Is there a role for bedside ultrasound in malaria? A survey of the literature

Early detection of deep vein thrombosis in patients with coronavirus disease 2019: who to screen and who not to with Doppler ultrasound?

PURPOSE

Aim of the study is to evaluate the incidence of DVT in COVID-19 patients and its correlation with the severity of the disease and with clinical and laboratory findings.

METHODS

234 symptomatic patients with COVID-19, diagnosed according to the World Health Organization guidelines, were included in the study. The severity of the disease was classified as moderate, severe and critical. Doppler ultrasound (DUS) was performed in all patients. DUS findings, clinical, laboratory's and therapeutic variables were investigated by contingency tables, Pearson chi square test and by Student t test and Fisher's exact test. ROC curve analysis was applied to study significant continuous variables.

RESULTS

Overall incidence of DVT was 10.7% (25/234): 1.6% (1/60) among moderate cases, 13.8% (24/174) in severely and critically ill patients. Prolonged bedrest and intensive care unit admission were significantly associated with the presence of DVT (19.7%). Fraction of inspired oxygen, P/F ratio, respiratory rate, heparin administration, D-dimer, IL-6, ferritin and CRP showed correlation with DVT.

CONCLUSION

DUS may be considered a useful and valid tool for early identification of DVT. In less severely affected patients, DUS as screening of DVT might be unnecessary. High rate of DVT found in severe patients and its correlation with respiratory parameters and some significant laboratory findings suggests that these can be used as a screening tool for patients who should be getting DUS.

Experience of an isolated use of low-intensity pulsed ultrasound therapy on fracture healing in established non-unions: a prospective case series

Fracture non-unions are responsible for approximately 5% of cases, with low expectation of spontaneous healing thereafter. The fractures that heal without complications can take months to heal completely. An ultrasound, typically at low intensities (0.5-50 mW/cm²), serves a diagnostic purpose, whereas at higher intensities (0.2-100 W/cm²), its role becomes more therapeutic by generating heat energy. Low-intensity pulsed ultrasound (LIPUS) is frequently used to stimulate or to accelerate fracture healing. We present a prospective review of fracture non-unions treated with low-intensity pulsed ultrasound (LIPUS). We enrolled 66 patients during August 2016 and December 2018, 38 males and 28 females; age range 19-85 years (average 49.2 years). All these patients were followed up to minimum 6 months. The average time of referral post-treatment for fractures was 8.2 months (range 6-18 months). Four patients were excluded due to various reasons. 39 out of 62 fractures showed successful healing with symptom improvement and callus formation with 67% success rate. In this case series, we noted LIPUS therapy failure in the post-ORIF scaphoid fracture and post-ankle joint fusion non-union. We did not observe any influence of a medical condition such as diabetes mellitus, osteoporosis or personal habits like smoking. The LIPUS therapy appears to have influence on bone healing, depending on the onset of therapy, fracture type and the approach to fracture care. In this case series, the compliant group showed 67% successful outcome.