Point-of-care ultrasound Usage and accuracy within a Canadian urology division.

INTRODUCTION: This research evaluates the utility and precision of point-of-care ultrasound (POCUS) in urology, inspired by recent affirmations of its feasibility and value.1,2 Our study provides valuable insights for urologists about POCUS's practical usage. METHODS: A prospective study assessed POCUS usage and accuracy in the University of Alberta's Division of Urology using data from April 4, 2022, to April 4, 2023. Data include POCUS indications, findings, and correlation with the final diagnosis/gold standard. Additionally, a qualitative survey was conducted among urologists and residents about POCUS's pros, cons, and barriers to integration. RESULTS: Thirty-three patients underwent POCUS examinations, mainly for suspected hydronephrosis (27%, n=9). Other indications included urinary retention, testicular mass, torsion, cryptorchidism, renal mass, extended focused assessment with sonography in trauma (eFAST ) exams, nephrostomy tube placement confirmation, and scrotal hematomas. POCUS findings matched the final diagnosis in most cases, showing 86% sensitivity, with an average exam time of 1-5 minutes. POCUS showed potential for suprapubic tube insertions. Residents (60%, n=20) were the most frequent users, followed by staff (33%, n=10), and students (6%, n=2). The surveyed urologists and residents expressed comfort with POCUS but cited time, cost, and practicality as barriers. CONCLUSIONS: POCUS proves accurate and beneficial in urology, particularly for hydronephrosis. Most findings align with the gold standard, and the average exam time is brief. Barriers include time and cost. Further research is necessary to evaluate cost-effectiveness and POCUS's impact on patient outcomes in routine urologic practice.

Maternal Distress During Pregnancy and Recurrence in Early Childhood Predicts Atopic Dermatitis and Asthma in Childhood.

BACKGROUND: Early-life stress is becoming an important determinant of immune system programming. Maternal prenatal distress is found to be associated with atopic disease in offspring but the separate effects of postnatal distress are not well-studied. RESEARCH QUESTION: Does the likelihood of asthma and atopic dermatitis in children increase when they are exposed to maternal distress pre- and postnatally in a sex-specific manner? STUDY DESIGN AND METHODS: Using data from a provincial newborn screen and health-care database for 12,587 children born in 2004, maternal distress (depression or anxiety) was defined as prenatal, self-limiting, recurrent, or late-onset postpartum. Atopic dermatitis (AD) and asthma at ages 5 years and 7 years of age were diagnosed by using hospitalization, physician visit, or prescription records. Associations between maternal distress and childhood asthma and AD were determined by using multiple logistic regression. RESULTS: After adjusting for risk factors, a significant association between maternal prenatal (OR, 1.27; 95% CI, 1.11-1.46), recurrent postpartum (OR, 1.28; 95% CI, 1.11-1.48), and late-onset postpartum (OR, 1.19, 95% CI, 1.06-1.34) distress was found with AD at age 5 years. Asthma at age 7 years was also associated with maternal prenatal distress (OR, 1.57; 95% CI, 1.29-1.91) and late-onset postnatal distress (OR, 1.22; 95% CI, 1.01-1.46). Self-limiting postnatal distress was not found to be a risk factor for either atopic condition. Associations with AD or asthma were of a similar magnitude in boys and girls; the exception was recurrent postnatal distress, which increased risk for asthma in boys only. INTERPRETATION: This population-based study provides evidence for sex-specific associations between maternal prenatal and postnatal distress, as well as the development of AD and asthma. The findings support recommendations for greater psychosocial support of mothers during pregnancy and early childhood to prevent childhood atopic disease.

The Kynurenine Pathway As a Novel Link between Allergy and the Gut Microbiome.

In the past few decades, the indoleamine 2,3 dioxygenase (IDO) subset of the kynurenine (KYN) pathway of tryptophan (TRP) metabolism has been the subject of much research in the area of immune tolerance. In this review, we aim to incorporate new findings on this pathway in relation to allergy and the gut microbiome, while providing a comprehensive overview of the pathway itself. Stimulated by interferon gamma, IDO acts as a tolerogenic, immunosuppressive enzyme to attenuate allergic responses by the induction of the KYN-IDO pathway, resultant depletion of TRP, and elevation in KYN metabolites. Acting through the aryl hydrocarbon receptor, KYN metabolites cause T-cell anergy and apoptosis, proliferation of Treg and Th17 cells, and deviation of the Th1/Th2 response, although the outcome is highly dependent on the microenvironment. Moreover, new evidence from germ-free mice and human infants shows that gut microbiota and breast milk are key in determining the functioning of the KYN-IDO pathway. As such, we recommend further research on how this pathway may be a critical link between the microbiome and development of allergy.