Point-of-Care Ultrasound Diagnosis of Tetralogy of Fallot Causing Cyanosis: A Case Report.

INTRODUCTION: Tetralogy of Fallot (TOF) is a congenital heart defect with characteristic features leading to unique physical exam and ultrasound findings. In settings where there is limited prenatal screening, TOF can present with cyanosis at any time from the neonatal period to adulthood depending on the degree of obstruction of the right ventricular outflow tract. CASE REPORT: This case describes a pediatric patient who presented with undifferentiated dyspnea and cyanosis, for whom point-of-care ultrasound (POCUS) supported the diagnosis of TOF. We highlight the important role POCUS can play in a setting with limited access to formal echocardiography or consultative pediatric cardiology services. CONCLUSION: This report highlights the utility of POCUS as an inflection point in the diagnostic and management pathway of this patient, which is particularly important when working in a limited-resource or rural setting.

Role of Tele-ultrasound for Teaching Ultrasound-guided Nerve Blocks in the Emergency Department: A Case Series from Peru.

INTRODUCTION: Ultrasound-guided nerve blocks (UGNB) represent a procedural skill set that can be used to treat acute pain by physicians in the emergency department (ED). However, limited access to education and training represents a barrier to widespread adoption of this core skill set. The implementation of UGNBs within the ED can aid in resource allocation, particularly in limited-resource settings. CASE SERIES: In this case series we discuss our experience using tele-ultrasound to train emergency physicians on the use of UGNBs within our international point-of-care ultrasound fellowship in Peru. We highlight the potential role UGNBs serve in management of acute pain when working in resource-limited, public safety-net hospitals in Peru. CONCLUSION: Tele-ultrasound may represent a strategy for teaching procedures such as UGNBs via remote guidance and supervision.

Bioaccessibility and human exposure to metals in urban soils (Huelva, SW Spain): evaluation by in vitro gastric extraction.

The main purpose of this study was to assess the human health risk of heavy metals in the urban-peri-urban soils from Huelva Township. The soils present high concentrations of potentially toxic elements well beyond the regional screening soil concentration. A site-specific health risk assessment of exposure (oral ingestion, oral inhalation and dermal contact) was conducted according to the regulatory normative. To reduce the uncertainty derived from soil characteristics, bioaccessibility and predicted bioavailability data were included in the assessment. Thereby, in order to evaluate the oral bioaccessibility, a simulation of the gastric condition (pH and T) was applied dissolving the samples in a solution of HCl and 0.4 M glycine. Soils located in industrial areas present higher bioaccessibility than those associated with urban or other uses. The adjusted-relative bioaccessibility total carcinogenic risk for As exceeded the regulatory level in all samples (except samples 7 and 184) indicating that children are more vulnerable, while no detrimental health effects are expected for Pb (except in sample 76, a "greenway" recreational area). The adjusted hazard index for non-carcinogenic effects also overpassed the threshold values in practically all possible scenarios for an adult resident working in Huelva, as well as for a child living and playing in the urban/recreational areas. The main pollutant contributions were related to As and Pb. For this reason, the reported soils exceeding the regulatory levels should be classified as polluted and, therefore, this study should be helpful to initiate necessary soil management interventions to avoid the human health risk.

Point-of-care Ultrasound Diagnosis of Pulmonary Hydatid Cyst Disease Causing Shock: A Case Report.

INTRODUCTION: Point-of-care ultrasound (POCUS) is accepted as an important tool for evaluating patients presenting to the emergency department (ED) with dyspnea1 and undifferentiated shock.2 Identifying the etiology and type of shock is time-critical since treatments vary based on this information. Clinicians typically rely on the history, exam, and diagnostics tests to identify the etiology of shock. In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies. The use of POCUS enables rapid classification and directed treatment of shock. Additionally, POCUS can aid in the diagnosis of rarer tropical diseases that can be important causes of shock in resource-limited settings. CASE REPORT: We discuss a case of a pediatric patient who presented to an ED in Cusco, Peru, with acute dyspnea and shock. Point-of-care ultrasound was used to expedite the diagnosis of a ruptured pulmonary hydatid cyst, guide proper management of septic and anaphylactic shock, and expedite definitive surgical intervention. CONCLUSION: In resource-limited settings where there is reduced access to timely laboratory and diagnostic studies, the use of POCUS enables rapid classification and directed treatment of shock.

[Air pollution and respiratory disease in children. Experience in Cartagena]. / Polución atmosférica y enfermedad respiratoria en niños. Experiencia de Cartagena.

Studies on air pollution (SO2) and their influence on respiratory diseases in children conducted in Cartagena are reviewed and compared with those from other spanish cities. In Cartagena we find a weak relation between SO2 levels and number of children admitted to hospital for asthma attack. Indoor pollution is stressed, specially smoking of mother.

[Lead and child health]. / Plomo y salud infantil.

Effects of lead toxicity in children are reviewed. Several epidemiological studies performed in Spain are also depicted, with special attention to the city of Cartagena where a mean of 8.05 +/- 4.2 mcg/dl is obtained. The fact that the small increment observed in children living in polluted area may be due more to socioeconomic level (related to indoor pollution) than to outdoor pollution is stressed.