The Application of BLUE (Bedside Lung Ultrasound in Emergency) protocol in the Emergency Department
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Introduction: This study aimed to evaluate the effectiveness of lung ultrasonography (US) in detecting the cause of acute respiratory distress in the emergency department. Methods: This cross-sectional analytical study was carried out on 195 adult patients who were admitted to the Emergency Department of a University Hospital with acute respiratory failure in 6months period. The validity of the US diagnoses was assessed by comparing the decisions made by researchers according to the BLUE protocol classification with the final judgments made by the primary doctors using gold-standard diagnostic techniques suggested by the guidelines. Results: The diagnostic accuracy of lung US was 89.7%. While Congestive Heart Failure (CHF) (n=91), Chronic Obstructive Pulmonary Disease (COPD) (n=53), pneumonia (n=69), and Pneumothorax (PTX) (n=5) could be diagnosed by ultrasound with high sensitivity and specificity, its specificity in the diagnosis of Pulmonary Thromboembolism (PTE)(n=18) was low (67%). Ultrasonography could also diagnose combined pathologies such as pneumonia associated with CHF, or pneumonia associated with COPD, with high sensitivity and specificity. It has been determined that the diagnostic accuracy of the routine physical examination and lung radiography used in the emergency room to assess bedside respiratory distress is lower than that of ultrasonography. Discussion: In this study, we found that lung US was effective in the diagnosis of CHF, COPD, pneumonia, PTE, and PTX. Compared to the gold standard tests, it shortened the duration of the diagnosis. Finally, US can also be applied safely in centers where advanced diagnostic facilities are not available.Keywords:
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Objective: To assess the diagnostic accuracy of rapid diagnostic kits test for diagnosis of malaria taking microscopy as gold standard Methodology: A total of 375 cases with age range 18-65 years of either gender as suspected for malaria were included in the study. We excluded all those cases already taking anti-malarial drugs. The study was conducted at Chughtais Lahore Lab, Lahore. Required blood sample were obtained following aseptic measures. Malaria RDT SD Bioline Malaria Antigen Pf/Pan (Catalogue No. 05FK60, Standard Diagnostics Inc, Hagal-Dong, Korea, from now on referred as “SD RDT”) was used. Patients were labeled as positive or negative on the basis of reports from hematology department assessed by microscopy and patients were labeled as positive or negative Results: The mean age of the patients was 41.84±13.44 years, male to female ratio of the patients was 1.01:1. The sensitivity, specificity, and diagnostic accuracy of the RDT for diagnosing malaria was 96.79%, 96.28% and 96.53% respectively taking microscopy as gold standard Conclusion: Rapid diagnostic kits is very useful reliable test with high diagnostic accuracy for diagnosis of malaria taking microscopy as gold standard Keywords: Microscopy, Rapid Diagnostic kits, Malaria,
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Rapid diagnostic test
Diagnosis of malaria
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INTRODUCTION: It is very important to find a a non invasive, less time consuming and relatively easy modality,
non operator dependent and available even remote areas for the common bile duct stones (choledocolithiasis) in
symptomatic patients. Instant diagnosis will lead to prompt decision making for treatment strategies that will
ultimately decrease the morbidity.
OBJECTIVE: To determine the diagnostic accuracy of ultrasonography in detection of Choledocholithiasis in
suspected patients taking intraoperative findings as gold standard.
STUDY DESIGN: Descriptive Cross sectional Study
SETTING: Department of Radiology, Jinnah postgraduate Medical Center, Karachi
DURATION: Six months study from Feb 2020 onwards.
SUBJECTS AND METHODS: All patients with age 30-60 years of either gender having clinically suspected with
duration of symptoms of more than or equal to 7 days were enrolled. The ultrasound was performed and presence of
CBD diameter of > 7 mm on US was taken as CBD stones. Presence of CBD stones intra operatively was noted.
RESULTS: Mean age of the patients was 51.29 ±7.03 years. There were 75 (62%) females and 46 (38%) males.
Overall diagnostic accuracy of ultrasonography was found to be 89.25%. Sensitivity was found to be 80.48%,
specificity 93.75%, PPV 86.84% and NPV 90.36%.
CONCLUSION: The diagnostic accuracy of ultrasonography was found satisfactory in detection of
Choledocholithiasis in suspected patients taking intraoperative findings as gold standard.
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Aim. The main purpose is to evaluate the predisposing factors, the evolution and the associated pathology of the pneumothorax in the neonatal period. Materials and methods. Retrospective study over two years between 2014 and 2015 on 11 patients hospitalized in the Neonatology department of “Louis Turcanu” Children’s Emergency Hospital, Timisoara, diagnosed with pneumothorax. Results. From 1689 newborn infants admitted, 11 patients developed pneumothorax, the incidence was 0.65%. 8 patients (73%) were males and 3 (27%) were females. 4 out of those 11 patients were term newborn infants (gestational age >37 weeks) and 7 patients were premature newborns (<37 weeks of gestational age). Based on the birth weight 4 patients had over 2,500 grams and 7 under 2,500 grams. The main cause of the pneumothorax in the study group was the respiratory distress syndrome (45,4%). Conclusions. Pneumothorax represents an important condition in the neonatal pathology, it is essential to recognize and initiate the treatment from early stages to reduce the complications.
Neonatology
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Pneumothorax, though rare, is a recognized cause of respiratory distress in the immediate newborn period. It may occur spontaneously or secondary to various underlying lung diseases. Here we share our experience of a neonate with spontaneous pneumothorax with mild to moderate respiratory distress, who recovered completely with conservative management with an oxygen-enriched atmosphere and no surgical intervention.
Conservative Management
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Acute appendicitis is the most common surgical abdominal emergency. Its clinical diagnosis remains a challenge to surgeons, so different imaging options were introduced to improve diagnostic accuracy. Among these imaging modality choices, diagnostic medical sonography (DMS) is a simple, easily available, and cost effective clinical tool. The purpose of this study was to assess the accuracy of DMS, in the diagnosis of acute appendicitis compared to the histopathology report, as a gold standard. Between May 2015 and May 2016, 215 patients with suspected appendicitis were examined with DMS. The DMS findings were recorded as positive and negative for acute appendicitis and compared with the histopathological results, as a gold standard. In all, 173 patients were correctly diagnosed as having acute appendicitis by DMS out of 200 cases, with a final histopathologic result. Similarly, DMS revealed 13 normal appendices out of 15 nonappendicitis patients. This demonstrated that DMS has a sensitivity of 86.5%, specificity of 86.6%, positive predictive value of 99.8%, negative predictive value of 32.5%, and overall accuracy of 86.5%. These results suggest that DMS may be an accurate, sensitive, and specific tool for diagnosing acute appendicitis and reducing unnecessary appendectomies. DMS should be considered as a credible imaging modality for diagnosing acute appendicitis.
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Histopathology
Surgical emergency
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Objective: To determine the diagnostic accuracy of colour Doppler ultrasound using twinkling artefact for the diagnosis of renal and ureteric calculi keeping non enhanced CT KUB as gold standard.
Study Design: Cross sectional study.
Place and Duration of Study: Departments of Diagnostic Radiology, HIT Hospital Taxila Cantt and Akbar Niazi Teaching Hospital, Islamabad, from Jan to Jun 2020.
Methodology: The sample size of 320 patients was calculated using WHO Calculator. Non probability consecutive sampling was used for recruitment of patients. It comprised patients between ages 12-60 years irrespective of gender presenting with acute flank pain. All patients underwent colour Doppler ultrasound and subsequently CT-KUB analysis (gold standard) to determine the diagnostic accuracy of twinkling artefact on colour Doppler imaging. Data was collected on prescribed proforma and analysed using SPSS-17. Chi-square test and ROC curve analysis were used for diagnostic accuracy measurement.
Results: Study results showed that twinkling artefact on colour Doppler had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 91.2%, 95.7%, 98.7%, 75.2% and 92.2% respectively. Likelihood ratio for positive test was 21.8.
Conclusion: Twinkling artefact on colour Doppler allows detection of renal and ureteric calculi with reasonable accuracy and can be used as an alternative tool in settings where CT scan cannot be done.
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Doppler ultrasound
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Spontaneous pneumothorax does not occur frequently in the newborn. The prevalence of spontaneous neonatal pneumothorax is twice in male as in female neonates. It should be suspected in any neonate with respiratory distress. In this article, we present a 2.6 kg term male neonate who developed respiratory distress 14 h after birth. An urgent chest X-ray anteroposterior was ordered for evaluation. Chest X-ray revealed a left-sided pneumothorax along with mediastinal and tracheal shift to the opposite side which was suggestive of tension pneumothorax. If considerable distress persists, continuous drainage of the pneumothorax should be provided by means of an intercostal drainage and an underwater seal.
Mediastinal Shift
Tension pneumothorax
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ABSTRACT Introduction; Magnetic resonance imaging (MRCP) has been used as non-invasive technique for diagnosing common bile duct stones. Rationale of this study was to gather data about MRCP in our settings to develop our local guidelines for early and non-invasive diagnosis of common bile duct stones. This will help in early initiation of definitive therapy in these patients. Objectives; To determine diagnostic accuracy of MRCP for detection of choledocholithiasis in obstructive jaundice patients taking surgical findings as gold standard. Materials and methods; It is a Cross-sectional (validation) study of six months duration. Study was performed in department of Diagnostic Radiology. MRCP of 125 patients of either gender with age between 20-60 years who had clinical and laboratory evidence of obstructive jaundice, was performed. MRI machine of 1.5Tesla was used. MRCP results were correlated with surgical findings. Sensitivity, specificity, PPV, NPV and overall accuracy was calculated. Results; 36.0% (n=45) patients were males and 64.0% (n=80) were females. 72.0 % (n=90) of patients were positive on MRCP and 74.4% (n=93) of patients were positive on surgery. Sensitivity, specificity, PPV, NPV and accuracy were found to be 94.6%, 93.8%, 97.8%, 85.7% and 94.4% respectively. Conclusions : MRCP allows non-invasive detection of common bile duct stones with excellent accuracy. KEY WORDS: Choledocholithiasis, obstructive jaundice, MRCP.
Magnetic resonance cholangiopancreatography
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Obstructive jaundice
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Objective: To determine the diagnostic accuracy of USG and CT compared with MRCP in the patients with obstructive jaundice considering ERCP as the gold standard Methodology: This cross-sectional study at Mayo Hospital, Lahore, spanned 6 months and included 71 cases meeting predefined criteria. A senior radiologist prepared all reports. The study used preliminary ultrasound, CECT abdomen, and MRCP for patients with cholestatic jaundice, comparing results with ERCP. MRCP showed higher diagnostic accuracy. Results: MRCP proved to be the most accurate in diagnostic accuracy. Its sensitivity and specificity for benign conditions were 94.87% and 93.75% while for CT it was 87.18% and 81.25% and for USG it was 84.62% and 90.63% respectively. For malignant conditions sensitivity and specificity for MRCP was 93.75% and 97.44% for CT it was 87.5% and 92.31% and for USG it was 81.25% and 89.74% respectively. Conclusion: The results of this study demonstrate that MRCP is a superior modality, exhibiting higher sensitivity, specificity, and diagnostic accuracy for evaluating both malignant and benign conditions in patients with obstructive jaundice compared to USG and contrast-enhanced CT. MRCP's specificity for various etiologies matches that of ERCP, which is considered the gold standard. While MRCP's cost and availability may be a concern, its non-invasiveness, contrast-free nature, and high diagnostic accuracy make it an ideal choice for evaluating patients with obstructive jaundice.
Gold standard (test)
Obstructive jaundice
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