Point-of-care ultrasound (POCUS) for hospitalists and general internists

Renal Lymphangiectasia: The Transcending of Serendipity

Renal lymphangiectasia, a rare entity of the renal lymphatic system affecting both genders and all ages, can manifest bilaterally or unilaterally and has been referred to by various terms, such as renal lymphangiomatosis, renal lymphangioma, and others. Distinguishing this condition from common pathologies, such as polycystic kidney disease or hydronephrosis, is crucial. This article presents an innovative clinical case of unilateral renal lymphangiectasia in a 67-year-old woman with a relevant medical history. Detection was achieved by ultrasound in primary care using the point-of-care ultrasound (POCUS) technique under the focused assessment with sonography in trauma (FAST) protocol, revealing findings suggestive of renal lymphangiomatosis. This case highlights the utility of advanced technologies, such as bedside ultrasound, in addressing and transforming the approach to rare medical conditions, offering a compelling reminder of the positive influence of technological innovation in clinical practice.

Point-of-Care Ultrasound in Neurology - Report of the EAN SPN/ESNCH/ERcNsono Neuro-POCUS Working Group

In the last decade, ultrasound examination in neurology has been undergoing a significant expansion of its modalities. In parallel, there is an increasing demand for rapid and high-quality diagnostics in various acute diseases in the prehospital setting, the emergency room, intensive care unit, and during surgical or interventional procedures. Due to the growing need for rapid answers to clinical questions, there is particular demand for diagnostic ultrasound imaging. The Neuro-POCUS working group, a joint project by the European Academy of Neurology Scientific Panel Neurosonology, the European Society of Neurosonology and Cerebral Hemodynamics, and the European Reference Centers in Neurosonology (EAN SPN/ESNCH/ERcNsono Neuro-POCUS working group), was given the task of creating a concept for point-of-care ultrasound in neurology called "Neuro-POCUS". We introduce here a new ultrasound examination concept called point-of-care ultrasound in neurology (Neuro-POCUS) designed to streamline conclusive imaging outside of the ultrasound center, directly at the bedside. The aim of this study is to encourage neurologists to add quick and disease-oriented Neuro-POCUS to accompany the patient in the critical phase as an adjunct not a substitution for computed tomography, magnetic resonance imaging, or standard comprehensive neurosonology examination. Another goal is to avoid unwanted complications during imaging-free periods, ultimately resulting in advantages for the patient.

Point-of-Care Ultrasound (POCUS) in the Field of Diabetology

Ultrasound is increasingly used in daily clinical practice to improve the efficiency of the clinical examination. In this article, we reviewed its various possible uses in the field of diabetology. The ultrasonic evaluation of the carotid arteries (plaques and intima media thickness) allows improving the assessment of the cardiovascular risk. Steatosis can be detected relatively easily on liver ultrasound. Ultrasound also allows a more sensitive detection of lipohypertrophy resulting in glycemic fluctuations and thus increasing the risk of hypoglycemia than the clinical examination. Finally, muscle ultrasound appears to be a promising tool to assess the nutritional status and its consequences (e.g., falls).

[Current state of research in abdominal ultrasonography at German university hospitals. A panel study over 20 years]

BACKGROUND

 The state of research in the field of abdominal ultrasonography has been deficient for years at German university hospitals. Neither research activity nor funding are appropriate given the actual clinical importance of this method.

OBJECTIVE

 In analogy to studies conducted in 1999 and 2009, this study aims to provide a survey into the state of research in the field of abdominal ultrasonography at German university hospitals. It focuses on the topics of research activity, research funding, publication rate and the development of structural conditions.

METHODS

 Chief gastroenterologists from Germany's 34 university hospitals were invited to respond to a postal survey asking about the aforementioned topics. We asked them to forward the survey in case somebody else was responsible for the respective tasks. The response rate was 79 %.

RESULTS

 The amount of hospitals doing research has roughly remained the same with 77 % compared to 74 % in 2009 and 80 % in 1999. On average, however, there are less research projects per department with 3.2 at the moment compared to 3.5 in 1999 and 3.6 in 2009, and research funding has continued to worsen. 75 % of the heads of departments state that they have not received any funding in addition to the usual budget. Funding by producers of ultrasound machines has also reached a low with 11 % compared to 45 % in 2009 and 31 % in 1999. Only public and university funding show a positive trend. The Deutsche Forschungsgemeinschaft (German Research Foundation) is currently not funding any research projects in the field of abdominal ultrasonography. 13 university hospitals provided information about their publication rate in 1999, 2009 and 2019. Whereas the rate had generally remained constant in the previous studies, the annual number of publications has continually increased in the current survey period. 75 % of the publications came from university hospitals that have established or are currently planning to establish interdisciplinary ultrasound centers. The previous studies also showed that more and more hospitals publish in English instead of German. This trend continues. During the survey period, 60 % of publications were both in English and German, 37 % in English and only 3 % exclusively in German. Most publications dealt with clinical and only a few technical or basic research questions. This was also the case in the previous studies. There have been less publications on the use of ultrasound contrast agents in the present survey period. There is also a decline in the number of systematic reviews. Similar to 2009, the impact factor of journals devoted to sonography is increasing and it is growing stronger than that of journals dedicated to radiology. However, only 29 % of the heads of departments agreed that ultrasonography was a field of research that improves your career prospects.

CONCLUSIONS

 The present study did not show a significant improvement of research activity in the field of abdominal ultrasonography. However, an increased publication rate indicates a trend towards high-performing research centers. Research funding remains deficient and has worsened in the past 20 years. The demands made by the previous studies for research funding appropriate to the importance of this clinical method remain.

Frequency of Abnormalities Detected by Point-of-Care Lung Ultrasound in Symptomatic COVID-19 Patients: Systematic Review and Meta-Analysis

The COVID-19 pandemic has resulted in significant morbidity, mortality, and strained healthcare systems worldwide. Thus, a search for modalities that can expedite and improve the diagnosis and management of this entity is underway. Recent data suggested the utility of lung ultrasound (LUS) in the diagnosis of COVID-19 by detecting an interstitial pattern (B-pattern). Hence, we aimed to pool the proportion of various reported lung abnormalities detected by LUS in symptomatic COVID-19 patients. We conducted a systematic review (PubMed, MEDLINE, and EMBASE until April 25, 2020) and a proportion meta-analysis. We included seven studies examining the role of LUS in 122 COVID-19 patients. The pooled proportion (PP) of B-pattern detected by lung ultrasound (US) was 0.97 (95% CI: 0.94-1.00 I 2 0%, Q 4.6). The PP of finding pleural line abnormalities was 0.70 (95% CI: 0.13-1.00 I 2 96%, Q 103.9), of pleural thickening was 0.54 (95% 0.11-0.95 I 2 93%, Q 61.1), of subpleural or pulmonary consolidation was 0.39 (95% CI: 0.21-0.58 I 2 72%, Q 17.8), and of pleural effusion was 0.14 (95% CI: 0.00-0.37 I 2 93%, Q 27.3). Our meta-analysis revealed that almost all SARS-CoV-2-infected patients have abnormal lung US. The most common abnormality is interstitial involvement depicted as B-pattern. The finding from our review highlights the potential role of this modality in the triage, diagnosis, and follow-up of COVID-19 patients. A sizable diagnostic accuracy study comparing LUS, computed tomography scan, and COVID-19-specific tests is warranted to further test this finding and to delineate the diagnostic and prognostic yield of each of these modalities.