Ultrasound diagnosis of malaria: examination of the spleen, liver, and optic nerve sheath diameter

Tafoya

Tropical Med Int Health

et al. 2016

154

146

Abstractobjectives To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low-and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used.methods The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand-carried ultrasound devices in LMIC were included if agreed upon as relevant by two-reviewer consensus based on our predefined research questions.results A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty-seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life-threatening conditions, using hand-carried and hand-held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound-guided diagnosis and treatment in resource-constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials).conclusions Hand-carried and hand-held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand-carried ultrasound in LMIC.

Section: Resultsmentioning

confidence: 99%

The use of portable ultrasound devices in low‐ and middle‐income countries: a systematic review of the literature

Tafoya

Tropical Med Int Health

et al. 2016

154

146

“…Even though they are seen in other common pathological condition, imaging of the liver and spleen could be helpful as part of a diagnostic support in severe malaria. 21 ACT is the recommended drug of choice in anti-malarial treatment protocol across the globe. In this study, ACT showed significant (p value <0.000) improvement (near normal levels) of bilirubin and hepatic enzymes by day 4.…”

Section: Discussionmentioning

confidence: 99%

Hepatic dysfunction in children with complicated malaria

Mannu

Agarwalla

Vasudevan

et al. 2018

Int J Contemp Pediatr

Background: Complicated malaria caused by Plasmodium falciparum alone or with P. vivax can lead to multi organ dysfunction. There is a paucity of studies about hepatic dysfunction in children with complicated malaria. Hence, this retrospective study was done to find out the clinico-biochemical profile of children with complicated malarial hepatic dysfunction from a malaria endemic region of India. Further, liver function test (LFT) response to Artemisinin-based combination therapy (ACT) i.e. artesunate + sulfadoxine-pyrimethamine therapy in the malarial hepatic dysfunction children was assessed. Methods: Out of 203 children confirmed to have malaria, 60 children were found to have complicated malaria with jaundice as per WHO malaria guidelines (total serum bilirubin >3 mg%). Physical examination, malaria related biochemical and ultra-sonographic findings were noted. All the children were found to be uniformly on ACT as per institute protocol adapted from WHO guidelines. Biochemical parameters of hepatic function were compared between day 1 and 4. Results: Presentations were fever, pallor and clinical jaundice in 100%, reddish urine in 63.3%, tender hepatomegaly in 100% and splenomegaly in 81.7% of the study population. Liver function test showed mild to moderate elevation of serum bilirubin and enzymes with remarkable recovery noticed with the use of ACT in all the study subjects. Conclusions: Clinical presentations of malarial hepatic dysfunction although mimics viral hepatitis, LFT showed mild to moderate elevation only. Further, ACT therapy was found effective in the management of all children with hepatic dysfunction in complicated malaria.

“…In addition, ultrasonography is not sensitive to lesions with low blood-flow perfusion or lack of blood supply. Therefore, examinations using CT and MRI for diagnosis are mainly adopted in clinical practice ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

Application of dual-source CT perfusion imaging and MRI for the diagnosis of primary liver cancer

Zhang

2017

Oncol Lett

The objective of the present study was to evaluate the application of dual-source CT perfusion imaging and MRI for the diagnosis of primary liver cancer. Sixty-three patients with primary liver cancer were selected between February 2015 and May 2016. All patients underwent examinations by dual-source CT perfusion imaging and MRI. The perfusion parameters of the focus center and normal liver parenchyma by CT examination and the hemodynamic parameters of the focus center and normal liver parenchyma by MRI examination were analyzed. The accuracy rates of the three detection methods (CT perfusion imaging, MRI, and combined examination) were analyzed and compared by ROC curves. Dual-source CT perfusion imaging revealed that blood flow and blood volume of the focus center were significantly higher than those of normal liver parenchyma (P<0.05). MRI examination showed that hepatic arterial perfusion and hepatic perfusion index of the focus center were significantly higher than those of normal liver parenchyma; portal venous perfusion of the focus center was significantly lower than that of normal liver parenchyma (P<0.05); the difference in total liver perfusion between the focus center and normal liver parenchyma was not significant (P>0.05); the accuracy rates of CT perfusion imaging, MRI, and combined examination were 76.19, 85.71, and 95.24% respectively; the area under the curve of CT perfusion imaging was 0.753 (P<0.05), the sensitivity was 79.2% and the specificity was 74.7%; the area under the curve of MRI was 0.846 (P<0.05), the sensitivity was 84.6%, and the specificity was 80.5%; the area under the curve of CT combined with MRI was 0.947 (P<0.05), the sensitivity was 94.6%, and the specificity was 86.5%. In conclusion, the effect of dual-source CT perfusion imaging combined with MRI for examination of primary liver cancer is superior to that of single use of CT or MRI, and has high clinical application and popularization value.