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2.
Radiol Med ; 125(5): 451-460, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32048157

RESUMO

PURPOSE: To evaluate the effect of dose reduction with iterative reconstruction (IR) on image quality of chest CT scan comparing two protocols. MATERIALS AND METHODS: Fifty-nine patients were enrolled. The two CT protocols were applied using Iterative Reconstruction (ASIR™) 40% but different noise indexes, recording dose-length product (DLP) and volume computed tomography dose index (CTDIvol). The subjective IQ was rated based on the distinction of anatomic details using a 4-point Likert scale based on the European Guidelines on Quality Criteria for CT. For each patient, two single CTs, at enrollment (group 1) and at follow-up after lowering the dose (group 2), were evaluated by two radiologists evaluating, for each examination, five different lung regions (central zone-CZ; peripheral zone-PZ; sub-pleural region-SPR; centrilobular region-CLR; and apical zone-AZ). An inter-observer agreement was expressed by weighted Cohen's kappa statistics (k) and intra-individual differences of subjective image analysis through visual grading characteristic (VGC) analysis. RESULTS: An average 50.4% reduction in CTDIvol and 51.5% reduction in DLP delivered were observed using the dose-reduced protocol. An agreement between observers evaluating group 1 CTs was perfect (100%) and moderate to good in group 2 examinations (k-Cohen ranging from 0.56 for PZ and AZ to 0.70 for SPR). In the VGC analysis, image quality ratings were significantly better for group 1 than group 2 scans for all regions (AUCVGC ranging from 0.56 for CZ to 0.62). However, disagreement was limited to a score 4 (excellent)-to-score 3 (good) IQ transition; apart from a single case in PZ, both the observers scored the IQ at follow-up as 2 (sufficient) starting from a score 4 (excellent). CONCLUSION: Dose reduction achieved in the follow-up CT scans, although a lower IQ still allows a good diagnostic confidence.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Pneumopatias/diagnóstico por imagem , Doses de Radiação , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/métodos , Adulto , Área Sob a Curva , Interpretação Estatística de Dados , Feminino , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Exposição à Radiação/prevenção & controle , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Radiografia Torácica/efeitos adversos , Infecções Respiratórias/diagnóstico por imagem , Razão Sinal-Ruído , Tecnologia Radiológica , Tomografia Computadorizada por Raios X/efeitos adversos
3.
Intern Med ; 59(2): 247-252, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31941871

RESUMO

Studies reporting chest images of respiratory syncytial virus (RSV)-induced lower respiratory tract infection (LRTI) in an outbreak setting and their relationship to the clinical manifestation are limited. During a genetically confirmed RSV outbreak, eight patients underwent both chest X-ray and computed tomography (CT). Among these, 5 cases had newly appearing abnormalities on CT, although chest X-ray was able to detect abnormalities in only 2 cases (40%). Although bronchial wall thickening was common, other findings and their distribution were variable, even in an outbreak setting. All patients with both a history of anticancer chemotherapy against hematological cancer and lower respiratory symptoms, such as wheezing, sputum, and hypoxemia, had abnormalities on CT, suggesting that these two factors might be important for predicting the existence of LRTI in RSV-infected patients.


Assuntos
Infecções por Vírus Respiratório Sincicial/diagnóstico por imagem , Infecções Respiratórias/diagnóstico por imagem , Idoso , Surtos de Doenças , Humanos , Japão/epidemiologia , Pessoa de Meia-Idade , Sons Respiratórios , Infecções por Vírus Respiratório Sincicial/epidemiologia , Infecções Respiratórias/epidemiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
4.
Med. intensiva (Madr., Ed. impr.) ; 44: 0-0, 2020. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-188034

RESUMO

La infección por SARS-CoV-2 (COVID-19) se caracteriza por producir en las formas graves, un cuadro de insuficiencia respiratoria que puede evolucionar hacia neumonía y síndrome de distrés respiratorio agudo (SDRA), presentar complicaciones como fenómenos trombóticos y disfunción cardiaca, lo que motiva el ingreso en la Unidad de Cuidados Intensivos (UCI).La ecografía, convertida en una herramienta de uso habitual en la UCI, puede ser muy útil durante la pandemia COVID-19 ya que la información obtenida por el clínico puede ser interpretada e integrada en la valoración global durante la exploración del paciente. Este documento describe algunas de sus aplicaciones con el objetivo de proporcionar una guía a los médicos responsables adaptado al paciente crítico con COVID-19. Alguna de sus aplicaciones desde el ingreso en la UCI incluyen confirmar la correcta posición del tubo endotraqueal, facilitar la inserción segura de las vías, e identificar complicaciones y fenómenos trombóticos. Además, la ecografía pleuropulmonar puede ser una alternativa diagnóstica válida que permite evaluar el grado de afectación pulmonar, mediante el análisis de patrones ecográficos específicos, identificación del derrame pleural y del barotrauma. La ecocardiografía proporciona información acerca de la afectación cardíaca, detección del cor pulmonaley estados de shock


The clinical picture of SARS-CoV-2 infection (COVID-19) is characterized in its more severe form, by an acute respiratory failure which can worsen to pneumonia and acute respiratory distress syndrome (ARDS), and get complicated with thrombotic events and heart dysfunction. Therefore, admission to the Intensive Care Unit (ICU) is common.Ultrasound, which has become an everyday tool in the ICU, can be very useful during COVID-19 pandemic, since it provides the clinician with information which can be interpreted and integrated within a global assessment during the physical examination A description of some of the potential applications of ultrasound is depicted in this document, in order to supply the physicians taking care of these patients with a adapted guide to the intensive care setting.Some of its applications since ICU admission include verification of the correct position of the endotracheal tube, contribution to safe cannulation of lines, and identification of complications and thrombotic events. Furthermore, pleural and lung ultrasound can be an alternative diagnostic test to assess the degree of involvement of the lung parenchyma by means of the evaluation of specific ultrasound patterns, identification of pleural effusions and barotrauma. Echocardiography provides information of heart involvement, detects cor pulmonaleand shock states


Assuntos
Humanos , Infecções por Coronavirus/diagnóstico por imagem , Ultrassonografia/instrumentação , Cuidados Críticos/métodos , Pneumonia Viral/diagnóstico por imagem , Ecocardiografia , Infecções por Coronavirus/epidemiologia , Espanha/epidemiologia , Pneumonia Viral/complicações , Infecções Respiratórias/diagnóstico por imagem , Doença Cardiopulmonar/diagnóstico por imagem , Unidades de Terapia Intensiva/tendências
5.
Medicine (Baltimore) ; 98(46): e17701, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725613

RESUMO

Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by SFTS virus (SFTSV) which involves multiple organ systems, including lungs. However, there is limited data on lung involvement of SFTS. Therefore, the present study investigated the chest radiographic findings of SFTS, including computed tomography (CT), and compared these with those of scrub typhus, which is the most common tick-borne illness in South Korea and share risk factors and occur in similar settings.Medical records of patients with confirmed SFTS and scrub typhus in a tertiary hospital in Seoul (South Korea), between January 2014 and June 2018, were reviewed. Initial chest radiography and CT were reviewed by 2 experienced radiologists.A total of 39 patients with SFTS and 101 patients with scrub typhus were analyzed. All patients except 3 patients with scrub typhus in both groups received chest radiography. Cardiomegaly (90%) and patchy consolidation with ground glass opacity (GGO) pattern (31%) were more common in SFTS group than scrub typhus group (20%, P < .001 and 2%, P < .001, respectively). About half of each group received chest CT. Consolidation (29%) and pericardial effusion (24%) were more common in SFTS group than scrub typhus group (6%, P = .02 and 4%, P = .008, respectively). Interstitial thickening in chest radiography (58%) and chest CT (65%) was more frequent in scrub typhus group than SFTS group (18%, P < .001 and 19%, P < .001, respectively).Cardiomegaly with/without pericardial effusion and patchy consolidation with GGO pattern were more frequent in SFTS group, whereas interstitial thickening was more frequent in scrub typhus group. These findings will assist the early differentiation of SFTS from scrub typhus.


Assuntos
Orientia tsutsugamushi , Febre por Flebótomos/diagnóstico por imagem , Phlebovirus , Radiografia/estatística & dados numéricos , Infecções Respiratórias/diagnóstico por imagem , Tifo por Ácaros/diagnóstico por imagem , Idoso , Estudos Transversais , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/microbiologia , Masculino , Pessoa de Meia-Idade , Febre por Flebótomos/microbiologia , Radiografia/métodos , República da Coreia , Infecções Respiratórias/microbiologia , Tifo por Ácaros/microbiologia , Síndrome , Trombocitopenia
6.
BMC Pulm Med ; 19(1): 143, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387559

RESUMO

BACKGROUND: A minority of patients presenting with lower respiratory tract infection (LRTI) to their general practitioner (GP) have community-acquired pneumonia (CAP) and require antibiotic therapy. Identifying them is challenging, because of overlapping symptomatology and low diagnostic performance of chest X-ray. Procalcitonin (PCT) can be safely used to decide on antibiotic prescription in patients with LRTI. Lung ultrasound (LUS) is effective in detecting lung consolidation in pneumonia and might compensate for the lack of specificity of PCT. We hypothesize that combining PCT and LUS, available as point-of care tests (POCT), might reduce antibiotic prescription in LRTIs without impacting patient safety in the primary care setting. METHODS: This is a three-arm pragmatic cluster randomized controlled clinical trial. GPs are randomized either to PCT and LUS-guided antibiotic therapy or to PCT only-guided therapy or to usual care. Consecutive adult patients with an acute cough due to a respiratory infection will be screened and included if they present a clinical pneumonia as defined by European guidelines. Exclusion criteria are previous antibiotics for the current episode, working diagnosis of sinusitis, severe underlying lung disease, severe immunosuppression, hospital admission, pregnancy, inability to provide informed consent and unavailability of the GP. Patients will fill in a 28 day-symptom diary and will be contacted by phone on days 7 and 28. The primary outcome is the proportion of patients prescribed any antibiotic up to day 28. Secondary outcomes include clinical failure by day 7 (death, admission to hospital, absence of amelioration or worsening of relevant symptoms) and by day 28, duration of restricted daily activities, episode duration as defined by symptom score, number of medical visits, number of days with side effects due to antibiotics and a composite outcome combining death, admission to hospital and complications due to LRTI by day 28. An evaluation of the cost-effectiveness and of processes in the clinic using a mixed qualitative and quantitative approach will also be conducted. DISCUSSION: Our intervention targets only patients with clinically suspected CAP who have a higher pretest probability of definite pneumonia. The intervention will not substitute clinical assessment but completes it by introducing new easy-to-perform tests. TRIAL REGISTRATION: The study was registered on the 19th of June 2017 on the clinicaltrials.gov registry using reference number; NCT03191071 .


Assuntos
Antibacterianos/uso terapêutico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Testes Imediatos , Pró-Calcitonina/sangue , Infecções Respiratórias/tratamento farmacológico , Antibacterianos/efeitos adversos , Biomarcadores/sangue , Infecções Comunitárias Adquiridas/diagnóstico por imagem , Hospitalização , Humanos , Modelos Logísticos , Estudos Multicêntricos como Assunto , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Ensaios Clínicos Pragmáticos como Assunto , Infecções Respiratórias/diagnóstico por imagem , Ultrassonografia
7.
Am J Trop Med Hyg ; 101(3): 689-695, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31287049

RESUMO

Lower respiratory tract infections (LRTIs) are the leading cause of deaths in children < 5 years old worldwide, particularly affecting low-resource settings such as Aweil, South Sudan. In these settings, diagnosis can be difficult because of either lack of access to radiography or clinical algorithms that overtreat children with antibiotics who only have viral LRTIs. Point-of-care ultrasound (POCUS) has been applied to LRTIs, but not by nonphysician clinicians, and with limited data from low-resource settings. Our goal was to examine the feasibility of training the mid-level provider cadre clinical officers (COs) in a Médecins Sans Frontières project in South Sudan to perform a POCUS algorithm to differentiate among causes of LRTI. Six COs underwent POCUS training, and each subsequently performed 60 lung POCUS studies on hospitalized pediatric patients < 5 years old with criteria for pneumonia. Two blinded experts, with a tiebreaker expert adjudicating discordant results, served as a reference standard to calculate test performance characteristics, assessed image quality and CO interpretation. The COs performed 360 studies. Reviewers rated 99.1% of the images acceptable and 86.0% CO interpretations appropriate. The inter-rater agreement (κ) between COs and experts for lung consolidation with air bronchograms was 0.73 (0.63-0.82) and for viral LRTI/bronchiolitis was 0.81 (0.74-0.87). It is feasible to train COs in South Sudan to use a POCUS algorithm to diagnose pneumonia and other pulmonary diseases in children < 5 years old.


Assuntos
Pessoal de Saúde/educação , Pediatria/educação , Sistemas Automatizados de Assistência Junto ao Leito , Infecções Respiratórias/diagnóstico por imagem , Ultrassonografia , Algoritmos , Pré-Escolar , Estudos de Viabilidade , Feminino , Recursos em Saúde , Humanos , Lactente , Pulmão/diagnóstico por imagem , Masculino , Pediatria/métodos , Pneumonia/diagnóstico por imagem , Sudão do Sul
9.
Nucl Med Commun ; 40(9): 894-897, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31343616

RESUMO

OBJECTIVE: The aim of this study was to analyse the potential effect of indwelling nasogastric tubes (NGTs) on the positive rate of pulmonary aspiration in the salivagram of paediatric patients. METHODS: This retrospective study evaluated 290 children suffering from respiratory tract infection with clinical suspicion of pulmonary aspiration (104 cases with NGT and 186 cases without NGT). Among them, 216 had good past health, while 74 had history of oropharyngeal diseases or brain injuries. Tc-DTPA salivagrams were performed to determine whether the risk of pulmonary aspiration was different between patients with and without NGT. RESULTS: The positive rates of aspiration in salivagram were 32.3% (60/186) and 29.8% (31/104) in the patients without and with NGT, respectively. The positive rates of the two groups had not statistically significant difference [risk ratio (RR) = 0.924; 95% confidence interval (CI): 0.644-1.326; P = 0.666]. Subgroup analyses showed that the patients with good past health had the positive rates of 24.4% (19/78) with NGT and 25.4 % (35/138) without NGT. The two groups had no statistically significant difference (RR = 0.960; 95% CI: 0.592-1.559; P = 0.870). For the patients with underlying diseases, the positive rates were 46.2% (12/26) with NGT and 52.1% (25/48) without NGT. These two groups also demonstrated no statistically significant difference (RR = 0.886; 95% CI: 0.540-1.455; P = 0.626). CONCLUSION: The positive rate of pulmonary aspiration was relatively high in patients with respiratory tract infection who have underlying diseases but NGT feeding did not affect salivagram accuracy.


Assuntos
Intubação Gastrointestinal , Nariz , Medicina Nuclear , Saliva/metabolismo , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/terapia , Estudos Retrospectivos
10.
Int J Pediatr Otorhinolaryngol ; 124: 90-93, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31174024

RESUMO

OBJECTIVE: This study sought to summarize the clinical characteristics of foreign body aspiration(FBA) in children with negative multi-detector Computed Tomography(MDCT) results and to explore the essential points which determined the patients to undergo bronchoscopy. METHODS: The medical records of 48 pediatric patients admitted to the department of respiratory medicine in our hospital from January 2011 to October 2018 and diagnosed with foreign body aspiration and negative chest MDCT results were retrospectively analyzed. They were compared with the patients of FBA whose MDCT findings suggested indirect signs, such as atelectasis or emphysema. RESULTS: Of the 48 patients, 33 were boys (68.8%) and 15 girls (31.2%), with a mean age of 35.3 months(range, 7-156 months). Cough (47 cases, 97.9%), fever (25 cases, 52.1%) and wheezing (23 cases,47.9%)were the main symptoms.39 patients (81.3%) had abnormal physical signs. None of the MDCT or three dimension(3D) images based on MDCT revealed foreign bodies in these children, while the results were: signs of lung infection without atelectasis or emphysema 52.1%(25 cases), increase of lung markings16.7%(8 cases),bronchiectasis 6.3%(3 cases), or normal 27.1%(13 cases). 41 Patients were successfully removed their foreign bodies(A further 5 had the FB removed from the tracheobronchial tree but it was then swallowed before retrieval. The remaining 2 cases had to be referred to another hospital for further management), most of which were organic. The shapes of foreign bodies were small granular (23 cases, 56.1%), sheet or powder (18 cases, 43.9%). The control group was 13 patients of FBA whose MDCT findings suggested indirect signs of atelectasis or emphysema during the same time. The result of comparison showed the clear history of FBA was statistically different between the two groups. CONCLUSIONS: Foreign body aspiration could not be ruled out with negative MDCT in patients clinically suspected. Typical foreign body aspiration history and ineffective conservative treatment could provide important basis of performing bronchoscopy. Complicated with lung infection and the shape of foreign bodies may affect the false negative results of MDCT.


Assuntos
Brônquios , Corpos Estranhos/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Aspiração Respiratória/diagnóstico por imagem , Infecções Respiratórias/diagnóstico por imagem , Adolescente , Bronquiectasia/diagnóstico por imagem , Bronquiectasia/etiologia , Broncoscopia , Criança , Pré-Escolar , Tosse/etiologia , Reações Falso-Negativas , Feminino , Febre/etiologia , Corpos Estranhos/complicações , Humanos , Imageamento Tridimensional , Lactente , Masculino , Atelectasia Pulmonar/diagnóstico por imagem , Atelectasia Pulmonar/etiologia , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/etiologia , Aspiração Respiratória/complicações , Sons Respiratórios/etiologia , Estudos Retrospectivos
12.
Acta Med Port ; 32(2): 101-110, 2019 Feb 28.
Artigo em Português | MEDLINE | ID: mdl-30896390

RESUMO

INTRODUCTION: Respiratory tract infections represent the most frequent conditions in pediatric clinical practice that motivate antibiotic prescribing. The objective was to identify the frequency and pattern of antibacterial prescribing in respiratory diseases. MATERIAL AND METHODS: Over a period of two years (divided by the presentation of the clinical guideline standards) data was collected from clinical records of children with respiratory disease. Chi-square tests or Fisher's exact test were used to test associations between variables, statistical significance p < 0.05. RESULTS: There were 547 visits (mean age 6 years ± 5.3, 55% male gender). Analysis for Group A Streptococcus of the oropharynx was most frequently requested by pediatric residents (p = 0.005). Chest x-rays were more frequently requested by the Family Physician (p = 0.033). An antibiotic was prescribed in 87% of pneumonias, 84% acute otitis media, 68% acute tonsillitis, 25% laryngitis, 17% upper respiratory infections, 16% acute bronchiolitis. The Family Physician prescribed antibiotics more often than the Pediatrics resident in acute tonsillitis (p = 0.003) and in acute otitis media (p = 0.013). The most frequently prescribed antibiotic was amoxicillin (61%). There were no significant differences between the two periods studied regarding the number of prescriptions and antibiotic choice of the conditions studied. DISCUSSION: Antibiotic prescribing in pediatric acute respiratory infections was high and the choice of antibiotic therapy could be adjusted. We found no difference in antibiotic prescribing after the presentation of the clinical guideline standards. CONCLUSION: An improvement in the antibiotic prescription in children and adolescents in the outpatient clinic is considered necessary.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Antibacterianos/uso terapêutico , Padrões de Prática Médica , Infecções Respiratórias/tratamento farmacológico , Adolescente , Amoxicilina/uso terapêutico , Anticorpos Antibacterianos/análise , Bronquite/tratamento farmacológico , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/tratamento farmacológico , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Internato e Residência/estatística & dados numéricos , Masculino , Otite Média/tratamento farmacológico , Pediatria/estatística & dados numéricos , Pneumonia/tratamento farmacológico , Estudos Prospectivos , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/microbiologia , Estudos Retrospectivos , Streptococcus pyogenes/imunologia , Tonsilite/tratamento farmacológico
13.
Radiol Med ; 124(9): 826-832, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30911987

RESUMO

BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF), characterized by fever and/or hemorrhage, is a zoonotic viral disease with high mortality. The agent causing CCHF is a Nairovirus. The virus is typically transmitted to humans through tick bites. CCHF is a life-threatening disease observed endemically over a wide geographical regions in the world, and there is limited information about pulmonary findings in CCHF patients. PURPOSE: We aimed to investigate the pulmonary findings belonging to a large CCHF patient cohort and to determine if there is any relationship between laboratory findings and disease severity. MATERIALS AND METHODS: A total of 165 patients who were diagnosed with CCHF and examined through chest X-ray (CXR) due to respiratory symptoms at their first examination and/or during their hospitalization were included in this study. In addition to demographical and laboratory findings of the patients, chest X-rays were also examined. RESULTS: Of the 165 patients examined, 96 were male (58.2%) and 69 were female (41.8%). The mean age was 51.64 ± 17.95 years (4-81 years). Single and/or multiple pathological findings were detected in 93 patients (56.4%) as a result of chest X-ray during their first examination. On chest X-ray, consolidation in 74 patients (44.8%), pleural effusion in 64 patients (39.8%), ground glass opacity in 49 patients (29.7%), and atelectasis in 30 patients (18.2%) were detected. CONCLUSION: According to the results of our study, it can be suggested that radiological examination in lungs should be performed primarily with CXR and pulmonary involvement (pleural effusion and consolidation) affects survival in CCHF negatively.


Assuntos
Febre Hemorrágica da Crimeia/complicações , Radiografia Torácica , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
15.
Pediatr Pulmonol ; 54(6): 873-880, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30838805

RESUMO

OBJECTIVE: Respiratory tract infections are among the most common causes of morbidity and mortality worldwide. Acute bronchiolitis (AB) is the leading cause of hospital admission among infants. Clinical scores have proven to be inaccurate in predicting prognosis. Our aim was to build a score based on findings of lung ultrasound (LU) performed at admission, to stratify patients at risk of needing respiratory support (non-invasive and invasive ventilation). STUDY DESIGN: Prospective, multicenter study including infants <6 months of age admitted with AB. Point-of-care LU was performed on admission, and a score was calculated based on ultrasound findings (presence and localization of B lines, B line confluence and/or consolidations) and clinical data. Main outcome was need of respiratory support. RESULTS: A total of 145 patients were included in the study, with a median age of 1.7 months [IQR: 1.2-2.8], 47.6% were female. Mean duration of symptoms prior to admission was 3.1 days (SD 1.8). Fifty-six patients (39%) required non-invasive ventilation (NIV), 14 (9.7%) were transferred to PICU, and 3 needed invasive ventilation (3/145). Identification of at least one posterior consolidation >1 cm was the main factor associated to NIV (RR 4.4; [CI95%1.8-10.8]) The LU score built according to the findings on admission showed an AUC: 0.845(CI95%:0.78-0.91). A score ≥3.5 showed a sensitivity of 89.1% (CI95%:78.2-94.9%) and specificity of 56% (CI95%: 45.3-66.1%) CONCLUSIONS: Among infants below 6 months of age admitted with AB, point-of-care LU was a helpful tool to identify patients at risk of needing respiratory support.


Assuntos
Bronquiolite/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Infecções Respiratórias/diagnóstico por imagem , Ultrassonografia , Doença Aguda , Feminino , Humanos , Lactente , Masculino , Análise Multivariada , Ventilação não Invasiva , Admissão do Paciente , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Respiração
16.
Respir Res ; 20(1): 23, 2019 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-30704502

RESUMO

BACKGROUND: To determine the clinical role, safety, and diagnostic accuracy of percutaneous transthoracic needle biopsy in the evaluation of pulmonary consolidation. METHODS: A retrospective review of all computed tomography (CT)-guided percutaneous transthoracic needle biopsies (PTNB) at a tertiary care hospital over a 4-year period was performed to identify all cases of PTNB performed for pulmonary consolidation. For each case, CT Chest images were reviewed by two thoracic radiologists. Histopathologic and microbiologic results were obtained and clinical follow-up was performed. RESULTS: Thirty of 1090 (M:F 17:30, mean age 67 years) patients underwent PTNB for pulmonary consolidation (2.8% of all biopsies). A final diagnosis was confirmed in 29 patients through surgical resection, microbiology, or clinicoradiologic follow-up for at least 18 months after biopsy. PTNB had an overall diagnostic accuracy of 83%. A final diagnosis of malignancy was made in 20/29 patients, of which 19 were correctly diagnosed by PTNB, resulting in a sensitivity of 95% and specificity of 100% for malignancy. In all cases of primary lung cancer, adequate tissue for molecular testing was obtained. A benign final diagnosis was made in 9 patients, infection in 5 cases and non-infectious benign etiology in 4 cases. PTNB correctly diagnosed all cases of infection. Minor complications occurred in 13% (4/30) of patients. CONCLUSIONS: Pulmonary consolidation can be safely evaluated with CT-guided percutaneous needle biopsy. Diagnostic yield is high, especially for malignancy. PTNB of pulmonary consolidation should be considered following non-diagnostic bronchoscopy.


Assuntos
Biópsia por Agulha/métodos , Biópsia Guiada por Imagem/métodos , Pneumopatias/diagnóstico , Pulmão/patologia , Infecções Respiratórias/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha/efeitos adversos , Feminino , Hemoptise/diagnóstico , Hemoptise/patologia , Humanos , Processamento de Imagem Assistida por Computador , Biópsia Guiada por Imagem/efeitos adversos , Pulmão/diagnóstico por imagem , Pneumopatias/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Infecções Respiratórias/diagnóstico por imagem , Estudos Retrospectivos , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios X
17.
J Med Virol ; 91(6): 958-962, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30659630

RESUMO

BACKGROUND: Human metapneumovirus (hMPV) is a recently detected virus, which can cause mild to severe respiratory tract infections. Through this study, we aimed to detail the outcomes of hMPV infections. MATERIALS/METHODS: Between January 2012 and November 2017, patients who had hMPV detected in nasopharyngeal or bronchoalveolar lavage by molecular respiratory pathogen tests were evaluated. The Food and Drug Administration cleared multiplexed-polymerase chain reaction system (Idaho Technology, Salt Lake City, UT) was used for diagnosis. Chest radiography (CR) and computed tomography (CT) were evaluated by an expert radiologist. RESULTS: In total 100 patients were included, the mean age was 22.9 (0-87) years, and 50% were male. The hospitalization rate was 52%. Lower respiratory system infection (LRTI) was diagnosed in 44 patients with clinical findings, and in 31 patients out of 44 the radiological findings supported the diagnosis. The LRTI rate was significantly higher in adults than children (66.7%-32.8%; P = 0.001). In CR, peribronchovascular infiltration (PI) was the most common feature seen in 14 out of 18 patients and was generally bilateral (13 out of 18 patients). In CT imaging, ground-glass opacity was the most common finding seen in 11 out of 16 patients and nodular consolidation in five patients. Ribavirin was given to four patients, three of whom were severe and required respiratory support. None of the patients died of hMPV infection. CONCLUSIONS: The ground-glass opacity in CT was similar to other respiratory virus infections, and PI in CR was very common and typical; however, nodular consolidation that may mimic bacterial infection was seen in one-fourth of CT.


Assuntos
Infecções por Paramyxoviridae/diagnóstico por imagem , Infecções por Paramyxoviridae/epidemiologia , Infecções Respiratórias/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Líquido da Lavagem Broncoalveolar/virologia , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Masculino , Metapneumovirus/genética , Pessoa de Meia-Idade , Nasofaringe/virologia , Infecções Respiratórias/virologia , Turquia/epidemiologia , Adulto Jovem
18.
Respir Med ; 146: 81-86, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30665523

RESUMO

Pulmonary infections are frequent complications in abdominal solid-organ transplantation (aSOT) which may threaten patient and allograft survival. Accurate diagnosis and treatment of pulmonary infections in this population can be challenging. Immunosuppressive therapy not only increases the risk of acquiring opportunistic and non-opportunistic infections, but it also impairs the inflammatory responses associated with microbial invasion which in an otherwise normal host produce clinical and radiologic responses that allow for early identification of the offending pathogen. Serologic testing is not a reliable diagnostic modality. Direct microbiological sampling is often necessary to make a definitive diagnosis early in the clinical course to optimize timely, targeted therapy while reducing the risk of developing antimicrobial resistance, and minimize adverse effects of therapy, if any. Fiber-optic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) or transbronchial lung biopsy (TBB) offers such diagnostic advantage and possesses a potential therapeutic value too. This comprehensive review discusses the potential benefits of FOB alongside its risks and complications, indications and contraindications, and techniques. Additionally, the essay highlights FOB's utility and yield specifically with regard to type and timing of infections in aSOT patients.


Assuntos
Broncoscopia/métodos , Imunossupressores/efeitos adversos , Pneumopatias/diagnóstico por imagem , Infecções Respiratórias/diagnóstico por imagem , Transplantados/estatística & dados numéricos , Biópsia , Lavagem Broncoalveolar , Broncoscopia/efeitos adversos , Tecnologia de Fibra Óptica , Humanos , Hospedeiro Imunocomprometido/imunologia , Imunossupressores/uso terapêutico , Inflamação/patologia , Pneumopatias/epidemiologia , Pneumopatias/microbiologia , Pneumopatias/patologia , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/etiologia
20.
Childs Nerv Syst ; 35(1): 113-118, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30361761

RESUMO

PURPOSE: The painful torticollis only itself may be a major sign for the diagnosis of Grisel's syndrome (GS). It is known as an inflammatory atlantoaxial rotatory subluxation following upper respiratory tract infections (URTI) and surgical otolaryngological procedures. PATIENTS AND METHODS: The analysis of 16 pediatric GS patients were reviewed retrospectively by considering the diagnosis, the treatment modality, and the prognosis at the Department of Neurosurgery and Otorhinolaryngology in Mersin University, Faculty of Medicine between 2008 and 2018. In addition to the clinical cases, five cadavers were used to demonstrate atlantoaxial region, particularly the ligamentous complex and articulation of the atlas-axis, for the mechanism of these rare entities. RESULTS: The most common etiological factor of GS was URTI with 81.25% among 16 patients. Painful torticollis was the primary symptom of pediatric patients at admission. The X-Ray, computerized tomography (CT), and magnetic resonance imaging (MRI) investigations were used for the definitive diagnosis in the first week of admission, except one. No morbidity, mortality, and deformity were reported in this series. CONCLUSIONS: Early diagnosis is the principle of GS for avoiding of permanent neck deformity and complex surgical procedures. If GS can be diagnosed without any doubt by only considering patient's history and clinical examination, CT scan is not recommended due to harmful effects of radiation. The treatment was achieved by reduction, external fixation under analgesia, or sedoanalgesia accompanying with antibiotic and anti-phylogistic treatment.


Assuntos
Articulação Atlantoaxial , Luxações Articulares/diagnóstico , Luxações Articulares/terapia , Adolescente , Articulação Atlantoaxial/anatomia & histologia , Articulação Atlantoaxial/diagnóstico por imagem , Cadáver , Criança , Pré-Escolar , Diagnóstico Precoce , Fixadores Externos , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Dor/etiologia , Prognóstico , Infecções Respiratórias/diagnóstico por imagem , Infecções Respiratórias/etiologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Torcicolo/diagnóstico por imagem , Torcicolo/etiologia , Resultado do Tratamento
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