Posteroanterior Chest X-ray Research Articles

Pinball-OCSVM for Early-Stage COVID-19 Diagnosis with Limited Posteroanterior Chest X-Ray Images

The conventional way of respiratory coronavirus disease 2019 (COVID-19) diagnosis is reverse transcription polymerase chain reaction (RT-PCR), which is less sensitive during early stages; especially if the patient is asymptomatic, which may further cause more severe pneumonia. In this context, several deep learning models have been proposed to identify pulmonary infections using publicly available chest X-ray (CXR) image datasets for early diagnosis, better treatment and quick cure. In these datasets, the presence of less number of COVID-19 positive samples compared to other classes (normal, pneumonia and Tuberculosis) raises the challenge for unbiased learning of deep learning models. This learning problem can be considered as one-class classification problem where the target class samples are present and other classes are absent or ill-defined. All deep learning models opted class balancing techniques to solve this issue; which however should be avoided in any medical diagnosis process. Moreover, the deep learning models are also data hungry and need massive computation resources. Therefore, for quicker diagnosis, this research proposes a novel pinball loss function based one-class support vector machine (PB-OCSVM), that can work in presence of limited COVID-19 positive CXR samples (target class or class-of-interest (CoI) samples) with objectives to maximize the learning efficiency and to minimize the false predictions. The performance of the proposed model is compared with conventional OCSVM and recent deep learning models, and the experimental results prove that the proposed model outperformed state-of-the-art methods. To validate the robustness of the proposed model, experiments are also performed with noisy CXR images and UCI benchmark datasets.

Anxiety in Patients with Post-COVID Syndrome: Associated Factors.

The term "post-COVID-19 syndrome" describes a range of symptoms persisting beyond the acute phase of the disease. These symptoms predominantly include fatigue, muscle pain, shortness of breath, and psychological issues. Research additionally suggests the possibility of long-term neurological and psychiatric impairment associated with COVID-19. The study included patients who visited the post-COVID outpatient clinic between April 2020 and June 2022. The examination included the detailed history taking, including the COVID-19 course, posteroanterior chest X-ray and pulmonary function tests. Anxiety level was assessed using the Beck Anxiety Inventory (BAI). The relationship between anxiety, demographic data, and course of the disease, need for hospital admission during the acute phase, oxygen therapy, post-inflammatory changes on the chest X-ray and lung function parameters was investigated. This study included 1756 patients who experienced COVID-19 and visited a post-COVID outpatient clinic. The majority of individuals experienced a mild form of the infection. The results showed that younger age and female gender were associated with significantly higher anxiety scores. Inpatients had lower BAI values than those who were not hospitalized during acute phase. Patients with post-inflammatory changes on chest X-ray had surprisingly lower BAI values. Lower values of FEV1 (forced expiratory volume in 1 second), DLCO (diffusing capacity of the lungs for carbon monoxide), and KCO (carbon monoxide transfer coefficient) were associated with significantly higher BAI values. Female gender was associated with higher levels of anxiety. In contrast, higher FEV1 values reduced the risk of a pathological level of anxiety. In our study, the influence of age, gender, inpatient care during the acute phase of infection, the presence of post-inflammatory changes on the chest diagram and selected parameters of lung function (FEV1, DLCO, and KCO) were shown to be important factors in the assessment of anxiety symptoms in post-COVID patients.

Automatic cardiothoracic ratio calculation based on lung fields abstracted from chest X-ray images without heart segmentation.

The cardiothoracic ratio (CTR) based on postero-anterior chest X-rays (P-A CXR) images is one of the most commonly used cardiac measurement methods and an indicator for initially evaluating cardiac diseases. However, the hearts are not readily observable on P-A CXR images compared to the lung fields. Therefore, radiologists often manually determine the CTR's right and left heart border points of the adjacent left and right lung fields to the heart based on P-A CXR images. Meanwhile, manual CTR measurement based on the P-A CXR image requires experienced radiologists and is time-consuming and laborious. Based on the above, this article proposes a novel, fully automatic CTR calculation method based on lung fields abstracted from the P-A CXR images using convolutional neural networks (CNNs), overcoming the limitations to heart segmentation and avoiding errors in heart segmentation. First, the lung field mask images are abstracted from the P-A CXR images based on the pre-trained CNNs. Second, a novel localization method of the heart's right and left border points is proposed based on the two-dimensional projection morphology of the lung field mask images using graphics. The results show that the mean distance errors at the x-axis direction of the CTR's four key points in the test sets T1 (21 × 512 × 512 static P-A CXR images) and T2 (13 × 512 × 512 dynamic P-A CXR images) based on various pre-trained CNNs are 4.1161 and 3.2116 pixels, respectively. In addition, the mean CTR errors on the test sets T1 and T2 based on four proposed models are 0.0208 and 0.0180, respectively. Our proposed model achieves the equivalent performance of CTR calculation as the previous CardioNet model, overcomes heart segmentation, and takes less time. Therefore, our proposed method is practical and feasible and may become an effective tool for initially evaluating cardiac diseases.

TransDL: A transfer learning-based concatenated model for Covid-19 identification and analysis of posteroanterior chest X-ray images

TransDL: A transfer learning-based concatenated model for Covid-19 identification and analysis of posteroanterior chest X-ray images

Use of Video-Assisted Thoracoscopic Surgery (VATS) in the Treatment of Primary Spontaneous Pneumothorax (PSP) in Children.

This study aims to review the primary spontaneous pneumothorax (PSP) patients we have treated and to discuss the results in terms of PSP treatment management and video-assisted thoracoscopic surgery (VATS) use in the light of the literature. The study was designed retrospectively and conducted at a tertiary referral university hospital between January 1, 2015 and May 1, 2021. Patients under the age of 18 years with a diagnosis of pneumothorax (PTX) were included in the study. Medical records were analyzed in terms of clinical characteristics, demographic data, findings from imaging data, procedures performed, and course of the disease at hospital. Patients with no evidence of PTX on radiologic imaging (direct postero-anterior chest X-ray (PACXR) or thoracic computed tomography (TCT)), incomplete medical records for follow-up, history of trauma, and neonatal PTX were excluded from the study. The study was conducted on a total of 98 PTX cases in 69 patients, 61 (88.4%) males and eight (11.6%) females. The ages of the patients ranged between 13 and 17 years with a mean of 16.59 ± 0.95 years. While 48 (49%) PTX cases were treated with tube thoracostomy, 19 (19.4%) were treated with medical follow-up (nonsurgical treatment) and 31 (31.6%) were treated with VATS. A total of 31 VATS procedures were performed on 28 patients. The follow-up period after VATS ranged from tthree to 78 months, with a mean of 31.5 ± 20.3 months and a median of 28 months. Our retrospective study showed that TCT scanning did not provide additional benefit when PSP was detected on PACXR in patients presenting with chest pain and respiratory distress. According to the findings of our study, it was thought that the probability of undergoing an invasive procedure and surgical intervention increased as the percentage of PTX detected in PACXR increased. Tube thoracostomy may be required in a patient with PSP if PTX does not start to decrease and lung expansion does not increase after an average of 60 hours after the decision for medical follow-up, and if PTX is progressive in the follow-up. VATS can be performed on a patient with PSP when lung expansion does not increase after an average of 18 hours after tube thoracostomy, when PTX progresses, when air leakage continues for more than 10 days despite increased lung expansion, and when recurrent PTX occurs.

Patient Identification Based on Deep Metric Learning for Preventing Human Errors in Follow-up X-Ray Examinations

Biological fingerprints extracted from clinical images can be used for patient identity verification to determine misfiled clinical images in picture archiving and communication systems. However, such methods have not been incorporated into clinical use, and their performance can degrade with variability in the clinical images. Deep learning can be used to improve the performance of these methods. A novel method is proposed to automatically identify individuals among examined patients using posteroanterior (PA) and anteroposterior (AP) chest X-ray images. The proposed method uses deep metric learning based on a deep convolutional neural network (DCNN) to overcome the extreme classification requirements for patient validation and identification. It was trained on the NIH chest X-ray dataset (ChestX-ray8) in three steps: preprocessing, DCNN feature extraction with an EfficientNetV2-S backbone, and classification with deep metric learning. The proposed method was evaluated using two public datasets and two clinical chest X-ray image datasets containing data from patients undergoing screening and hospital care. A 1280-dimensional feature extractor pretrained for 300 epochs performed the best with an area under the receiver operating characteristic curve of 0.9894, an equal error rate of 0.0269, and a top-1 accuracy of 0.839 on the PadChest dataset containing both PA and AP view positions. The findings of this study provide considerable insights into the development of automated patient identification to reduce the possibility of medical malpractice due to human errors.

Chest X-ray predicts cases of pulmonary tuberculosis among women of reproductive age with acute respiratory symptoms: A multi-center cross-sectional study

BackgroundTuberculosis (TB) prevalence is increasing among women of reproductive age (WRA) in sub-Saharan Africa, yet undiagnosed and untreated cases remain rather high with serious health and socio-economic consequences. We aimed to assess the prevalence and predictors of TB in WRA seeking health care for acute respiratory symptoms. MethodsWe consecutively enrolled outpatient WRA with acute respiratory symptoms seeking care at four healthcare facilities in Ethiopia between July 2019 and December 2020. Data on sociodemographic characteristics and clinical information were collected using a structured questionnaire administered by trained nurses. Posteroanterior chest X-ray was performed in non-pregnant WRA and interpreted independently by two radiologists. Sputum samples were collected from all patients and tested for pulmonary TB using Xpert MTB/RIF and/or smear microscopy. Predictors of bacteriologically confirmed TB cases were determined using binary logistic regression, with clinically relevant variables included in the final Firth’s multivariate-penalized logistic regression model. ResultsWe enrolled 577 participants, of whom 95 (16%) were pregnant, 67 (12%) were living with HIV, 512 (89%) had cough of less than 2 weeks, and 56 (12%) had chest-x-ray findings suggestive of TB. The Overall prevalence of TB was 3% (95% CI: 1.8%-4.7%) with no significant difference observed between patient groups categorized by duration of cough or HIV serostatus (P-value = 0.9999). In multivariable analysis, TB-suggestive CXR abnormality (AOR 18.83 [95% CI, 6.20–57.18]) and history of weight loss (AOR 3.91 [95% CI, 1.25–12.29]) were associated with bacteriologically-confirmed TB cases. ConclusionsWe found a high TB prevalence among low-risk women of reproductive age with acute respiratory symptoms. Routine CXR may improve early case detection and thereby TB treatment outcomes.

Azygos lobe: A rare cause of right paratracheal opacity in children

he azygos lobe is a rare anatomical variation located in the upper mediastinum. It is more common in males and has a genetic predisposition. It is often located on the right lung. Azygos lobe is usually asymptomatic and does not require specific treatment. The azygos lobe should be kept in mind when examining the posteroanterior chest X-ray, one of the well-implemented medical inspections in pediatric clinics. In this case study, we report a 6-year-old male patient who was admitted to the emergency service because of a three-day-lasting cough, a fever that can reach 39,2°C, and difficulty in inspirium that started an hour ago and computed tomography revealed azygos lobe.

The Diagnostic Performance and Utility of Chest XR in Relation to Chest CT in Nontraumatic Respiratory Emergency Patients

ABSTRACT Background and Aim: This study aimed to determine the diagnostic performance and utility of chest radiography in relation to chest computed tomography (CT) in nontraumatic respiratory emergency patients. Patients and Methods: Patients presenting to the emergency department with respiratory complaints due to nontraumatic pathologies and who had consecutive chest XR and chest CT assessments with an interval of fewer than 6 hours were enrolled in the study (n = 561). Results: The two methods were determined to be consistent with moderate agreement in detecting pleural effusion (k = 0.576, P < 0.001), pneumothorax (k = 0.567, P < 0.001), increased cardiothoracic ratio (k =0.472, P < 0.001), and pneumonic consolidation (k = 0.465, P < 0.001). The consistency rate was significantly higher in patients aged <40 years (95.5% in ≤30 years and 90.9% in 31–40 years) as compared to older patients (81.8%, 68.2%, and 72.7% in 41–60 years, 61–80 years, and >80 years, respectively; P < 0.001 for each). The consistency rate was also higher for posteroanterior (PA) chest XR views than for anteroposterior (AP) chest XR views (72.7% vs. 68.2%, P = 0.005) and for high- and moderate-quality chest XR views than for poor-quality views (72.7% and 77.3% vs. 70.5%, P = 0.001). Conclusion: The consistency between the chest XR and CT was more likely in patients aged <40 years and for PA and moderate-to-high quality chest XR views, as compared to older patients and AP and poor-quality views, respectively. We suggest that an upright position PA chest X-ray with high imaging quality may be the first choice, especially in patients aged <40 years admitted to the emergency department with respiratory symptoms.

A survey investigating postero-anterior chest X-ray clinical technique amongst radiographers and assistant practitioners in the UK: An extended pilot study

IntroductionWhilst many technical factors for the postero-anterior (PA) chest projection are well-researched and standardised, anecdotal evidence suggests a discrepancy regarding positioning of the X-ray tube; some radiographers using a horizontal tube, and others apply an angle. Currently there is a lack of published evidence supporting the benefits of either technique. MethodsFollowing University ethical approval, an invitation e-mail containing a link to a short questionnaire and participant information sheet was sent to radiographers and assistant practitioners in Liverpool and the surrounding areas, via professional networks/research team contacts. Questions related to length of experience, highest qualification and reasoned choice of horizontal versus angled tube preference in Computed Radiography (CR) and Digital Radiography (DR) rooms. The survey was open for nine weeks, with reminders at five and eight weeks. ResultsThere were 63 respondents. Both techniques were commonplace, with a non-statistically significant preference (p = 0.439) for a horizontal tube in both DR rooms (59%, n = 37) and CR rooms (52%, n = 30). Angled technique was employed by 41% (n = 26) of participants in DR rooms and 48% (n = 28) in CR rooms. Many participants indicated ‘taught’, or ‘protocol’, influenced their approach (46% [n = 29] in DR, 38% [n = 22] in CR). 35% (n = 10) of participants using caudal angulation, identified dose optimisation as the rationale in both CR and DR rooms. Most specifically noted reduced dose to the thyroid (69% [n = 11] in CR, 73% [n = 11] in DR). ConclusionsThere is evidence of variation in practice regarding horizontal versus an angled X-ray tube but no consistent rationale for either choice. Implications for practiceThere is a need to standardise tube positioning in PA chest radiography in line with future empirical research into the dose-optimisation implications of tube angulation.

Unsupervised anomaly detection for posteroanterior chest X-rays using multiresolution patch-based self-supervised learning

The demand for anomaly detection, which involves the identification of abnormal samples, has continued to increase in various domains. In particular, with increases in the data volume of medical imaging, the demand for automated screening systems has also risen. Consequently, in actual clinical practice, radiologists can focus only on diagnosing patients with abnormal findings. In this study, we propose an unsupervised anomaly detection method for posteroanterior chest X-rays (CXR) using multiresolution patch-based self-supervised learning. The core aspect of our approach is to leverage patch images of different sizes for training and testing to recognize diverse anomalies characterized by unknown shapes and scales. In addition, self-supervised contrastive learning is applied to learn the generalized and robust features of the patches. The performance of the proposed method is evaluated using posteroanterior CXR images from a public dataset for training and testing. The results show that the proposed method is superior to state-of-the-art anomaly detection methods. In addition, unlike single-resolution patch-based methods, the proposed method consistently exhibits a good overall performance regardless of the evaluation criteria used for comparison, thus demonstrating the effectiveness of using multiresolution patch-based features. Overall, the results of this study validate the effectiveness of multiresolution patch-based self-supervised learning for detecting anomalies in CXR images.

REFERRING PHYSICIANS' KNOWLEDGE OF THE RADIATION DOSES FOR COMMONLY RADIOLOGICAL INVESTIGATIONS IN NASIRIYA TURKISH HOSPITAL.

The aim: To assess the referring physicians' knowledge of the radiation doses for commonly radiological investigations in Nasiriya Turkish Hospital (NTH). Materials and methods: A cross-sectional study of referring physicians in NTH was carried out. A two-part questionnaire was distributed to all Referring Physicians' apart from radiologists. Radiological examinations were listed and Referring Physicians' were asked to estimate equivalent doses using the dose of postero-anterior chest X-Ray as a reference. Questions on knowledge of radiation (including radiation exposure and doses, protection, maximizing effectiveness, impacts of ionizing radiation) and utilization of referral guidelines were included. Results: A total of 50 were distributed to the participants, 32 were returned and deemed acceptable for inclusion in this study. The participants' demographic data shows that most are male 21 (65.6%), while 11 (34.4%) are female. Up to 23 (71.9%) of participants had knowledge of ionizing radiation, but only 7 (21.9%) physicians were aware of its unit measurement. Most participants were unable to accurately estimate the radiation dose absorbed by patients during the various radiological examinations; 68.8% had no knowledge of radiations' stochastic and non-stochastic impacts; 14 (43.7%) were aware of the referral guidelines and used them. The majority of the participants 24 (75%) are aware that USS is safe for pregnant women. only 1(3%) physician knew that there is no ionizing radiation involved in MRI. Conclusion: Most participants did not able to accurately estimate the radiation dose absorbed by patients during the various radiological examinations.

The effect of an artificial intelligence algorithm on chest X-ray interpretation of radiology residents.

Chest X-rays are the most commonly performed diagnostic examinations. An artificial intelligence (AI) system that evaluates the images fast and accurately help reducing workflow and management of the patients. An automated assistant may reduce the time of interpretation in daily practice. We aim to investigate whether radiology residents consider the recommendations of an AI system for their final decisions, and to assess the diagnostic performances of the residents and the AI system. Posteroanterior (PA) chest X-rays with confirmed diagnosis were evaluated by 10 radiology residents. After interpretation, the residents checked the evaluations of the AI Algorithm and made their final decisions. Diagnostic performances of the residents without AI and after checking the AI results were compared. Residents' diagnostic performance for all radiological findings had a mean sensitivity of 37.9% (vs 39.8% with AI support), a mean specificity of 93.9% (vs 93.9% with AI support). The residents obtained a mean AUC of 0.660 vs 0.669 with AI support. The AI algorithm diagnostic accuracy, measured by the overall mean AUC, was 0.789. No significant difference was detected between decisions taken with and without the support of AI. Although, the AI algorithm diagnostic accuracy were higher than the residents, the radiology residents did not change their final decisions after reviewing AI recommendations. In order to benefit from these tools, the recommendations of the AI system must be more precise to the user. This research provides information about the willingness or resistance of radiologists to work with AI technologies via diagnostic performance tests. It also shows the diagnostic performance of an existing AI algorithm, determined by real-life data.

Characteristics of patients with transudative efusion followed in an university hospital

Aim: To determine the etiological causes, radiological and laboratory features of transudative pleural effusions and to observe the clinical course after therapeutic thoracentesis. Material and Method: The files of patients with transudative effusion who underwent therapeutic thoracentesis by the Interventional Radiology Department between 01.01.2012 and 30.11.2012 were retrospectively reviewed. Pleural effusion (PE) anatomical features were evaluated with Postero anterior (PA) chest X-ray and Thorax Ultrasonography (USG). Demographic and clinical features, pleural effusion analysis results, presence and rates of complications were analyzed. Results: As a result of pleural fluid analysis, our study group consisted of 60 transudative pleural effusion cases, 36 (60%) women. The mean age was 71.23±2.36 years. Patients using diuretic therapy in cases with pleural effusion were statistically significantly higher than patients who did not (p<0.05). The most common etiologic causes were Congestive heart failure (CHF) and the accompanying disease hypertension (HT). Fifty (83.3%) of the pleural effusions were unilateral and 39 (65%) of them were right-sided (p<0.05). Diagnostic and therapeutic thoracentesis of our cases was performed by the radiologist under the guidance of thorax USG, and pneumothorax was observed in only one case (1.7%). In our 2-month clinical follow-up, the presence of recurrent pleural effusion was not detected in any of the cases. Conclusion: In cases with persistent transudative pleural effusion, therapeutic thoracentesis can be considered in cases where fluid resorption is not at the desired level despite effective treatment.

Severe multilobar lung echinococcosis with multiorgan involvement in a child.

Multilobar lung echinococcosis with multiorgan involvement is an extremely rare entity in pediatric populations. We would like to share an adolescent girl with very demonstrative postero-anterior chest X-ray and computed tomography images.

Compliance to radiography practice of high-kilovoltage technique for chest radiography in South South Nigeria

BackgroundThe production of a good quality chest radiograph depends on the selection of appropriate kilovoltage and current–time product while keeping the radiation dose to patients as low as possible. This study assessed radiographers’ level of compliance to the use of high kV as standard for postero-anterior (PA) chest X-ray in the South South region of Nigeria.ResultsSeventy-seven of the 82 questionnaires administered were completely filled and returned giving a response rate of 94%. Of these 77 respondents, only 74% (n = 57) were aware of high-kV technique as the recommended procedure for PA chest X-ray. Departmental protocols (technique chart with exposure factors) were also non-existent in all hospitals/diagnostic centres used in this study. Thirty-one respondents were males (40%); 44% (n = 34) working in public hospitals only and 32% (n = 25) with less than five years of working experience were aware of this technique. On the benefits, more than 50% of the respondents were familiar with the benefits of using high-kV technique as the recommended standard for PA chest X-rays. Responses on the benefits of the technique varied from 77% (n = 59) for patient dose reduction to 51% (n = 39) for better imaging of the airways. The use of high-kV technique for PA chest X-rays showed only 13% compliance. Factors influencing compliance included imaging system (film screen /digital), X-ray tube rating and X-ray unit with preset/manual exposure factors (p < 0.05).ConclusionsThe present study revealed low compliance to high-kV technique in this region, suggesting a potential increase in ionizing radiation dose to patients during chest radiography, hence the need to improve adherence to the recommended standard.

Prediction of Stature to Discriminate Chest X-Ray Using Longitudinal Scapular and Clavicular Lengths

Aim: In clinical examinations, it is sometimes unknown whether the chest X-ray belongs to the patient. Here, we aimed to develop estimation equations that can predict the stature of male and female patients using scapular and clavicular length measurements on chest X-rays to determine to who the chest X-ray belongs. Methods: This cross-sectional study was conducted on 200 adult patients (104 females and 96 males; mean age 50.6 years) who underwent a routine posteroanterior chest x-ray. The longitudinal scapular length and longitudinal clavicular length were measured on the chest x-ray. Multiple linear regression analysis was used to develop the estimation equations. External validation of the estimated equations was tested on 100 adult patients (50 females and 50 males; mean age 56.7 years) and agreement between measured and estimated stature was investigated by the Bland and Altman method. Results: Stature was equal to 11.1-fold of longitudinal scapular length and 10.5-fold of longitudinal clavicular length in males while it was equal to 11.8-fold of longitudinal scapular length and 10.7-fold of longitudinal clavicular length in females. Stature was found to be significantly correlated with age, weight, longitudinal scapular length, and longitudinal clavicular length in men, and with age and longitudinal clavicular length in women. Multiple linear regression analysis revealed an estimation equation for stature in males was: 131.3 - 0.174 (Age) + 0.161 (Weight) + 0.083 (longitudinal scapular length) + 0.134 (longitudinal clavicular length), and in females was 131.2 - 0.137 (Age) + 0.225 (longitudinal clavicular length). There was good agreement between measured and estimated stature in male and female patients. Conclusion: The stature of the patient can be estimated using the derived equations based on the longitudinal scapular length and longitudinal clavicular length measurements on chest x-ray. If it is not possible to determine to who the chest X-ray belongs in clinical practice, the patient's stature can be estimated with the help of the equations and possible errors can be prevented. Keywords: chest x-ray, clavicle, scapula, estimation techniques, stature

Effectiveness of the polyglycolic acid patch in preventing prolonged air leakage after pulmonary decortication.

This study aimed to investigate the effectiveness of an absorbable polyglycolic acid patch (PGA) in the early prevention of alveolar air leaks after pulmonary decortication operations. Between January 2016 and December 2019, files of 185 patients with pleural effusion, empyema, or hemothorax were examined retrospectively. Thirty-five patients who underwent decortication surgery were included in the study. Two-way posteroanterior (PA) chest x-ray, computed tomography (CT), pulmonary function tests (PFT), arterial blood gas, hemogram, and biochemical tests were performed for all patients before the operation. The patients were divided into two groups. Group 1 was composed of 16 patients (45.7%) with standard decortication, and Group 2 was formed with 19 patients (54.3%) with standard decortication + PGA patch. The median age was 55 years (minimum=25, maximum=75) and the vast majority (82.9%; n=29) of patients were males. There was no significant difference between groups in age, aetiology, or sex. The most common etiological cause in both Group 1 and Group 2 was nonspecific infection (56.3% and 73.7%, respectively). When Group 2 and Group 1 were compared regarding median times (day) of air leak cessation (Group 2=4; Group 1=8.5), chest drain removal (Group 2=5; Group 1=10), and hospital discharge times (Group 2=8; Group 1=13),the durations were statistically significantly shorter in Group 2 than in Group 1 (P < 0.001). Use of the PGA patch in pulmonary decortication operations significantly reduced the duration of air leaks, drain removal, and discharge time from the hospital in the postoperative period.

Case Report: Delayed treatment of tuberculosis of the elbow joint

Extrapulmonary tuberculosis (TB) is known to occur in the musculoskeletal system, including the elbow joints. These cases are rarely found because the signs and symptoms are not specific to extrapulmonary TB or other diseases. We report a case of a 24-year-old male, who complained about pain in his left elbow and noticed swelling. Initially, he complained about pain all over his left arm, after several reflexology massages to alleviate his toothache. However, instead of seeking medical treatment, he visited a traditional massage therapist every week without improvement in his left arm pain including his left elbow for almost one year. Examination showed skin perforation with discharge. He also had fever during the first few days when the elbow became swollen. Weight loss and a decreased appetite were also noticed by the patient. The patient went to the orthopedic department and underwent surgery. Radiological examination indicated bone erosion on the left humerus and radius, while posteroanterior chest X-ray did not show any abnormality. Histopathological examinations from biopsy and fluid aspiration showed granulomas and datia Langhans cells. Mycobacterium tuberculosis was found on acid-fast bacteria smear and culture. The patient was administered multidrug tuberculosis therapy, which consisted of two months of an intensive phase and seven months of a continuation phase, in accordance with the World Health Organization's guidelines for extrapulmonary tuberculosis treatment. He has currently undergone the continuation phase of the treatment and his condition has improved. Early detection of tuberculosis of the elbow can prevent damage to joint structure and impairment of joint function.

Chest radiograph patterns and their correlation with CD4 count in adults with Human Immunodeficiency Virus (HIV) in Lagos University Teaching Hospital, Nigeria

The only available treatment for Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) at the moment is antiretroviral therapy (ART). The chest radiograph patterns in adults with HIV could be used as an alternative or surrogate to CD4 count in monitoring the progress of treatment in resource poor settings where these tests and expertise are not available. This study was aimed at evaluating chest the radiograph patterns in HIV sero-positive adults and correlating with the CD4 cells count. This was a cross-sectional study conducted among patients diagnosed of HIV using the National algorithm at the HIV Clinic of the Lagos University Teaching Hospital. A purposive sampling method was employed and three hundred and twenty (320) HIV sero-positive adult participants were recruited. Postero-anterior chest x-ray projection was performed on all the participants and the radiographs were reported by two consultant Radiologists and the CD4 counts was determined. Pulmonary TB was the most frequent finding (22.1%) while bronchitis was the least frequent finding (0.9%). and normal radiograph (52.6%). The CD4 count was less than, 200 cells/mm3 in 38.3% of the participants. There was a strong correlation between chest radiograph patterns and CD4 cells count (r=-0.53; p=0.001). This study revealed that the most predominant radiographic patterns are Pulmonary Tuberculosis. A strong negative correlation was observed between chest radiograph patterns and CD4 count. The Chest radiograph patterns may be recommended as a measure of immunosuppression in adults with HIV in Nigeria.