with idiopathic pulmonary fibrosis (IPF) from a cohort of patients attending a quaternary referral clinic. Participants with IPF were matched 1:1 by FEV1 %predicted to adults with COPD and 1:1 by age to lifetime non-smokers.Coronary artery calcium (CAC), a surrogate for CAD, was measured by visual quantification on CT using the Weston score. Significant CAC was defined as Weston score ≥7. Multivariable regression models were used to test the association of the presence of COPD or IPF with CAC, with adjustment for age, sex, body-mass-index, smoking status, hypertension, diabetes mellitus, and hyperlipidemia. ResultsWe included 732 subjects in the study; 244 with IPF, 244 with COPD, and 244 lifetime non-smokers. The mean (SD) age was 72.6 (8.1), 62.6 (7.4), and 67.3 (6.6) years, and median (IQR) CAC was 6 (6), 2 (6), and 1 (4), in IPF, COPD, and non-smokers, respectively. On multivariable analyses, the presence of COPD was associated with higher CAC compared to non-smokers (adjusted regression coefficient, β = 1.10 ± SE0.51; P = 0.031). The presence of IPF was also associated with higher CAC compared to non-smokers (β = 03.43 ± SE0.41; P < 0.001). The adjusted odds ratio for having significant CAC was 1.3, 95% CI 0.6 to 2.8; P = 0.53 in COPD and 5.6, 95% CI 2.9 to 10.9; P < 0.001 in IPF, compared to non-smokers. In sex stratified analyses, these associations were mainly noted in women. ConclusionAdults with IPF displayed higher coronary artery calcium than those with COPD after accounting for age and lung function impairment.

Environmental Ethics From Perspective Of The Quran And Sunnah

– Environmental ethics is a knowledge of ethics that is based on an ethical approach and used to respond to various environmental crises caused by human behavior. This article refers to verses of the Quran and hadiths as the basis of spiritual and environmental ethics values ​​on human interaction with the environment. It elaborates on verses and prophetic traditions that are relevant for obtaining full inspiration of concepts through interpretations and thematic hadiths. It is achieved by reading the full text without separating the context, after identifying the verses of the Quran and hadiths explored based on the context. The religion established by the Whites’ has been accused as one of the causes of environmental damage. However, despite igniting the reaction of religious refusal, it also encourages the reflection on critical theology and methods of reading sacred texts. In principle, Islam teaches environmental ethics integrated into the concepts of tawhîd, khilâfah, amanah, and akhîrah based on Quran and hadith.

Deep learning for improving ZTE MRI images in free breathing

IntroductionDespite a growing interest in lung MRI, its broader use in a clinical setting remains challenging. Several factors limit the image quality of lung MRI, such as the extremely short T2 and T2* relaxation times of the lung parenchyma and cardiac and breathing motion. Zero Echo Time (ZTE) sequences are sensitive to short T2 and T2* species paving the way to improved “CT-like” MR images. To overcome this limitation, a retrospective respiratory gated version of ZTE (ZTE4D) which can obtain images in 16 different respiratory phases during free breathing was developed. Initial performance of ZTE4D have shown motion artifacts. To improve image quality, deep learning with fully convolutional neural networks (FCNNs) has been proposed. CNNs has been widely used for MR imaging, but it has not been used for improving free-breathing lung imaging yet. Our proposed pipeline facilitates the clinical work with patients showing difficulties/uncapable to perform breath-holding, or when the different gating techniques are not efficient due to the irregular respiratory pace. Materials and methodsAfter signed informed consent and IRB approval, ZTE4D free breathing and breath-hold ZTE3D images were obtained from 10 healthy volunteers on a 1.5 T MRI scanner (GE Healthcare Signa Artist, Waukesha, WI). ZTE4D acquisition captured all 16 phases of the respiratory cycle. For the ZTE breath-hold, the subjects were instructed to hold their breath in 5 different inflation levels ranging from full expiration to full inspiration. The training dataset consisting of ZTE-BH images of 10 volunteers was split into 8 volunteers for training, 1 for validation and 1 for testing. In total 800 ZTE breath-hold images were constructed by adding Gaussian noise and performing image transformations (translations, rotations) to imitate the effect of motion in the respiratory cycle, and blurring from varying diaphragm positions, as it appears for ZTE4D. These sets were used to train a FCNN model to remove the artificially added noise and transformations from the ZTE breath-hold images and reproduce the original quality of the images. Mean squared error (MSE) was used as loss function. The remaining 2 healthy volunteer's ZTE4D images were used to test the model and qualitatively assess the predicted images. ResultsOur model obtained a MSE of 0.09% on the training set and 0.135% on the validation set. When tested on unseen data the predicted images from our model improved the contrast of the pulmonary parenchyma against air filled regions (airways or air trapping). The SNR of the lung parenchyma was quantitatively improved by a factor of 1.98 and the CNR lung- blood, which is indicating the visibility of the intrapulmonary vessels, was improved by 4.2%. Our network was able to reduce ghosting artifacts, such as diaphragm movement and blurring, and enhancing image quality. DiscussionFree-breathing 3D and 4D lung imaging with MRI is feasible, however its quality is not yet acceptable for clinical use. This can be improved with deep learning techniques. Our FCNN improves the visual image quality and reduces artifacts of free-breathing ZTE4D. Our main goal was rather to remove ghosting artifacts from the ZTE4D images, to improve diagnostic quality of the images. As main results of the network, diaphragm contour increased with sharper edges by visual inspection and less blurring of the anatomical structures and lung parenchyma. ConclusionWith FCNNs, image quality of free breathing ZTE4D lung MRI can be improved and enable better visualization of the lung parenchyma in different respiratory phases.

Clinical applicability of peak expiratory flow measured with peak flow metre compared to spirometer in a resource-limited setting

Background: Peak Expiratory Flow (PEF) is the maximum flow produced during a forced expiration following a full inspiration. It is useful in the management of lung diseases especially the domiciliary assessment of disease control in patients with Asthma. PEF can be measured with either a peak flow meter or a spirometer. We aimed at comparing PEF measured using a Mini Wright peak flow meter with PEF measured using Spirolab III spirometer in order to assess its clinical applicability in resource-limited settings.Method: A method-comparison study with records of PEF values at the Niger-Delta University Teaching Hospital, Okolobiri. Hypotheses were formulated and tested after data was analyzed using the IBM SPSS version 25 software.Results: PEF readings of a total of 100 adults were analyzed. Mean age was 48.90 ± 19.77 years. Males (51%) were slightly more than females (49%). One- sample t-test showed no statistical difference in the mean PEF values measured with the two devices (p = 0.295). There was significant correlation between the PEF values measured with the two devices (p&lt;0.0001) with demonstration of agreement and absence of proportional bias in the PEF values measured by the two methods following linear regression analysis (p = 0.959).Conclusion: PEF values obtained from the Mini wright PEF meter and the Spirolab III spirometer are comparable. Therefore, the Mini Wright peakflow meter may be effectively used in the diagnosis and monitoring of Asthma and other lung diseases in resource-limited settings.

Quantification of Emphysema in Chronic Obstructive Pulmonary Disease by Volumetric Computed Tomography of Lung

Chronic obstructive pulmonary disease (COPD) is a heterogeneous disease with small airway inflammation and emphysema. Emphysema is permanent enlargement of air spaces distal to terminal bronchioles accompanied by destruction of alveolar walls. These morphological changes can be studied on quantitative computed tomography (CT). Thirty-four patients diagnosed to have COPD as per Global Initiative for Chronic Obstructive Lung Disease guidelines underwent chest CT using full inspiration with low dose radiation protocol. Pulmo-CT software was used to analyse the scans. The primary aim was to quantify emphysema and emphysema clusters and secondary aim was to assess correlation between percentage emphysema and lung function. Their mean [standard deviation (SD)] age was 66.4 (7.0) years; 11 (32.4%) were current smokers (median pack years 45.5). Their mean (SD) forced expiratory volume in the first second (FEV1%) was 55.6 (17.6), mean (SD) %emphysema was 26.8 (11.1), mean (SD) lung density was -848.35 (29.5) Hounsfield units (HU), median (interquartile range) %cluster class 4 emphysema was 22.4 (13.5-32.6). There was no significant difference in %low attenuation volume (%LAV) in current and exsmokers (p=0.4); across various severity grades of COPD (p=0.15). Further, no significant correlation was observed between %emphysema and post-bronchodilator FEV1%. Volumetric CT can detect and quantify emphysema. Majority of emphysema clusters in COPD are >25mm. The %emphysema does not correlate to the severity of the disease. Quantitative CT is a good objective method to study emphysema and can be used to phenotype COPD radiologically.

MONITORING OF PULMONARY EDEMA USING ULTRASOUND RADIOFREQUENCY SIGNAL.

Objectives: Excessive accumulation of extravascular lung water impairs respiratory gas exchange and results in respiratory distress. Real-time radiofrequency signals of ultrasound can continuously and quantitatively monitor excessive lung water. This study aims to evaluate the availability of continuous real-time quantitative pulmonary edema monitoring using ultrasound radiofrequency signals and compare it with Pa o2 (partial pressure of arterial oxygen)/F io2 (fraction of inspired oxygen) (PF) ratio, conventional lung ultrasound, and the Hounsfield unit of chest computed tomography. Methods: Male Yorkshire pigs (40.5 ± 0.5 kg) were anesthetized and mechanically ventilated. A balanced crystalloid was administered to induce hydrostatic pulmonary edema. Three different infusion rates of 2, 4, and 6 mL/kg per minute were tested to determine the infusion rate for the appropriate swine model. The chest computed tomography and ultrasonography with radiofrequency signals were taken every 5 min during the full inspiration. The ultrasonography scans with radiofrequency signals were measured at the intercostal space where the line crossing the two armpits and the right anterior axillary line intersected. Results: The infusion rate of fluid for the pulmonary edema model was determined to be 6 mL/kg per minute, and a total of four pigs were tested at an injection rate of 6 mL/kg. The adjusted R2 values of regression analysis between the radiofrequency signal and computer tomography Hounsfield score were 0.990, 0.993, 0.988, and 0.993 (all P values <0.05). All radiofrequency signal changes preceded changes in PF ratio or lung ultrasound changes. The area under the receiver operating characteristic curve of the radiofrequency signal for predicting PF ratio <300 was 0.88 (95% confidence interval, 0.82-0.93). Conclusion: We evaluated ultrasound radiofrequency signals to assess pulmonary edema in a swine model that can worsen gradually and showed that quantitative ultrasound radiofrequency signal analysis could assess pulmonary edema and its progression before PF ratio or lung ultrasound changes.

Environmental Ethics from Perspective of the Quran and Sunnah

Environmental ethics is a knowledge of ethics that is based on an ethical approach and used to respond to various environmental crises caused by human behavior. This article refers to verses of the Quran and hadiths as the basis of spiritual and environmental ethics values ​​on human interaction with the environment. It elaborates on verses and prophetic traditions that are relevant for obtaining full inspiration of concepts through interpretations and thematic hadiths. It is achieved by reading the full text withoutseparating the context, after identifying the verses of the Quran and hadiths explored based on the context. The religion established by the Whites’ has been accused as one of the causes of environmental damage. However, despite igniting the reaction of religious refusal, it also encourages the reflection on critical theology and methods of reading sacred texts. In principle, Islam teaches environmental ethics integrated into the concepts of tawhîd, khilâfah, amanah, and akhîrah based on Quran and hadith.

When Treatment of Pulmonary Emphysema with Endobronchial Valves Did Not Work: Evaluation of Quantitative CT Analysis and Pulmonary Function Tests Before and After Valve Explantation.

PurposeTo investigate changes in quantitative CT analysis (QCT) and pulmonary function tests (PFT) in pulmonary emphysema patients who required premature removal of endobronchial valves (EBV).Patients and MethodsOur hospital’s medical records listed 274 patients with high-grade COPD (GOLD stages 3 and 4) and pulmonary emphysema who were treated with EBV to reduce lung volume. Prior to intervention, a complete evaluation was performed that included quantitative computed tomography analysis (QCT) of scans acquired at full inspiration and full expiration, pulmonary function tests (PFT), and paraclinical findings (6-minute walking distance test (6MWDT) and quality of life questionnaires). In 41 of these 274 patients, EBV treatment was unsuccessful and the valves had to be removed for various reasons. A total of 10 of these 41 patients ventured a second attempt at EBV therapy and underwent complete reevaluation. In our retrospective study, results from three time points were compared: Before EBV implantation (BL), after EBV implantation (TP2), and after EBV explantation (TP3). QCT parameters included lung volume, total emphysema score (TES, ie, the emphysema index) and the 15th percentile of lung attenuation (P15) for the whole lung and each lobe separately. Differences in these parameters between inspiration and expiration were calculated (Vol. Diff (%), TES Diff (%), P15 Diff (%)). The results of PFT and further clinical tests were taken from the patient’s records.ResultsWe found persistent therapy effect in the target lobe even after valve explantation together with a compensatory hyperinflation of the rest of the lung. As a result of these two divergent effects, the volume of the total lung remained rather constant. Furthermore, there was a slight deterioration of the emphysema score for the whole lung, whereas the TES of the target lobe persistently improved.ConclusionInterestingly, we found evidence that, contrary to our expectations, unsuccessful EBV therapy can have a persistent positive effect on target lobe QCT scores.

INTRIGUING LUNG FUNCTION TESTS IN NEUROMUSCULAR WEAKNESS

INTRIGUING LUNG FUNCTION TESTS IN NEUROMUSCULAR WEAKNESS