C B F in Neonatal Sepsis

 Abstract
Background: Neonatal sepsis is an important cause of morbidity and mortality among newborns. As there is paucity of literature regarding early alteration of the cerebral blood flow (CBF) in neonatal sepsis our study aims to evaluate the changes in the CBF velocities and Doppler indices in neonates with early‑onset neonatal sepsis (EONS) and to evaluate the predictive accuracy of cerebral blood flow velocities (CBFV) by using ultrasound Doppler as a diagnostic marker of EONS.
Methods: This cross‑sectional analytical study was conducted over a period of 2 years with 123 neonates enrolled in the study. The neonates were divided into two groups: Group I (with 54 neonates) ‑ neonates with EONS and group II (with 69 neonates) ‑ age‑matched neonates without any signs of sepsis. Ultrasound Doppler examination was performed and the cerebral hemodynamics assessed in neonates during the first seventy two hours of life. Doppler indices and CBFV were measured in the internal carotid artery (ICA), middle cerebral artery (MCA), and vertebral artery (VA) of either side. Data were analyzed using the statistical program SPSS version 23.0 (SPSS Inc., Chicago, IL, USA). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated at different selected cutoff values for CBFV parameters.
Results: Lower resistance and higher peak systolic velocity and end diastolic velocity have been documented in neonates with EONS.
Conclusion: Our study shows that the cerebral hemodynamics in neonates with EONS is altered which can be assessed bedside by noninvasive ultrasound Doppler examination.

PoCUS for Syncope

Point-of-care ultrasound to complete physical exam and to reach the diagnosis in a young man with syncope

• Fatemeh Rasooli, 
• Mehrnoosh Aligholi Zahraie & 
• Maryam Bahreini 

The Ultrasound Journal volume 12

Abstract

Background

Cardiac syncope can result from an atrial myxoma due to outflow obstruction. Myxoma is the most common primary cardiac tumor that may cause sudden death and the nonspecific symptoms may make early diagnosis difficult.

Case presentation

A 27-year-old man presented to our emergency department after two episodes of syncope and severe fatigue. He had no complaint of fever, weight loss, sweating, chest pain or dyspnea. Vital signs were within normal limits. A loud heart S1 was detected and normal neck veins. Other systemic examinations including neurological assessment were normal. Electrocardiography showed normal sinus rhythm. An obvious variability in heart rate was noticed on cardiac monitor changing by the patient’s position. Point-of-care ultrasonography (PoCUS) showed a large hyperechoic lesion with a well-defined stalk originating from the left atrium (LA). Thus, the patient was transferred to a cardiac surgery center for surgical intervention. Histopathology reported an LA mass compatible with myxoma.

Conclusions

Emergency physicians should be familiar with the vague presentations of cardiac tumors to improve patient outcomes. It is beneficial to take advantage of bedside ultrasound for prompt diagnosis and subsequent treatment.

Feasibility of renal resistive index

Feasibility of renal resistive index measurements performed by an intermediate and novice sonographer in a volunteer population

• Mårten Renberg, 
• Naima Kilhamn, 
• […]
• Max Bell 

The Ultrasound Journal volume 12

Abstract

Background

The Doppler-derived renal resistive index (RRI) is emerging as a promising bedside tool for assessing renal perfusion and risk of developing acute kidney injury in critically ill patients. It is not known what level of ultrasonography competence is needed to obtain reliable RRI values.

Objective

The aim of this study was to evaluate the feasibility of RRI measurements by an intermediate and novice sonographer in a volunteer population.

Methods

After a focused teaching session, an intermediate (resident), novice (medical student) and expert sonographer performed RRI measurements in 23 volunteers consecutively and blinded to the results of one another. Intraclass correlation coefficients and Bland–Altman plots were used to evaluate interobserver reliability, bias and precision.

Results

Both non-experts were able to obtain RRI values in all volunteers. Median RRI in the population measured by the expert was 0.58 (interquartile range 0.52–0.62). The intraclass correlation coefficient was 0.96 (95% confidence interval 0.90–0.98) for the intermediate and expert, and 0.85 (95% confidence interval 0.69–0.94) for the novice and expert. In relation to the measurements of the expert, both non-experts showed negligible bias (mean difference 0.002 [95% confidence interval − 0.005 to 0.009, p = 0.597] between intermediate and expert, mean difference 0.002 [95% confidence interval − 0.011 to 0.015, p = 0.752] between novice and expert) and clinically acceptable precision (95% limits of agreement − 0.031 to 0.035 for the intermediate, 95% limits of agreement − 0.056 to 0.060 for the novice).

Conclusions

RRI measurements by both an intermediate and novice sonographer in a volunteer population were reliable, accurate and precise after a brief course. RRI is easy to learn and feasible within the scope of point-of-care ultrasound. 

AA in Patient < 50years of age

Abstract

Introduction

Practitioners of US routinely include a survey of the abdominal aorta during abdominal US in accordance with international guidelines. Such practice is of uncertain value in younger patients.

Results

The most common indications for US were abdominal pain (1337, 44%), deranged liver function tests (453, 15%), nausea and/or vomiting (229, 8%), elevated inflammatory markers (146, 5%), pancreatitis (134, 4%) and pyrexia (127, 4%). Fewer than half (977, 49%) of the reports contained a comment regarding the aorta. Aortic pathology was reported in 2 (0.1%) cases. Both were reported as aortic ectasia and both represented a false‐positive diagnosis. One male patient had a known abdominal aortic aneurysm with endovascular aortic repair. No new aortic aneurysms were found. All cases of atherosclerotic disease were ignored, and none were reported. Periaortic pathology was encountered on 1 patient, but this was known. No case of new periaortic pathology was detected.

US autopsies help doctors understand COVID-19

  By Theresa Pablos, AuntMinnie staff writer

 June 3, 2020 -- A hospital in São Paulo used a portable ultrasound machine to perform autopsies on 10 patients with fatal cases of COVID-19. The authors described the modality's benefits for studying the effects of the disease caused by the novel coronavirus in a paper published on May 22 in Histopathology.

Using a technique called ultrasound-based minimally invasive autopsies (MIA-US), an ultrasound examiner and technologist took tissue samples from the most affected parts of each patient's organs. The findings confirmed that COVID-19 affects multiple organs and tissues, including the kidneys, spleen, lymph nodes, brain, testicles, and skin.

The ultrasound team also wore head-to-toe personal protective equipment, including two aprons, rubber boots, plastic sleeves, three glove layers, a rubber cap, an N95 mask, a surgical mask, and eye protection.

During the autopsies, the examiner and technologist used a portable ultrasound machine with multifrequency broadband transduces and standard image quality. They scanned patients' organs to identify the most-affected locations, then cut 10-cm openings at the appropriate locations to take ultrasound-guided tissue samples from the lung, liver, kidneys, spleen, and heart. They also took unguided samples from the quadriceps, skin, and brain.

The samples revealed significant lung findings, including exudative and/or proliferative diffuse alveolar damage. The authors also found severe alveolar epithelial changes, which they described as more intense and prevalent than findings for other respiratory viruses.

Many but not all findings outside of the lungs could be attributed to the comorbidities of the patients or to septic shock, the authors noted. For instance, eight patients had fibrinous thrombi in alveolar arterioles and a high density of alveolar megakaryocytes, which the authors believed could be evidence of a hypercoagulative state in severely ill patients. The researchers also found cases with superficial perivascular dermatitis, myositis, orchitis, and myocarditis.

Abdominal imaging reveals bowel injuries in COVID-19 patients

Matt O'Connor | May 12, 2020 | Advanced Visualization

https://www.healthimaging.com/topics/advanced-visualization/imaging-bowel-injuries-covid-19?utm_source=newsletter&utm_medium=hi_monthly

A number of studies have shown how COVID-19 can impact a patient’s lungs, but new research suggests individuals may experience bowel abnormalities as well.

Boston-area physicians retrospectively looked at more than 400 patients admitted to a single center to reach their conclusions, published May 11 in Radiology. They found that abnormalities were most commonly seen in sicker patients with the coronavirus who were also admitted to the intensive care unit.

... "abdominal manifestations” in those who are infected, said study author Rajesh Bhayana, MD, abdominal imaging fellow at Massachusetts General Hospital’s Department of Radiology.

“Some findings were typical of bowel ischemia, or dying bowel, and in those who had surgery we saw small vessel clots beside areas of dead bowel,” Bhayana said in a statement. “Patients in the ICU can have bowel ischemia for other reasons, but we know COVID-19 can lead to clotting and small vessel injury, so bowel might also be affected by this.”

As part of their study, Bhayana et al. included patients who tested positive for severe acute respiratory syndrome coronavirus between March 27 and April 10. With an average age of 57 years, 17% of individuals had cross-sectional abdominal imaging, which included 44 ultrasounds, 42 CT scans and one MRI.

In total, 31% of CTs showed bowel abnormalities, which represented 3.2% of all patients involved in the study. Findings included thickening and ischemia-related discoveries such as pneumatosis (gas in the bowel wall) and portal venous gas. In two individuals who had bowel resection, the team found ischemia with patchy necrosis, and both had injuries that suggested bowel ischemia may be caused by small blood clots.

There are a number of potential explanations for this laundry-list of findings, the authors noted, including direct viral infection, small vessel thrombosis, or nonocclusive mesenteric ischemia. But one thing is for sure: More studies are required to determine if SARS-CoV-2 plays a direct role in bowel or vascular injury in those with COVID-19.

Ultrasound Can Diagnose Many Arm Fractures in Kids

News > Reuters Health Information

By Lisa Rappaport

May 22, 2020

https://www.medscape.com/viewarticle/930981

(Reuters Health) - While ultrasound can accurately diagnose many upper extremity fractures in children, a new study suggests it may not always catch elbow fractures.

Researchers conducted a systematic review and meta-analysis, examining data from 32 studies with 2,994 pediatric patients who had a total of 3,415 scans for symptoms consistent with upper extremity fracture. As a reference point to compare the accuracy of ultrasounds, 30 studies used plain radiographs; one study used radiographs, MRI or bone scan; and one study used MRI.

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