Normal Chest Imaging Research Articles

AI-Powered Chest Disease Detection and Classification using Deep Learning

AI-Powered Chest Disease Detection and Classification using Deep Learning Method presents an innovative approach to revolutionize chest disease diagnosis through the integration of advanced deep learning techniques. This initiative focuses on the development of an intelligent system that can effectively detect and classify a variety of chest diseases by analysing medical images, such as chest X-rays and CT scans. At its core, the project involves the compilation and preparation of a diverse dataset containing both normal and disease-affected chest images. Leveraging the capabilities of deep learning, particularly convolutional neural networks (CNNs), the project then designs and trains models to learn intricate patterns and features indicative of different chest diseases. The models are optimized for accuracy and robustness. This efficiency translates to quicker diagnoses, enabling prompt medical interventions. The AI system serves as a complementary tool for healthcare professionals, aiding in decision- making by providing valuable insights and augmenting their expertise.

Analysis of Histogram and Grayscale on Chest X-Ray in Lung Cancer Using Image-J

Posteranterior (PA) chest radiographic examination is a support in screening for the diagnosis of lung cancer. Computed radiography (CR) modality can produce chest images quickly, optimally and can be processed as needed. However, so far radiologists interpret images only by visual assessment, so the results are very subjective. Therefore digital medical image processing can be done by looking at the histogram and gray scale values to increase the accuracy of enforcing patient diagnoses. This study aims to analyze the comparison of histograms and gray degree values on CR chest images between normal patients and lung cancer patients. The study was conducted using 30 chest images consisting of normal and lung cancer patient groups with 15 images each. All images are calculated grayscale and display histogram graphics with the Image-J application and statistically analyzed using the Independent T-Test. The results show that there is a difference in grayscale values between normal chest images and lung cancer (p<0.001). The grayscale and histogram values on lung cancer chest images ( 103.2908 + 6.119 ) are higher and tend to the right compared to the grayscale and histogram values on normal chest images ( 64.5848 + 3.28) . Histogram and grayscale values add objective image interpretation in diagnosing lung cancer.

Energy- efficient model “Inception V3 based on deep convolutional neural network” using cloud platform for detection of COVID-19 infected patients

Abstract Objectives COVID-19 is frightening the health of billions of persons and speedily scattering worldwide. Medical studies have revealed that the majority of COVID-19 patients. X-ray of COVID-19 is extensively used because of their noticeably lower price than CT. This research article aims to spot the COVID-19 virus in the X-ray of the chest in less time and with better accuracy. Methods We have used the inception-v3 available on the cloud platform transfer learning model to classify COVID-19 infection. The online Inception v3 model can be reliable and efficient for COVID-19 disease recognition. In this experiment, we collected images of COVID-19-infected patients, then applied the online inception-v3 model to automatically extract features, and used a softmax classifier to classify the COVID-19 images. Finally, the experiment shows inception v3 is significant for COVID-19 image classification. Results Our results demonstrate that our proposed inception v3 model available on the cloud platform can detect 99.41% of COVID-19 cases between COVID-19 and Lung Mask diseases in 44 min only. We have also taken images of the normal chest for better outcomes. To estimate the computation power of the model, we collected 6018 COVID-19, Lung Masks, & Normal Chest images for experimentation. Our projected model offered a trustworthy COVID-19 classification by using chest X-rays. Conclusions In this research paper, the inception v3 model available on the cloud platform is used to categorize COVID-19 infection by X-ray images. The Inception v3 model available on the cloud platform is helpful to clinical experts to examine the enormous quantity of human chest X-ray images. Scientific and clinical experiments will be the subsequent objective of this paper.

Treatment in Latent Tuberculosis Uveitis-Is Immunosuppression Effective or Is Conventional 3- or 4-Drug Antituberculosis Therapy Mandatory?

Background/Aims: Controversy exists regarding 3- or 4 drug antituberculosis therapy (conventional ATT) in uveitis patients having latent tuberculosis (LTB), especially while initiating therapy with corticosteroids and/or other immunosuppressants. Methods: We performed a monocentral retrospective analysis of posterior uveitis patients with latent TB. Latent TB was diagnosed, in case of a positive QuantiFERON®-TB-Gold test and normal chest imaging, after ruling out other causes of infectious and noninfectious uveitis. Patients with active TB were excluded. From 2016 to 2020 we included 17 patients. Ophthalmological evaluation consisted of Best corrected visual acuity (BCVA), slit lamp examination, fundoscopy, OCT, and fluorescein- and indocyaningreen- angiography before and at months 3, 6, 12, 24, and the last follow-up after treatment. Results: Initially, all patients had active posterior uveitis with occlusive (n = 5 patients) and nonocclusive retinal vasculitis (n = 12 patients). Mean follow up was 28 ± 15 months. Therapy was started with systemic corticosteroids (mean prednisolone equivalent 71.3 mg/d) and already after 3 months it could be tapered to a mean maintenance dosage of 8.63 mg/d. Additional immunosuppressive treatment with cs- or bDMARDs was initiated in 14 patients (82%) due to recurrences of uveitis while tapering the corticosteroids <10 mg per/day or because of severe inflammation at the initial visit. While being on immunosuppression, best corrected visual acuity increased from 0.56 logMAR to 0.32 logMAR during follow-up and only three patients had one uveitis relapse, which was followed by switch of immunosuppressive treatment. As recommended, TB prophylaxis with 300 mg/d isoniazid was administered in 11 patients for at least 9 months while being on TNF-alpha-blocking agents. No patient developed active tuberculosis during immunosuppressive therapy. Conclusion: Mainly conventional ATT is strongly recommended—as monotherapy or in combination with immunosuppressives—for effective treatment in patients with uveitis due to latent TB. Although in our patient group no conventional ATT was initiated, immunosuppression alone occurred as an efficient treatment. Nevertheless, due to possible activation of TB, isoniazid prophylaxis is mandatory in latent TB patients while being on TNF-alpha blocking agents.

A Multicenter Cohort Study From India of 75 Kidney Transplants in Recipients Recovered After COVID-19.

There is limited current knowledge on feasibility and safety of kidney transplantation in coronavirus disease-19 (COVID-19) survivors. We present a retrospective cohort study of 75 kidney transplants in patients who recovered from polymerase chain reaction (PCR)-confirmed COVID-19 performed across 22 transplant centers in India from July 3, 2020, to January 31, 2021. We detail demographics, clinical manifestations, immunosuppression regimen, laboratory findings, treatment, and outcomes. Patients with a previous diagnosis of COVID-19 were accepted after documenting 2 negative severe acute respiratory syndrome coronavirus 2 PCR tests, normal chest imaging with complete resolution of symptom for at least 28 d and significant social distancing for 14 d before surgery. Clinical severity in patients ranged from asymptomatic (n = 17, 22.7%), mild (n = 36.48%), moderate (n = 15.20%), and severe (n = 7.9.3%) disease. Median duration between PCR positive to transplant was 60 d (overall) and increased significantly from asymptomatic, mild, moderate, and severe disease (49, 57, 83, 94 d, P 0.019), respectively. All recipients and donors were asymptomatic with normal creatinine after surgery at a median (interquartile range) follow-up of 81 (56-117) d without any complications relating to surgery or COVID-19. Patient and graft survival was 100%, and acute rejection was reported in 6.6%. Prospective kidney transplant recipients post-COVID-19 can be considered for transplantation after comprehensive donor and recipient screening before surgery using a combination of clinical, radiologic, and laboratory criteria, careful pretransplant evaluation, and individualized risk-benefit analysis. Further large-scale prospective studies with longer follow-up will better clarify our initial findings. To date, this remains the first and the largest study of kidney transplantation in COVID-19 survivors.

Automatic Detection of COVID-19 Disease by Using Transfer Learning of Light Weight Deep Learning Model

COVID-19 began to appear in China in December 2019 with cases of pneumonia. Controlling the effects of this virus type is closely related to all scientists, especially medical doctors. In this study, ShuffleNet CNN architecture, which is suitable for mobile devices, is one of the deep learning models that perform today's most successful image recognition and classification processes. Obtaining a large data set in the training process is an important problem for the diagnosis of COVID-19 disease. However, rapid diagnosis of COVID-19 X-ray or CT images plays a crucial role in the immediate decision of medical doctors. However, the lack of training data causes poor performance due to the problem of over-fitting. Also, the back propagation algorithm used in CNN training is often very slow and requires the tuning of different hyper parameters. To overcome these disadvantages, this study proposed a new approach based entirely on the machine learning algorithms, extracting CNN features from the light weight ShuffleNet architecture. In this study, a total of 300 images were used, the images diagnosed as COVID-19 and normal chest images. During the classification phase, 10-fold cross validation was applied to the database and 99.98% accuracy rate was obtained.

Association Between Clinical Characteristics and Short-Term Outcomes in Adult Male COVID-19 Patients With Mild Clinical Symptoms: A Single-Center Observational Study.

Majority of patients with 2019 novel coronavirus infection (COVID-19) exhibit mild symptoms. Identification of COVID-19 patients with mild symptoms who might develop into severe or critical illness is essential to save lives. We conducted an observational study in a dedicated make-shift hospital for adult male COVID-19 patients with mild symptoms between February and March 2020. Baseline characteristics, medical history, and clinical presentation were recorded. Laboratory tests and chest computed tomography were performed. Patients were observed until they were either transferred to a hospital for advanced care owing to disease exacerbation or were discharged after improvement. Patients were grouped based on their chest imaging findings or short-term outcomes. A total of 125 COVID-19 patients with mild symptoms were enrolled. Of these, 7 patients were transferred for advanced care while 118 patients were discharged after improvement and showed no disease recurrence during an additional 28-day follow-up period. Eighty-five patients (68.0%) had abnormal chest imaging findings. Patients with abnormal chest imaging findings were more likely to have disease deterioration and require advanced care as compared to those with normal chest imaging findings. Patients with deteriorated outcomes were more likely to have low peripheral blood oxygen saturation and moderately-elevated body temperature. There were no significant differences between patients with deteriorated or improved outcomes with respect to age, comorbidities, or other clinical symptoms (including nasal congestion, sore throat, cough, hemoptysis, sputum production, shortness of breath, fatigue, headache, nausea or vomiting, diarrhea). Abnormal chest imaging findings, low peripheral blood oxygen saturation, and elevated temperature were associated with disease deterioration in adult male COVID-19 patients with mild clinical symptoms.Clinical Trial Registration: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S0009RA3&selectaction=Edit&uid=U0003F4L&ts=2&cx=-ajpsbw, identifier NCT04346602.

Spectrum of pleuropulmonary paragonimiasis: An analysis of 685 cases diagnosed over 22 years

Paragonimiasis is a global foodborne zoonosis. Overlapping clinical and imaging features with other lung pathologies hamper correct diagnosis and require differential diagnosis. During 1982-2003, 49,012 samples were referred for immunodiagnosis of helminthiases. We detected paragonimiasis cases by enzyme-linked immunosorbent assay (ELISA). We assessed clinical, radiographical and laboratory characteristics, and diagnostic dilemmas associated with delayed diagnosis. We analyzed 685 pleuropulmonary paragonimiasis cases. ELISA-positive was 665. Eggs were detected in 50. Symptom duration correlated well with the appearance of chest radiographs; 359 pleural, 33 pleuroparenchymal, and 264 parenchymal lesions (P < 0.001). Twenty-nine had normal chest images. Eosinophilia, seen in 304, was common in pleural and pleuroparenchymal patients (P < 0.05). Chest pain and dyspnea were characteristic for pleurisy patients. Sputum (odds ratios [OR]: 6.79; 95% CI: 4.41-10.47), blood-tinged sputum (OR: 5.62; 95% CI: 3.75-8.42), and foul-odor (OR: 2.70; 95% CI: 1.42-5.16) were significant in parenchymal patients. Delayed diagnosis (119) for ≥ 25 weeks was attributed mainly to misdiagnosis as tuberculosis, malignancy, or chronic obstructive pulmonary disease (COPD) (OR: 111.75; 95% CI: 43.25-288.74). Variable symptoms and radiographs of pleuropulmonary paragonimiasis depended on the stage of infection. Suspicion of tuberculosis, malignancy, or COPD was major cause of delayed diagnosis.

COVID-19 in Kidney Transplantation: Outcomes, Immunosuppression Management, and Operational Challenges.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2, has led to the death of hundreds of thousands of people worldwide. If infected, older individuals and those with diabetes, hypertension, cardiovascular disease, and compromised immune systems are at higher risk for unfavorable outcomes. These comorbidities are prevalent in patients with kidney disease, hence the significant burden of COVID-19 on kidney transplant programs. Multiple case series of kidney transplant recipients with COVID-19 have shown increased mortality compared to nontransplant patients. To date, we do not have high-level evidence to inform immunosuppression minimization strategies in infected transplant recipients. Most centers however have adopted early antimetabolite withdrawal in addition to other interventions. This review summarizes the published COVID-19 literature as it relates to outcomes and immunosuppression management in kidney transplant recipients. It also discusses challenges pertaining to pretransplant evaluation and wait-listed patients.

Clinical phenotyping: role in treatment decisions in sarcoidosis.

A variety of phenotypic categorisations have been developed for sarcoidosis. Phenotyping has been used for genetics studies and to guide treatment selection. The authors participated in a Delphi expert consensus panel to develop a proposed phenotype categorisation and treatment recommendations for pulmonary sarcoidosis patients. Panellists reached consensus that asymptomatic patients with normal pulmonary function and adenopathy alone or normal chest imaging do not require therapy, while symptomatic patients with impaired pulmonary function or infiltrates should be treated. The panel did not reach consensus on asymptomatic patients with abnormal chest imaging or reduced pulmonary function, or symptomatic patients with normal chest imaging and pulmonary function. The proposed phenotype categories and associated treatment recommendations are asymptomatic (no therapy), acute (disease duration <1-2 years, apparently self-limited, corticosteroids), chronic (antimetabolites and other second-line therapies) and advanced (biologics). Some clinical settings, such as dyspnoea/hypoxaemia at rest, severely impaired or rapidly decreasing pulmonary function tests, and severe cardiac, neurologic, ocular or renal involvement warrant immediate therapy.

Clinical Course and Outcome of 395 Covid 19 Patients Admitted to One Hospital in Jeddah- Saudi Arabia

Background: Since the first case of SARS-CoV 2 has been reported from Wuhan China back in December 2019, the virus has spread all over the world and has so far infected more than 35 million humans and led to more than one million deaths woldwide. We describe in this paper the clinical characteristics and outcome of PCR confirmed Covid 19 patients that were admitted to a tertiary care hospital in Saudi Arabia. Methods: Retrospective review of patients that had positive PCR on nasopharyngeal swab for SARS Cov2 and that were admitted and discharged from a tertiary care hospital in the city of Jeddah, Saudi Arabia between March and July 2020. Epidemiological, demographic, and clinical data were collected. The clinical course of patients was reviewed. Risk factors for involvement of lower respiratory tract (Pneumonia), for need for ICU and for death were analyzed. Results: The records of total of 395 patients were reviewed. 15% of Covid 19 patients in our population were completely asymptomatic, one quarter of which had abnormalities on chest imaging. Among the patients with one or more Covid 19 symptoms, 75% had lower respiratory tract involvement and one quarter had normal chest imaging. One third of all patients developed leukopenia and around 2 thirds had lymphocytopenia. Thrombocytopenia was not common (occurred in 15%), 29% of our patients had CRP>10 and 25.1% had elevated ALT (not exceeding 5 times upper normal). Nine percent of our patients needed ICU admission, 3.8% needed mechanical ventilation. 9 patients (2.3%) in our population died. Advancing age, increasing BMI, and smoking history were significantly associated with increased mortality. Developing abnormalities on chest imaging (Pneumonia) was significantly associated with increasing BMI, advancing age, not receiving BCG vaccination at birth, history of smoking and presence of co-morbidities (p value less 0.05 with all these variables). Blood group and presence of co-morbidities was significantly associated with need for ICU care but not with mortality. In our population neither ethnicity, nor gender, had significant association with hospital course or outcome, and no one younger than 45 years and no one with BMI less than 24 died. Conclusion: Advancing age, increasing BMI and history of smoking were found to be significant risk factors for mortality in our population. History of Bacille calmette Guerin (BCG) vaccination was significantly associated with less involvement of lower respiratory tract but had no significant association with final outcome. Asymptomatic Covid 19 is more of a silent active infection rather than a silent inactive carrier state.

AN UNEXPECTED CULPRIT OF SHORTNESS OF BREATH

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Nitrofurantoin is one of the recommended first-line agents for the treatment of uncomplicated urinary tract infections. Nitrofurantoin-induced pulmonary toxicity is a documented rare, though potentially fatal adverse reaction. CASE PRESENTATION: A 35-year-old woman presented with complaints of worsening shortness of breath, fevers and abdominal discomfort. She had had an uncomplicated pregnancy and uncomplicated vaginal delivery 11 weeks prior to presentation. Two weeks prior she had been diagnosed with an uncomplicated urinary tract infection at a routine postpartum follow-up visit and prescribed Nitrofurantoin. Six days into treatment she developed subjective fevers and a generalized lace-like rash; both resolved spontaneously. Three days after the rash she started experiencing progressively worsening shortness of breath and recurrent subjective fevers which prompted her presentation to the Emergency Department. On presentation, she was febrile, tachycardic and tachypneic. The only notable physical exam finding was crackles at bilateral lung bases prompting concern for pulmonary edema due to peripartum cardiomyopathy. CBC, CMP, BNP, and UA were within normal limits and an echocardiogram revealed elevated right ventricular systolic (35-40mmHg) and a dilated inferior vena cava suggestive of increased right atrial pressure. This prompted a CT-Chest with contrast which showed increased interlobular septi and prominent of peribronchial interstitial structures, particularly in the right lower lobe and mediastinum. A careful reexamination of her history of presenting illness lead to a clinical diagnosis of acute Nitrofurantoin-induced pulmonary toxicity. This diagnosis was made on the basis of her unremarkable past medical history, previously uncomplicated peripartum clinical course, prior normal chest imaging and the temporal relationship between the initiation of Nitrofurantoin and the onset of her symptoms. She was managed supportively. She did not receive glucocorticoids and had already completed her course of Nitrofurantoin at the time of diagnosis. DISCUSSION: Nitrofurantoin-induced pulmonary toxicity has an incidence of less than 1%. Diagnosis can be made based on characteristic symptoms and temporal relation to drug exposure. Symptoms typically include fever, dyspnea, cough and/or rash. Crepitant crackles at the lung bases are heard in most patients and the most common laboratory findings are eosinophilia, leukocytosis, and elevated ESR. The majority of patients have parenchymal changes on imaging. Treatment is the cessation of Nitrofurantoin, however, it may take weeks to months for complete symptom resolution. The benefit of glucocorticoids has not been clearly demonstrated and typically are only employed in patients with significant respiratory compromise. CONCLUSIONS: This case illustrates the importance of knowing the possible adverse reactions to commonly prescribed medications. Reference #1: Camus P, Fanton A, Bonniaud P, et al. Interstitial lung disease induced by drugs and radiation. Respiration 2004; 71:301. Reference #2: Holmberg L, Boman G. Pulmonary reactions to nitrofurantoin. 447 cases reported to the Swedish Adverse Drug Reaction Committee 1966-1976. Eur J Respir Dis 1981; 62:180. Reference #3: Bhullar S, Lele SM, Kraman S. Severe nitrofurantoin lung disease resolving without the use of steroids. J Postgrad Med 2007; 53:111. DISCLOSURES: No relevant relationships by Oshioke Esivue, source=Web Response No relevant relationships by Diana Rodriguez, source=Web Response

Clinical Features of Extrapulmonary Sarcoidosis Without Lung Involvement

Compared with pulmonary sarcoidosis, sarcoidosis without lung involvement may involve other immunopathologic mechanisms and be associated with other demographic and clinical features. This was a retrospective analysis of clinical data collected in real time on 1,686 patients with biopsy-proven sarcoidosis from two large university sarcoidosis outpatient clinics in the United States. We compared differences in demographics characteristics and clinical presentation between pulmonary and nonpulmonary sarcoidosis (NPS). Patients were considered to have NPS only if they had normal chest imaging and no features consistent with pulmonary involvement on the basis of currently accepted criteria. A total of 8.3%of this sarcoidosis cohort met criteria for NPS. NPS was significantly more common in white than black patients, and more common in women than men. The skin was the most common organ involved, and was observed in nearly one-half of patients with NPS. Isolated skin sarcoidosis was the overwhelmingly most common pattern of organ involvement seen in the NPS group (25%), and no other pattern of involvement was found in more than 5%of patients with NPS. Significant demographic and sex differences were observed between patients with pulmonary and nonpulmonary sarcoidosis. These differences reflect previous data concerning differences between patients with skin and lung sarcoidosis because the skin was the major organ involved with NPS. Although the lungs are likely the primary site of exposure in pulmonary sarcoidosis, the high prevalence of skin involvement in NPS suggests the skin is the most conducive site of antigen capture outside of the respiratory tract.

The effects of obesity on lung volumes and oxygenation

IntroductionObesity can cause hypoxemia by decreasing lung volumes to where there is closure of lung units during normal breathing. Studies describing this phenomenon are difficult to translate into clinical practice. We wanted to determine the lung volume measurements that are associated with hypoxemia in obese patients, and explore how we could use these measurements to identify them. MethodsWe collected pulmonary function test results and arterial blood gas data on 118 patients without obstruction on pulmonary function testing. We included only patients with normal chest imaging and cardiac testing within one year of the pulmonary function test, to exclude other causes of hypoxemia. ResultsWe found that as BMI increases, the mean paO2, ERV % predicted, and ERV/TLC decrease (BMI 20-30 kg/m2: paO2=90±8 mmHg, ERV% predicted 112±50, ERV/TLC (%) 19.7±6.5; BMI 30-40 kg/m2: paO2=84±10 mmHg, ERV% predicted 84±40 ERV/TLC(%) 13.6±7.6; BMI>40 kg/m2: paO2 78 ±12 mmHg, ERV% predicted 64±27 ERV/TLC(%) 11.4±5.8, ANOVA p<0.001). The A-a gradient increases as BMI increases (r=0.42, p<0.001). This correlation was stronger in men (r=0.54) than in women (r=0.35). The paO2 is lower in patients with a low ERV than in those with a normal ERV (p<0.001). In a multivariate linear regression, only the ERV/TLC predicted (%), age, and BMI were associated with oxygenation (r2 for A-a gradient =0.28, p=0.036). ConclusionsIn obese patients without cardiopulmonary disease, oxygen levels decrease as BMI increases. This effect is associated with the obesity-related reduction in ERV and is independent of hypoventilation.

Broncho-alveolar Lavage (BAL) for the Diagnosis of Sarcoidosic Uveitis

Purpose: To evaluate the use of BAL for the diagnosis of sarcoidosic uveitis.Methods: Retrospective study of 109 consecutive patients with uveitis and minimum 2 signs of ocular sarcoidosis who had a BAL and chest imaging. BAL+ was defined as an alveolar (a) lymphocytosis (L) aL > 15% with aCD4/CD8 > 3.5. Serum angiotensin converting enzyme (sACE), tuberculin skin test and gallium scan were tested in 83, 95 and 24 patients.Results: BAL was + in 26.6% of patients (86.2% females, mean age 50.8y) with mean aL = 46.8% and mean aCD4/CD8 = 8.5 which significantly differed form BAL− patients: 62.5% females, p < 0.02, mean age 43.6y, p < 0.05, mean aL = 17.2%, p < 0.001 and mean aCD4/CD8 = 1.8, p < 0.001. BAL+ patients had 31% of bilateral hilar adenopathy (BHL+), and 59.1% of elevated sACE which significantly differed form BAL− patients: 8.8%, p = < 0.01 and 14.8% p < 0.001.Conclusion: Our findings suggest that BAL have a high diagnostic value and might be a useful additional test for the diagnosis of sarcoidosic uveitis, even with normal chest imaging.

Bilateral Vestibular Hypofunction in Neurosarcoidosis: A Case Report

We describe the case of a 59-year-old woman who presented with progressive bilateral vestibular hypofunction and who was found to have bilateral granulomatous mass lesions of the mesial temporal lobe. Initially, her condition stabilized neurologically with corticosteroids, but a diagnosis of neurosarcoidosis was delayed because of the unusual presentation and persistently normal chest imaging results and serum angiotensin-converting enzyme (ACE) levels. Approximately 1 year after her initial presentation, the patient died of complications of a myocardial infarction and pulmonary embolism. Sarcoidosis should be considered in the differential diagnosis of idiopathic bilateral vestibular hypofunction even if the chest imaging and serum ACE levels are normal, particularly when there is evidence of a multisystem process.

The Use of Antimicrobial Agents after Diagnosis of Viral Respiratory Tract Infections in Hospitalized Adults: Antibiotics or Anxiolytics?

Because extensive antibiotic use by inpatients has been associated with the development of multidrug-resistant organisms, we aimed to determine which variables were associated with the use of antibiotics after viral respiratory tract infection diagnosis among adult patients admitted to the hospital with respiratory symptoms. A retrospective cohort study was conducted at 2 affiliated urban hospitals in Pennsylvania. We identified all adult patients admitted to the hospital during the period from November 1, 2005, through August 1, 2007, with a viral assay positive for influenza A or B, parainfluenza, adenovirus, or respiratory syncytial virus. Among these patients, we identified those who received antibiotics after the diagnosis of viral RTI. Data on demographics; comorbidities; and physical examination, laboratory, and radiographic findings were ascertained to identify risk factors for antimicrobial use among these patients. A total of 196 hospitalized patients with positive viral assay results were included; 125 of 131 patients administered antibiotics continued to receive them after viral RTI diagnosis. Among 52 patients with an abnormal chest radiograph, 46 continued antibiotic therapy. An abnormal chest radiograph was independently associated with continued antibiotic use (adjusted odds ratio, 4.28 [95% confidence interval, 1.71-10.77]; P = .002). However, the majority of patients (79 of 125 [63%]) who continued antibiotic therapy had normal chest imaging findings. Eight patients (6%) who continued antibiotic therapy and no patients who stopped developed C. difficile infection (95% CI, 1.5-∞; P = .05), but there was no significant difference in length of stay or mortality. Antibiotics are commonly used to treat hospitalized patients with known acute viral RTIs. Continued use is strongly associated with abnormal radiograph findings at admission. However, the reasons for continuation of antibiotics in the treatment of the majority of patients with normal radiographs are unclear and may represent inappropriate use.

The relationship between chest CT findings and viral load in patients with novel influenza A (H1N1)

To evaluate the value of chest CT findings and dynamic changes of viral load in patients with novel influenza A (H1N1) infection in clinical diagnosis, differential diagnosis and treatment. Fifty-one patients with confirmed novel influenza A (H1N1) according to the diagnostic criteria of the Ministry of Health, received chest X-ray, CT scans (HRCT) and viral load tests in our hospital from May to December of 2009. Based on whether there were signs of pneumonia in CT imaging, the patients were divided into a pneumonia group (n = 31) and a non-pneumonia group (n = 20). The relationship between chest CT changes and viral load was observed and analyzed statistically using SPSS 10.5 software. Patchy consolidations of lungs were the main findings in pneumonia group with influenza A (H1N1) infection, and ground-glass opacities were the main CT findings at acute and convalescent phases. Lobular and segmental shadows of the lungs were diffusely distributed, mostly found in lower lungs, especially the left lung. In some cases, the lung diseases were accompanied with mediastinal lymphadenopathy. Co-existence of pulmonary parenchymal, interstitial and pleural diseases was observed. Peak viral load occurred at the early phase of illness, with the mean initial viral load being 7.7 copies/ml and 4.2 copies/ml in the pneumonia and the non-pneumonia groups respectively. The viral nucleic acid became negative 4 days after antiviral treatment (course of 6 days). Dynamic observation of 3 patients with novel influenza A (H1N1) pneumonia showed that, the viral clearance period preceded the absorption of lung lesions in 2 cases, but viral clearance period of a young patient was significantly prolonged. In patients with the novel influenza A (H1N1) infection, the viral load in the pneumonia group was significantly higher than that in the group with normal chest imaging. Dynamic observation on chest imaging and viral load may be beneficial for clinicians to start prompt and effective treatment.

Projection profile analysis for automated detection of abnormalities in chest radiographs

Abnormalities in chest images often present as abnormal opacity or abnormal asymmetry. We have developed a novel method for automated detection of abnormalities in chest radiographs by use of these features. Our method is based on an analysis of the projection profile obtained by projecting the pixels data of a frontal chest image on to the mediolateral axis. Two indices, lung opacity index and lung symmetry index, are computed from the projection profile. Lung opacity index and lung symmetry index are then combined to detect gross abnormalities in chest radiographs. The values of lung opacity index are found to be 0.38 +/- 0.05 and 0.37 +/- 0.06 for normal right and left lung, respectively. The values of lung symmetry index are found to be 0.018 +/- 0.014 for normal chest images. The discrimination for the combination of the two indices is evaluated by linear discriminant analysis and receiver operating characteristic (ROC) analysis. Area Az under the ROC curve with the combination of the two indices in the classification of normal and abnormal chest images is 0.963.

Bochdalek diaphragmatic hernia: not only a neonatal disease

Aims: To characterise the clinical manifestations of late presenting Bochdalek diaphragmatic hernia (DH), the incidence of misdiagnosis, and prognosis; and to explore the sequence of events that leads to this...