Conference Material > Poster
Niykayo LF, Mahajan R, Sagrado MJ, Ajack YBP, Chol BT, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/CO9XKuY
Journal Article > ResearchFull Text
Diagnostics (Basel). 2021 February 22; Volume 11 (Issue 2); DOI:10.3390/diagnostics11020373
Mateos Gonzalez M, de Casasola Sanchez G, Munoz FJ, Proud K, Lourdo D, et al.
Diagnostics (Basel). 2021 February 22; Volume 11 (Issue 2); DOI:10.3390/diagnostics11020373
Point-of-care lung ultrasound (LUS) is an attractive alternative to chest X-ray (CXR), but its diagnostic accuracy compared to CXR has not been well studied in coronavirus disease 2019 (COVID-19) patients. We conducted a prospective observational study to assess the correlation between LUS and CXR findings in COVID-19 patients. Ninety-six patients with a clinical diagnosis of COVID-19 underwent an LUS exam and CXR upon presentation. Physicians blinded to the CXR findings performed all LUS exams. Detection of pulmonary infiltrates by CXR versus LUS was compared between patients categorized as suspected or confirmed COVID-19 based on reverse transcriptase-polymerase chain reaction. Sensitivities and correlation by Kappa statistic were calculated between LUS and CXR. LUS detected pulmonary infiltrates more often than CXR in both suspected and confirmed COVID-19 subjects. The most common LUS abnormalities were discrete B-lines, confluent B-lines, and small subpleural consolidations. Most important, LUS detected unilateral or bilateral pulmonary infiltrates in 55% of subjects with a normal CXR. Substantial agreement was demonstrated between LUS and CXR for normal, unilateral or bilateral findings (Κ = 0.48 (95% CI 0.34 to 0.63)). In patients with suspected or confirmed COVID-19, LUS detected pulmonary infiltrates more often than CXR, including more than half of the patients with a normal CXR.
Journal Article > ResearchAbstract
Cardiol Young. 2021 March 8; DOI:10.1017/S1047951121000834
Muhame RM, Dragulescu A, Nadimpalli A, Martinez D, Bottineau MC, et al.
Cardiol Young. 2021 March 8; DOI:10.1017/S1047951121000834
Background: In resource limited settings, children with cardiac disease present late, have poor outcomes and access to paediatric cardiology programmes is limited. Cardiac point of care ultrasound was introduced at several Médecins Sans Frontières sites to facilitate cardiopulmonary assessment. We describe the spectrum of disease, case management and outcomes of cases reviewed over the Telemedicine platform.
Methods: Previously ultrasound naïve, remotely placed clinical teams received ultrasound training on focussed image acquisition. The Médecins Sans Frontières Telemedicine platform was utilised for remote case and imaging review to diagnose congenital and acquired heart disease and guide management supported by a remotely situated paediatric cardiologist.
Results: Two-hundred thirty-three cases were reviewed between 2016 and 2018. Of 191 who underwent focussed cardiac ultrasound, diagnoses included atrial and ventricular septal defects 11%, atrioventricular septal defects 7%, Tetralogy of Fallot 9%, cardiomyopathy/myocarditis 8%, rheumatic heart disease 8%, isolated pericardiac effusion 6%, complex congenital heart disease 4% and multiple other diagnoses in 15%. In 17%, there was no identifiable abnormality while 15% had inadequate imaging to make a diagnosis. Cardiologist involvement led to management changes in 75% of cases with a diagnosis. Mortality in the entire group was disproportionately higher among neonates (38%, 11/29) and infants (20%, 16/81). There was good agreement on independent review of selected cases between two independent paediatric cardiologists.
Conclusion: Cardiac point of care ultrasound performed by remote clinical teams facilitated diagnosis and influenced management in cases reviewed over a Telemedicine platform. This is a feasible method to support clinical care in resource limited settings.
Methods: Previously ultrasound naïve, remotely placed clinical teams received ultrasound training on focussed image acquisition. The Médecins Sans Frontières Telemedicine platform was utilised for remote case and imaging review to diagnose congenital and acquired heart disease and guide management supported by a remotely situated paediatric cardiologist.
Results: Two-hundred thirty-three cases were reviewed between 2016 and 2018. Of 191 who underwent focussed cardiac ultrasound, diagnoses included atrial and ventricular septal defects 11%, atrioventricular septal defects 7%, Tetralogy of Fallot 9%, cardiomyopathy/myocarditis 8%, rheumatic heart disease 8%, isolated pericardiac effusion 6%, complex congenital heart disease 4% and multiple other diagnoses in 15%. In 17%, there was no identifiable abnormality while 15% had inadequate imaging to make a diagnosis. Cardiologist involvement led to management changes in 75% of cases with a diagnosis. Mortality in the entire group was disproportionately higher among neonates (38%, 11/29) and infants (20%, 16/81). There was good agreement on independent review of selected cases between two independent paediatric cardiologists.
Conclusion: Cardiac point of care ultrasound performed by remote clinical teams facilitated diagnosis and influenced management in cases reviewed over a Telemedicine platform. This is a feasible method to support clinical care in resource limited settings.
Conference Material > Video
Moreto-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, et al.
MSF Scientific Days International 2022. 2022 June 7; DOI:10.57740/50a1-ba02
Journal Article > ResearchFull Text
J Clin Med. 2024 June 2; Volume 13 (Issue 11); 3282.; DOI:10.3390/jcm13113282
Lightowler MS, Sander JV, García de Casasola Sánchez G, Mateos González M, Güerri-Fernández R, et al.
J Clin Med. 2024 June 2; Volume 13 (Issue 11); 3282.; DOI:10.3390/jcm13113282
BACKGROUND
During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes.
METHODS
We conducted a single-centre prospective study (August 2020–April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64–0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38–20.4), ICU admission (OR 3.50; 95%CI: 1.37–8.94) and need for IMV (OR 3.31; 95%CI: 1.19–9.13).
CONCLUSIONS
Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.
During the COVID-19 pandemic and the burden on hospital resources, the rapid categorization of high-risk COVID-19 patients became essential, and lung ultrasound (LUS) emerged as an alternative to chest computed tomography, offering speed, non-ionizing, repeatable, and bedside assessments. Various LUS score systems have been used, yet there is no consensus on an optimal severity cut-off. We assessed the performance of a 12-zone LUS score to identify adult COVID-19 patients with severe lung involvement using oxygen saturation (SpO2)/fractional inspired oxygen (FiO2) ratio as a reference standard to define the best cut-off for predicting adverse outcomes.
METHODS
We conducted a single-centre prospective study (August 2020–April 2021) at Hospital del Mar, Barcelona, Spain. Upon admission to the general ward or intensive care unit (ICU), clinicians performed LUS in adult patients with confirmed COVID-19 pneumonia. Severe lung involvement was defined as a SpO2/FiO2 ratio <315. The LUS score ranged from 0 to 36 based on the aeration patterns. Results: 248 patients were included. The admission LUS score showed moderate performance in identifying a SpO2/FiO2 ratio <315 (area under the ROC curve: 0.71; 95%CI 0.64–0.77). After adjustment for COVID-19 risk factors, an admission LUS score ≥17 was associated with an increased risk of in-hospital death (OR 5.31; 95%CI: 1.38–20.4), ICU admission (OR 3.50; 95%CI: 1.37–8.94) and need for IMV (OR 3.31; 95%CI: 1.19–9.13).
CONCLUSIONS
Although the admission LUS score had limited performance in identifying severe lung involvement, a cut-off ≥17 score was associated with an increased risk of adverse outcomes. and could play a role in the rapid categorization of COVID-19 pneumonia patients, anticipating the need for advanced care.
Journal Article > Case Report/SeriesFull Text
Oxf Med Case Reports. 2024 January 27; Volume 2024 (Issue 1); omad147.; DOI:10.1093/omcr/omad147
Phillipo D, Lucas S, Kalunga MP, Inyasi E, Lebba JP, et al.
Oxf Med Case Reports. 2024 January 27; Volume 2024 (Issue 1); omad147.; DOI:10.1093/omcr/omad147
False-negative qualitative Human Chorionic Gonadotropin (hCG) result is a phenomenon in which large amounts of β-hCG are produced by molar pregnancy, oversaturating the test’s assay system and leading to false-negative results known as the ‘prozone phenomenon’ or the ‘hook effect’. This can lead to misdiagnosis and delay in management despite high suspicious clinical and ultrasound findings. We report a case of an 18-year-old female who presented to our health facility with amenorrhea of 16 weeks, lower abdominal pain, soft and large fundal height for gestational age, and cramping with slight per-vaginal bleeding, and a negative urinary pregnancy test (UPT). Based on clinical presentation, ultrasound findings and a positive UPT after urine dilution, molar pregnancy was diagnosed. Aspiration was performed under ultrasound guidance, and follow-up was done as per MSF guidelines. HCPs need to be familiar with some rare cases for which the possibility of finding false-negative UPT is likely.
Conference Material > Poster
Phillip E, Adede J, Onduto S, Ochola C, Simba R, et al.
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/w8leOu
Conference Material > Slide Presentation
Moreto-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, et al.
MSF Scientific Days International 2022. 2022 May 11; DOI:10.57740/mpdr-x060
Conference Material > Poster
Branthwaite C, Alasri H, Naif M, Schwanfelder C
MSF Paediatric Days 2024. 2024 May 3; DOI:10.57740/mhQfPz4Ph
Conference Material > Abstract
Moreto-Planas L, Sagrado MJ, Mahajan R, Gallo J, Biague E, et al.
MSF Scientific Days International 2022. 2022 May 11; DOI:10.57740/b8m1-p572
INTRODUCTION
Tuberculosis (TB) is an important cause of morbidity and mortality in children and over 50% of childhood TB remains undiagnosed every year. As microbiological confirmation is low (<30%), the majority of cases in low and middle-income countries are diagnosed on clinical grounds. Point-of-care ultrasound (POCUS) is a non-invasive bedside tool, and TB-focused POCUS has been validated for diagnosis of TB in adults with HIV. We aimed to describe the performance and findings of TB-focused POCUS for children with presumptive TB at a tertiary care hospital in Guinea- Bissau, a setting with a high burden of HIV, malnutrition and TB.
METHODS
This observational study took place at Simão Mendes hospital in Bissau, from July 2019 to April 2020. Patients aged between 6 months and 15 years with presumptive TB underwent clinical and laboratory assessment, with at least one sample analysed with GeneXpert Ultra, and unblinded clinician-performed POCUS evaluation. POCUS was used to assess for subpleural nodules (SUN’s), lung consolidation, pleural effusion, pericardial effusion, ascites, liver and splenic focal lesions, and abdominal lymph nodes. Presence of any of these signs prompted a POCUS- positive result. Images and clips were evaluated by an expert reviewer and, if discordant, by a second expert reviewer.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the Guinea-Bissau Ministry of Health ERB.
RESULTS
A total of 139 children were enrolled, with 62 (45%) female and 55 (40%) aged under 5 years. HIV infection and severe acute malnutrition (SAM) were found in 59 (42%) and 83 (60%) of patients, respectively. Confirmation of TB was achieved in 27 (19%); 62 (45%) had unconfirmed TB, and 50 (36%) had unlikely TB. Children with TB were more likely to have a POCUS positive result (83/89; 93%) as compared to children with unlikely TB (17/50; 34%). The most common POCUS signs in TB patients were: lung consolidation (51; 57%), SUN’s (49; 55%), pleural effusion (27; 30%), and focal splenic lesions (25; 28%). In children with confirmed TB (n=27), POCUS sensitivity was 85.2% (95% confidence interval (CI) 67.5-94.1). In those with unlikely TB (n=50), specificity was 66% (95%CI 2.2-77.6). Unlike HIV infection, SAM was associated with higher risk of positive POCUS. Cohen’s kappa coefficient for concordance between field and expert reviewers ranged from 0.6 to 0.9 depending on the POCUS sign, while overall POCUS concordance was 0.8.
CONCLUSION
We found high prevalence of any POCUS sign in children with TB, as compared to children with unlikely TB. POCUS positivity was independent of HIV status, but not of nutritional status. POCUS concordance between field and expert reviewers was moderate to high. TB-focused POCUS could potentially play a supportive role in the diagnosis of TB in children.
CONFLICTS OF INTEREST
None declared.
Tuberculosis (TB) is an important cause of morbidity and mortality in children and over 50% of childhood TB remains undiagnosed every year. As microbiological confirmation is low (<30%), the majority of cases in low and middle-income countries are diagnosed on clinical grounds. Point-of-care ultrasound (POCUS) is a non-invasive bedside tool, and TB-focused POCUS has been validated for diagnosis of TB in adults with HIV. We aimed to describe the performance and findings of TB-focused POCUS for children with presumptive TB at a tertiary care hospital in Guinea- Bissau, a setting with a high burden of HIV, malnutrition and TB.
METHODS
This observational study took place at Simão Mendes hospital in Bissau, from July 2019 to April 2020. Patients aged between 6 months and 15 years with presumptive TB underwent clinical and laboratory assessment, with at least one sample analysed with GeneXpert Ultra, and unblinded clinician-performed POCUS evaluation. POCUS was used to assess for subpleural nodules (SUN’s), lung consolidation, pleural effusion, pericardial effusion, ascites, liver and splenic focal lesions, and abdominal lymph nodes. Presence of any of these signs prompted a POCUS- positive result. Images and clips were evaluated by an expert reviewer and, if discordant, by a second expert reviewer.
ETHICS
This study was approved by the MSF Ethics Review Board (ERB) and by the Guinea-Bissau Ministry of Health ERB.
RESULTS
A total of 139 children were enrolled, with 62 (45%) female and 55 (40%) aged under 5 years. HIV infection and severe acute malnutrition (SAM) were found in 59 (42%) and 83 (60%) of patients, respectively. Confirmation of TB was achieved in 27 (19%); 62 (45%) had unconfirmed TB, and 50 (36%) had unlikely TB. Children with TB were more likely to have a POCUS positive result (83/89; 93%) as compared to children with unlikely TB (17/50; 34%). The most common POCUS signs in TB patients were: lung consolidation (51; 57%), SUN’s (49; 55%), pleural effusion (27; 30%), and focal splenic lesions (25; 28%). In children with confirmed TB (n=27), POCUS sensitivity was 85.2% (95% confidence interval (CI) 67.5-94.1). In those with unlikely TB (n=50), specificity was 66% (95%CI 2.2-77.6). Unlike HIV infection, SAM was associated with higher risk of positive POCUS. Cohen’s kappa coefficient for concordance between field and expert reviewers ranged from 0.6 to 0.9 depending on the POCUS sign, while overall POCUS concordance was 0.8.
CONCLUSION
We found high prevalence of any POCUS sign in children with TB, as compared to children with unlikely TB. POCUS positivity was independent of HIV status, but not of nutritional status. POCUS concordance between field and expert reviewers was moderate to high. TB-focused POCUS could potentially play a supportive role in the diagnosis of TB in children.
CONFLICTS OF INTEREST
None declared.