BACKGROUNDAppropriate use criteria (AUC) in echocardiography are essential tools for aligning the indications of echocardiography with the best clinical standards, improving clinical outcome, restraining abuse, and preserving health-care resources.OBJECTIVESThe aim of this study was to ascertain the AUC for transthoracic echocardiography in a university hospital and create a quality improvement project (QIP).METHODSThe assessment of 501 inpatients who received transthoracic cardiac echo was conducted according to the 2011 AUC report. Indications were classified as appropriate, uncertain, or inappropriate, and patients not matching any of the abovementioned divisions were grouped in the nonfitting category.RESULTSOf the 501 eligible patients, 374 patients (74.66%) were in the appropriate group, 85 patients (16.96%) in the inappropriate group, 20 patients (3.99%) in the uncertain group, and 22 patients (4.39%) in the nonfitting category.DISCUSSIONInterpretation and analysis of the obtained results are presented, along with the results of many comparable studies; moreover, a QIP was set up accordingly.CONCLUSIONAUC are useful to assess local practice, preserve health-care resources, and improve clinical outcome.
Acute soft head syndrome is an extremely rare complication in children with sickle cell anemia. We present a 16-year old male patient known to have sickle cell anemia who presented to our emergency department with low grade fever, headache, skull pain and swelling. Magnetic Resonance of the brain was done demonstrating subgaleal collections overlying calvarial signal abnormalities. The combination of clinical and radiological findings were indicative of acute soft head syndrome. Acute soft head syndrome is a rare complication in children with sickle cell anemia and the pathophysiology is related to osteonecrosis and bone infarcts of the calvarium as well as secondary reactive sub-galeal collections. Treatment includes conservative management with intravenous fluids and analgesics, in addition, our patient was treated with antibiotics since differentiation clinically and by imaging can be challenging. Acute soft head syndrome should be considered in the differential diagnosis of headache and skull swelling in children with sickle cell anemia.
Pulmonary hypertension is a severe and debilitating disease with no definite cure, and the domain of targeted therapies is a promising field for better management of this severe condition. The disease comprises pulmonary arterial remodeling, hypoxia, endothelial dysfunction, and inflammation, with subsequent organ damage including right heart and liver dysfunction. Biomarkers have a valuable role at different levels of the disease, from diagnosis to risk assessment and management, in order to decrease the burden of the disease in terms of both morbidity and mortality.
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