The Accuracy of Point-of-Care Ultrasound in Detecting Small Bowel Obstruction in Emergency Department

Radiological imaging plays an essential role in the evaluation of a patient with suspected small bowel obstruction (SBO). In a few studies, point-of-care ultrasound (POCUS) has been utilized as a primary imaging modality in patients with suspected SBO. POCUS has been shown to be an accurate tool in the diagnosis of SBO with multiple research studies noting a consistent high sensitivity with a range of 94–100% and specificity of 81–100%. Specific sonographic findings that increase the likelihood of SBO include dilatation of small bowel loops \u3e 25 mm, altered intestinal peristalsis, increased thickness of the bowel wall, and intraperitoneal fluid accumulation. Studies also reported that emergency physicians could apply this technique with limited and short-term ultrasound training. In this article, we aim to review the sensitivity and specificity of ultrasound examinations performed by emergency physicians in patients with suspected SBO

Neuronal and epithelial cell rescue resolves chronic systemic inflammation in the lipid storage disorder Niemann-Pick C

Chronic systemic inflammation is thought to be a major contributor to metabolic and neurodegenerative diseases. Since inflammatory components are shared among different disorders, targeting inflammation is an attractive option for mitigating disease. To test the significance of inflammation in the lipid storage disorder (LSD) Niemann-Pick C (NPC), we deleted the macrophage inflammatory gene Mip1a/Ccl3 from NPC diseased mice. Deletion of Ccl3 had been reported to delay neuronal loss in Sandhoff LSD mice by inhibiting macrophage infiltration. For NPC mice, in contrast, deleting Ccl3 did not retard neurodegeneration and worsened the clinical outcome. Depletion of visceral tissue macrophages also did not alter central nervous system (CNS) pathology and instead increased liver injury, suggesting a limited macrophage infiltration response into the CNS and a beneficial role of macrophage activity in visceral tissue. Prevention of neuron loss or liver injury, even at late stages in the disease, was achieved through specific rescue of NPC disease in neurons or in liver epithelial cells, respectively. Local epithelial cell correction was also sufficient to reduce the macrophage-associated pathology in lung tissue. These results demonstrate that elevated inflammation and macrophage activity does not necessarily contribute to neurodegeneration and tissue injury, and LSD defects in immune cells may not preclude an appropriate inflammatory response. We conclude that inflammation remains secondary to neuronal and epithelial cell dysfunction and does not irreversibly contribute to the pathogenic cascade in NPC disease. Without further exploration of possible beneficial roles of inflammatory mediators, targeting inflammation may not be therapeutically effective at ameliorating disease severity

A Nationwide Epidemiological Approach to Firearm-Related Emergency Department Visits from 2005-2015

Background: The majority of gun violence research focuses on local data and examines all violent assaults broadly. We analyzed the epidemiological risk factors associated primarily with firearm-related injuries that were managed within emergency departments (ED) nationwide. Methods: This study uses the CDC’s National Hospital Ambulatory Medical Care Survey (NHAMCS) to complete a retrospective analysis of firearm injuries managed within US EDs from 2005-2015. All visits related to intentional injury were examined, and an analysis of gunshot injuries was completed, and compared to other assaults resulting in ED visits. Bivariate analyses and logistic regressions were performed to elucidate the relationship between these visits and patient demographics. Results: From 2005-2015 NHAMCS data, 318,114 patient visits were included which represented an estimated 1.25 billion ED visits. Of these, 644,711 were the result of a gunshot wound. In total, gunshot victims demonstrated increased odds (OR 3.4 95% CI 2.4-4.9, p\u3c0.001) of identifying as Black. These Black gunshot victims were overwhelmingly male (90.2% vs 75.7%) and had a younger average age (26.8 vs 32.8) than their White counterparts. Black patients aged 15 to 25 represented 26.7% of all US ED visits within their age-range, but represented 66.1% (95% CI 49.3-79.7, p\u3c0.001) of gunshot victims and 33.7% (95% CI 29.4-38.2, p\u3c0.001) of all assault victims. In this same age group, Black youth represented a disproportionately smaller proportion of ED visits for self-inflicted injury (15.9%, 95% CI 12.9-19.5). Young Black gunshot victims showed increased odds of being intubated in the ED (OR 20.1, 95% CI 8.0-54.0, p\u3c0.001), dying within or en-route to the ED (OR 13.7, 95% CI 3.5-53.6 P\u3c0.001), having an assault-related injury (OR 57.2, 95% CI 24.4-134.7), or receiving any imaging services (OR 6.4 95% CI 2.6-15.7 p\u3c0.001). Conclusion: Black male youth between the ages 15 and 25 are particularly at risk for sustaining gun violence related injuries. This same subset of patients is more likely to utilize an increased number of resources within EDs for management of injuries

Point-of-care Transperineal Ultrasound to Diagnose Abscess in the Emergency Department.

Perineal and rectal pain are common presentations in the emergency department (ED). In the majority of cases, clinical examination is sufficient to detect local anorectal pathologies. However, perianal and rectal abscesses and fistulas are often the primary concerns prompting diagnostic imaging in the ED. Currently, computed tomography is the preferred imaging modality. Recently, transperineal ultrasound has emerged as an optimal imaging modality for the diagnosis of perineal and perianal abscesses. We present a case in which point-of-care ultrasound accurately detected an intersphincteric abscess, and review the appropriate ultrasound technique to evaluate patients with suspected perianal and rectal abscesses