Leveraging existing mid-end ultrasound machine for point-of-care intestinal ultrasound in low-resource settings: Prospective, real-world impact on clinical decision-making.

BACKGROUND: Point-of-care ultrasound (POCUS) has transformed inflammatory bowel disease (IBD) management, but the cost to purchase high-end equipment can be prohibitive. AIM: To assess prospectively the feasibility of POCUS using pre-existing mid-end ultrasound equipment without incurring additional cost. METHODS: Consecutive IBD patients underwent POCUS with or without faecal calprotectin (FCP) using a mid-end ultrasound machine. If POCUS with or without FCP could not guide management, we performed additional ileocolonoscopy or cross-sectional imaging. We evaluated the impact of POCUS on IBD management and its correlation with ileocolonoscopy or cross-sectional imaging. We analysed pregnant, paediatric and post-operative patients separately. RESULTS: Among 508 patients with IBD, we analysed 419 (60.4% Crohn's disease [CD]; 61.3% male, age [years]: 36 [18-78]) undergoing 556 POCUS sessions. POCUS with or without FCP independently influenced clinical management in 42.8% of patients with CD and 49.7% with ulcerative colitis (UC). POCUS helped avoid colonoscopy in 51.4% of patients with CD and 51.8% with UC, and cross-sectional imaging in 38.1% of suspected active small bowel CD. In patients with additional diagnostics, POCUS-based decisions remained unchanged in 81.2% with CD and 85% with UC. Sensitivity and specificity of POCUS compared to ileocolonoscopy were 80% and 94.4% for CD and 80.8% and 92.8% for UC, respectively. Sensitivity and specificity compared to cross-sectional imaging were 87.2% and 87.5%, respectively. CONCLUSION: POCUS using existing mid-end ultrasound equipment in low-resource settings influenced IBD clinical decision-making with excellent accuracy, often avoiding colonoscopy and cross-sectional imaging.

A prospective observational study to correlate lung ultrasound with clinical severity and prognosis score in patients with primary pulmonary pathology on invasive ventilatory support.

Background: Lung ultrasound (LUS) is a known imaging modality employed for monitoring patients in an intensive care unit. This study evaluates, LUS in assessing disease severity and prognosis, by correlating its score with the three commonly used clinical severity scoring systems (CSSS), namely, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE) II score, and simplified acute physiology score (SAPS) II. Methods: This single-center prospective observational study included 54 adult patients of primary lung disease-induced acute respiratory distress syndrome (ARDS), on invasive ventilation. The primary objective was to correlate LUS score with SOFA score. Secondary objectives were to correlate LUS score with APACHE II and SAPS II scores. LUS score was also correlated with the estimated mortality derived from the above-mentioned scores. A subgroup analysis on COVID-19-positive cases was also carried out. All scores were calculated on the initiation of mechanical ventilation, daily for 7 days or mortality, whichever was earlier. Results: A significant positive correlation (P < 0.001) was found between LUS and all three severity scores, as well as their corresponding estimated mortality percentages, for all days of the study period, in both non-COVID-19 ARDS patients and in COVID-19 patients. The merit of all four scores in differentiating between the survivor and mortality group for the duration of study also showed significant (P < 0.05) to very significant (P < 0.001) results. Conclusion: Point-of-care LUS in conjunction with CSSS is a reliable tool for assessing the severity and progression of primary lung disease.

Evaluation of ultrasound based acoustic radiation force impulse (ARFI) and eSie touch sonoelastography for diagnosis of inflammatory pancreatic diseases.

CONTEXT: Pathology changes the consistency of the tissues. OBJECTIVE: To prospectively assess the accuracy of per-abdominal US elastography in the form of acoustic radiation force impulse--virtual touch tissue quantification (ARFI-VTQ) and eSie touch elasticity imaging in characterizing and differentiating inflammatory pancreatic diseases. PATIENTS: One-hundred and 66 patients from among the patients that visited the Asian Institute of Gastroenterology, Hyderabad, India, during the period April 2009 to December 2010, for master health check-up, blood donation and those with pancreatic pathology. SETTING: Based on the clinical symptomatic criteria and diagnostic imaging findings, the patients were divided into normal, chronic and acute, or acute resolving, pancreatitis group. MAIN OUTCOME MEASURES: The ultrasound based ARFI-VTQ and eSie touch elasticity imaging techniques were applied. DESIGN: Prospective single-center study. RESULTS: The mean ARFI-VTQ values were 1.28 m/s, 1.25 m/s and 3.28 m/s for the normal, chronic and acute pancreas, respectively. The eSie touch gray scale and color elastograms were light gray and purple-greenish, respectively for both normal and chronic pancreas, while for acute pancreas the elastograms were dark black on the gray scale and orange to red on color scale. CONCLUSION: Both the ARFI-VTQ and eSie touch elasticity imaging techniques may be successfully adopted in order to diagnose acute pancreatitis, to assess extent of inflammation (whether focal or diffuse), to assess peripancreatic edema, to identify presence of necrotic areas and early pseudocyst formation, to early diagnose acute recurrent attacks and to monitor patient's response to treatment.