US Protocol Research Articles

The straight head of rectus femoris: An underdiagnosed cause of chronic pain post hip replacement

Groin pain following hip arthroplasty has a spectrum of aetiologies. Although mild post-operative pain at six months to a year is common, other causative factors should be considered where pain is severe or persistent. The rectus femoris (RF) muscle is the most common of the quadriceps tendons to be injured or strained. Pathologies are known to occur in athletic adults and children and include tendinopathy, tear, and avulsion, but the RF is rarely attributed to hip pain post-arthroplasty. However, tendinopathy may occur as a result of altered biomechanics and muscle loading. We performed a retrospective analysis of 100 patients, at our tertiary orthopedic hospital, who presented with chronic pain post hip arthroplasty. We identified three patients with RF straight (direct) head tendinopathy and one patient with RF straight (direct) head calcific tendinopathy. Established causes of chronic post-operative pain include septic/aseptic loosening, pseudotumor, iliopsoas bursitis/impingement, and bursitis. In this report, we describe the scanning technique, sonographic appearances, and our institutional experience of post-arthroplasty pathologies of the RF straight (direct) head which is an underreported cause of chronic pain following hip replacement. We also recommend including the RF straight (direct) head in routine US protocols of the post-operative hip.

Could internal jugular vein ultrasound be useful in the assessment of patients with heart failure? A systematic review

Many recent studies have validated the internal jugular vein ultrasound (IJV-US) ultrasound for estimating volemic status in critical patients. If research confirms its accuracy in detecting intravascular volume, congestion, and prognosis, this method could help manage heart failure (HF) because it is simple, fast, and applicable in several settings. This review examines the IJV-US’s reliability, diagnostic accuracy, and ability to predict poor outcomes for HF, as well as its correlation with surrogate congestion tests like natriuretic peptides and elevated central venous pressure (CVP). Our systematic review followed the PRISMA statement for systematic reviews and meta-analyses. Eleven studies examined the reliability and validity of IJV-US measures in predicting congestion, volume status, and prognosis in adult spontaneously breathing HF patients. We searched PubMed, Cochrane Library, and EMBASE. IJV-US measurements using Valsalva and sniffing seem more accurate for predicting congestion, volume status, high CVP, and poor prognosis. The IJV ratio in chronic HF and out-hospital patients and the absence of IJV area [cross-sectional area (CSA)] changes in acute HF (AHF) and in-hospital patients are the most validated measurements. No evidence suggests the method is reliable between and within raters. AHF patients’ IJV ratio and CSA absence appear to correlate with CVP and atrial natriuretic peptides. In conclusion, the IJV-US may be useful for managing HF patients, but more research is needed to confirm its reliability and prognostic accuracy. Develop a standard US protocol lastly.

Evaluation of parameters used in echocardiography and ultrasound protocol for the diagnosis of shock etiology in emergency setting

BackgroundEarly recognition and appropriate treatment has shown to decrease morbidity and mortality in patients with undifferentiated shock. There are many ultrasound protocols in shock; each protocol combines core ultrasound elements such as IVC and cardiac assessment which includes detection of cardiac tamponade, left ventricular function and right ventricular strain.Valvular assessment is absent in majority of ultasound protocols, while lung ultrasound is included in some of them.ObjectiveIn this study we investigated which parameters used in Echo – US protocol help differentiate shock types.MethodsThis cross sectional study was conducted on 150 patients with shock (140 patients were included while, 10 patients were excluded).Sensitivity and specificity of different parameters used in the Echo-US protocol were analyzed to detect which parameters can diffentiate shock types.ResultsVelocity time integral of Aorta and IVC maximum diameter were good discriminators for distributive shock, with area under the ROC curve (AUC) = 0.8885 (95% CI 0.8144 to 0.9406) and 0.7728 (95% CI 0.6832 to 0.8473) (Z = 10.256 p < 0.0001) and (Z = 5.079 p < 0.0001) respectively. Left ventricular systolic function, presence of pneumonia, pneumothorax or valve vegetations were of great value in differentiating shock types, while CUST, FAST, TAPSE and RV diameter were not useful in differentiating shock types.ConclusionUltrasound and echocardiography are powerful tools that can be used to identify shock etiology when the clinical picture overlaps.

Ultrasound in anti-CCP+ at-risk individuals without clinical synovitis: development of a novel 6-joint protocol for feasible risk prediction.

To investigate, in anti-CCP antibody-positive individuals with musculoskeletal symptoms but no clinical synovitis (CCP+ at-risk), the additional value of US for the prediction of inflammatory arthritis. Furthermore, to define a concise US protocol for feasible risk prediction. Demographic and clinical data were collected in 417 CCP+ at-risk (Leeds CCP cohort) with a baseline US scan assessing synovitis and bone erosions in 36 joints, and a follow-up duration ≥24 months. Multivariable binary regression models for inflammatory arthritis development at 24 months evaluated routine clinical variables associated with inflammatory arthritis alone ('clinical' model) and combined with a 36-joint US scanning protocol ('clinical-US extended' model). A 'clinical-US short' model was also developed. At 24 months, 92/417 (22.1%) CCP+ at-risk developed inflammatory arthritis (median time 7 months, interquartile range 3-12). The 'clinical-US extended' model performed better than the 'clinical' model [area under the curve (AUC) 0.788 vs AUC 0.731, respectively, P < 0.001] with an odds ratio for inflammatory arthritis development of 3.18 (95% CI 1.80-5.63) for US synovitis and 2.54 (95% CI 1.21-5.37) for bone erosions. The 'clinical-US short' model, which retained the wrists, knees and MTP5 joints, performed better (AUC 0.782) than the 'clinical' model (P < 0.001) and similarly (difference in Akaike information criteria <2) to the 'clinical-US extended' model. US provides valuable information for predicting progression to inflammatory arthritis in CCP+ individuals both alone and in addition to clinical variables. US synovitis was associated with a 3-fold increase risk of inflammatory arthritis development. A concise US protocol of six joints provides clinically feasible risk prediction in CCP+ at-risk.

The utility of point-of-care ultrasound protocol to confirm central venous catheter placement in the preterm infant.

Central vascular access is frequently required for preterm infants. Confirmation of positioning of central line is typically on chest and abdominal radiographs; POCUS is a relatively novel diagnostic method. Misdiagnosis is the main concern limiting use of this modality. The aim of this study is to validate our standard protocol accuracy in locating the central catheter position by correlating catheter position as determined by POCUS with radiographs. Premature babies < or equal to 30weeks gestation who had peripheral central lines or surgical lines were enrolled. Confirmation of line position by radiographs was compared to images obtained through a specific US protocol technique. The operator of US exam was blinded to the radiograph findings. All images were reviewed by two radiologists who were blinded to the radiograph findings. 35 central line placements were assessed. 22 lines were inserted in the UL, and 13 were inserted in the LL with a total of 91 ultrasound scans and radiographs. The position of the line was interpreted as normal in 79/91 scans with interpreter reliability of [Formula: see text]=0.778 (p < 0.001), sensitivity of 0.83 and specificity of 0.96, and positive predictive value of 0.77 and negative predictive value of 0.97. There was no significant difference between the ultrasound interpretation and the radiograph interpretation of UL and LL. Conclusion: The protocol of POCUS that we propose is a reliable tool for assessing the central line positions in preterm infants. What is Known: • POCUS is a reliable tool assessing the central line positions in preterm infants. What is New: • The protocol of POCUS that we propose is a reliable tool for assessing the central line positions in preterm infants.

Serological Evidence of HIV/HBV Co-infection among HIV-infected patients in Onitsha, Anambra State, Nigeria

Research suggests that HIV-infected individuals who have also been co-infected with HBV face a greater risk of HIV progression. Hepatitis B and HIV infections pose serious public health challenges in sub-Saharan Africa. This study examined the possible HBV co-infection with the socio-demographic traits of HIV-infected individuals attending the HIV clinic at a referral specialist mission hospital in Onitsha, Anambra State, Nigeria. Two hundred and twenty (220) HIV-infected individuals gave consent to participate in the study. Between March 2022 and October 2022, blood samples (about 5ml) were aseptically collected during routine investigations into sterile EDTA bottles, and plasma samples were obtained by centrifugation. These samples were tested for HBsAg using a Monolisa HBsAg ULTRA kit (Bio-Rad, USA). CD4 counts were measured using the Partec CyFlow. Plasma viral loads (PVL) were also determined using the Abbott Real-Time HIV-1 Assay US protocol. HIV/HBV co-infection was 40.9%. The results showed that most (39.7%) study participants co-infected with HBV had a CD4 cell count of 350 cells/µl. The virological assay revealed that the highest HBsAg seroprevalence was detected in the study participants whose viral loads were between 40 and 1000µl (61.9%). The majority of the study participants were female HIV patients (74.5%), while those co-infected with HBV were mainly male patients (48.2%). HIV-positive individuals aged 18-30 (53.3%) were mostly affected. None of the socio-demographic variables tested was significantly associated with HBV in HIV-infected patients in Onitsha, Anambra State, Nigeria. This study showed a high HIV/HBV co-infection in Onitsha, Anambra State, Nigeria.

One-year volume growth of abdominal aortic aneurysms measured by extended field-of-view ultrasound.

Measurement of volume has the potential to detect subtle growth not recognized in the current surveillance paradigm of abdominal aortic aneurysms (AAAs). Currently available three-dimensional ultrasound allows for estimation of AAA volume, but for most patients, the AAA extends beyond the ultrasound field-of-view and only allows visualization of a partial AAA volume. A new extended field-of-view three-dimensional ultrasound protocol (XFoV US) has been found to improve the proportion of patients with visualization of the full AAA volume. To investigate the applicability of the XFoV US protocol in estimating AAA volume growth in follow-up, 86 patients with AAAs were recruited from the surveillance program at a university hospital. All were imaged by XFoV US at baseline and at one-year follow-up. Assessment of full volume, based on visualization of the AAA neck and bifurcation at both baseline and one-year follow-up, was achieved in 67/86 (78%) of patients. One-year mean growth in maximum diameter was 2.8 mm (6%/year), in centerline length 2.9 mm (4%/year), and in volume 15.9 mL (19%/year). In 17/67 (25%) of patients, volume growth was detected in diameter-stable AAAs. Baseline XFoV US volume was associated with one-year AAA volume growth, while, conversely, maximum baseline diameter was not associated with one-year AAA diameter growth. This study concludes that the XFoV US protocol provides a safe and repeatable modality for assessing AAA volume growth, and that AAA volume is a promising predictive measure of AAA growth.

Japanese patients need slower, personalized clozapine titrations: A comment on the case described by Kikuchi et al.

Japanese patients need slower, personalized clozapine titrations: A comment on the case described by Kikuchi et al.

Ultrasound for necrotizing enterocolitis: how can we optimize imaging and what are the most critical findings?

Necrotizing enterocolitis (NEC) is a common condition in the neonatal intensive care unit that continues to present challenges in terms of diagnosis and management. Traditionally NEC has been diagnosed and managed by clinical and radiographic findings, but US has shown promise in characterizing and prognosticating NEC. In this manuscript we review the abdominal US technique for NEC, the clinical significance of individual sonographic findings of NEC, and how US can be integrated in the clinical decision process for diagnosing and managing NEC. We also discuss the potential value-added role of a limited abdominal US protocol that focuses on the sonographic findings most indicative of a poor prognosis to include pneumoperitoneum, complex free fluid and focal fluid collections.

Accuracy of echocardiography and ultrasound protocol to identify shock etiology in emergency department

BackgroundEarly diagnosis and appropriate management of shock aimed at prevention of prolonged hypoperfusion has shown to decrease morbidity and mortality in patients with undifferentiated shock. However, there is often a challenge in emergency department (ED) – where diagnosis is mainly based on clinical signs and standard monitoring parameters. Early use of point of care ultrasound could reduce the diagnostic time and improve diagnostic accuracy.PurposeThe aim of this study is to investigate the accuracy of echocardiography - ultrasound protocol to identify the cause of shock in ED.MethodThe study was conducted on 150 shocked patients admitted to emergency department of Alexandria Main University Hospital from December 2018 to December 2020. The study was conducted to reach initial impression about shock etiology which was then compared to final diagnosis to determine accuracy, agreement, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).ResultsOne hundred forty patients were included in the study (10 patients were excluded). The protocol was 100% accurate for diagnosing cases with obstructive and mixed obstructive distributive shock. It showed excellent rule- out characteristics for cardiogenic shock (sensitivity and NPV = 100%). There was almost perfect agreement between provisional and final shock type for mixed distributive cardiogenic shock (kappa 0.915). Echo- US protocol had lowest agreement and PPV for patients with hypovolemic shock Kappa 0.48 and 35% respectively.ConclusionThe Echo- US protocol showed a high accuracy in identifying shock etiology in ED and is likely a promising diagnostic tool in emergency care.

Risankizumab as maintenance therapy for moderately to severely active Crohn's disease: results from the multicentre, randomised, double-blind, placebo-controlled, withdrawal phase 3 FORTIFY maintenance trial

There is a great unmet need for new therapeutics with novel mechanisms of action for patients with Crohn's disease. The ADVANCE and MOTIVATE studies showed that intravenous risankizumab, a selective p19 anti-interleukin (IL)-23 antibody, was efficacious and well tolerated as induction therapy. Here, we report the efficacy and safety of subcutaneous risankizumab as maintenance therapy. FORTIFY is a phase 3, multicentre, randomised, double-blind, placebo-controlled, maintenance withdrawal study across 273 clinical centres in 44 countries across North and South America, Europe, Oceania, Africa, and the Asia-Pacific region that enrolled participants with clinical response to risankizumab in the ADVANCE or MOTIVATE induction studies. Patients in ADVANCE or MOTIVATE were aged 16-80 years with moderately to severely active Crohn's disease. Patients in the FORTIFY substudy 1 were randomly assigned again (1:1:1) to receive either subcutaneous risankizumab 180 mg, subcutaneous risankizumab 360 mg, or withdrawal from risankizumab to receive subcutaneous placebo (herein referred to as withdrawal [subcutaneous placebo]). Treatment was given every 8 weeks. Patients were stratified by induction dose, post-induction endoscopic response, and clinical remission status. Patients, investigators, and study personnel were masked to treatment assignments. Week 52 co-primary endpoints were clinical remission (Crohn's disease activity index [CDAI] in the US protocol, or stool frequency and abdominal pain score in the non-US protocol) and endoscopic response in patients who received at least one dose of study drug during the 52-week maintenance period. Safety was assessed in patients receiving at least one dose of study medication. This study is registered with ClinicalTrials.gov, NCT03105102. 712 patients were initially assessed and, between April 9, 2018, and April 24, 2020, 542 patients were randomly assigned to either the risankizumab 180 mg group (n=179), the risankizumab 360 mg group (n=179), or the placebo group (n=184). Greater clinical remission and endoscopic response rates were reached with 360 mg risankizumab versus placebo (CDAI clinical remission was reached in 74 (52%) of 141 patients vs 67 (41%) of 164 patients, adjusted difference 15% [95% CI 5-24]; stool frequency and abdominal pain score clinical remission was reached in 73 (52%) of 141 vs 65 (40%) of 164, adjusted difference 15% [5-25]; endoscopic response 66 (47%) of 141 patients vs 36 (22%) of 164 patients, adjusted difference 28% [19-37]). Higher rates of CDAI clinical remission and endoscopic response (but not stool frequency and abdominal pain score clinical remission [p=0·124]) were also reached with risankizumab 180 mg versus withdrawal (subcutaneous placebo; CDAI clinical remission reached in 87 [55%] of 157 patients, adjusted difference 15% [95% CI 5-24]; endoscopic response 74 [47%] of 157, adjusted difference 26% [17-35]). Results for more stringent endoscopic and composite endpoints and inflammatory biomarkers were consistent with a dose-response relationship. Maintenance treatment was well tolerated. Adverse event rates were similar among groups, and the most frequently reported adverse events in all treatment groups were worsening Crohn's disease, arthralgia, and headache. Subcutaneous risankizumab is a safe and efficacious treatment for maintenance of remission in patients with moderately to severely active Crohn's disease and offers a new therapeutic option for a broad range of patients by meeting endpoints that might change the future course of disease. AbbVie.

An ultrasound negative for subclinical synovitis in arthralgia patients: is it helpful in identifying those not developing arthritis?

To investigate the negative predictive value (NPV) of musculoskeletal US (MSUS) in arthralgia patients at risk for developing inflammatory arthritis. An MSUS examination of hands and feet was performed in arthralgia patients at risk for inflammatory arthritis in four independent cohorts. Patients were followed for one-year on the development of inflammatory arthritis. Subclinical synovitis was defined as greyscale ≥2 and/or power Doppler ≥1. NPVs were determined and compared with the prior risks of not developing inflammatory arthritis. Outcomes were pooled using meta-analyses and meta-regression analyses. In sensitivity analyses, MSUS imaging of tender joints only (rather than the full US protocol) was analysed and ACPA stratification applied. After 1 year 78, 82, 77 and 72% of patients in the four cohorts did not develop inflammatory arthritis. The NPV of a negative US was 86, 85, 82 and 90%, respectively. The meta-analysis showed a pooled non-inflammatory arthritis prevalence of 79% (95% CI 75%, 83%) and a pooled NPV of 86% (95% CI 81, 89%). Imaging tender joints only (as generally done in clinical practice) and ACPA stratification showed similar results. A negative US result in arthralgia has a high NPV for not developing inflammatory arthritis, which is mainly due to the high a priori risk of not developing inflammatory arthritis. The added value of a negative US (<10% increase) was limited.

Inferior Vena Cava And Lung Ultrasound-guided Therapy For The Reduction Of Clinical Events In Acute Heart Failure - Caval Us-hf Trial

<h3>Introduction</h3> Readmissions for acute heart failure (AHF) are frequent, mostly due to persistent congestion on discharge. However, as the optimal evaluation of decongestion is not clearly defined, it is necessary to implement new tools to identify subclinical congestion to guide treatment. <h3>Objective</h3> To develop a therapeutic algorithm guided by lung (LUS) and inferior vena cava (IVC) ultrasound protocol in patients with AHF.Methods: Design of the interventions was carried out between August 2020-January 2021, and was developed in 3 phases: (1)Systematic and narrative review on the use of ultrasound-guided therapy, and treatments algorithms proposed by scientific societies; (2)Panel of experts for the creation of the CAVAL US protocol for the evaluation of right (VCI) and left (LUS) congestion and (3)Algorithms adaptation to our setting with the incorporation of CAVAL US protocol. <h3>Results</h3> Diuretic treatment algorithms were adapted and incorporated into the CAVAL US protocol as part of the daily congestion evaluation (Figure 1). The ultrasound results were divided into 3 categories (Figure 2): Group A) without or mild congestion, Group B) signs of moderate congestion, and Group C) severe signs of congestion and identified as poor prognostic factors. To define persistent congestion, we chose the cut-off point of >5 B lines, since it has been identified as a risk factor for rehospitalization due to AHF or death at six months; and for severe congestion >30 B lines were determined, as they predict hospitalization for HF or mortality at 90 days. <h3>Conclusion</h3> Through a systematic approach we have developed an evidence-based therapeutic algorithm to guide therapeutic interventions in the recently initiated CAVAL US randomized controlled trial. That will investigate whether lung and IVC ultrasound-guided therapy complementing clinical evaluation, reduces the combined end point of readmission, unplanned visit for worsening HF or death at 90 days in AHF.

Synthesis, Biological Evaluation and Molecular Docking Studies Against EGFR Tyrosine Kinase of 3,5-bis(substituted benzylidene)-1- ethylpiperidin-4-one Analogues

Cancer is one of the leading causes of death. The aim of the present study was to synthesize and investigate the anticancer and antioxidant activities of some 3,5-bis(substituted benzylidene)- 1-ethylpiperidin-4-one analogues (4a-g). The 3,5-bis(substituted benzylidene)-1-ethylpiperidin-4-one analogues (4a-g) were prepared from the precursor, piperidin-4-one hydrochloride (1). The initial step involved the synthesis of intermediates, 3,5-bis(substituted benzylidene)piperidin-4-one analogues (3a-g) followed by their ethylation with C2H5I in acetone and K2CO3 to obtain the title compounds (4a-g). The Fourier transform infrared (FTIR), nuclear magnetic resonance (1H &amp; 13C NMR), mass spectrometry and microanalysis were used to characterize the title compounds (4a-g). All the compounds were further evaluated for their anticancer activity by SRB assay and NCI US protocol, while the antioxidant activity was evaluated by DPPH free radical assay. All the title compounds (4a-g) were subjected to molecular docking studies against EGRF tyrosine kinase, a potential target for anticancer agents, to study the possible mode of interaction of our compounds with the molecular target. : The compound 4g showed significant anticancer activity with GI50 of 28.2 μM against MCF-7 (Breast cancer cell line). The antioxidant activity of compound 4g (IC50 = 14.98±0.91 μM) was found to be comparable to the standard drug ascorbic acid. The binding modes of compounds 4a-g against the molecular target EGFR tyrosine kinase were also studied. The structure-activity relationship (SAR) was also studied. : The compound 4g showed significant anticancer activity with GI50 of 28.2 μM against MCF-7 (Breast cancer cell line). The antioxidant activity of the compound, 4g was found to be comparable to the standard drug ascorbic acid, while its anticancer activity was found to be less than that of the standard drug adriamycin.

Untwisting the complexity of midgut malrotation and volvulus ultrasound.

Abdominal US is emerging as an alternative to the upper gastrointestinal (GI) series as the preferred diagnostic imaging test for midgut malrotation complicated by volvulus. Unlike the upper GI series, US is free from ionizing radiation, does not require oral contrast agent, and can be performed portably and at times remotely from the interpreting radiologist, expediting diagnosis. Although some institutions do not have a standardized US protocol for midgut volvulus, many routinely use US in the setting of an infant or child with acute abdominal signs or symptoms to evaluate for common conditions such as hypertrophic pyloric stenosis, intussusception, necrotizing enterocolitis and appendicitis. Because these common conditions can overlap in age and clinical presentation with midgut volvulus, the aim of this pictorial essay is to provide instruction on the technique and diagnostic findings of midgut volvulus on US to ensure confident, accurate interpretation, and prompt treatment.

Experimental research of retreatability of root canals filled with bioceramic sealer

Aim. This study aimed to determine the residual filling material and the reestablishment of working length and apical patency after retreatment of TotalFill® BC Sealer.Materials and methods. Thirty maxillary incisors were used in a single cone obturation technique with TotalFill BC Sealer (FKG, Switzerland) and randomly divided into 6 groups according to the retreatment technique. The samples were scanned by micro-CT before and after retreatment in order to evaluate the residual filling material on the root dentin walls. Data were analyzed statistically with the Kruskal-Wallis tests (p &lt; 0.05).Results. No instrumental protocol was able to remove all obturation material from the root canals. The differences in reduction in the total volume of filling material percentage were statistically significant (p &lt; 0.05) among groups with and without ultrasound or sound activation in retreatment protocol.Conclusions. The most effective root canal retreatment was determined with D-Race + XP-endo Shaper + XP-Endo Finisher R + US (3.0 W) protocol; it was found that the efficiency of filling material removal was more than 92%.

Contrast-enhanced ultrasound (CEUS) reliably rules out neoplasm in developmental renal pseudotumor.

Renal pseudotumors appear as benign cortical hypertrophies and are typically assessed by contrast-enhanced computed tomography or magnetic resonance imaging to rule out malignancy. To investigate whether contrast-enhanced ultrasound (CEUS) can rule out renal neoplasm and thus potentially reduce cross-sectional imaging and further follow-up in these patients. Thirty-two patients with presumption of developmental renal pseudotumor on CEUS between June 2011 and July 2019 were retrospectively analyzed. All patients were examined with a standardized renal US protocol including B-mode, color-coded duplex sonography (CCDS), and CEUS by an experienced radiologist (EFSUMB level 3). Images were retrospectively interpreted in consensus by two highly experienced radiologists. Histopathological reports, cross-sectional imaging findings, and clinical course (treatment response, long-term imaging follow-up) were defined as standard of reference. CEUS correctly identified 8/9 neoplastic lesions and missed one oncocytoma within the 32 included patients. Irregular vessel structure (88.9% vs. 13.0%, P = 0.007) and hyperenhancement (66.6% vs. 17.4%, P = 0.031) on CEUS were more common in neoplasm compared to developmental pseudotumors reaching statistical significance. Compared with the standard of reference, CEUS had 89% sensitivity (95% confidence interval [CI] 57-98), 96% specificity (95% CI 80-99), a positive predictive value of 89% (95% CI 57-98), and a negative predictive value of 96% (95% CI 79-99) for ruling out renal malignancy in developmental pseudotumors. CEUS is a safe and fast method to rule out neoplasm in the diagnostic work-up of renal pseudotumors. In conjunction with B-mode and CCDS, CEUS has the potential to reduce further (invasive) diagnostic procedures.

Synthesis, Antiproliferative, and Antioxidant Activities of Substituted N-[(1,3,4-Oxadiazol-2-yl) Methyl] Benzamines

Background:Oxadiazole emerged as an important class of heterocyclic compound with diverse biological activities like anticancer, antitubercular, anticonvulsant, anti-tubulin, antimicrobial, anti-inflammatory, antioxidant etc.Objective:The objective of this study is to synthesis series of twelve substituted N-[(1,3,4-oxadiazol-2- yl)methyl]benzamines (6a-l) and their evaluation as antiproliferative and antioxidant agents.Methods:The substituted N-[(1,3,4-oxadiazol-2-yl)methyl]benzamines (6a-l) analogues were synthesized as per the reported procedure. The antiproliferative activity was tested against nine different panels cancer cell lines (leukemia, colon, renal, non-small cell lung, breast, CNS, melanoma, prostate, and ovarian cancer) at 10 µM drug concentrations as per the NCI US Protocol.Results:2-(5-((3-Chloro-4-fluorophenylamino)methyl)-1,3,4-oxadiazol-2-yl)phenol (6e) revealed the significant antiproliferative activity among the series of title compounds (6a-l). The compound, 6e showed maximum sensitivity towards CCRF-CEM, MCF-7, MOLT-4, T-47D, and SR cell lines with percent growth inhibitions (%GIs) of 79.92, 56.67, 39.62, 34.71 and 33.35, respectively. Furthermore, the compounds, 6e and 6c showed promising antioxidant activity with an IC50 value of 15.09 and 19.02 µM, respectively in DPPH free radicals (FR) scavenging activity.RConclusion:The present study may support a significant value in cancer drug discovery programme.

Diagnostic performance of standardized ultrasound protocol for detecting perforation in pediatric appendicitis.

Recent clinical trials in adults and children have shown that uncomplicated acute appendicitis can be successfully treated with antibiotics alone. As treatment strategies for acute appendicitis diverge, accurate preoperative diagnosis of complicated appendicitis and appendiceal perforation has become increasingly important for clinical decision-making. To examine diagnostic performance of ultrasound for detecting perforated appendicitis in a single institution using a standardized technique. In this retrospective single-center study we evaluated 113 ultrasounds from pediatric patients who underwent appendectomy between November 2014 and December 2015. All ultrasounds were performed using a standardized US protocol including still and cine images of all four abdominal quadrants, with more targeted evaluation of the right lower quadrant (RLQ) using graded compression technique. We compared US findings to intraoperative diagnosis of non-perforated or perforated acute appendicitis. The standardized image protocol generated a reproducible set of ultrasound images in all cases. The most common primary appendiceal finding on US in perforated appendicitis was appendix wall thickening >3mm (54%, 171/314) and most common secondary finding was echogenic mesenteric fat (75%, 237/314). Thinning of the appendix wall and loculated fluid collection in the right lower quadrant were both highly specific (>90%) for perforation. The diagnostic performance of ultrasound using a standardized US technique was similar to that reported in prior studies for detecting perforated appendicitis. Despite low sensitivity, individual ultrasound findings and overall diagnostic impression of "evidence of appendix perforation" remain highly specific.

Detection of hearing loss in newborns: Definition of a screening strategy in Bogotá, Colombia

ObjectiveTo describe the results from the hearing screening protocol adopted in a Hospital in Colombia emphasizing the importance of performing screening on an outpatient basis, when the newborn is more than 24 h old. MethodsA prospective study at Hospital Universitario San Ignacio in Bogota, Colombia was carried out, from May 1st, 2016 to Nov 30th, 2017, the study sample included 2.088 newborns examined using transient otoacoustic emissions. ResultsWe obtained written consent from the parents of 1.523 newborns and 24 individuals (1.6%) failed the first stage of the screening, nine cases unilateral and 15 bilateral. A total of nine neonates (0,6%) failed the second screening test, six cases unilateral and three bilateral. Four (0,3%) did not return to the second test. Our false altered screening rate was 0.7%. ConclusionsIn a developing country with limited human and economic resources, in which newborn early discharge is the norm, a newborn hearing screening program linked to infants’ check-ups, that uses otoacoustic emissions after 48 h of life, seems a feasible option compare to the standard US protocol aiming to conduct hearing screening prior to discharge.