PA Chest Research Articles

December 2024 Medical Image of the Month: An Endobronchial Tumor

No abstract available. Article truncated after 150 words. A 61-year-old woman was for wheezing. She reported that the symptoms were sudden in onset and persisted for 2 months without improvement. There was no infectious prodrome, no history of an aspiration event, and the symptoms had no exacerbating or relieving factors. The patient reported a past medical history of reflux (controlled on omeprazole), dyslipidemia, hypertension, and migraine headaches. Her past surgical history includes remote histories of breast augmentation, hysterectomy and salpingo-oophorectomy, cholecystectomy, and urethral sling. The patient was a never-smoker with no history of illicit drug use, travel, or exposures. Family history was non-contributory. The patient medications included Crestor, Thiazide, Imitrex, Losartan, and Omeprazole. No known drug allergies. Her vital signs were normal. Physical exam demonstrated an inspiratory wheeze which was diffuse and best appreciated anteriorly. A PA and Lateral chest x-ray was done at the time of initial referral (Figure 1). A CT scan was subsequently obtained (Figure …

205 - The Study of Detector Exposure Index regarding Chest PA examination with Auto Exposure Control

205 - The Study of Detector Exposure Index regarding Chest PA examination with Auto Exposure Control

Differential Association of COPD Subtypes With Cardiovascular Events and COPD Exacerbations

The coronary artery calcium score (CACS) and ratio of the pulmonary artery to aorta diameters (PA:A ratio) measured from chest CT scans have been established as predictors of cardiovascular events and COPD exacerbations, respectively. However, little is known about the reciprocal relationship between these predictors and outcomes. Furthermore, the prognostic implications of COPD subtypes on clinical outcomes remain insufficiently characterized. How can these two chest CT scan-derived parameters predict subsequent cardiovascular events and COPD exacerbations in different COPD subtypes? Using COPDGene study data, we assessed prospective cardiovascular disease (CVD) and COPD exacerbation risk in patients with COPD (Global Initiative for Chronic Obstructive Lung Disease spirometric grades 2-4), focusing on CACS and PA:A ratio at study enrollment, with logistic regression models. These outcomes were analyzed in three COPD subtypes: 1,042 patients with non-emphysema-predominant disease (NEPD) (low attenuation area at-950 Hounsfield units [LAA-950]< 5%), 1,324 patients with emphysema-predominant disease (EPD) (LAA-950≥ 10%), and 465 patients with intermediate emphysema disease (5%≤ LAA-950< 10%). Our study indicated significantly higher overall risk for cardiovascular events in patients with higher CACS (≥ median; OR, 1.61; 95%CI, 1.30-2.00) and increased COPD exacerbations in those with higher PA:A ratios (≥ 1; OR, 1.80; 95%CI, 1.46-2.23). Notably, patients with NEPD showed a stronger association between these indicators and clinical events than those with EPD (with CACS/CVD, NEPD vsEPD: OR, 2.02 vs1.41; with PA:A ratio/COPD exacerbation, NEPD vsEPD: OR, 2.50 vs1.65); the difference in ORs between COPD subtypes was statistically significant for CACS/CVD. Two chest CT scan parameters, CACS and PA:A ratio, hold distinct predictive values for cardiovascular events and COPD exacerbations that are influenced by specific COPD subtypes. ClinicalTrials.gov; No.: NCT00608764; URL: www. gov.

Adapted Anatomical Image Criteria for PA Chest Radiographs at Managil Teaching Hospital, Sudan 2023

Adapted Anatomical Image Criteria for PA Chest Radiographs at Managil Teaching Hospital, Sudan 2023

Through the Looking Glass Darkly: How May AI Models Influence Future Underwriting?

Applications of Artificial Intelligence (AI) deep-learning models to screening for clinical conditions continue to evolve. Instances provided in this treatise include using a simple one-view PA chest radiograph to screen for Type 2 Diabetes Mellitus (T2DM), congestive heart failure, valvular heart disease, and to assess mortality in asymptomatic persons with respiratory diseases. This technology incorporates hundreds of thousands of CXRs into a convoluted neural network and is generally named AI CXR. As an example, the AUROC (Area Under Receiving Operator Characteristic) of screening for T2DM was 0.84, with sensitivity and specificities that exceed those of the United States Preventative Services Task Force (USPSTF) guidelines for screening with HBA1c or blood glucose studies. The AUROC's for diagnosing ejection fractions less than 40% was 0.92, and for detecting valvular heart diseases was 0.87. The potential implications for underwriting life and disability policies may be significant. A companion article in the Journal of Insurance Medicine addresses this same technology using a simple 12-lead ECG, generally named AI ECGs.

Near-zero fluoroscopy technique for cardiac electronic device implantation: long-term outcomes

Abstract Introduction Radiation hazards are a major concern for both patients and staff. We have previously described a near-zero fluoroscopy technique for cardiac electronic device implantation. In this study, we aimed to investigate the long-term safety of this technique and compare outcomes and procedural metrics with a conventional approach in a larger population. Methods Low-dose fluoroscopy technique. Radiation exposure during fluoroscopy is directly proportional to the time the unit is activated. Typically, the pedal switch is depressed for at least a few seconds per imaging sequence in order to visualize "live" movements of either the leads during their positioning or the needle during a fluoroscopy-guided puncture of the subclavian vein. Our technique consists of setting a low frame rate per second (0.5-3.75fps) and momentarily triggering the foot pedal switch only to obtain screenshots of the position of the leads/needle. Use of live electrograms to assist spatial awareness of lead position (e.g. Atrial, Coronary Sinus, Ventricular signals) acts as an adjunct to guidance. Study design We included consecutive patients undergoing permanent pacemaker (PPM) or cardiac defibrillator (ICD) implant at our center from July 2018 to December 2022 using the near-zero fluoroscopy technique. Procedures were performed by three operators (AC, MD, MF). Cumulative radiation dose was measured using dose-area product (DAP). We assessed procedure success and complication rate during long-term follow-up. We compared the procedural metrics and outcomes with a cohort of patients with PPM or ICD implanted in our centre by senior operators, using a traditional fluoroscopic approach. Propensity score was adopted to match baseline characteristics between the study and control group. Results The total population consisted of 412 patients (74.2±13.9 years, 60.9% male). We included 206 who underwent PPM or ICD implantation using the low-dose fluoroscopy technique, and 206 matched-control. A PPM or ICD was successfully implanted in all patients. Fluoroscopy time and DAP were significantly lower in the low-dose fluoroscopy group, mean 2.3±2.0 seconds versus 258.4±252.1 seconds (P&amp;lt;0.001) and 3.4±3.5 µGym2 versus 29.8±55.4 µGym2 (P&amp;lt;0.001), respectively. Mean procedure time was 49.0±20.8 minutes in the low fluoroscopy group and 65.7±26.8 minutes in the control group (P&amp;lt;0.001). Median frame per second setting was 0.5 in the low-dose cohort. After a mean follow-up of 441±470 days, the rate of complications was identical across groups (2.4%, p = 1.0). Conclusion This near-zero dose fluoroscopy technique is effective and safe, enabling a 10x reduction in radiation exposure during device implant. Modification of traditional implant and imaging techniques can provide material reductions in fluoroscopy dose to even below that for a standard PA chest radiograph.

Follicular Ameloblastoma of Maxillary: A Case Report

Introduction: Ameloblastoma is a benign odontogenic tumor that appears in the mandible and maxilla. Ameloblastoma has slow growth that takes several years for symptoms to appear, but ameloblastoma in the maxilla has a more aggressive clinical course compared to the mandible. The lack of initial symptoms leading to diagnosis at an advanced disease when the tumour has already extended beyond maxilla. The cancellous structure of the maxillary bone makes it easier for tumors to spread to the nasal cavity, paranasal sinuses, orbitals, parapharyngeal tissue and skull base. This article reports a case of resection of maxillary ameloblastoma. Case Report: A 63 year old female patient came with complaints of a lump on her right cheek since 2 years back that gradually increased in size. Since 2 months ago, pus and blood have been coming out of the lump. Extra oral examination revealed a well-defined mass with a solid and hard consistency, there were no ulcers or fistulas. Intraorally, a mass measuring 5x5x3cm was found in the region of teeth 12 to 15 which extended to the buccal-palatal area. History of allergies and weight loss was denied. Supporting examinations including panoramic radiography, PA chest radiography, CT-Scan, FNAB, and biopsy resulted in a diagnosis of ameloblastoma. Treatment was carried out by resection of the right maxillary tumor mass under general anesthesia. Discussion: In this case, the patient's clinical examination showed a hard and large palpable swelling in the right maxilla area which extended from the region of tooth 12 to tooth 15 which caused facial asymmetry and no tooth mobility was found. This hard and painless swelling takes about 2 years before the patient experiences symptoms of pus and blood discharge. The post-maxillectomy defect in this case was covered with an intraoral prosthesis in the form of a post-surgical obturator made of acrylic resin. The obturator functions to hold the surgical packing, and prevent food or dirt contamination in the defect area which can cause infection and slow healing. The use of a prosthesis also helps restore swallowing and speech function to the patient. Conlussion: In principle, the treatment for ameloblastoma is resection of the involved bone, as in this case the action taken is a maxillectomy. Maxillectomy can result in facial and oral cavity deformities characterised by facial disfigurement and alterations in oral functionality.Therefore, maxillary reconstruction is needed to treat maxillary defects after surgical procedures involving the loss of part or all of the maxilla.

AI Models for Chest Radiograph Analysis: Internal Clinical Trial vs. Gold Standards

Our vision is to develop an AI-based software which is capable of analyzing frontal PA chest X-rays for disease diagnosis, detection, and prediction through the analysis of several different X-ray manifestations and findings which are inter-correlated to arrive to a final result. We utilize state of-the-art AI, thereby facilitating in empowering of the world through our med-tech ecosystem. It is being developed with the intention of enhanced cardiopulmonary care, bridging the gaps in healthcare, by giving conclusive and comprehensive diagnosis at lower costs and reducing the number of unnecessary diagnostic tests which, often, serve as the main cause of the delay between diagnosis and treatment. Why X-rays? X-rays have been chosen as the input because it is Non-invasive mode of diagnostic test, affordable, accessible and has much lesser radiation exposure compared to other imaging methods of CT, MRI, PET.

Implementasi Pemahaman Radiografer terhadap Exposure Index dalam Optimasi Prosedur Pemeriksaan Radiografi Computed Radiography

Background: Increasing the exposure factor is often carried out by radiographers to reduce noise and maintain image quality in computer radiography (CR). Therefore, there is a need for awareness and understanding of the exposure index (EI) to implement optimization procedures in radiographic examinations. Methods: The research method is descriptive and analytical by providing questionnaires to radiographers in PA chest radiographic examinations. This research was carried out at hospitals A, B, and C in the Jakarta-Bogor area with the research carried out between August – October 2023. Statistical analysis used SPSS 27 with data coding previously. After that, the data is processed with descriptive statistics to determine the frequency, distribution, percentage, average, and standard deviation. Then, the test chi-square to determine the relationship between gender, age, education, and work experience in understanding CR optimization procedures. Next, to find out the relationship between age and weight and EI, a test was carried out by Pearson test to determine the level of relationship between the two variablesResults: was found that the level of awareness and understanding of radiographers regarding optimization procedures using EI is still low. Test results chi-square age-understanding 0.309, gender-understanding 0.772, education-understanding 0.036, experience-understanding 0.201. next are the test results Pearson for Hospital-A: age-EI 0.09, weight-EI -0.49, Hospital-B: age-EI -0.21, weight-EI 0.06, Hospital-C: age-EI -0.37, weight-EI 0.56. Conclusions: implementing EI in the optimization procedure, it needs to be confirmed by measuring the patient's radiation dose so that there are no errors in implementing the optimization.

Entrance surface air kerma to patients during digital radiographic examinations in Tanzania.

The aim of this study was to determine the entrance surface air kerma (ESAK) in adult patients during digital radiography and to evaluate the optimisation potential in five common X-ray examinations in Tanzania. Based on a sample of 240-610 patients, ESAK was estimated using X-ray tube output measurements, patient information and backscatter factors. The results show that the mean ESAK values were higher or comparable to data from the literature. The diagnostic reference values of ESAK for digital radiography were 0.31 mGy (chest PA), 4 mGy (lumbar spine AP), 5.4 mGy (lumbar spine LAT), 3.8 mGy (abdomen AP) and 2.4 mGy (pelvis AP). For computed radiography, the mean ESAK ranges were 0.44-0.57 mGy (thoracic AP), 3.59-3.72 mGy (lumbar spine AP), 6.16-6.35 mGy (lumbar spine LAT), 3.89-3.44 mGy (abdominal AP) and 2.92-3.47 mGy (pelvic AP). In conclusion, high ESAK variations show the potential for optimising protection in digital radiology.

Evaluasi Diagnostic Reference Levels (DRL) Pada Pemeriksaan Thorax PA di Pulau Jawa Berdasarkan Database DRL BAPETEN

The International Commission of Radiation Protection (ICRP) defines the diagnostic Reference Level (DRL) as a tool for optimizing patient radiation dose during radiological examinations. However, its implementation has obstacles, such as the unavailability and completeness of inspection data. Because DRL plays a role in controlling the patient's dose so that it is optimal, regular DRL evaluation is needed, especially on the island of Java. This research is a retrospective study of the results of PA chest radiography examinations in the database BAPETEN DRL between 2018-2022. PA chest radiography examination data used are examination procedure, patient position, age, body weight, exposure factors (kVp and mAs), and ESAK dose (mGy). After that, statistical analysis was carried out using IBM SPSS version 26 and Microsoft Excel with descriptive statistical analysis of the mean, median, standard deviation, 1st quartile, 2nd quartile, 3rd quartile, and minimum to maximum ratio values for the ESAK dose. Next, the 3rd quartile values of the Java island province were analyzed and compared with several Asian countries and Australia. The results of the research on the 3rd quartile radiation dose values on the island of Java with the highest to the lowest were West Java (0,31 mGy, n=1273), Yogyakarta (0,5 mGy, n=33), East Java (0,24 mGy, n=1206), Central of Java (0,22 mGy, n=725), Banten (0,20 mGy, n=2349), Jakarta (0,17 mGy, n=1870). The DRL on the island of Java is still controlled and lower than the National DRL and DRL in Asian countries and Australia. Keywords: Java Island, Diagnostic Reference Level, Thorax PA, 3rd quartile.

PENENTUAN TIPIKAL DOSIS PADA PEMERIKSAAN RADIOGRAFI THORAKS PA BERDASARKAN KURVA REFERENSI-DRL MENGGUNAKAN DATABASE SI-INTAN BAPETEN

Consideration of patient weight as an essential indicator in optimization efforts. This is because the radiation dose varies not only for age groups but is accompanied by changes in body weight. This research method uses a retrospective study of PA chest radiography examination results in the BAPETEN DRL database between 2018-2022. PA chest radiography examination data used: examination projection, body weight, age, source image distance, exposure factor consisting of kV and mAs, and entrance surface air kerma (ESAK) dose. Data were analyzed to create a DRL-reference curve by grouping body weight from 30-101 kg with a range of 5 kg. The first stage of data fitting is to determine the relationship between body weight (kg) and radiation dose (mGy). The second stage creates a DRL reference curve using the exponential function. Next, determine the DRL value for each weight group with the 25th percentile, 50th percentile, and 75th percentile values. Continue by determining descriptive statistical values: average, standard deviation, and range. As well as comparing the 75th percentile typical dose value between the Jakarta DRL Local value and the Indonesian National DRL value. As a result of the research, a DRL reference curve for body weight groups against radiation dose was created. DRL reference curves can be compared according to further research needs or as an optimization effort. The 75th percentile DRL reference curve for the Jakarta DRL Local data is higher than the Indonesian DRL National data. Therefore, collaboration between all parties is needed to optimize radiography procedures to control the Jakarta DRL-reference curve. Data limitations are also an important factor that can cause the shape of the exponential curve to change. Keywords: DRL-reference curve, diagnostic reference level, Thorax PA.

Evaluation of patient radiation doses using DAP meter in diagnostic radiology procedures in Birjand, Iran

BackgroundThe concept of diagnostic reference level (DRL) is considered a regular method to optimize radiation protection in diagnostic imaging system. The objective of implementing a reference level for dose is to produce high-quality images by applying a minimum dose of radiation based on the As Low As Reasonably Achievable (ALARA) principle. Therefore, this study aimed to evaluate the status of radiation protection in diagnostic radiology wards of educational hospitals affiliated with Birjand University of Medical Sciences.MethodsThis study was performed during a period of 11-months in the radiology center of the teaching hospital of Birjand University of Medical Sciences. The studied population included 477 patients who were referred to as clinically indicated x-ray radiography. In order to calculate local DRLs, dose area product (DAP) was measured by a DAP-meter (KERMAX-plus SPD, model 120–131 HS) for 11 devices at educational hospitals affiliated with Birjand University of Medical Sciences. The local DRL values was calculated as 75% of the mean DAP distribution for a specific patient trial at each center.ResultsDAP for Chest PA examination was gained to be in the range from 0.12 Gy.cm2 to 0.42 Gy.cm2 with an average value of 0.23 Gy.cm2 which is above the value of the reference level (0.12 Gy.cm2) for Chest PA. For Chest lateral the observed DAP was found to be in the range from 0.18 Gy.cm2 to 1.48 Gy.cm2 with an average value of 0.65 Gy.cm2 and are therefore twice the reference value (0.3 Gy.cm2). The higher DRL values (average = 2.73) are for lumbar spine lateral radiography. It is observed that the DRL values of chest PA, abdomen AP and Lumbar spine AP are much lower with the earlier studies.ConclusionsThe DRLs helps in understanding the current practices in radiographic examinations. Comparison with other hospitals, the scope of dose optimization and ultimately patient dose reduction in hospitals affiliated with Birjand University of Medical Sciences needs further investigation.

Radiation Dose Estimation to Adult Patients Undergoing Diagnostic Chest X-Rays Examinations in Kebbi State, North-Western Nigeria

The hyperconsciousness of radiation dose delivered to the patient during chest radiological X-ray procedures are prerequisite to negate menace of exposure. The pinpoint of this research is to inquest radiation doses received by the patient for routine individual radiological chest x-ray procedures in health care system associated to Kebbi State Government, Nigeria. Entrance Surface Dose and effective dose in accordance with the exposure factors collected for the real examinations were estimated by Cal Dose_X 5.0 software. Diagnostic reference levels [75^th percentile] and other statistical parameters were calculated by the use of M. S excels spread sheet. The results obtained for ESD in this research work were 2.95mGy, 2.24mGy & 2.25mGy and 1.71mGy, 1.77mGy & 2.55mGy for Chest anteroposterior [AP], posteroanterior [PA] and lateral [LAT] respectively for Sir Yahaya Memorial Hospital (SYMH) and Federal Medical Centre (FMC), Birnin Kebbi. The effective doses were 0.68 mSv, 0.18 mSv& 0.09 mSv and 0.31 mSv, 0.13 mSv & 0.14 mSv for Chest AP, PA & LAT for SYMH and FMC respectively. Similarly, diagnostic reference level for chest AP, PA, & LAT were 2.34, 3.32 & 2.82, and 2.02, 1.88 & 3.19 respectively for SYMH and FMC. The results were compared with national and international studies. The ESD and DRLs reported in this research work for chest examinations were remarkably higher than that of the European Commission (2010), Australia (2017), NRPB (2000), UNSCEAR (2008), Iran (2008) and other research work reported elsewhere. For effective dose, the results were comparatively high except for few research work published in literatures. Therefore, the obtained results in this work revealed that the variations in the results among the two centres and other studies may likely be due to the improper selection of exposure parameters, patientbody sizes, and technical know-how of the staff. Finally, proper selection of radiological parameters and educational training to the staff can significantly reduce the risk of absorbed dose to patients.

COMPARISON AND CORRELATION OF CARDIOTHORACIC RATIO ON CHEST RADIOGRAPH AND COMPUTED TOMOGRAPHY

Chest radiograph is an easily available non invasive tool in evaluation of health. The cardiothoracic ratio (CTR) is commonly used as an indicator of cardiomegaly in clinical radiology. It can promptly diagnose congestive cardiomegaly apart from other lung and pleural pathologies and also depicts repsonse to treatment given, like diuretics in heart failure. Although there are better modalities available like echocardiography, computed tomography and magentic resonance imaging, chest radiography and cardiothoracic ratio are still being used by clinicians, especially in emergency department, intensive care unit and for frequent follow ups . CTR is calculated by dividing the cardiac diameter (CD) by the thoracic diameter (TD) as measured on posteroanterior chest radiography (chest PA). CTR of &gt;0.5 is abnormal on an inspiratory breath-hold chest radiograph. The purpose of this study was to compare the statistical correlation of CTR between chest radiograph with CT and to present real Heart Size (HS), Thoracic Size (TS), and Cardiothoracic Ratio (CTR) on chest PA and chest AP in the DR system and in computed tomography (CT). The conclusion of the study is that the measurement of CTR from radiograph &amp; computed tomography (CT) from both axial &amp; coronal reformations were concordant with another

Correlation between mAs and ESAK (mGy) for male and female chest x-ray in Digital radiography

The data were collected from 350 patients, who underwent routine x-ray examinations for chest PA examination with digital imaging in the x-ray department of Alshab Teaching Hospital in Khartoum state in Sudan. During the period from November 2019 to February 2020. The data for optimization phase were collected from phantom from computed radiography, which include chest PA, chest AP in Karary University during the period from January 2020 to February 2020. It was passed successfully the extensive quality control tests performed by Sudan atomic energy commission. The objective was to correlate between mAs and ESAK (mGy) for male and female chest x-ray. The study concluded that there was a strong relationship between mAs and ESAK, also significant correlation between Age groups and incidence risk cancer and mortality.

Pulmonary changes among asymptomatic smokers using high-resolution computed tomography and pulmonary function tests

Objective To detect pulmonary changes among asymptomatic smokers using an inspiratory and expiratory high-resolution computed tomography (HRCT) and pulmonary function tests (PFT). Pulmonary changes associated with smoking are now an increasing public health concern. Computed tomography, especially HRCT, is the best choice for visualizing lung morphology. Patients and methods The study was a cohort study conducted at Shebeen Chest Hospital from January 2019 to January 2021. The study was carried out on 120 adult males; 80 of them were asymptomatic smokers and 40 matched healthy nonsmokers served as the control group. All underwent routine chest radiograph, PA view, HRCT (inspiratory, expiratory) film, and PFTs in the form of forced expiratory vital capacity (FVC), forced expiratory volume after 1 s (FEV1), FEV1/FVC, mean forced expiratory flow, and peak expiratory flow. Comparison between the two groups was done according to HRCT and PFT. Result There was significant difference between inspiratory and expiratory HRCT regarding air trapping between cases. Inspiratory air trapping was present in 4% while expiratory air trapping was present in 18%. There was highly significant difference between cases and controls regarding emphysema and bronchial thickening, subpleural line. There was no statistically significant difference between the two groups regarding FVC, forced expiratory flow 25–75, and FEV1/FVC, while there was a significant difference between them regarding PFT pattern results (P&lt;0.05). Conclusion HRCT is the most sensitive imaging modality for diagnosing early emphysema in asymptomatic smokers. HRCT of the lung can detect lung abnormalities noninvasively.

Understanding reasons for image rejection by radiologists and radiographers.

A core element of a radiographer's role is the decision on whether a radiograph is sufficient for diagnosis, or a repeat examination is needed. Studies illustrate the disagreement on the diagnostic value of radiographs between radiographers and radiologists, which may influence repeat examinations. This study investigates if parameters contributing to image quality are possible determinants to explain the difference between professions. A total of 74 radiographers and radiologists from three different countries assessed three data sets (chest PA, hip HBL, c-spine lateral), each containing 25 radiographs. All observers scored image quality in terms of anatomical visualisation, positioning, collimation, detector exposure and judged the diagnostic value using the ACR RadLex classification. All assessments were performed on a clinically relevant display. Visual grading characteristics were used to compare image quality evaluations between groups. Radiographers scored the visualisation of anatomical structures lower than radiologists though the difference was not statistically significant. A difference in classification using the RadLex categories - with radiographers rejecting more radiographs - was demonstrated. Only the subjective evaluation of the detector exposure correlated statistically with RadLex ratings. There was no difference between radiographers and radiologists when reviewing patient positioning and collimation. Radiographers and radiologists agree on the visualisation of anatomical structures, but radiographers are more critical towards the diagnostic value. Within the criteria studied, the evaluation of anatomical structures does not explain the difference. Radiographs have a higher change of being rejected if the observer (subjectively) assessed the detector exposure as inappropriate. This correlation is stronger for radiographers.

Effectiveness of Integrated Management of Neonatal Childhood Illness (IMNCI) Tool in Chest X-Ray Positive Pneumonia Cases among Children Ages 2 Months to 5 Years A Cross-Sectional Study

IMNCI tool has widely been applied in many countries for screening, clinical diagnosis, and as a management tool for many common diseases, including cases of pneumonia. This study determines the effectiveness of IMNCI tools in the diagnosis of pneumonia as that of diagnosing pneumonia by gold standard method of X-ray Chest PA view besides finding out the sustainability in using the IMNCI guided antibiotics in managing cases of pneumonia from first care to the tertiary care facilities. Methodology: We conducted a prospective, cross-sectional study among children with World Health Organization (WHO) Integrated Management of Childhood Illness (IMCI) chest-indrawing pneumonia at a tertiary care hospital in Pakistan and assessed CXR examinations. The primary endpoint was interrater reliability between CXR for pneumonia diagnosis among children with WHO IMCI chest-indrawing pneumonia. Results: The study was done among 165 children aged between 2 months to 59 months who have visited Fatima Hospital, Baqai Medical University, due to their medical condition of cough OR fast breathing. Most of the mothers had been taking antibiotics for their sick children before they reached our set up and very few of them (15%) were found adherent to taking IMCI guided IMCI-guided antibiotic Amoxicillin, whereas the rest of all a huge majority of the cases were found using non-IMCI guided antibiotics constituting 85%, means other than oral Amoxicillin. A Sensitivity of 68.75% and a Specificity of 92.3% were found to IMCI tools validity in diagnosing pneumonia against X-ray chest positivity. Conclusion: This study concludes that the accuracy of IMCI tools in recognizing childhood pneumonia was good rather than the diagnosis as that to the positive findings in Xray Chest findings. However, with good sensitivity and the best specificity with high PPV, it can be the best screening tool for the early detection of pneumonia among children&lt;5 years and can achieve a better outcome with in-time recognition, appropriate care seeking, and early intervention avoiding irrational antibiotics. Keywords: ARI: Acute Respiratory Infection, AIDS: Acquired Immunodeficiency Syndrome, BMU: Baqai Medical University, IMCI: Integrated Management of Childhood Illness, IMNCI: Integrated Management of Neonatal &amp; Childhood Illness, WHO: World Health Organization, UNICEF: United Nations International Children’s Education Funds, MDG: Millennium Development Goal, SDG: Sustainable Development Goal, MNCH: Maternal, Neonatal &amp; Child Health Program

Pre-anesthetic evaluation: Is it only for risk assessment?

Objective: The aim of this study was to report the number of patients who get wised to that they have another health problem for the first time by anesthesiologist during preoperative anesthesia visits. Material And Methods: Patients who admitted to anesthesiology clinic of Gaziantep University Faculty of Medicine for preoperative examination and who were diagnosed with a new disease by anesthesiologist as results of consultations from other departments and/or examinations were evaluated. Results: Due to changes in the ECG and chest X-rays, as a result of cardiology consultation 18 patients were diagnosed of valvular heart disease. One of these patients was diagnosed as severe AR+MR with pleural effusion. Six patients diagnosed with prior MI and CAD, 4 of these patients were undergone to the CABG surgery with emergency conditions. One patient was diagnosed with left bundle branch block because of being VES + in the ECG. Because of the changes in the PA chest x-ray, 16 patients were diagnosed with COPD and 2 patients were diagnosed with hydatid cyst. One patient was diagnosed as lung cancer and undergone thoracotomy surgery primarily. In addition, 4 patients were diagnosed with scoliosis due to spine seen in chest x-ray. According to biochemistry tests, while 2patients were diagnosed with new DM, 3 patients had the diagnosis of steatosis due to higher AST/ALT values. With the ELISA tests, 15 patients came to know that they are HBsAg + and 8 patients are HCV +. Conclusion: Preoperative visit can reveal other unknown health problems not only the patients’ risks for operations. These diagnoses are in favor for both the anesthesiologist's and surgeon not only medical but a legal case.