Chest radiological findings of influenza A H1N1 pneumonia

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Data are presented as means±SD. * Indicates a significant difference (P<0.05) between goups." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Vidal, G. Fortunato, W. Klein, L. Cortizo, J. Vasconcelos, R. Ribeiro-dos-Santos, M. Soares, S. Macambira" "autores" => array:8 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Vidal" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Fortunato" ] 2 => array:2 [ "nombre" => "W." "apellidos" => "Klein" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "Cortizo" ] 4 => array:2 [ "nombre" => "J." "apellidos" => "Vasconcelos" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Ribeiro-dos-Santos" ] 6 => array:2 [ "nombre" => "M." "apellidos" => "Soares" ] 7 => array:2 [ "nombre" => "S." 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Guimarães, M.V. Martins, J. Moutinho dos Santos" "autores" => array:3 [ 0 => array:2 [ "nombre" => "C." "apellidos" => "Guimarães" ] 1 => array:2 [ "nombre" => "M.V." "apellidos" => "Martins" ] 2 => array:2 [ "nombre" => "J." 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Nicolini, L. Ferrera, F. Rao, R. Senarega, M. Ferrari-Bravo" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Nicolini" "email" => array:1 [ 0 => "antonellonicolini@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Ferrera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "F." "apellidos" => "Rao" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "R." "apellidos" => "Senarega" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "M." "apellidos" => "Ferrari-Bravo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Respiratory Diseases Department, Villa Scassi Hospital, Genoa, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Rehabilitation Pulmonology Division, Hospital of Arenzano, Genoa, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Radiology, Hospital of Sestri Levante, Sestri Levante, Italy" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Department of Public Health and Preventive Medicine, Chiavari, Italy" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Achados radiológicos do tórax da pneumonia da gripe A H1N1" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1805 "Ancho" => 1800 "Tamanyo" => 360448 ] ] "descripcion" => array:1 [ "en" => "A 39-year-old man with Influenza A (H1N1) virus pneumonia and severe respiratory failure (PaO2/FIO2 at admission 170) respiratory underwent non-invasive mechanical ventilation: chest computed tomography shows alveolar consolidation, peripheral ground-glass opacities in both middle and lower lung zones and small bilateral pleural effusions." ] ] ] "textoCompleto" => "IntroductionInfluenza A viruses belong to the family Orthomyxovirus, with 16 varieties of hemagglutinin and 9 varieties of neuraminidase proteins used for subtyping. Influenza<a class="elsevierStyleCrossRef" href="#bib0005">1</a> A pandemics occurred three times in the 20th Century: H1N1 in 1918, H2N2 in 1957, and H3N2 in 1968. H1N1 re-emerged in 1977 to periodically circulate with A (H3N2) subtypes as “seasonal flu”. A new influenza pandemic arrived in April 2009. This novel H1N1 virus was initially termed “swine origin influenza virus” but further studies revealed that it represents a quadruple reassortment of one human, one avian and two swine strains. Retrospective studies showed a virus similar to swine origin influenza virus that appeared in Thailand in 2000.<a class="elsevierStyleCrossRef" href="#bib0010">2</a>Children and young adults are the most susceptible to this infection and high risk groups for complications are pregnant women, adults older than 65 years, children younger than 5 years, patients with underlying conditions such as chronic obstructive pulmonary disease (COPD), cardiovascular or neurological diseases, immunosuppression, hematological disorders, chronic liver diseases, chronic renal failure, metabolic diseases (especially diabetes mellitus and obesity).<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> Although patients with conditions that confer some degree of immunosuppression, such as asplenia, should not have increased risk of influenza-associated complications, they can be at high risk of secondary invasive infections such as pneumococcal or methycillin-resistant Staphylococcus aureus pneumonia.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> The signs and symptoms are similar to those of “seasonal flu”, except for the fact that a greater number of subjects develop gastrointestinal symptoms.<a class="elsevierStyleCrossRefs" href="#bib0010">2,3</a> The most important complications are lower respiratory tract involvement, acute respiratory failure and acute lung injury or respiratory distress syndrome (ALI/ARDS) with refractory hypoxemia. Other severe complications include secondary invasive bacterial infections, septic shock, acute renal failure, reversible cardiac dysfunction, and the multiple organ failure syndrome. Moreover, worsening of underlying chronic diseases such as asthma, COPD or congestive heart failure may occur.<a class="elsevierStyleCrossRefs" href="#bib0010">2–4</a> Non-specific laboratory features include: elevated lactate dehydrogenase levels, lymphopenia or leucopenia or leucocytosis, thrombocytopenia and increased creatinine-phosphokinase and transaminases levels. The diagnostic test of choice is RT-PCR; samples must be collected through nasopharyngeal aspirate, or nasopharyngeal or pharyngeal swab, or, in the case of pneumonia, through the lower respiratory tract.<a class="elsevierStyleCrossRefs" href="#bib0015">3,5</a>The radiological appearance has been described in previous studies and presents similar findings, but there is a quantitative difference between cases of mild or severe illness. The predominant findings consist of ground-glass opacities or areas of consolidation, or a mixed pattern of ground glass and areas of consolidation.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> Bilateral opacities are common, with involvement of multiple lung zones. Findings in four or more zones and bilateral peripheral distribution occurred with significantly higher frequency in patients with poorer outcomes.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The aim of this study was to review radiological findings on chest X-ray (CXR) and on chest computed tomography (CT) of influenza A (H1N1) virus-correlated pneumonia, and to evaluate whether radiological findings may be linked to clinical outcome.Materials and methodsThe study was carried out in the Hospital of Sestri Levante and in Villa Scassi Hospital, Genoa, and was approved by the Institutional Review Board of each hospital. The subjects included 28 patients (15 males and 13 females, ranging in age from 26 to 78 years, average age 31.7±24.5) with RT-PCR confirmed influenza A H1N1 pneumonia in the period from September 2009 to December 2009.The inclusion criteria were: patients aged 16 years or more, diagnosed of influenza A H1N1 infection and a CXR report compatible with pneumonia. The exclusion criteria were: admission to hospital in the preceding 10 days or coexistence of lung cancer or tuberculosis. The first aim of the study was to describe CXR and chest CT abnormalities of patients admitted to our hospitals with PCR-confirmed diagnosis of influenza A H1N1 virus pneumonia.Most of our patients had a more favorable outcome (only one died), compared to previously described cases.<a class="elsevierStyleCrossRefs" href="#bib0025">5,8,11</a> The second aim was to determinate whether there were differences in radiological findings between patients who underwent mechanical ventilation and those who received only medical therapies (including oxygen therapy).We retrospectively reviewed CXRs and chest CTs of two community hospitals in Liguria, a region of Northern Italy where our study was done. Informed patient consent was waived due to the study's observational nature. Initial CXRs were obtained in all twenty-eight patients: twelve patients had posterior–anterior projections and sixteen had both posterior–anterior and lateral projections. All radiographs were obtained using a Proteus unit (General Electrics). Chest CT scan was performed in eighteen of the twenty-eight patients within 24h of admission and in the other ten within 72h of admission.Unenhanced HRCTs were performed with a 64-detector-row CT scanner (Somaton Sensation, Siemens Forchheim, Germany) or with a single slice helical scanner (High Speed CTi, GE Medical System, Milwaukee, WI, USA). End-inspiratory images were acquired from pulmonary apex to the diaphragm with a spiral technique (120kV, 120mA, slice thickness 1mm, pitch 1.4, ultra sharp reconstruction algorithm) on the 64-detector CT scanner, and with high-resolution axial technique (140kV, 160mA, slice thickness 1mm, interval 10mm, 1.5s acquisition time, ‘bone’ reconstruction algorithm) on the single slice scanner. CT images were displayed with a lung window (width 1800 UH, level −500) and with a mediastinal window (width 400, level 50) for evaluation. The imagining data were displayed directly on monitors of a picture archiving and communication system. CXR and the chest CT images stored in the Picture Archiving and Communications System (PACS) were examined and interpreted by two trained radiologists (with more than 20 years in CXR and CT imaging) until both reached a consensus. Each radiologist knew the diagnosis, but was blinded to all other information concerning the subjects.Their findings were described according to the pattern of opacity: ground-glass opacity is defined as an area of hazy increased lung opacity within which definition of lung structures is usually preserved; this pattern is less opaque than consolidation. Consolidation is defined as a homogeneous increase in pulmonary parenchymal attenuation which obscures the margins of vessel and airways.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> Nodular opacities were defined as focal round opacities and reticular opacities were defined as linear opacities forming a web pattern.<a class="elsevierStyleCrossRefs" href="#bib0045">9,10</a> The distribution of abnormalities is categorized as focal, multifocal or diffuse.A focal distribution was defined as a single focus of abnormality. A multifocal distribution described more than one focus, further classified as unilateral or bilateral. A diffuse distribution was defined as an abnormality is bilateral and involved an equivalent volume of one or both lungs.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> The anatomical distribution of radiological findings is characterized as central (from 1 to 4cm from the hila) or peripheral.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> The location of each abnormality on the CXR is divided into upper, middle or lower (based on dividing the vertical distance between the apices and the hemidiaphragmatic domes into thirds).<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a>The presence and size of pleural effusion were recorded. We have adapted a scoring system described by Opravil to grade the severity of pulmonary infiltrates in CXR: each lung is divided into four equal quadrants and each quadrant is scored on a scale of 0–3 (0: normal, 1: subtle increase interstitial markings, 2: prominent interstitial opacities, 3: confluent interstitial and acinar opacities). This system allows a maximum score of 24 for both lungs.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a>The twenty-eight patients were divided in two groups: Group 1 consisted of ten critically ill patients admitted to ICU or to the Intermediate Respiratory Care Unit, who required invasive or non-invasive mechanical ventilation. Group 2 consisted of eighteen patients who required brief hospitalization without mechanical ventilation or vasopressor medications. A retrospective review of clinical and laboratory data was also performed to evaluate correlations between clinical, laboratory and radiological features and the severity of illness.Statistical analysisResults are expressed as average with standard deviation and medians with quartiles for continuous variables and as frequency of occurrence of the group from which they derive for categorical variables. Regression analysis has been used to evaluate the correlation between severity and continuous variables (Age, LDH, pO2, P/F, number of lobes involved, XRC score).Logistic regression has been used for the categorical variables to evaluate the increase of risk in the severe group versus mild group.In both analyses p values of ≤0.05 were considered statistically significant. Statistical analyses were performed with R-Project version 2.13.2.ResultsThere was no statistical difference between the age range of the two groups (53.8±18.2 in mild disease group versus 40.78±10.4 in severe group, p>0.058), and the predominant radiological findings in the patients at presentation were unilateral or bilateral multifocal ground glass opacities (twenty-three patients) (84.5%) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>The consolidation areas had a peribronchovascular and subpleural predominance and were found mainly in the middle and upper zones of the lung (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). Reticular opacities were found in six cases. The most outstanding CXR and chest CT features of the disease were basal and axial interstitial-alveolar consolidation and ground-glass opacities (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>): the extent of disease was greater in Group 1 (patients requiring mechanical ventilation) with a greater number of lobes involved and a greater CXR score (p<0.001). Airway thickening and dilatation, small airway involvement with centrilobular nodules and tree-in-bud opacities was not found.<elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia>Predominant distribution was bilateral with involvement of lower lung zone: 21 patients presented these findings and 8 of them underwent mechanical ventilation. Patients having multifocal and bilateral distribution of opacities had a more severe course of the disease and a significantly higher frequency of mechanical ventilation (p≤0.02). Crazy-paving pattern was found in only 7 patients. The chest CT findings of the patients of our study appear in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Pleural effusions (500ml or less) were found: two patients in Group 1 and four patients in Group 2; these decreased gradually on follow-up. No evidence of hilar or mediastinal lymphnode enlargement was seen.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Higher levels of LDH, lower pO2 and pO2/FIO2 ratio at admission as well as higher number of involved pulmonary lobes and a higher XRC score were the independent variables associated with severity of illness and use of mechanical ventilation (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionsInfluenza A H1N1 virus can cause either a mild influenza-type illness that is indistinguishable from seasonal influenza, or less often, a rapidly progressive, community-acquired pneumonic illness that can develop acute respiratory failure and can lead to death, most often in persons with underlying medical conditions.<a class="elsevierStyleCrossRef" href="#bib0050">10</a> CXR is usually the first imaging test performed for the assessment of acute respiratory symptoms.However, an increasing number of patients undergo chest CT when there is high clinical suspicion of pneumonia in the presence of normal or questionable radiological findings. Chest CT is also helpful in assessing complication or evidence of mixed infection.<a class="elsevierStyleCrossRef" href="#bib0070">14</a> The predominant CT findings at presentation of illness were unilateral or more often bilateral multi-focal asymmetric ground-glass opacities, either alone or associated with areas of consolidation.<a class="elsevierStyleCrossRefs" href="#bib0035">7,13,14</a>The abnormalities have a predominantly peripheral and subpleural distribution: patients who exhibit consolidation on chest CT have a more severe clinical course, occasionally requiring mechanical ventilation, compared with those who present with ground-glass opacities.<a class="elsevierStyleCrossRefs" href="#bib0035">7,15</a> All the patients described originally by Perez-Padilla et al.<a class="elsevierStyleCrossRef" href="#bib0025">5</a> had radiologically confirmed pneumonia with bilateral patchy alveolar consolidation. Subsequent studies have described ground-glass opacities, areas of consolidation and pleural effusions as the predominant computed tomography findings<a class="elsevierStyleCrossRefs" href="#bib0030">6,8</a>.<a class="elsevierStyleCrossRef" href="#bib0045">9</a> and bilateral crazy-paving.<a class="elsevierStyleCrossRefs" href="#bib0115">13,14</a>The crazy-paving pattern is a common finding on chest CT of the lungs: it consists of scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines.<a class="elsevierStyleCrossRefs" href="#bib0115">13,14</a> Some authors presume that crazy-paving pattern is also closely related to an adverse course, requiring not only treatment with mechanical ventilation, but often ECMO therapy.<a class="elsevierStyleCrossRefs" href="#bib0070">14,16</a> Marchiori et al.<a class="elsevierStyleCrossRef" href="#bib0120">15</a> have recently described high resolution computed tomography (HRCT)-pathological correlation: the predominant HRCT findings included areas of airspace consolidation and ground-glass opacities; the main pathological features consisted of diffuse alveolar damage with hyaline membrane formation, associated with various degrees of pulmonary congestion, edema, hemorrhage, inflammatory infiltration and bronchiolitis often evolving into organizing pneumonia.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>The most common chest CT abnormalities of pandemic H1N1 influenza virus infection were multifocal consolidation and ground-glass and more rarely poorly defined nodules with upper lobe predominance.<a class="elsevierStyleCrossRef" href="#bib0090">18</a> The predominant findings in our study were bilateral consolidation and reticular opacities similar to those reported in previous literature and the predominant computed tomographic findings were ground-glass opacities and areas of consolidation.<a class="elsevierStyleCrossRefs" href="#bib0040">8,14,19</a> Multifocal bilateral distribution and Opravil CXR score were directly correlated with the severity of the illness: actually all the patients who underwent invasive or non-invasive mechanical ventilation had multifocal bilateral opacities and a higher CXR score. Secondary bacterial pneumonia usually presents a pattern consistent with bronchopneumonia, including lobular, subsegmental or segmental consolidation.<a class="elsevierStyleCrossRef" href="#bib0100">20</a> In our case-series only one patient presented a bacterial co-infections (Staphylococcus aureus MRSA) with radiological findings of lobar pneumonia (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>).<elsevierMultimedia ident="fig0020"></elsevierMultimedia>This study has several limitations: it is retrospective; there are a small number of patients (which results in low statistical power in our analyses). It does not present the follow-up of the patients, only their hospital courses (this may explain why organizing pneumonia was not found as a late complication of influenza A H1N1 virus pneumonia). Moreover, the study did not include children (who frequently present patchy consolidation with mediastinal lymph node, pleural effusion and pneumomediastinum) and pregnant women (who sometimes have a more severe course of illness).<a class="elsevierStyleCrossRefs" href="#bib0100">20,21</a>ConclusionsThe predominant findings in our study were bilateral consolidation and reticular opacities similar to those reported in previously and the predominant CT findings were ground-glass opacities and areas of consolidation.<a class="elsevierStyleCrossRefs" href="#bib0040">8,14,19,20</a> Multifocal bilateral distribution and Opravil XRC score were directly correlated with the severity of the illness. Furthermore, the results of the present study indicate that higher serum level of LDH or lower PaO2 and PaO2/FIO2 ratio correlated directly with lung involvement based on chest CT findings of bilateral or diffuse areas of ground-glass areas and consolidation.These correlations were associated with severity of illness. A combination of clinical and chest CT indicators may aid in predicting the clinical course and outcome of influenza A H1N1 pneumonia.Conflict of interestThe authors have no conflict of interest to declare." "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres547589" "titulo" => array:5 [ 0 => "Abstract" 1 => "Objective" 2 => "Materials and methods" 3 => "Results" 4 => "Conclusion" ] ] 1 => array:2 [ "identificador" => "xpalclavsec565467" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres547588" "titulo" => array:5 [ 0 => "Resumo" 1 => "Objetivo" 2 => "Materiais e métodos" 3 => "Resultados" 4 => "Conclusão" ] ] 3 => array:2 [ "identificador" => "xpalclavsec565466" "titulo" => "Palavras-chave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Materials and methods" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Statistical analysis" ] ] ] 6 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussions" ] 8 => array:2 [ "identificador" => "sec0030" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0035" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack184906" "titulo" => "Acknowledgements" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-04-03" "fechaAceptado" => "2011-12-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec565467" "palabras" => array:5 [ 0 => "Influenza H1N1 virus pneumonia" 1 => "Radiological findings" 2 => "Ground-glass opacity" 3 => "Consolidation" 4 => "Chest radiological score" ] ] ] "pt" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palavras-chave" "identificador" => "xpalclavsec565466" "palabras" => array:5 [ 0 => "Pneumonia do vírus da gripe H1N1" 1 => "Resultados radiológicos" 2 => "Opacidades em vidro fosco" 3 => "Consolidação" 4 => "Pontuação radiográfica do tórax" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "ObjectiveThe objective of this study was to review chest radiographs (CXR) and chest computer tomography (CT) findings in patients with influenza A H1N1 virus pneumonia. Materials and methodsOf ninety-eight patients with influenza A H1N1 infections seen in the General Hospitals of Villa Scassi, Genoa, and Sestri Levante from September 2009 to December 2009, twenty-eight developed pneumonia. The initial CXR were evaluated for radiological patterns: (ground-glass, consolidation, nodules, reticulation), distribution, and extent of the disease. Chest CT scans were reviewed for the same findings. A new radiographic score (CXR score) was used to evaluate the severity of the illness. ResultsThe predominant radiological findings on chest CT in the patients at presentation were unilateral or bilateral multifocal ground glass opacities (84.5% of the patients).Consolidation areas had a peribronchovascular and subpleural predominance and were found mainly in the middle and upper zones of the lung. Reticular opacities were found in about 20% of the cases. The most outstanding CXR and chest CT features of the disease were basal and axial alveolar consolidation and ground-glass opacities. The severity of disease as determinate by need for mechanical ventilation was greater in patients with a greater number of lobes involved and a higher CXR score. ConclusionBilateral ground-glass opacities and areas of consolidation were the predominant radiological findings of influenza A (H1N1) virus pneumonia. Multifocal bilateral opacities and CXR score are strictly correlated with the severity of the illness." ] "pt" => array:2 [ "titulo" => "Resumo" "resumen" => "ObjetivoO objetivo deste estudo foi rever radiografias ao tórax (RXT) e tomografia computadorizada do tórax (TC) em pacientes com pneumonia pelo vírus gripe A H1N1. Materiais e métodosDos noventa e oito pacientes com infecção pelo vírus gripe A H1N1 vistos nos Hospitais Gerais de Villa Scassi, Génova e em Sestri Levante, de setembro de 2009 a dezembro de 2009, vinte e oito desenvolveram pneumonia. Os RXT iniciais foram avaliados através de padrões radiológicos: (consolidação em vidro despolido, nódulos, reticulação), distribuição e extensão da doença. As TC do tórax foram revistas para os mesmos achados. Uma nova escala radiográfica (escala RXT) foi utilizada para avaliar a gravidade da doença. ResultadosOs achados radiológicos predominantes na TC do tórax em pacientes na apresentação foram opacidades multifocais em vidro despolido (84% dos pacientes).As áreas de consolidação tinham uma predominância peribroncovascular e subpleural e foram encontradas principalmente nas áreas médias e superiores do pulmão. Foram encontradas opacidades reticulares em cerca de 20% dos casos. As características mais notórias da doença na TC e RXT do tórax foram a consolidação basal e alveolar axial e as opacidades em vidro despolido. A gravidade da doença determinada pela necessidade de ventilação mecânica foi maior nos pacientes com um maior número de lóbulos envolvidos e com uma pontuação na escala RXT mais elevada. ConclusãoAs opacidades bilaterais em vidro despolido e as áreas de consolidação foram os achados radiológicos predominantes da pneumonia do vírus da gripe A (H1N1). As opacidades multifocais bilaterais e a pontuação da escala RXT estão estritamente correlacionados com a gravidade da doença." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1697 "Ancho" => 1800 "Tamanyo" => 458929 ] ] "descripcion" => array:1 [ "en" => "A 40-year-old man with influenza A (H1N1) virus pneumonia and severe respiratory failure (paO2/FIO2 at admission 180) who underwent non-invasive mechanical ventilation: chest computed tomography demonstrates patchy bilateral interstitial infiltrates and peripheral focal ground-glass opacities in the middle and lower lung zones." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1788 "Ancho" => 1800 "Tamanyo" => 399337 ] ] "descripcion" => array:1 [ "en" => "A 28-year-old man with severe obesity and sleep apnea with influenza A (H1N1) virus pneumonia and not severe respiratory failure (PaO2/FIO2 at admission 340): chest computed tomography exhibits bilateral, patchy, confluent areas of consolidation in all lung zones." ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1805 "Ancho" => 1800 "Tamanyo" => 360448 ] ] "descripcion" => array:1 [ "en" => "A 39-year-old man with Influenza A (H1N1) virus pneumonia and severe respiratory failure (PaO2/FIO2 at admission 170) respiratory underwent non-invasive mechanical ventilation: chest computed tomography shows alveolar consolidation, peripheral ground-glass opacities in both middle and lower lung zones and small bilateral pleural effusions." ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 900 "Ancho" => 950 "Tamanyo" => 138083 ] ] "descripcion" => array:1 [ "en" => "A 53-year-old man with Influenza A (H1N1) virus pneumonia and bacterial coinfection (Staphylococcus aureus) and severe respiratory failure (PaO2/FIO2 at admission 250). Chest computed tomography shows prominent interstitial opacity with ground-glass areas and air bronchogram." ] ] 4 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Opravil et al. (modified).<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mechanical ventilation (10 pts) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. mechanical ventilation (18 pts) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">p-Value \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Opacity</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Ground-glass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.821 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Reticular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.937 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Nodular \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.492 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Consolidation \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.422 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Pleural effusion \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.677 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Distribution</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Focal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.062 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Multifocal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.268 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Multifocal bilateral \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Diffuse \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.110 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top">Predominant distribution</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Upper lung zone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.121 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Middle lung zone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.234 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Lower lung zone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.039 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab884558.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Radiological findings of the patients with Influenza A H1N1 pneumonia." ] ] 5 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "LDH, lactate dehydrogenase; CXR, chest X-ray." "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "fx1.jpeg" "imagenAlto" => 1831 "imagenAncho" => 3202 "imagenTamanyo" => 255815 ] ] ] ] ] "descripcion" => array:1 [ "en" => "Regression analyses showing the independent variables associated with more severe disease and mechanical ventilation." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Emergence of a novel swine-origin influenza A virus (S-OIV) virus in humans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.S. Peiris" 1 => "L.L. Poon" 2 => "Y. Guan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jcv.2009.06.006" "Revista" => array:6 [ "tituloSerie" => "J Clin Virol" "fecha" => "2009" "volumen" => "45" "paginaInicial" => "169" "paginaFinal" => "173" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19540800" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on 2009 pandemic influenza A (H1N1) virus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M. Marjani" 1 => "P. Baghaei" 2 => "P. Tabarsi" 3 => "S.D. Mansouri" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Tanaffos" "fecha" => "2010" "volumen" => "9" "paginaInicial" => "8" "paginaFinal" => "14" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Update on 2009 pandemic influenza A (H1N1) virus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S.M. Gordon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3949/ccjm.76a.05009" "Revista" => array:6 [ "tituloSerie" => "Cleve Clin J Med" "fecha" => "2009" "volumen" => "76" "paginaInicial" => "577" "paginaFinal" => "582" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19797457" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0110" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reversible cardiac dysfunction associated with pandemic-2009-H1N1 influenza A" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "S.S. Martin" 1 => "C.L. Hollingsworth" 2 => "S.G. Norfolk" 3 => "C.R. Wolfe" 4 => "J.W. Hollingsworth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1378/chest.10-0032" "Revista" => array:6 [ "tituloSerie" => "Chest" "fecha" => "2010" "volumen" => "137" "paginaInicial" => "1195" "paginaFinal" => "1197" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20139224" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Perez-Padilla" 1 => "D. De La Rosa-Zamboni" 2 => "S. Ponce del Leon" 3 => "M. Hernandez" 4 => "F. Quinones-Falconi" 5 => "E. Bautista" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0904252" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "361" "paginaInicial" => "680" "paginaFinal" => "689" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19564631" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High resolution computed tomography findings from adult patients with influenza A (H1N1) virus-associated pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Marchiori" 1 => "G. Zanetti" 2 => "B. Hochhegger" 3 => "R.S. Rodrigues" 4 => "C.A. Pantaleao Fontes" 5 => "L.F. Nobre" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejrad.2009.11.005" "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2010" "volumen" => "74" "paginaInicial" => "93" "paginaFinal" => "98" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19962842" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "H1N1 Influenza: initial chest radiographic findings in helping predict patient outcome" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Aviram" 1 => "A. Bar-Shai" 2 => "J. Sosna" 3 => "O. Rogowski" 4 => "G. Rosen" 5 => "I. 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Battegay" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Acquir Immune Defic Syndr" "fecha" => "1994" "volumen" => "7" "paginaInicial" => "39" "paginaFinal" => "45" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8263751" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0115" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Crazy-paving pattern on HRCT of patients with H1N1 pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Marchiori" 1 => "G. Zanetti" 2 => "G. D’Ippolito" 3 => "B. 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Bartling" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.acra.2010.03.013" "Revista" => array:6 [ "tituloSerie" => "Acad Radiol" "fecha" => "2010" "volumen" => "17" "paginaInicial" => "681" "paginaFinal" => "685" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20457412" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0120" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influenza A (H1N1) virus-associated pneumonia: high-resolution computed tomography-pathologic correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Marchiori" 1 => "G. Zanetti" 2 => "C.A. Pantaleao Fontes" 3 => "M.L. Oliveira Santos" 4 => "P.M. Valiante" 5 => "C.M. Mano" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Radiol" "fecha" => "2011" "volumen" => "80" "paginaInicial" => "500" "paginaFinal" => "504" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Severe respiratory disease concurrent with circulation of H1N1 influenza" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Chowell" 1 => "S.M. Bertozzi" 2 => "M.A. Colchero" 3 => "H. Lopez-Gatell" 4 => "C. Alpuche-Aranda" 5 => "M. Hernandez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0904023" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2009" "volumen" => "361" "paginaInicial" => "674" "paginaFinal" => "679" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19564633" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Organizing pneumonia associated with swine-origin Influenza A H1N1 2009 viral pneumonia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Gomez-Gomez" 1 => "R. Martinez-martinez" 2 => "M.B. 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Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3348/kjr.2010.11.4.417" "Revista" => array:6 [ "tituloSerie" => "Korean J Radiol" "fecha" => "2010" "volumen" => "11" "paginaInicial" => "417" "paginaFinal" => "424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20592925" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcome of pandemic H1N1 pneumonia: clinical and radiological findings for severity assessment" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.H. Cho" 1 => "Y.S. Kim" 2 => "D.S. Jeon" 3 => "J.E. kim" 4 => "K.I. kim" 5 => "H.Y. 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Original article

Chest radiological findings of influenza A H1N1 pneumonia

Achados radiológicos do tórax da pneumonia da gripe A H1N1

A. Nicolinia,

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antonellonicolini@gmail.com

Corresponding author.

, L. Ferrerab, F. Raoc, R. Senaregad, M. Ferrari-Bravoe

a Respiratory Diseases Unit, Hospital of Sestri Levante, Sestri Levante, Italy

b Respiratory Diseases Department, Villa Scassi Hospital, Genoa, Italy

c Rehabilitation Pulmonology Division, Hospital of Arenzano, Genoa, Italy

d Department of Radiology, Hospital of Sestri Levante, Sestri Levante, Italy

e Department of Public Health and Preventive Medicine, Chiavari, Italy

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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A 39-year-old man with Influenza A &#40;H1N1&#41; virus pneumonia and severe respiratory failure &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FIO<span class="elsevierStyleInf">2</span> at admission 170&#41; respiratory underwent non-invasive mechanical ventilation&#58; chest computed tomography shows alveolar consolidation&#44; peripheral ground-glass opacities in both middle and lower lung zones and small bilateral pleural effusions&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Influenza A viruses belong to the family Orthomyxovirus&#44; with 16 varieties of hemagglutinin and 9 varieties of neuraminidase proteins used for subtyping&#46; Influenza<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> A pandemics occurred three times in the 20th Century&#58; H1N1 in 1918&#44; H2N2 in 1957&#44; and H3N2 in 1968&#46; H1N1 re-emerged in 1977 to periodically circulate with A &#40;H3N2&#41; subtypes as &#8220;seasonal flu&#8221;&#46; A new influenza pandemic arrived in April 2009&#46; This novel H1N1 virus was initially termed &#8220;swine origin influenza virus&#8221; but further studies revealed that it represents a quadruple reassortment of one human&#44; one avian and two swine strains&#46; Retrospective studies showed a virus similar to swine origin influenza virus that appeared in Thailand in 2000&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Children and young adults are the most susceptible to this infection and high risk groups for complications are pregnant women&#44; adults older than 65 years&#44; children younger than 5 years&#44; patients with underlying conditions such as chronic obstructive pulmonary disease &#40;COPD&#41;&#44; cardiovascular or neurological diseases&#44; immunosuppression&#44; hematological disorders&#44; chronic liver diseases&#44; chronic renal failure&#44; metabolic diseases &#40;especially diabetes mellitus and obesity&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> Although patients with conditions that confer some degree of immunosuppression&#44; such as asplenia&#44; should not have increased risk of influenza-associated complications&#44; they can be at high risk of secondary invasive infections such as pneumococcal or methycillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span> pneumonia&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The signs and symptoms are similar to those of &#8220;seasonal flu&#8221;&#44; except for the fact that a greater number of subjects develop gastrointestinal symptoms&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> The most important complications are lower respiratory tract involvement&#44; acute respiratory failure and acute lung injury or respiratory distress syndrome &#40;ALI&#47;ARDS&#41; with refractory hypoxemia&#46; Other severe complications include secondary invasive bacterial infections&#44; septic shock&#44; acute renal failure&#44; reversible cardiac dysfunction&#44; and the multiple organ failure syndrome&#46; Moreover&#44; worsening of underlying chronic diseases such as asthma&#44; COPD or congestive heart failure may occur&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#8211;4</span></a> Non-specific laboratory features include&#58; elevated lactate dehydrogenase levels&#44; lymphopenia or leucopenia or leucocytosis&#44; thrombocytopenia and increased creatinine-phosphokinase and transaminases levels&#46; The diagnostic test of choice is RT-PCR&#59; samples must be collected through nasopharyngeal aspirate&#44; or nasopharyngeal or pharyngeal swab&#44; or&#44; in the case of pneumonia&#44; through the lower respiratory tract&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The radiological appearance has been described in previous studies and presents similar findings&#44; but there is a quantitative difference between cases of mild or severe illness&#46; The predominant findings consist of ground-glass opacities or areas of consolidation&#44; or a mixed pattern of ground glass and areas of consolidation&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Bilateral opacities are common&#44; with involvement of multiple lung zones&#46; Findings in four or more zones and bilateral peripheral distribution occurred with significantly higher frequency in patients with poorer outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The aim of this study was to review radiological findings on chest X-ray &#40;CXR&#41; and on chest computed tomography &#40;CT&#41; of influenza A &#40;H1N1&#41; virus-correlated pneumonia&#44; and to evaluate whether radiological findings may be linked to clinical outcome&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">The study was carried out in the Hospital of Sestri Levante and in Villa Scassi Hospital&#44; Genoa&#44; and was approved by the Institutional Review Board of each hospital&#46; The subjects included 28 patients &#40;15 males and 13 females&#44; ranging in age from 26 to 78 years&#44; average age 31&#46;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>24&#46;5&#41; with RT-PCR confirmed influenza A H1N1 pneumonia in the period from September 2009 to December 2009&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">The inclusion criteria were&#58; patients aged 16 years or more&#44; diagnosed of influenza A H1N1 infection and a CXR report compatible with pneumonia&#46; The exclusion criteria were&#58; admission to hospital in the preceding 10 days or coexistence of lung cancer or tuberculosis&#46; The first aim of the study was to describe CXR and chest CT abnormalities of patients admitted to our hospitals with PCR-confirmed diagnosis of influenza A H1N1 virus pneumonia&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Most of our patients had a more favorable outcome &#40;only one died&#41;&#44; compared to previously described cases&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;8&#44;11</span></a> The second aim was to determinate whether there were differences in radiological findings between patients who underwent mechanical ventilation and those who received only medical therapies &#40;including oxygen therapy&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">We retrospectively reviewed CXRs and chest CTs of two community hospitals in Liguria&#44; a region of Northern Italy where our study was done&#46; Informed patient consent was waived due to the study&#39;s observational nature&#46; Initial CXRs were obtained in all twenty-eight patients&#58; twelve patients had posterior&#8211;anterior projections and sixteen had both posterior&#8211;anterior and lateral projections&#46; All radiographs were obtained using a Proteus unit &#40;General Electrics&#41;&#46; Chest CT scan was performed in eighteen of the twenty-eight patients within 24<span class="elsevierStyleHsp" style=""></span>h of admission and in the other ten within 72<span class="elsevierStyleHsp" style=""></span>h of admission&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Unenhanced HRCTs were performed with a 64-detector-row CT scanner &#40;Somaton Sensation&#44; Siemens Forchheim&#44; Germany&#41; or with a single slice helical scanner &#40;High Speed CTi&#44; GE Medical System&#44; Milwaukee&#44; WI&#44; USA&#41;&#46; End-inspiratory images were acquired from pulmonary apex to the diaphragm with a spiral technique &#40;120<span class="elsevierStyleHsp" style=""></span>kV&#44; 120<span class="elsevierStyleHsp" style=""></span>mA&#44; slice thickness 1<span class="elsevierStyleHsp" style=""></span>mm&#44; pitch 1&#46;4&#44; ultra sharp reconstruction algorithm&#41; on the 64-detector CT scanner&#44; and with high-resolution axial technique &#40;140<span class="elsevierStyleHsp" style=""></span>kV&#44; 160<span class="elsevierStyleHsp" style=""></span>mA&#44; slice thickness 1<span class="elsevierStyleHsp" style=""></span>mm&#44; interval 10<span class="elsevierStyleHsp" style=""></span>mm&#44; 1&#46;5<span class="elsevierStyleHsp" style=""></span>s acquisition time&#44; &#8216;bone&#8217; reconstruction algorithm&#41; on the single slice scanner&#46; CT images were displayed with a lung window &#40;width 1800 UH&#44; level &#8722;500&#41; and with a mediastinal window &#40;width 400&#44; level 50&#41; for evaluation&#46; The imagining data were displayed directly on monitors of a picture archiving and communication system&#46; CXR and the chest CT images stored in the Picture Archiving and Communications System &#40;PACS&#41; were examined and interpreted by two trained radiologists &#40;with more than 20 years in CXR and CT imaging&#41; until both reached a consensus&#46; Each radiologist knew the diagnosis&#44; but was blinded to all other information concerning the subjects&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Their findings were described according to the pattern of opacity&#58; ground-glass opacity is defined as an area of hazy increased lung opacity within which definition of lung structures is usually preserved&#59; this pattern is less opaque than consolidation&#46; Consolidation is defined as a homogeneous increase in pulmonary parenchymal attenuation which obscures the margins of vessel and airways&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a> Nodular opacities were defined as focal round opacities and reticular opacities were defined as linear opacities forming a web pattern&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;10</span></a> The distribution of abnormalities is categorized as focal&#44; multifocal or diffuse&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">A focal distribution was defined as a single focus of abnormality&#46; A multifocal distribution described more than one focus&#44; further classified as unilateral or bilateral&#46; A diffuse distribution was defined as an abnormality is bilateral and involved an equivalent volume of one or both lungs&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> The anatomical distribution of radiological findings is characterized as central &#40;from 1 to 4<span class="elsevierStyleHsp" style=""></span>cm from the hila&#41; or peripheral&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> The location of each abnormality on the CXR is divided into upper&#44; middle or lower &#40;based on dividing the vertical distance between the apices and the hemidiaphragmatic domes into thirds&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The presence and size of pleural effusion were recorded&#46; We have adapted a scoring system described by Opravil to grade the severity of pulmonary infiltrates in CXR&#58; each lung is divided into four equal quadrants and each quadrant is scored on a scale of 0&#8211;3 &#40;0&#58; normal&#44; 1&#58; subtle increase interstitial markings&#44; 2&#58; prominent interstitial opacities&#44; 3&#58; confluent interstitial and acinar opacities&#41;&#46; This system allows a maximum score of 24 for both lungs&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">The twenty-eight patients were divided in two groups&#58; Group 1 consisted of ten critically ill patients admitted to ICU or to the Intermediate Respiratory Care Unit&#44; who required invasive or non-invasive mechanical ventilation&#46; Group 2 consisted of eighteen patients who required brief hospitalization without mechanical ventilation or vasopressor medications&#46; A retrospective review of clinical and laboratory data was also performed to evaluate correlations between clinical&#44; laboratory and radiological features and the severity of illness&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">Results are expressed as average with standard deviation and medians with quartiles for continuous variables and as frequency of occurrence of the group from which they derive for categorical variables&#46; Regression analysis has been used to evaluate the correlation between severity and continuous variables &#40;Age&#44; LDH&#44; pO2&#44; P&#47;F&#44; number of lobes involved&#44; XRC score&#41;&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Logistic regression has been used for the categorical variables to evaluate the increase of risk in the severe group versus mild group&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">In both analyses <span class="elsevierStyleItalic">p</span> values of &#8804;0&#46;05 were considered statistically significant&#46; Statistical analyses were performed with R-Project version 2&#46;13&#46;2&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0080" class="elsevierStylePara elsevierViewall">There was no statistical difference between the age range of the two groups &#40;53&#46;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>18&#46;2 in mild disease group versus 40&#46;78<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;4 in severe group&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;058&#41;&#44; and the predominant radiological findings in the patients at presentation were unilateral or bilateral multifocal ground glass opacities &#40;twenty-three patients&#41; &#40;84&#46;5&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">The consolidation areas had a peribronchovascular and subpleural predominance and were found mainly in the middle and upper zones of the lung &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Reticular opacities were found in six cases&#46; The most outstanding CXR and chest CT features of the disease were basal and axial interstitial-alveolar consolidation and ground-glass opacities &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#58; the extent of disease was greater in Group 1 &#40;patients requiring mechanical ventilation&#41; with a greater number of lobes involved and a greater CXR score &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; Airway thickening and dilatation&#44; small airway involvement with centrilobular nodules and tree-in-bud opacities was not found&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Predominant distribution was bilateral with involvement of lower lung zone&#58; 21 patients presented these findings and 8 of them underwent mechanical ventilation&#46; Patients having multifocal and bilateral distribution of opacities had a more severe course of the disease and a significantly higher frequency of mechanical ventilation &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;02&#41;&#46; Crazy-paving pattern was found in only 7 patients&#46; The chest CT findings of the patients of our study appear in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Pleural effusions &#40;500<span class="elsevierStyleHsp" style=""></span>ml or less&#41; were found&#58; two patients in Group 1 and four patients in Group 2&#59; these decreased gradually on follow-up&#46; No evidence of hilar or mediastinal lymphnode enlargement was seen&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">Higher levels of LDH&#44; lower pO2 and pO2&#47;FIO2 ratio at admission as well as higher number of involved pulmonary lobes and a higher XRC score were the independent variables associated with severity of illness and use of mechanical ventilation &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussions</span><p id="par0100" class="elsevierStylePara elsevierViewall">Influenza A H1N1 virus can cause either a mild influenza-type illness that is indistinguishable from seasonal influenza&#44; or less often&#44; a rapidly progressive&#44; community-acquired pneumonic illness that can develop acute respiratory failure and can lead to death&#44; most often in persons with underlying medical conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> CXR is usually the first imaging test performed for the assessment of acute respiratory symptoms&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">However&#44; an increasing number of patients undergo chest CT when there is high clinical suspicion of pneumonia in the presence of normal or questionable radiological findings&#46; Chest CT is also helpful in assessing complication or evidence of mixed infection&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The predominant CT findings at presentation of illness were unilateral or more often bilateral multi-focal asymmetric ground-glass opacities&#44; either alone or associated with areas of consolidation&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;13&#44;14</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The abnormalities have a predominantly peripheral and subpleural distribution&#58; patients who exhibit consolidation on chest CT have a more severe clinical course&#44; occasionally requiring mechanical ventilation&#44; compared with those who present with ground-glass opacities&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;15</span></a> All the patients described originally by Perez-Padilla et al&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> had radiologically confirmed pneumonia with bilateral patchy alveolar consolidation&#46; Subsequent studies have described ground-glass opacities&#44; areas of consolidation and pleural effusions as the predominant computed tomography findings<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;8</span></a><span class="elsevierStyleSup">&#46;</span><a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> and bilateral crazy-paving&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">13&#44;14</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">The crazy-paving pattern is a common finding on chest CT of the lungs&#58; it consists of scattered or diffuse ground-glass attenuation with superimposed interlobular septal thickening and intralobular lines&#46;<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">13&#44;14</span></a> Some authors presume that crazy-paving pattern is also closely related to an adverse course&#44; requiring not only treatment with mechanical ventilation&#44; but often ECMO therapy&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;16</span></a> Marchiori et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">15</span></a> have recently described high resolution computed tomography &#40;HRCT&#41;-pathological correlation&#58; the predominant HRCT findings included areas of airspace consolidation and ground-glass opacities&#59; the main pathological features consisted of diffuse alveolar damage with hyaline membrane formation&#44; associated with various degrees of pulmonary congestion&#44; edema&#44; hemorrhage&#44; inflammatory infiltration and bronchiolitis often evolving into organizing pneumonia&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The most common chest CT abnormalities of pandemic H1N1 influenza virus infection were multifocal consolidation and ground-glass and more rarely poorly defined nodules with upper lobe predominance&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> The predominant findings in our study were bilateral consolidation and reticular opacities similar to those reported in previous literature and the predominant computed tomographic findings were ground-glass opacities and areas of consolidation&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;14&#44;19</span></a> Multifocal bilateral distribution and Opravil CXR score were directly correlated with the severity of the illness&#58; actually all the patients who underwent invasive or non-invasive mechanical ventilation had multifocal bilateral opacities and a higher CXR score&#46; Secondary bacterial pneumonia usually presents a pattern consistent with bronchopneumonia&#44; including lobular&#44; subsegmental or segmental consolidation&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In our case-series only one patient presented a bacterial co-infections &#40;<span class="elsevierStyleItalic">Staphylococcus aureus</span> MRSA&#41; with radiological findings of lobar pneumonia &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">This study has several limitations&#58; it is retrospective&#59; there are a small number of patients &#40;which results in low statistical power in our analyses&#41;&#46; It does not present the follow-up of the patients&#44; only their hospital courses &#40;this may explain why organizing pneumonia was not found as a late complication of influenza A H1N1 virus pneumonia&#41;&#46; Moreover&#44; the study did not include children &#40;who frequently present patchy consolidation with mediastinal lymph node&#44; pleural effusion and pneumomediastinum&#41; and pregnant women &#40;who sometimes have a more severe course of illness&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;21</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conclusions</span><p id="par0130" class="elsevierStylePara elsevierViewall">The predominant findings in our study were bilateral consolidation and reticular opacities similar to those reported in previously and the predominant CT findings were ground-glass opacities and areas of consolidation&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;14&#44;19&#44;20</span></a> Multifocal bilateral distribution and Opravil XRC score were directly correlated with the severity of the illness&#46; Furthermore&#44; the results of the present study indicate that higher serum level of LDH or lower PaO2 and PaO2&#47;FIO2 ratio correlated directly with lung involvement based on chest CT findings of bilateral or diffuse areas of ground-glass areas and consolidation&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">These correlations were associated with severity of illness&#46; A combination of clinical and chest CT indicators may aid in predicting the clinical course and outcome of influenza A H1N1 pneumonia&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflict of interest</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors have no conflict of interest to declare&#46;</p></span></span>"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2011-04-03"
    "fechaAceptado" => "2011-12-18"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec565467"
          "palabras" => array:5 [
            0 => "Influenza H1N1 virus pneumonia"
            1 => "Radiological findings"
            2 => "Ground-glass opacity"
            3 => "Consolidation"
            4 => "Chest radiological score"
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          "clase" => "keyword"
          "titulo" => "Palavras-chave"
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          "palabras" => array:5 [
            0 => "Pneumonia do v&#237;rus da gripe H1N1"
            1 => "Resultados radiol&#243;gicos"
            2 => "Opacidades em vidro fosco"
            3 => "Consolida&#231;&#227;o"
            4 => "Pontua&#231;&#227;o radiogr&#225;fica do t&#243;rax"
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        "titulo" => "Abstract"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The objective of this study was to review chest radiographs &#40;CXR&#41; and chest computer tomography &#40;CT&#41; findings in patients with influenza A H1N1 virus pneumonia&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Materials and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Of ninety-eight patients with influenza A H1N1 infections seen in the General Hospitals of Villa Scassi&#44; Genoa&#44; and Sestri Levante from September 2009 to December 2009&#44; twenty-eight developed pneumonia&#46; The initial CXR were evaluated for radiological patterns&#58; &#40;ground-glass&#44; consolidation&#44; nodules&#44; reticulation&#41;&#44; distribution&#44; and extent of the disease&#46; Chest CT scans were reviewed for the same findings&#46; A new radiographic score &#40;CXR score&#41; was used to evaluate the severity of the illness&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The predominant radiological findings on chest CT in the patients at presentation were unilateral or bilateral multifocal ground glass opacities &#40;84&#46;5&#37; of the patients&#41;&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Consolidation areas had a peribronchovascular and subpleural predominance and were found mainly in the middle and upper zones of the lung&#46; Reticular opacities were found in about 20&#37; of the cases&#46; The most outstanding CXR and chest CT features of the disease were basal and axial alveolar consolidation and ground-glass opacities&#46; The severity of disease as determinate by need for mechanical ventilation was greater in patients with a greater number of lobes involved and a higher CXR score&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Bilateral ground-glass opacities and areas of consolidation were the predominant radiological findings of influenza A &#40;H1N1&#41; virus pneumonia&#46; Multifocal bilateral opacities and CXR score are strictly correlated with the severity of the illness&#46;</p></span>"
      ]
      "pt" => array:2 [
        "titulo" => "Resumo"
        "resumen" => "<span><span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">O objetivo deste estudo foi rever radiografias ao t&#243;rax &#40;RXT&#41; e tomografia computadorizada do t&#243;rax &#40;TC&#41; em pacientes com pneumonia pelo v&#237;rus gripe A H1N1&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Materiais e m&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Dos noventa e oito pacientes com infec&#231;&#227;o pelo v&#237;rus gripe A H1N1 vistos nos Hospitais Gerais de Villa Scassi&#44; G&#233;nova e em Sestri Levante&#44; de setembro de 2009 a dezembro de 2009&#44; vinte e oito desenvolveram pneumonia&#46; Os RXT iniciais foram avaliados atrav&#233;s de padr&#245;es radiol&#243;gicos&#58; &#40;consolida&#231;&#227;o em vidro despolido&#44; n&#243;dulos&#44; reticula&#231;&#227;o&#41;&#44; distribui&#231;&#227;o e extens&#227;o da doen&#231;a&#46; As TC do t&#243;rax foram revistas para os mesmos achados&#46; Uma nova escala radiogr&#225;fica &#40;escala RXT&#41; foi utilizada para avaliar a gravidade da doen&#231;a&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Os achados radiol&#243;gicos predominantes na TC do t&#243;rax em pacientes na apresenta&#231;&#227;o foram opacidades multifocais em vidro despolido &#40;84&#37; dos pacientes&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">As &#225;reas de consolida&#231;&#227;o tinham uma predomin&#226;ncia peribroncovascular e subpleural e foram encontradas principalmente nas &#225;reas m&#233;dias e superiores do pulm&#227;o&#46; Foram encontradas opacidades reticulares em cerca de 20&#37; dos casos&#46; As caracter&#237;sticas mais not&#243;rias da doen&#231;a na TC e RXT do t&#243;rax foram a consolida&#231;&#227;o basal e alveolar axial e as opacidades em vidro despolido&#46; A gravidade da doen&#231;a determinada pela necessidade de ventila&#231;&#227;o mec&#226;nica foi maior nos pacientes com um maior n&#250;mero de l&#243;bulos envolvidos e com uma pontua&#231;&#227;o na escala RXT mais elevada&#46;</p></span> <span><span class="elsevierStyleSectionTitle">Conclus&#227;o</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">As opacidades bilaterais em vidro despolido e as &#225;reas de consolida&#231;&#227;o foram os achados radiol&#243;gicos predominantes da pneumonia do v&#237;rus da gripe A &#40;H1N1&#41;&#46; As opacidades multifocais bilaterais e a pontua&#231;&#227;o da escala RXT est&#227;o estritamente correlacionados com a gravidade da doen&#231;a&#46;</p></span>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A 40-year-old man with influenza A &#40;H1N1&#41; virus pneumonia and severe respiratory failure &#40;paO<span class="elsevierStyleInf">2</span>&#47;FIO<span class="elsevierStyleInf">2</span> at admission 180&#41; who underwent non-invasive mechanical ventilation&#58; chest computed tomography demonstrates patchy bilateral interstitial infiltrates and peripheral focal ground-glass opacities in the middle and lower lung zones&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A 28-year-old man with severe obesity and sleep apnea with influenza A &#40;H1N1&#41; virus pneumonia and not severe respiratory failure &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FIO<span class="elsevierStyleInf">2</span> at admission 340&#41;&#58; chest computed tomography exhibits bilateral&#44; patchy&#44; confluent areas of consolidation in all lung zones&#46;</p>"
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A 39-year-old man with Influenza A &#40;H1N1&#41; virus pneumonia and severe respiratory failure &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FIO<span class="elsevierStyleInf">2</span> at admission 170&#41; respiratory underwent non-invasive mechanical ventilation&#58; chest computed tomography shows alveolar consolidation&#44; peripheral ground-glass opacities in both middle and lower lung zones and small bilateral pleural effusions&#46;</p>"
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          "en" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">A 53-year-old man with Influenza A &#40;H1N1&#41; virus pneumonia and bacterial coinfection &#40;<span class="elsevierStyleItalic">Staphylococcus aureus</span>&#41; and severe respiratory failure &#40;PaO<span class="elsevierStyleInf">2</span>&#47;FIO<span class="elsevierStyleInf">2</span> at admission 250&#41;&#46; Chest computed tomography shows prominent interstitial opacity with ground-glass areas and air bronchogram&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Opravil et al&#46; &#40;modified&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;12</span></a></p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Characteristics&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mechanical ventilation &#40;10 pts&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No&#46; mechanical ventilation &#40;18 pts&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>-Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Opacity</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Ground-glass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;821&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Reticular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;937&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Nodular&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;492&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Consolidation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;422&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pleural effusion&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;677&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleItalic">Distribution</span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Focal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;062&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Multifocal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;268&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Multifocal bilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5&nbsp;\t\t\t\t\t\t\n
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      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
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            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Emergence of a novel swine-origin influenza A virus &#40;S-OIV&#41; virus in humans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;S&#46; Peiris"
                            1 => "L&#46;L&#46; Poon"
                            2 => "Y&#46; Guan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jcv.2009.06.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Virol"
                        "fecha" => "2009"
                        "volumen" => "45"
                        "paginaInicial" => "169"
                        "paginaFinal" => "173"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19540800"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update on 2009 pandemic influenza A &#40;H1N1&#41; virus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; Marjani"
                            1 => "P&#46; Baghaei"
                            2 => "P&#46; Tabarsi"
                            3 => "S&#46;D&#46; Mansouri"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Tanaffos"
                        "fecha" => "2010"
                        "volumen" => "9"
                        "paginaInicial" => "8"
                        "paginaFinal" => "14"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Update on 2009 pandemic influenza A &#40;H1N1&#41; virus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "S&#46;M&#46; Gordon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3949/ccjm.76a.05009"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cleve Clin J Med"
                        "fecha" => "2009"
                        "volumen" => "76"
                        "paginaInicial" => "577"
                        "paginaFinal" => "582"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19797457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reversible cardiac dysfunction associated with pandemic-2009-H1N1 influenza A"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;S&#46; Martin"
                            1 => "C&#46;L&#46; Hollingsworth"
                            2 => "S&#46;G&#46; Norfolk"
                            3 => "C&#46;R&#46; Wolfe"
                            4 => "J&#46;W&#46; Hollingsworth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1378/chest.10-0032"
                      "Revista" => array:6 [
                        "tituloSerie" => "Chest"
                        "fecha" => "2010"
                        "volumen" => "137"
                        "paginaInicial" => "1195"
                        "paginaFinal" => "1197"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20139224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pneumonia and respiratory failure from swine-origin influenza A &#40;H1N1&#41; in Mexico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Perez-Padilla"
                            1 => "D&#46; De La Rosa-Zamboni"
                            2 => "S&#46; Ponce del Leon"
                            3 => "M&#46; Hernandez"
                            4 => "F&#46; Quinones-Falconi"
                            5 => "E&#46; Bautista"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0904252"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
                        "volumen" => "361"
                        "paginaInicial" => "680"
                        "paginaFinal" => "689"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19564631"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High resolution computed tomography findings from adult patients with influenza A &#40;H1N1&#41; virus-associated pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Marchiori"
                            1 => "G&#46; Zanetti"
                            2 => "B&#46; Hochhegger"
                            3 => "R&#46;S&#46; Rodrigues"
                            4 => "C&#46;A&#46; Pantaleao Fontes"
                            5 => "L&#46;F&#46; Nobre"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejrad.2009.11.005"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Radiol"
                        "fecha" => "2010"
                        "volumen" => "74"
                        "paginaInicial" => "93"
                        "paginaFinal" => "98"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19962842"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "H1N1 Influenza&#58; initial chest radiographic findings in helping predict patient outcome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Aviram"
                            1 => "A&#46; Bar-Shai"
                            2 => "J&#46; Sosna"
                            3 => "O&#46; Rogowski"
                            4 => "G&#46; Rosen"
                            5 => "I&#46; Weinstein"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1148/radiol.10092240"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiology"
                        "fecha" => "2010"
                        "volumen" => "255"
                        "paginaInicial" => "252"
                        "paginaFinal" => "259"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20308461"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Swine-origin influenza A &#40;H1N1&#41; viral infection&#58; radiographic and CT findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "A&#46;M&#46; Ajlan"
                            1 => "B&#46; Quiney"
                            2 => "S&#46; Nicolaou"
                            3 => "N&#46;L&#46; Muller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2214/AJR.09.3625"
                      "Revista" => array:6 [
                        "tituloSerie" => "AJR"
                        "fecha" => "2009"
                        "volumen" => "193"
                        "paginaInicial" => "1494"
                        "paginaFinal" => "1499"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19933639"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pneumonia in novel swine-origin influenza A &#40;H1N1&#41; virus infection&#58; high-resolution CT findings"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "P&#46; Li"
                            1 => "D&#46;-J&#46; Su"
                            2 => "J&#46;-F&#46; Zhang"
                            3 => "X&#46;-D&#46; Xia"
                            4 => "H&#46; Sui"
                            5 => "D&#46;-H&#46; Zhao"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Radiol"
                        "fecha" => "2011"
                        "volumen" => "80"
                        "paginaInicial" => "146"
                        "paginaFinal" => "152"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiological findings of pneumonia in patients with swine-orogin influenza A virus &#40;H1N1&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "E&#46; Busi-Rizzi"
                            1 => "V&#46; Schinina&#8217;"
                            2 => "F&#46; Ferraro"
                            3 => "L&#46; Rovighi"
                            4 => "M&#46; Critoforo"
                            5 => "D&#46; Chiappetta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11547-010-0553-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Radiol Med"
                        "fecha" => "2010"
                        "volumen" => "115"
                        "paginaInicial" => "507"
                        "paginaFinal" => "515"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20526820"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High mortality from respiratory failure secondary to swine-origin influenza A &#40;H1N1&#41;&#46; In South Africa"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "C&#46;F&#46;N&#46; Koegelenberg"
                            1 => "E&#46;M&#46; Irusen"
                            2 => "R&#46; Cooper"
                            3 => "A&#46;H&#46; Diacon"
                            4 => "J&#46;J&#46; Talijard"
                            5 => "A&#46; Mowlana"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Q J Med"
                        "fecha" => "2010"
                        "volumen" => "103"
                        "paginaInicial" => "319"
                        "paginaFinal" => "325"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Shortcomings of chest radiography in detecting Pneumocystis carinii pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Opravil"
                            1 => "B&#46; Marincek"
                            2 => "W&#46;A&#46; Fuchs"
                            3 => "R&#46; Weber"
                            4 => "R&#46; Speich"
                            5 => "M&#46; Battegay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Acquir Immune Defic Syndr"
                        "fecha" => "1994"
                        "volumen" => "7"
                        "paginaInicial" => "39"
                        "paginaFinal" => "45"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8263751"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Crazy-paving pattern on HRCT of patients with H1N1 pneumonia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Marchiori"
                            1 => "G&#46; Zanetti"
                            2 => "G&#46; D&#8217;Ippolito"
                            3 => "B&#46; Hochhegger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ejrad.2010.10.004"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Radiol"
                        "fecha" => "2011"
                        "volumen" => "80"
                        "paginaInicial" => "573"
                        "paginaFinal" => "575"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21035973"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Image findings of patients with H1N1 virus pneumonia and acute respiratory failure"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Henzler"
                            1 => "M&#46; Meyer"
                            2 => "A&#46; Kalenka"
                            3 => "M&#46; Alb"
                            4 => "G&#46; Schmidt-Bindert"
                            5 => "S&#46; Bartling"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.acra.2010.03.013"
                      "Revista" => array:6 [
                        "tituloSerie" => "Acad Radiol"
                        "fecha" => "2010"
                        "volumen" => "17"
                        "paginaInicial" => "681"
                        "paginaFinal" => "685"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20457412"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influenza A &#40;H1N1&#41; virus-associated pneumonia&#58; high-resolution computed tomography-pathologic correlation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "G&#46; Zanetti"
                            2 => "C&#46;A&#46; Pantaleao Fontes"
                            3 => "M&#46;L&#46; Oliveira Santos"
                            4 => "P&#46;M&#46; Valiante"
                            5 => "C&#46;M&#46; Mano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Radiol"
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                        "paginaInicial" => "500"
                        "paginaFinal" => "504"
                      ]
                    ]
                  ]
                ]
              ]
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              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Severe respiratory disease concurrent with circulation of H1N1 influenza"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Chowell"
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                            2 => "M&#46;A&#46; Colchero"
                            3 => "H&#46; Lopez-Gatell"
                            4 => "C&#46; Alpuche-Aranda"
                            5 => "M&#46; Hernandez"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "2009"
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                        "paginaInicial" => "674"
                        "paginaFinal" => "679"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19564633"
                            "web" => "Medline"
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                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "17"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Organizing pneumonia associated with swine-origin Influenza A H1N1 2009 viral pneumonia"
                      "autores" => array:1 [
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46; Gomez-Gomez"
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                            2 => "M&#46;B&#46; Gotway"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "AJR"
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                        "volumen" => "196"
                        "paginaInicial" => "103"
                        "paginaFinal" => "104"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiological and clinical characteristics of a military out break of pandemic H1N1 influenza virus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46;J&#46; Yun"
                            1 => "G&#46;J&#46; Kwon"
                            2 => "M&#46;K&#46; Oh"
                            3 => "S&#46;K&#46; Woo"
                            4 => "S&#46;H&#46; Choi"
                            5 => "H&#46;J&#46; Lee"
                          ]
                        ]
                      ]
                    ]
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                    0 => array:2 [
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                        "tituloSerie" => "Korean J Radiol"
                        "fecha" => "2010"
                        "volumen" => "11"
                        "paginaInicial" => "417"
                        "paginaFinal" => "424"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20592925"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "identificador" => "bib0095"
              "etiqueta" => "19"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outcome of pandemic H1N1 pneumonia&#58; clinical and radiological findings for severity assessment"
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                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;H&#46; Cho"
                            1 => "Y&#46;S&#46; Kim"
                            2 => "D&#46;S&#46; Jeon"
                            3 => "J&#46;E&#46; kim"
                            4 => "K&#46;I&#46; kim"
                            5 => "H&#46;Y&#46; Seol"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:2 [
                      "doi" => "10.3904/kjim.2011.26.2.160"
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                        "tituloSerie" => "Korean J Intern Med"
                        "fecha" => "2011"
                        "volumen" => "26"
                        "paginaInicial" => "160"
                        "paginaFinal" => "167"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21716592"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
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              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Clinical and radiological Features of pandemic H1N1 2009 influenza virus infection manifesting as acute febrile respiratory illness at their initial presentations&#58; comparison with contemporaneous non-H1N1 patients"
                      "autores" => array:1 [
                        0 => array:2 [
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                            1 => "C&#46;M&#46; Park"
                            2 => "G&#46;J&#46; Kwon"
                            3 => "S&#46;K&#46; Woo"
                            4 => "S&#46;H&#46; Park"
                            5 => "S&#46;H&#46; Choi"
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                        ]
                      ]
                    ]
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                  "host" => array:1 [
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                        "tituloSerie" => "Acta Radiol"
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                        "volumen" => "52"
                        "paginaInicial" => "410"
                        "paginaFinal" => "416"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21498293"
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                ]
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                      "titulo" => "Chest radiograph findings in children with laboratory confirmed pandemic H1N1 virus infection"
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                        "paginaFinal" => "278"
                        "link" => array:1 [
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        "texto" => "<p id="par0145" class="elsevierStylePara elsevierViewall">The authors thank Giovanni Circella MD&#44; Gabriella Bregante MD&#44; Silvia Cantoni MD Radiological Department&#44; Hospital of Sestri Levante&#44; for the help in the study concept and design&#44; and their assistance in the revision of chest X-rays and chest computed tomographies&#44; Monica Bonfiglio MD Intensive Care Unit&#44; Hospital of Lavagna&#44; Alessandro Perazzo MD&#44; Piergiorgio Gatto MD&#44; Pulmonary Diseases Unit Hospital of Sestri Levante for the help in the data collection and Cornelius Barlascini for the help in reviewing the manuscript&#46;</p>"
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Article information

ISSN: 08732159
Original language: English

DOI:10.1016/j.rppneu.2011.12.008

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Year/Month	Html	Pdf	Total

2024 November	17	12	29
2024 October	123	42	165
2024 September	187	33	220
2024 August	210	34	244
2024 July	200	44	244
2024 June	148	52	200
2024 May	144	32	176
2024 April	111	29	140
2024 March	150	33	183
2024 February	168	39	207
2024 January	249	42	291
2023 December	203	26	229
2023 November	155	42	197
2023 October	161	43	204
2023 September	93	32	125
2023 August	87	21	108
2023 July	89	33	122
2023 June	135	25	160
2023 May	121	31	152
2023 April	128	21	149
2023 March	185	29	214
2023 February	155	21	176
2023 January	148	25	173
2022 December	202	25	227
2022 November	177	41	218
2022 October	142	41	183
2022 September	115	36	151
2022 August	131	49	180
2022 July	127	49	176
2022 June	120	42	162
2022 May	111	41	152
2022 April	84	29	113
2022 March	60	43	103
2022 February	74	32	106
2022 January	83	39	122
2021 December	57	40	97
2021 November	74	39	113
2021 October	142	42	184
2021 September	86	32	118
2021 August	103	36	139
2021 July	92	22	114
2021 June	113	26	139
2021 May	136	42	178
2021 April	327	86	413
2021 March	236	25	261
2021 February	177	22	199
2021 January	180	38	218
2020 December	204	21	225
2020 November	236	37	273
2020 October	183	36	219
2020 September	245	47	292
2020 August	233	27	260
2020 July	340	47	387
2020 June	385	48	433
2020 May	358	60	418
2020 April	677	63	740
2020 March	652	78	730
2020 February	392	87	479
2020 January	434	45	479
2019 December	536	33	569
2019 November	339	31	370
2019 October	330	56	386
2019 September	268	42	310
2019 August	431	42	473
2019 July	459	34	493
2019 June	497	36	533
2019 May	585	33	618
2019 April	560	33	593
2019 March	621	20	641
2019 February	506	28	534
2019 January	549	39	588
2018 December	370	14	384
2018 November	210	0	210
2018 October	275	11	286
2018 September	153	28	181
2018 August	341	36	377
2018 July	342	22	364
2018 June	237	24	261
2018 May	369	32	401
2018 April	214	29	243
2018 March	154	32	186
2018 February	57	19	76
2018 January	83	29	112
2017 December	56	14	70
2017 November	107	16	123
2017 October	113	29	142
2017 September	186	24	210
2017 August	215	36	251
2017 July	128	27	155
2017 June	201	39	240
2017 May	159	21	180
2017 April	46	7	53
2017 March	17	12	29
2017 February	25	13	38
2017 January	77	7	84
2016 December	82	10	92
2016 November	200	14	214
2016 October	178	23	201
2016 September	220	21	241
2016 August	136	17	153
2016 July	93	24	117
2016 June	3	0	3
2016 May	12	36	48
2016 April	228	8	236
2016 March	383	42	425
2016 February	328	48	376
2016 January	328	42	370
2015 December	275	42	317
2015 November	201	26	227
2015 October	366	42	408
2015 September	249	31	280
2015 August	201	43	244
2015 July	264	29	293
2015 June	194	19	213
2015 May	270	34	304
2015 April	325	41	366
2015 March	571	18	589
2015 February	609	28	637
2015 January	330	36	366
2014 December	272	30	302
2014 November	242	20	262
2014 October	261	22	283
2014 September	321	25	346
2014 August	515	19	534
2014 July	1131	34	1165
2014 June	625	27	652
2014 May	358	24	382
2014 April	345	27	372
2014 March	476	40	516
2014 February	532	35	567
2014 January	560	44	604
2013 December	333	30	363
2013 November	263	21	284
2013 October	252	21	273
2013 September	180	24	204
2013 August	191	33	224
2013 July	175	24	199
2013 June	215	30	245
2013 May	204	36	240
2013 April	161	41	202
2013 March	158	28	186
2013 February	127	34	161
2013 January	139	30	169
2012 December	72	32	104
2012 November	91	17	108
2012 October	49	21	70
2012 September	25	16	41
2012 January	339	0	339

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