Background: The SARS-CoV-2 infection has occurred in neonates, but it is a fact that radiation exposure is not recommended given their age. The aim of this review is to assess the evidence on the utility of lung ultrasound (LUS) in neonates diagnosed with COVID-19. Methods: A systematic literature review was performed so as to find a number of published studies assessing the benefits of lung ultrasound for newborns diagnosed with COVID and, in the end, to make a comparison between LUS and the other two more conventional procedures of chest X-rays or CT exam. The key terms used in the search of several databases were: “lung ultrasound”, “sonography”, “newborn”, “neonate”, and “COVID-19′. Results: In total, 447 studies were eligible for this review, and after removing the duplicates, 123 studies referring to LU were further examined, but only 7 included cases of neonates. These studies were considered for the present research paper. Conclusions: As a non-invasive, easy-to-use, and reliable method for lung lesion detection in neonates with COVID-19, lung ultrasound can be used as a useful diagnosis tool for the evaluation of COVID-19-associated lung lesions. The benefits of this method in this pandemic period are likely to arouse interest in opening new research horizons, with immediate practical applicability.
IntroductionIdiopathic pulmonary fibrosis (IPF) is the most common and severe form of idiopathic interstitial pneumonia, accounted for 20% of cases of interstitial lung disease (ILD). In this study, we sought to compare the lung changes of IPF using a lung ultrasound (LUS) protocol of 12 zones with “current standard” high resolution computed tomography (HRCT) diagnostic method and overlap it with the functional pulmonary test as a complete clinical and imaging evaluation.MethodsThirty‐one patients were included in the study and performed HRCT and pulmonary functional tests (PFT). A 12‐lung zones' LUS protocol was used and compared with HRCT and PFT.ResultsThe HRCT total fibrotic score had a correlation coefficient of 0.454 (P < 0.005) with predicted FVC and 0.713 with predicted DLCO (P < 0.001). Both the median of the number of B‐lines and the average of the thickness of the pleural line obtained in the LUS assessment had a positively and statistically significant correlation with the HRCT fibrotic score P < 0.001. The pleural thickness of 2.4 mm is the cut‐off value of the mild form of fibrosis with a sensitivity of 0.958 and a specificity of 0.994.ConclusionB‐lines and the average thickness of the pleural line as LUS markers of the fibrotic interstitial syndrome are highly and positively correlated with HRCT score, FVC and DLCO. LUS as a complementary method in the clinical management of IPF could be used more often by skilled clinicians to assess patients in terms of possible diagnosis and monitoring of IPF.
The external fixation stabilizes the anterior pelvic ring lesions and it can be combined with the posterior stabilization using percutaneous sacro-iliac screws in case of associated lesions of the posterior ring. The external fixator is very useful especially in the acute phase, acquiring an acceptable reduction and an adequate stability in the partially unstable lesions (Tile B) and also reduces the pelvic volume and bleeding, being considered essential within the resuscitation protocols. The external fixator can be used as a permanent stabilization method when it guarantees a satisfying reduction.
The aim of our study was to analyze the distribution of biochemical markers (free-â hCG and PAPP-A) and nuchal translucency (NT) values and their deviation from expected median in our screening program. NT, free-â hCG and PAPP-A values were measured in first trimester sera of 1313 singleton pregnant women. The age (mean ±standard deviation) of pregnant women at the time of screening was 28.94±4.95 years and the gestational age was 87.66±4.74 days. The value of NT (median±standard error of mean) was 0.87±0.01 multiple of median corrected (MoMc), of free-β hCG was 1.07±0.02 MoMc and of PAPP-A was 1.06±0.01 MoMc. Since the huge majority of pregnant women carried a healthy fetus it was assumed that the median value of measurements was equal to 1 MoMc and the deviation from median was equal to null. Our results showed that the greatest deviation from the expected median (-0.13 MoMc) was recorded for the NT measurement while the deviation for the free-â hCG and PAPP-A values was 0.07 respectively 0.06. In conclusion the main disturbing factor in calculating the aneuploidy risk was the measurement of NT. A systematic audit of laboratory and ultrasound measurement is necessary.
BackgroundOccult hip fractures are often difficult to identify in busy trauma units. We aimed to present our institutions experience in the diagnosis and treatment of occult fractures around the hip and to help define a clinical and radiological management algorithm.MethodWe conducted a seven-year retrospective hospital medical record analysis. The electronic database was searched for ICD-10 CM codes S72.0 and S72.1 used for proximal femoral fractures upon patient discharge. We identified 34 (4.83 %) femoral neck fractures and 48 (4.42 %) trochanteric fractures labeled as occult.ResultsThe majority of the cases were diagnosed by primary MRI scan (57.4 %) and 12 were diagnosed by emergency CT scan (14.6 %). For the remaining cases the final diagnosis was confirmed by 72 h CT scan in 9 patients (representing 39 % of the false negative cases) or by MRI in the rest of 14 patients. MRI was best at detecting incomplete pertrochanteric fracture patterns (13.45 % of total) and incomplete fractures of the greater trochanter (3.65 % of total) respectively. It also detected the majority of Garden I femoral neck fractures (20.7 % of total). CT scanning accurately detected 100 % of Garden 2 fractures (2.44 %) and 25 % (3.65 %) of the complete pertrochanteric fractures (false negative 25 %).ConclusionOccult fractures should be suspected in all patients with traumatic onset of hip pain that is inconsistent with normal radiographic findings. MRI is the golden standard but not as readily available not as cheap and not quite as quick to perform as as a CT scan. The latter which in turn can provide falsely negative results in the first 24 h. Improved imaging protocols could expedite management and improve treatment.
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