Survey of Physicians Concerning the Use of Chest Radiography in the Diagnosis of Pneumonia in Out-Patients

OBJECTIVE: To determine how physicians use chest radiography in the diagnosis of pneumonia in ambulatory patients.STUDY POPULATION: A convenience sample of 176 Nova Scotia family physicians and internists selected to represent all geographic areas of the province proportional to population.STUDY INSTRUMENT: A 35-item questionnaire covering demographics, experience with out-patients with pneumonia, use of chest radiographs to make this diagnosis and factors that were considered important in the decision to perform initial and follow-up chest radiographs. Two skill-testing questions were also included.RESULTS: One hundred and fourteen of 176 (64.7%) responded; 88% had treated out-patients with pneumonia in the previous three months. Fifty-seven per cent of physicians requested chest radiographs on 90% to 100% of out-patients in whom they had made a clinical diagnosis of pneumonia. These physicians were more likely to be internists and to have graduated before 1970. Factors that ranked most important in the decision to request the initial chest radiograph were clinical appearance, respiratory distress and physical findings, while age and smoking history contributed most to the decision to perform a follow-up chest radiograph.CONCLUSIONS: There is considerable variability among physicians in requesting chest radiographs on out-patients with a clinical diagnosis of pneumonia. Physician and patient factors contribute to this variability.

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Disappearance of a 47,XX,C+ Leucocyte Cell Line in an Infant Who Had Previously Exhibited 46,XX/47,XX,C+ Mosaicism

PEDIATRICS ◽

10.1542/peds.43.4.623 ◽

1969 ◽

Vol 43 (4) ◽

pp. 623-626

Author(s):

Richard L. Neu ◽

Gerald J. Bargman ◽

Lytt I. Gardner

Keyword(s):

Bone Marrow ◽

Cell Line ◽

Cell Lines ◽

Chromosomal Abnormality ◽

Thoracic Vertebrae ◽

Fetal Life ◽

Clinical Appearance ◽

Abnormal Cell ◽

Physical Findings

Follow-up observations are reported on an infant with numerous phenotypic abnormalities who had been reported at 7 months of age to have an extra C group autosome in 17% of her peripheral leucocytes. Examination of the patient at age 2½ years revealed that the physical findings were essentially unchanged, except for increased prominence of the sixth, seventh, and eighth thoracic vertebrae. The abnormal cell line was found to have disappeared from her leucocytes in cultures repeated at ages 2½ and 2[unknown] years. Analysis of bone marrow metaphases showed that 7% were of the 47,XX,C+ karyotype. Other reported examples of disappearing abnormal cell lines are reviewed. These findings may help explain those cases having the clinical appearance of a syndrome associated with chromosomal abnormality, but whose karyotypes are normal. It is possible that a mosaicism existed during fetal life, and that the cytogenetically abnormal cell line caused abnormal organogenesis prior to its later disappearance.

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Soft Tissue/Bone Decomposition of Conventional Chest Radiographs Using Nonparametric Image Priors

Applied Bionics and Biomechanics ◽

10.1155/2019/9806464 ◽

2019 ◽

Vol 2019 ◽

pp. 1-17

Author(s):

Yunbi Liu ◽

Wei Yang ◽

Guangnan She ◽

Liming Zhong ◽

Zhaoqiang Yun ◽

...

Keyword(s):

Soft Tissue ◽

Chest Radiograph ◽

Chest Radiography ◽

Chest Radiographs ◽

Data Set ◽

Decomposition Model ◽

Dense Matching ◽

Image Patches ◽

Lung Vessels ◽

Posterior Anterior

Background and Objective. When radiologists diagnose lung diseases in chest radiography, they can miss some lung nodules overlapped with ribs or clavicles. Dual-energy subtraction (DES) imaging performs well because it can produce soft tissue images, in which the bone components in chest radiography were almost suppressed but the visibility of nodules and lung vessels was still maintained. However, most routinely available X-ray machines do not possess the DES function. Thus, we presented a data-driven decomposition model to perform virtual DES function for decomposing a single conventional chest radiograph into soft tissue and bone images. Methods. For a given chest radiograph, similar chest radiographs with corresponding DES soft tissue and bone images are selected from the training database as exemplars for decomposition. The corresponding fields between the observed chest radiograph and the exemplars are solved by a hierarchically dense matching algorithm. Then, nonparametric priors of soft tissue and bone components are constructed by sampling image patches from the selected soft tissue and bone images according to the corresponding fields. Finally, these nonparametric priors are integrated into our decomposition model, the energy function of which is efficiently optimized by an iteratively reweighted least-squares scheme (IRLS). Results. The decomposition method is evaluated on a data set of posterior-anterior DES radiography (503 cases), as well as on the JSRT data set. The proposed method can produce soft tissue and bone images similar to those produced by the actual DES system. Conclusions. The proposed method can markedly reduce the visibility of bony structures in chest radiographs and shows potential to enhance diagnosis.

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The Hilar Height Ratio in Normal Chest Radiographs of Adults Seen at Selected Tertiary Hospitals in Kampala, Uganda; A Forgotten Parameter in Pulmonary Medicine

10.21203/rs.3.rs-955671/v1 ◽

2021 ◽

Author(s):

Daniel Muhati Wendo ◽

Samuel Bugeza ◽

Sam Nseko ◽

Senai Goitom Sereke ◽

Faith Ameda

Keyword(s):

Chest Radiograph ◽

Age Groups ◽

Chest Radiographs ◽

Volume Changes ◽

Height Ratio ◽

Tertiary Hospitals ◽

Study Population ◽

Normal Chest ◽

The Right ◽

Pulmonary Volume

Abstract Background: The hilar height ratio (HHR) is a numerical expression of the hila position. Displacement of the pulmonary hilum is the most reliable indirect sign, in conditions that result in pulmonary volume changes. Despite the high utility of the chest radiograph, it has a relatively low diagnostic accuracy, high interobserver disagreement and numerous errors following interpretation. Routine use of the HHR with knowledge of the normal ranges would, therefore, help improve the overall chest radiograph sensitivity, reduce on errors and the interobserver disagreement in the interpretation of pulmonary volume changes. This study aims to determine the HHR in our study population, compare it with previous studies, and to relate it with sex, stratified age groups, height and body mass index (BMI).Methods: A consecutive cross-sectional study with purposive sampling were used to filter out a total of 384 normal chest radiographs of adults seen from three tertiary hospitals in Kampala, Uganda. The right and left HHRs were evaluated for each chest radiograph, along with the age, sex weight, height and BMI.Results: The median right HHR for the participants was 1.42 (IQR = 1.31- 1.57), and the median left HHR was 0.92 (IQR = 0.86- 0.98). There was a significant mean difference in the right HHR between the sex groups (p = 0.017) and age groups (p = 0.001). The mean difference in the left HHR was not affected by sex (p = 0.178) or age (p = 0.198). The right and left HHRs showed a very weak correlation to height (r = - 0.10 and r = 0.08, respectively). The right and left HHRs were not significantly different among the BMI groups (p = 0.254 and 0.20 respectively).Conclusion: The median left HHR was not affected by sex, age, weight and height while the right HHR varied with sex and age in our study population. Weight and height do not affect HHRs. The females in our study population had a higher positioned right hilum, whereas the position of the right hilum progressively lowered with increasing age.

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Stellenwert der 67Ga-Szintigraphie in der Primärdiagnostik und Verlaufsbeurteilung opportunistischer Pneumonien bei Patienten mit AIDS

Nuklearmedizin ◽

10.1055/s-0038-1629454 ◽

1988 ◽

Vol 27 (05) ◽

pp. 219-225 ◽

Cited By ~ 1

Author(s):

P. Knesewitsch ◽

C.-M. Kirsch ◽

G. Küffer ◽

G. Dörner ◽

A. Matuschke ◽

...

Keyword(s):

Chest Radiograph ◽

Pathogen Detection ◽

Chest Radiographs ◽

Uptake Ratio ◽

67Ga Scintigraphy ◽

Pulmonary Uptake ◽

Highly Sensitive ◽

Aids Related Complex ◽

The One

Opportunistic pneumonias are a life-threatening complication in patients with AIDS. Early diagnosis and therapy is necessary to improve prognosis. This study was designed to assess the value of 67Ga scintigraphy in the primary detection and follow-up of these special pneumonias. 67Ga scintigraphy was performed in 40 patients: 10 normal controls and 30 HIV-positive patients with AIDS or AIDS-related complex (ARC). 67Ga scan results were compared with current chest radiographs and the results of pathogen detection. The evaluation of positive scans was based on a quantification of the pulmonary uptake, expressed as a pulmonary/soft-tissue uptake ratio. Only 8/30 patients had a normal scan, 22/30 showed diffuse (13/22) or focal (9/22) increases of pulmonary uptake. In 7/8 patients with normal scans the chest radiograph was negative as well. The one patient with negative scan but positive chest radiograph had pulmonary Kaposi’s sarcoma. In 11/22 patients the 67Ga scan and chest radiograph were positive simultaneously. In the other 11/22 patients with positive scans chest radiographs were initially negative but showed pathology in 5 cases within 1-2 weeks. The reason for positive scans in most cases was an opportunistic lung infection; other forms of pneumonia were only observed in two cases. The defined uptake ratio demonstrated to be a highly sensitive parameter for monitoring pneumonia and the effects of therapy in follow-up studies. In conclusion, quantitative 67Ga scintigraphy proved to be a reliable and highly sensitive method for primary detection and follow-up of opportunistic pneumonias in patients with AIDS.

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Relative Sparing of the Left Upper Zone on Chest Radiography in Severe COVID-19 Pneumonia

Respiration ◽

10.1159/000516325 ◽

2021 ◽

pp. 1-5

Author(s):

Alexandra M. Buckley ◽

Stephanie Griffith-Richards ◽

Razaan Davids ◽

Elvis M. Irusen ◽

Peter S. Nyasulu ◽

...

Keyword(s):

Intensive Care ◽

Chest Radiograph ◽

Chest Radiography ◽

Chest Radiographs ◽

Ground Glass ◽

Lung Edema ◽

Radiological Findings ◽

Intensive Care Admission ◽

The Right ◽

Extent Of Disease

The radiological findings of COVID-19 are well-described, including its evolution. In an earlier report of admission chest radiographs of patients with COVID-19, we anecdotally noted relative sparing of the left upper zone (LUZ). We subsequently aimed to describe the main chest radiograph findings in another cohort, focusing on zonal predominance. The admission chest radiographs of 111 patients with COVID-19 pneumonia requiring intensive care admission were reviewed by 2 thoracic radiologists and categorized according to the predominant pattern into either ground-glass opacities (GGOs), alveolar infiltrates and/or consolidation, or reticular and/or nodular infiltrates or an equal combination of both, and the extent of disease involvement of each of the zones using a modified Radiologic Assessment of Lung Edema (RALE) score. Parenchymal changes were detected in all. In total, 106 radiographs showed GGOs, alveolar infiltrates, and/or consolidation, and 5 had a combination of reticular/nodular infiltrates as well as GGOs, alveolar infiltrates, and/or consolidation. The LUZ had a significant lower grading score than the right upper zone: 1 versus 2 (<i>p</i> < 0.001). Likewise, the upper zones had a significant lower score than the mid and lower zones (<i>p</i> < 0.001). Our findings confirmed the relative sparing of the LUZ in severe COVID-19 pneumonia.

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THE RELATIONSHIP BETWEEN INFLAMMATORY DIETARY PATTERN AND INCIDENCE OF PERIODONTITIS

British Journal Of Nutrition ◽

10.1017/s0007114520005231 ◽

2021 ◽

pp. 1-36

Author(s):

Ahmed A. Alhassani ◽

Frank B. Hu ◽

Bernard A. Rosner ◽

Fred K. Tabung ◽

Walter C. Willett ◽

...

Keyword(s):

Confidence Interval ◽

Periodontal Disease ◽

Secondary Analysis ◽

Hazard Ratio ◽

Reduced Rank Regression ◽

Rank Regression ◽

Increased Risk ◽

Cox Proportional Hazard Models ◽

Study Population

ABSTRACT The long-term inflammatory impact of diet could potentially elevate the risk of periodontal disease through modification of systemic inflammation. The aim of the present study was to prospectively investigate the associations between a food based, reduced rank regression (RRR) derived, empirical dietary inflammatory pattern (EDIP) and incidence of periodontitis. The study population was composed of 34,940 men from the Health Professionals Follow-Up Study, who were free of periodontal disease and major illnesses at baseline (1986). Participants provided medical and dental history through mailed questionnaires every 2 years, and dietary data through validated semi-quantitative food frequency questionnaires every 4 years. We used Cox proportional hazard models to examine the associations between EDIP scores and validated self-reported incidence of periodontal disease over a 24-year follow-up period. No overall association between EDIP and the risk of periodontitis was observed; the hazard ratio comparing the highest EDIP quintile (most proinflammatory diet) to the lowest quintile was 0.99 (95% confidence interval: 0.89 -1.10, p-value for trend = 0.97). A secondary analysis showed that among obese non-smokers (i.e. never and former smokers at baseline), the hazard ratio for periodontitis comparing the highest EDIP quintile to the lowest was 1.39 (95% confidence interval: 0.98 -1.96, p-value for trend = 0.03). In conclusion, no overall association was detected between EDIP and incidence of self-reported periodontitis in the study population. From the subgroups evaluated EDIP was significantly associated with increased risk of periodontitis only among nonsmokers who were obese. Hence, this association must be interpreted with caution.

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Analysis of risk scores and duration of hospital stay in prognosis of STEMI patients after pPCI

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.128 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

SR Thangasami ◽

JS Prajapati ◽

GL Dubey ◽

VR Pandey ◽

PM Shaniswara ◽

...

Keyword(s):

Length Of Stay ◽

Hospital Stay ◽

Early Discharge ◽

Risk Scores ◽

Timi Score ◽

Study Population ◽

Event Rates ◽

Grace Score

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Advances in the immediate management of ST elevation myocardial infarction (STEMI) have led to a dramatic decline in mortality and reduction in hospital length of stay (LOS). We analysed the prognostic value of selected risk models in STEMI treated with primary percutaneous coronary intervention (PPCI) and to identify additional parameters to strengthen risk scores in categorizing patients for safe early discharge and to identify parameters prolonging hospital stay. Purpose To assess parameters and risk scores to categorize patients for safe early discharge following STEMI and to assess the composite of death, MI, unstable angina (UA), stroke, unplanned hospitalization at the end of 30 days, 6 months and at 1year follow up. Methods The study included 222 patients, who were diagnosed as STEMI, treated with successful pPCI. The risk scores like TIMI score, GRACE score, ZWOLLE score, CADILLAC score were calculated for all patients from the baseline clinical data collected on admission. Routine blood investigations along with Brain natri-uretic peptide (BNP) were done for all patients. The entire cohort was divided into three groups on the basis of length of stay: ≤3 days (n = 150), 4–5 days (n = 47), and >5 days (n = 25). All-cause mortality and major cardiovascular events (MACEs) were assessed up to 1 year. Results The mean age group (yrs) of the study population was 53.92 ± 12.9. Patients in LOS <3 days had a mean age (yrs) of 52.41 ± 11.74, patients in LOS 4-5 days group had 54.19 ±13.59 and patient with LOS >5 days had 62.52 ± 15.32. The most important parameters that predicted hospital stay in our study are BNP levels OR: 1.003, 95% CI: 1.002-1.004, P < 0.001, GRACE score OR: 1.02 ,95% CI: 1.01-1.03, P < 0.001, TIMI score OR: 1.35, 95% CI: 1.18-1.55, P = 0.007, ZWOLLE score OR: 1.26, 95% CI: 1.16-1.37, P < 0.001, CADILLAC score OR: 1.24, 95% CI; 1.15-1.3: P < 0.001. 32 (14.4%) patients expired in the study population. 36% patients of LOS >5 days expired in 1year follow up with maximum mortality in the first 6 months. 56% of the patients in LOS > 5 days had an adverse cardiac event in 1 year follow up. Patients in LOS >5 days had increased event rates in 30 days,6 months and in 1 year follow up. Patients with LOS 4-5 days (30%) had increased event rates than patients in LOS < 3 days (19%).Unadjusted Kaplan Meir survival curves for 1 year mortality among hospital survivors showed a significant increase in mortality at 6 months in length of stay> 5 days group. (P value < 0.001). CONCLUSION Long hospital stay after PCI among patients with STEMI was associated with increased long-term all-cause mortality. Addition of BNP to this risk scores can better predict the course of hospital stay and adverse clinical outcomes in follow up. Long hospital stay may be used as a marker to identify patients at higher risk for long-term mortality. Abstract Figure. Kaplan meir survival curve

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Nasal symptoms increase the risk of snoring and snoring increases the risk of nasal symptoms. A longitudinal population study

Sleep And Breathing ◽

10.1007/s11325-020-02287-8 ◽

2021 ◽

Author(s):

Maria Värendh ◽

Christer Janson ◽

Caroline Bengtsson ◽

Johan Hellgren ◽

Mathias Holm ◽

...

Keyword(s):

Risk Factors ◽

Respiratory Health ◽

Smoking Status ◽

Northern Europe ◽

Nasal Breathing ◽

Nasal Symptoms ◽

Increased Risk ◽

Study Population ◽

Independent Risk Factors

Abstract Purpose Humans have a preference for nasal breathing during sleep. This 10-year prospective study aimed to determine if nasal symptoms can predict snoring and also if snoring can predict development of nasal symptoms. The hypothesis proposed is that nasal symptoms affect the risk of snoring 10 years later, whereas snoring does not increase the risk of developing nasal symptoms. Methods In the cohort study, Respiratory Health in Northern Europe (RHINE), a random population from Denmark, Estonia, Iceland, Norway, and Sweden, born between 1945 and 1973, was investigated by postal questionnaires in 1999–2001 (RHINE II, baseline) and in 2010–2012 (RHINE III, follow-up). The study population consisted of the participants who had answered questions on nasal symptoms such as nasal obstruction, discharge, and sneezing, and also snoring both at baseline and at follow-up (n = 10,112). Results Nasal symptoms were frequent, reported by 48% of the entire population at baseline, with snoring reported by 24%. Nasal symptoms at baseline increased the risk of snoring at follow-up (adj. OR 1.38; 95% CI 1.22–1.58) after adjusting for age, sex, BMI change between baseline and follow-up, and smoking status. Snoring at baseline was associated with an increased risk of developing nasal symptoms at follow-up (adj. OR 1.22; 95% CI 1.02–1.47). Conclusion Nasal symptoms are independent risk factors for development of snoring 10 years later, and surprisingly, snoring is a risk factor for the development of nasal symptoms.

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Design of a prospective follow-up study on early parenthood and smoking behaviour during pregnancy in Finnish primary healthcare

Scandinavian Journal of Public Health ◽

10.1177/14034948211022433 ◽

2021 ◽

pp. 140349482110224

Author(s):

Mikael O. Ekblad ◽

Hanna P. Wallin ◽

Marjukka Pajulo ◽

Päivi E. Korhonen

Keyword(s):

Pregnant Women ◽

Study Design ◽

Primary Healthcare ◽

Routine Data ◽

Smoking Behaviour ◽

Self Report ◽

Health Clinic ◽

Follow Up Study ◽

Study Population

Aims: The primary aim of the study is to explore different factors affecting parents’ smoking behaviour, and especially how smoking may be connected with individual differences in the psychological process of becoming a parent. In the current paper, we present the study design together with basic information on the study population. Methods: The Central Satakunta Maternity and Child Health Clinic (KESALATU) Study is an ongoing prospective follow-up study in primary healthcare of the Satakunta region of southwest Finland. Families were recruited during their first maternity clinic visit between 1 September 2016 and 31 December 2019, and participation will continue until the child is 1.5 years of age. The study combines different sources and types of data: e.g. routine data obtained from primary healthcare clinic records, specific parental self-report data and data from a new exhaled carbon monoxide meter indicating maternal smoking. The data are collected using frequently repeated assessments both during pregnancy and postnatally. The methods cover the following areas of interest: family background factors (including smoking and alcohol use), self-reported parental–foetal/infant attachment and mentalization, self-reported stress, depression and quality of life. Results: 589 pregnant women and their partners were asked to participate in the study during the collection time period. The final study population consisted of 248 (42.1%) pregnant women and 160 (27.1%) partners. Conclusions: The new methods and study design have the potential to increase our understanding about the link between early parenting psychology, prenatal psychosocial risk factors and parental health behaviour.

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Exploring the gateway hypothesis of e-cigarettes and tobacco: a prospective replication study among adolescents in the Netherlands and Flanders

Tobacco Control ◽

10.1136/tobaccocontrol-2021-056528 ◽

2021 ◽

pp. tobaccocontrol-2021-056528

Author(s):

Thomas Martinelli ◽

Math J J M Candel ◽

Hein de Vries ◽

Reinskje Talhout ◽

Vera Knapen ◽

...

Keyword(s):

The Netherlands ◽

Tobacco Use ◽

Tobacco Smoking ◽

Longitudinal Design ◽

Positive Association ◽

Cigarette Use ◽

Convenience Sample ◽

Frequent Use ◽

Never Smokers

BackgroundStudies demonstrated that adolescent e-cigarette use is associated with subsequent tobacco smoking, commonly referred to as the gateway effect. However, most studies only investigated gateways from e-cigarettes to tobacco smoking. This study replicates a cornerstone study revealing a positive association between both adolescent e-cigarette use and subsequent tobacco use; and tobacco and subsequent e-cigarette use in the Netherlands and Flanders.DesignThe longitudinal design included baseline (n=2839) and 6-month (n=1276) and 12-month (n=1025) follow-up surveys among a school-based cohort (mean age: 13.62). Ten high schools were recruited as a convenience sample. The analyses involved (1) associations of baseline e-cigarette use and subsequent tobacco smoking among never smokers; (2) associations of e-cigarette use frequency at baseline and tobacco smoking frequency at follow-up; and (3) the association of baseline tobacco smoking and subsequent e-cigarette use among non-users of e-cigarettes.FindingsConsistent with prior findings, baseline e-cigarette use was associated with higher odds of tobacco smoking at 6-month (OR=1.89; 95% CI 1.05 to 3.37) and 12-month (OR=5.63; 95% CI 3.04 to 10.42) follow-ups. More frequent use of e-cigarettes at baseline was associated with more frequent smoking at follow-ups. Baseline tobacco smoking was associated with subsequent e-cigarette use (OR=3.10; 95% CI 1.58 to 6.06 at both follow-ups).ConclusionOur study replicated the positive relation between e-cigarette use and tobacco smoking in both directions for adolescents. This may mean that the gateway works in two directions, that e-cigarette and tobacco use share common risk factors, or that both mechanisms apply.

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