قفسه سینه

With the increase in the number of infections and deaths of covid-19, the need is felt to use artificial intelligence and machine learning tools to diagnose the corona virus quickly and on time. In this study, using chest x-ray images and VGG-16 deep neural network, an automatic system was designed and implemented to detect cases of covid-19.

In this research, chest x-ray images obtained from the Kaggle database were used. The design of this study included: data sampling, training division, creating directories, transferring images to their own folders, classifying images, creating the proposed VGG-16 model in Python programming language and Keras and Tensorflow libraries, evaluation of the proposed model and finally the creation of the confusion matrix and their analysis and interpretation.

The accuracy and Precision of the proposed model for the positive Covid-19 class were 91 and 93%, respectively. Also, the recall rate and F1-Score for cases with covid-19 were 94% and 88% respectively.

Due to the high accuracy and precision of the proposed model, it can be used to diagnose covid-19 and separate COVID-19 cases from healthy cases and also be used as an auxiliary tool to help doctors diagnose this disease.

Chest trauma is a major threat to human life and disability for war wounded. A high percentage of war-wounded are associated with chest trauma, lung and pleural damage. The purpose of this study was to evaluate complications and treatment results of chest trauma with lung and pleural damage in the wounded referred to Baqiyatallah hospital in Tehran.

In this cross-sectional study, during 2015 and 2016, 154 war-wounded patients were transferred to Baqiyatallah Hospital in Tehran with diagnosis of lung damage. They were selected using the census sampling method. After obtaining informed consent, collection of demographic questionnaire information, wound formation factor, the time from wound formation to initial repair and treatment measures before and after transfer were done in two stages. Data were analyzed by SPSS-24 software using Chi-square test.

In this study, the total number of people was male. Their mean age was 28.16 ± 8.69 years. The most common complications of chest trauma with the diagnosis of lung and pleural damage, Hemothorax was 16 (10.4%) patients. The most common cause of trauma between the injured, the fragments were 79 (51.2%). In the evaluation of medical measures on all injured before transfer, 22 (26.19%) patients required re-implantation of a chest tube and 2 patients (2.3%) thoracotomy, while in post-transfer treatment measures, 3 (5.26%) patients required re-implantation of a chest tube and 5 (8.77%) patients VATS in Baqiyatallah Medical Center. There was significant relationship between the time of removal of the chest tube required re-implantation of a chest tube.

The most common complication of chest trauma with the diagnosis of lung and pleural damage was Hemothorax. The wounds that came out of the chest tube after the transfer had better treatment It is necessary for the military medicine officials to pay attention to the management and appropriate measures in order to improve the medical care of war wounds and the proper repair and reduction of the complications of patients’ trauma and training in chest tube implantation skills for all medical staff in military centers.

Chest injuries account for nearly a quarter of all deaths from trauma - after head and neck injuries. Although rapid and immediate interventions at the scene of the accident are generally necessary, the importance of time at the scene of the accident should always be considered as one of the priorities in transferring the injured to higher hospital levels. Generally, pre-hospital management and transfer in the case of war victims may be somewhat different from urban injuries, because the type and severity of injuries are different and significant.

Case Report: 

A 34-year-old combatant was shot following his activities in the war zone and was taken to the field hospital within half an hour after the injury. He had been shot in the left side of the body, which penetrated the right side of the chest. At the time of his visit, the victim was conscious and speaking, complaining of abdominal pain and shortness of breath.

Since many cases of pneumothorax have a traumatic origin, special attention is needed in the diagnosis of simple or tension pneumothorax; especially in the manner of chest injuries. This may be done in an urban trauma with a more regular assessment than in combat situations. However, bullet-induced chest trauma is much more difficult and therefore more important in a crowded, stressful, and life-threatening condition on the battlefield.

Damage prevention is always considered the first step. The use of personal protection equipment (PPE) such as bulletproof vests could be somewhat preventive. In case of chest injuries, special chest wound dressing adhesives and especially asherman chest seals could be useful.

Imaging technique plays an important role in management of chest trauma and chest x-ray, ultrasonography, and computed tomography (CT) scan are used to diagnose chest injuries. Chest CT scan is the Gold standard for diagnosing chest injuries. The aim of this study was to evaluate the positive findings of chest CT scan in patients referring to the emergency department of Imam Reza Hospital, Tabriz, in 2016-2017.

This is a descriptive study performed on multiple trauma patients referring to Imam Reza Hospital in Tabriz from April 2016 to March 2017. The sampling method was census and all patients with multiple trauma and chest trauma who had referred to Imam Reza Hospital during the study period and had undergone a chest spiral CT were included in the study. Independent t-test was used to compare quantitative data and chi-square was used to compare qualitative data.

During the study period, 390 patients with chest trauma and multiple trauma had undergone chest CT. Of which, 296 were male (75.9%) and 94 (24.1%) were female. The mean age of the patients was 48.35 years. Traffic accidents were the most common cause of trauma. In nearly half of the patients there was no positive finding on chest spiral CT scan. However, there were multiple findings in 21 patients. The most common injuries were: rib fracture (11.3%), pneumothorax (12.3%), pneumomediastinum (2%), hemothorax (4.6%), and pulmonary contusion (4.9%).

In patients with multiple trauma, the most common positive CT findings were rib fractures, followed by pneumothorax, subcutaneous emphysema and hemothorax. In cases where there is a fracture of the first three ribs or flail chest, or a fracture of the scapula and high-energy trauma, the rate of visceral damage inside the chest and abdomen is higher, and chest CT scan can diagnose hemothorax and minor pneumothorax, which are not detectable in chest x-ray.

The presence of pleural adhesions may render video-assisted thoracoscopic surgery difficult or impossible. The aim of this study was to assess the value of chest ultrasonography in the detection of pleural adhesions prior to thoracotomy.

Between 2009 and 2010, 42 consecutive patients undergoing thoracotomies (including video-assisted thoracic surgery) were evaluated with chest ultrasonography. These patients underwent a preoperative ultrasonic examination of the chest wall using a 7.5-10-MHz linear ultrasound probe at 7 points along the chest wall. We measured the movement of the visceral pleural slide.

In the upper thoracic wall, ultrasonography demonstrated a sensitivity of 63.0%, a specificity of 66%, a negative predictive value of 77%, a positive predictive value of 50.0%, and an overall accuracy of 65.0%. And for lower thoracic wall, ultrasonography demonstrated a sensitivity of 81.0%, a specificity of 59.0%, a negative predictive value of 89.0%, a positive predictive value of 44.0%, and an overall accuracy of 65.0%.

Chest ultrasonography is moderately accurate in detecting the presence and location of pleural adhesions. Use of preoperative chest sonographic findings to plan trocar placement and to determine the need for an open approach is valuable in helping prevent visceral injury and facilitating video-assisted thoracoscopic surgery.

Introduction & Trauma is the most common cause of death during the first three decades of life. Chest trauma apply for 10 to 30% of all traumas and is responsible for 25% of death in trauma patients. Present study was done with the aim of assessing epidemiologic features of chest traumas in admitted to Hamedan Beasat hospital، during 2008-2009. In this descriptive retrospective study all patients with chest trauma who had referred to this hospital during years 2008 and 2009 were assessed. Data collection was done by obtaining information from dossiers and registering them in data collection forms. In the present study 568 patients were assessed. The mean age of these patients was 36. 70±17. 58 years، the minimum age was 5 years and the maximum age was 98 years. Most of these patients were male (87. 3%)، and the majority of them (76. 8%) were living in cities; 68. 5% of the patients were married، and 40. 7% of patients were smoking cigarette and 8. 8% of them were using narcotics. Only one patient (0. 2%) was using alcohol. In 59. 5% of the cases، the type of trauma was non-penetrating. In most cases cause of injury was motor vehicle accident (43. 8%). 5. 6% of patients died. The mean age of the dead patients (61. 53 ± 22. 66 years) was significantly higher than other patients (35. 30 ± 16. 10 years) (P = 0. 000). The cause of death was hypovolemic shock، with respiratory failure in 50% of the cases. The results of the present study showed that motor vehicle accident was the most common cause of injury in the studied patients. The most common cause of death was hypovolemic shock، with respiratory failure and it was mostly seen in older patients.

Hospitals are hazardous environments for the emergence and transmission of tuberculosis. This study was carried out to evaluate the prevalence of latent tuberculosis infection (LTBI) and chest X-ray findings in health care workers (HCWs) with and without LTBI. A cross sectional survey was conducted in Rasool Akram hospital، Tehran، Iran. One hundred HCWs were tuberculin skin tested to measure LTBI and were asked for Chest X-ray to detect any lesions compatible with active or latent tuberculosis in two groups with and without LTBI. Chest x-ray findings were reported as: calcified nodule، fibrotic lesions، hilar adenopathy، tuberculoma، pleural effusion، and miliary. Statistical significances were analyzed by Chi-squared test. The obtained data were analyzed by SPSS version 16 software. A total of 100 HCWs were included in our study. Tuberculin skin test (TST) was positive in 49 (49%) cases. There was no significant difference between sex and positive tuberculin skin test. Abnormal findings in chest radiography were reported in 9 (9%) cases. There was no significant difference between LTBI and gender (P=0. 8). There was no significant difference between chest x-ray findings and LTBI (P=0. 5). Although nearly half of participants had positive tuberculin skin test، chest abnormality was reported only in nine percent. Specific tests and imaging such as QuantiFERON and chest CT scan seems to be more effective for latent tuberculosis diagnosis than TST among HCWs.

Chondromatous hamartoma of the chest wall is an extremely rare, benign lesion that usually occurs in early infancy. It usually manifests as a palpable chest wall mass. In the present case report, the clinical, radiologic and histopathologic features of a rare neonatal case of chondromatous hamartoma are reported.Case report: A baby boy of 16 days old was admitted to Hazrat-e-Ali Asghar Childrens Hospital for a palpable right-side anterior chest wall mass with the dimensions of 3×5×4 cm. Ultrasonographic (US) and CT scanning evaluations showed a 16×28 mm mass without mediastinal invasions, necrosis or calcifications. The mass was surgically excised and benign chondroma without significant nuclear atypia, without any mitosis or necrosis, was histopathologically reported. Although rare, this condition ought to be kept in mind while dealing with infantile chest wall masses in order to avoid its complications such as respiratory problems. Surgical excision is usually curative in combination with conservative therapy if possible.

Endotracheal suctioning is one of the most frequently used methods for airway clearance in patients under mechanical ventilation. Chest physiotherapy techniques such as expiratory rib cage compression before endotracheal suctioning can be used as a means to facilitate mobilizing and removing airway secretions and improving alveolar ventilation. This study was carried out to determine the effects of expiratory rib cage compression before endotracheal suctioning on arterial blood gases in patients mechanically ventilated patients. This research was a clinical trial study with a crossover design. The subjects consisted of 70 (35 females, 35 males) mechanically ventilated patients who were admitted to medical and surgical intensive care units and emergency department of Hazrat-Rasool Hospital in Tehran. Subjects were selected with consecutive sampling. The patients received endotracheal suctioning with and without rib cage compression, with a minimum 3-hours interval between the two interventions. Expiratory rib cage compression was performed for 5 minutes before endotracheal suctioning. Arterial blood gases were measured 5 minutes before and 25 minutes after endotracheal suctioning. Data were recorded on the data recording sheet. Data were analyzed using Wilcoxon and paired t-tests. There were a statistically significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (Pao2/Fio2), Paco2, and arterial oxygen saturation (Sao2) between before and after endotracheal suctioning in both methods (endotracheal suctioning with and without rib cage compression) (p=0.000). Moreover, there were statistically significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (P=0.000), Paco2 (P=0.048), and arterial oxygen saturation (P=0.000) between the two methods. Findings showed that expiratory rib cage compression before endotracheal suctioning improves arterial blood gases exchanges in patients under mechanical ventilation, so, performing expiratory rib cage compression before endotracheal suctioning in these patients is recommended.

Trauma is the most common cause of death, admission and disability in all age groups ranging between 1-40 years. The present study was conducted to survey the frequency of chest trauma (blunt and penetrating) in Air Force Hospital in a two-year period, 2002–2004. A retrospective study was conducted at Surgery and Emergency departments of Air Force hospital on all consecutive (blunt and penetrating) chest trauma patients treated between March 2002 and March 2004. Totally, 814 cases referred with chief complain of chest trauma. Blunt chest trauma was reported in 78.1% of cases (636 patients) and penetrating chest trauma in the remaining 21.9% (178 patients). Totally, 84.7% were males and 76.4% aged 14-40 years. The most common site of injury was chest wall (90.3%) and soft tissue injury was the most prevalent form of trauma (31.6%). Extremities were the most common site of co-injury (13.3%). Car accident was by far the most frequent cause of trauma (57.9%). The mortality rate was 3.8% (31 patients). Car accident was the most common cause of chest trauma. Meanwhile, soft tissue injury was the most frequent type of injury.

Macicnant plevral mesothestioma is a primary neoplasm of the plevra asbestos exposune Ïs known to bean important risk factor in abovt 80% of cases. Ths case report presents  32 yr oldman who has no history of asbestos onset plevrstsl chestpain whsch msmecs pulmonary in farction. Due to embols. By revewing the records there are few case of sudden onset pasn. Ïn addstion pleuritic pasn was awother unusuas Fea ture of the pasent.

Mustard gas is one of the chemical warfare agents that was used by Iraqi army many times in Iraq-Iran war. It has different effects on various organs. Chronic pulmonary complication is the most common. We studied chest X-ray and spirometric findings regarding these common chronic side effects of some victims. From 1017 victims of chemical warfare agent 231 cases were selected that had positive history of exposure to mustard gas and pulmonary complication. Pulmonary chest X-ray and spirometry was performed for these patients. Chest X-ray and spirometry findings were analyzed with SPSS software by Chi-square and Fisher exact tests. The mean age of 231 victims of mustard gas exposure was 32.18 years, who had been exposed 110.04 months ago (On the average). Chest X-ray abnormal findings were studied in 4 areas with most of the abnormal findings observed in lung and hilum, pleural sinuses, heart and mediastinum. In lungs an increased non-specific marking, bronchiectasia and hyperinflation were noticeable. Blunting or right and then left sinus. Large Aortic arch and cardiomegaly were other abnormal findings. In spirometric investigation, we found that 70% of them had abnormal spirometry with signs of obstruction, restriction or a combination of these in mild, moderate or severe forms. There is a meaningful relation between X-ray abnormal finding in heart and mediastinum and aging that suggest senescence has caused abnormal changes (P<0.0001). Most o the subjects with abnormal spirometric findings showed abnormal chest X-ray findings that is indicative of pulmonary disorders.