Malaria Diagnosis by U.S. Providers on Short-term Medical Mission Trips to Uganda.

Malaria is one of the top 10 leading causes of death in Uganda. Short-term medical missions (STMMs) to address unmet medical needs in lower-resource settings are increasingly common. Th is study evaluates correlations between patient and clinician variables and accurate malaria diagnosis by providers on STMMs to Uganda. We surveyed 18 U.S. providers and performed a retrospective chart review of 246 patients seen by those providers on STMMs in Uganda between 2016 to 2017. All providers recorded their clinical level of suspicion for patients who met inclusion criteria, following which a rapid diagnostic test (RDT) was performed. Fift y-four percent of the patients tested positive for malaria. Level of provider accuracy ranged widely from 30.0% to 95.5% correct. Our fi ndings reaffirm that signs and symptoms of malaria are too nonspecifi c to be used alone without diagnostic testing by STMM providers. Pre-departure STMM training on malaria diagnosis is a necessity.

Point-of-Care Ultrasound as Part of a Short-Term Medical Mission to Rural Nicaragua.

OBJECTIVES: The lack of access to diagnostic imaging in resource-limited settings (RLSs) poses a worldwide problem. Advances in ultrasound (US) imaging technology bridge this gap, particularly when examinations are performed by physicians and integrated into the patient encounter, termed point-of-care ultrasound (POCUS). Because the number of physicians participating in short-term medical missions (STMMs) is increasing, the authors sought to characterize how the use of POCUS would affect care delivered as part of a 1-week outreach trip in rural Nicaragua. METHODS: In February 2017, as part of an ongoing collaboration among the University of South Carolina, the Medical University of South Carolina, and OneWorld Health, the authors conducted an observational prospective study of all of the patients who received a POCUS examination as part of standard clinical practice during an STMM to Sébaco, Nicaragua. The goal was to determine how often POCUS changed medical management. In addition, the number and types of scans performed were recorded to assess the most common reasons for POCUS use. RESULTS: More than 1100 patients were seen, and a total of 79 POCUS examinations were performed on 59 patients by 2 physicians with extensive POCUS training. Eighty percent of the patients were women, with an average age of 40.5 years (range 1.6-87 years). The use of US changed management for 35.6% of total patients examined (N = 21), divided among changes in diagnosis, pharmacotherapy, new referral, or referral not needed. The average time to perform a POCUS examination was 6.0 minutes. A wide range of POCUS examinations were performed, with lung, gallbladder, obstetric/gynecologic, and cardiac examinations performed most often. CONCLUSIONS: Incorporating POCUS by trained physicians in an RLS as part of an STMM was successful and often changed management. As interest in nonemergency and noncritical care POCUS increases and proliferation of low-cost, accurate, handheld US devices continues, it is probable that more physicians traveling to RLSs will use POCUS as part of STMMs, positively affecting patient care.

Idiopathic Spinal Epidural Lipomatosis Causing Cauda Equina Syndrome.

Spinal epidural lipomatosis (SEL) is a rare condition defined by the hypertrophy of adipose tissue in the spinal epidural space, often resulting in compression of nerves in the region affected.1 This case describes a 64-year-old man who presented with cauda equina syndrome. Magnetic resonance imaging of the spine revealed extensive SEL of the lumbar spine. He underwent decompression and fusion with subsequent improvement of symptoms. This is one of the few cases reported of lumbar SEL in a non-obese patient in absence of long-term corticosteroid usage. We review possible etiologies.